Heterogeneous Apolipoprotein B Response to the Paleolithic Diet in South Asian Adults: A Novel Phenotypic Pattern
Abstract
Objective: While European-ancestry populations demonstrate consistent apolipoprotein B elevation on low-carbohydrate diets, South Asian responses remain unexplored. This study investigated apolipoprotein B response patterns to the culturally adapted Paleolithic diet in South Asian adults.
Material and Methods: A prospective study involving 232 South Asian adults aged 18-55 years following the culturally adapted Paleolithic diet (20:15:65 carbohydrate:protein:fat) for 90-215 days. Primary outcomes included apolipoprotein B, apolipoprotein A1, and cardiovascular markers.
Results: Three distinct response phenotypes emerged: apolipoprotein B reducers (40.1%), moderate elevators (45.7%), and significant elevators (14.2%). Mean apolipoprotein B increased modestly (+8.9 mg/dL, p-value=0.003) while apolipoprotein A1 increased significantly (+13.8 mg/dL, p-value<0.001). The apolipoprotein B/apolipoprotein A1 ratio remained unchanged (p-value=0.684), demonstrating preserved cardiovascular risk balance. Baseline Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) ≥2.5 predicted favorable response area under the curve (AUC)=0.782, sensitivity=72.3%, specificity=71.4%).
Conclusion: This report of heterogeneous apolipoprotein B response provides novel evidence that differs from the universal elevation paradigms and demonstrates population-specific adaptations. Maintained apolipoprotein B/apolipoprotein A1 ratio confirms cardiovascular safety, while baseline insulin resistance enables personalized recommendations.
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