Effect of Commercially and Home-Made Concoction on Serum LDL, HDL, Cholesterol and Concentrations in Dyslipidemia Adult
Received: 20-May-2022, Manuscript No. AMHSR-22-64542; Editor assigned: 23-May-2022, Pre QC No. AMHSR-22-64542; Reviewed: 06-Jun-2022 QC No. AMHSR-22-64542; Revised: 20-Jul-2022, Manuscript No. AMHSR-22-64542; Published: 05-Aug-2022
Citation: Quddoos MY. Effect of Commercially and Home- Made Concoction on Serum LDL, HDL, Cholesterol and Concentrations in Dyslipidemia Adult. Ann Med Health Sci Res. 2022;12:1-6.
This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact [email protected]
Dyslipidemia is a condition in which amount of lipids in blood increases above its normal level. The prevalence of dyslipidemia in Pakistan is 16–20% in both men and women. It may be treated through dietary interventions prepared from indigenous sources. Garlic and ginger have a potential to reduce the amount of LDL and triglycerides and also increase the amount of HDL. Honey has antimicrobial, antioxidant and anti-dyslipidemia effect and adjusts immunity and glycemic response. Apple cider vinegar contains polyphenol like chromogenic acid which may reduce the serum TGs by reducing the lipogenesis and enhance the removal of the TGs through bile. Vitamin C that is the main constituent of lemon may lower down the risk of coronary Heart disease. Concoction is devised by mixing of several ingredients, like garlic (Allium sativum L.) ginger (Zingier officinale), lemon (Citrus aurantifolia), apple cider vinegar and honey. Concoction was prepared after preliminary trial and evaluated for physiochemical, microbial and sensory parameters for 2 months at two different temperatures ((0-4oC) and (25-40oC)) and in two different packaging (plastic bottles and glass bottles). The dyslipidemic males and females (n=4210) were approached from different hospitals and clinics from different areas. They were assessed through anthropometrics, body composition, clinical signs and symptoms, dietary intake by FFQ along with biomarkers i.e. lipid pro ile, CBC, LDL, HDL, urea. Creatinine, TC and TGs. The selected treatment of concoctions (T0, T4 and T8) was provided to the volunteers for 120 days. The data was analyzed statistically to validate the results of the study. Results showed that there were decrease in TC, TGs, and LDL about 15, 33.7 and 16% correspondingly, while it also increases about 13% of HDL. Other parameters that were also decreased are Urea, uric acid and cretonne. It is recapitulated that concoction stored at refrigerated temperature (0-4oC) in glass bottle is appropriate and cost effective indigenous source for the treatment of dyslipidemia.
Triglycerides; Garlic; Ginger; Dyslipidemia; lemon; Apple cider vinegar; Honey
Knowledge cholesterol is a fat, produced in liver and imperative for proper functioning of body. It is a vivacious fat in the blood. If the level of cholesterol surpasses its limit in blood, it might root solemn health complications like arteriosclerosis. The development of plaque in arteries that causes myocardial infarction is termed as arteriosclerosis. The outermost sheath of each cell of human being is fabricated by cholesterol. Cholesterol travels in body with the help of lipoprotein. The disease which may be acute or chronic causes mortality. Increased or decreased level of nutrients and many essential entities are capable to root complications in the body. Therefore, increased level of serum cholesterol may lead to an alarming circumstance resulting in diverse diseases. According to WHO 40% of mortality rate occasioned due to cardiovascular ailment by the year 2020.
Hypertension, hyperglycemia, hypercholesterolemia, low physical activity, genetic predisposition, gender, age and smoking are some important factors which may causes diseases leading to death. HDL is 1 of the 5 chief assemblages of lipoproteins. It is also acknowledged as virtuous cholesterol that plays a conflicting role to LDL because it constrains arterio-sclerosis. It works in the transportation of cholesterol from cells to liver. LDL is also recognized as adverse cholesterol because it works contradictory to HDL, so it conveys cholesterol from liver to cells of the body due to which arteriosclerosis may result. The development of clot in arteries takes place due to increased amount of Low Density Lipoprotein (LDL) in the blood. An ester derived from 3 fatty acids and glycerol is known as Triglyceride (TGs).
Elevated level of TGs in blood has been associated with heart disease, atherosclerosis and stroke. The main cause of hyperlipidemia involves changes in lifestyle habits in which the risk factor is a basically poor diet i.e. with >40% fat intake of total calories, the amount of saturated fat is >10% of total calories; cholesterol is >300 mg/d or medical conditions can be treated.
The cure of dyslipidemia, innumerable food plants has been utilized. Lipid profile has been normalized by an aid of ginger (Zingiber officinale Roscoe) oil. Ginger (Zingiber officinale Roscoe) comprises several bioactive amalgams that are potentially valuable in the cure of innumerable illnesses including hyper-cholesterolemia. Concoction fabricated by mixing garlic (Allium sativum L.) ginger (Zingiber officinale), lemon (Citrus aurantifolia), apple cider vinegar and honey has been proved to be exciting and convenient household therapy in dealing heart diseases.
In addition, lowering the serum cholesterol level, it correspondingly decreases high blood pressure. Probabilities of infection, joint aching, rheumatism and gout can also be reduced by consuming this concoction. It is a best cardio tonic and also a weight controller. The purpose os the study to develop and evaluate the concoction from indigenous sources and investigate the effects of selected concoction treatments in dyslipidemia adults [1-4].
Materials and Methods
Permission, approach and informed consent
The written permission from concerned authority was occupied to conduct the research work. Research project briefed in detail to target population after approached. The handouts of Education, Information and Communication (EIC) materials were given to the volunteers. Received the informed consent (willingness) from the adults who want to be part of the research. The study conformed to the ethical guidelines of the University of Sargodha.
75 Adult male and female were target population. Different hospitals and clinics in different areas were selected as study site for the research project after getting permission from the authority. The selection of the human volunteer was carried out in accordance with two stage sampling that is convenience and purposive sampling technique; a part of non-probability sampling method [5,6].
The research design was randomized controlled clinical trial in which blood samples of all the volunteer were collected in two phases, in first phase lab test of volunteer performed which indicated volunteer were dyslipidemic then these volunteer carried out for further research, at the end again lab test performed of dyslipidemic volunteers. The data was collected through tools like questionnaires, family, medical and diet history.
Duration of study
The research was for three months of dyslipidemic adults. In which their initial and final test was performed which mentioned above. The parameters like volunteer’ name, age, gender, qualification, occupation, income, family diseases and physical activity level of demographics was collected. The parameters height, weight, body composition, body mass index, basal metabolic rate and active metabolic rate of anthropometric, energetic, clinical assessment, medical and family history, dietary intakes assessment and biomarker of selected volunteer were recorded for their nutritional status assessment.
Appropriate statistical analyses were performed for treatment selection and further evaluation on the basis of sensory evaluation results and blood sample results. Significant value was tested by parametric and non-parametric test. Tables, graph and chart were used to mention the data. Data’s frequency and distribution was checked by descriptive statistics [7-10].
Highly significant variation was found among physiological status and non-significant variation was found among gender was noted regarding weight but there was non-significant variation between 0 day and 120 days in dyslipidemic and non-dyslipidemic and highly significant variation was found among physiological status and gender was noted regarding body fat but non-significant variation in between days (Table 1). Non-Significant variation found in means values (days) of body water, muscle mass, bones mass and BMI while lightly signification between Physiological Status (PS) and gender [11-14].
|Table 1: Anthropometric measurements of volunteers.|
|PS||Gender||Age||Weight (Kg)||Body Fat (%)||Body Water (%)||Bone Mass (%)||Muscle Mass (%)||BMI|
|0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days|
|Dislipidemic||Male||25 ± 7||66.17 ± 3.59A||64.17 ± 3.6A||33.27 ± 1B||33.27 ± 1B||40.38 ± 1.18B||40.42 ± 1.18B||7.09± 0.26A||7.09 ± 0.26A||30.09 ± 0.57C||30.09 ± 0.57C||25.63 ± 1.5AB||24.81 ± 1.5AB|
|Female||25 ± 7||66.55 ± 2.37A||64.48 ± 2.28A||37.07 ± 0.57A||37.07 ± 0.57A||36.76 ± 0.63B||36.8 ± 0.63B||7.08±0.23A||7.08 ± 0.23A||25.86± 0.26D||25.86 ± 0.26D||27.45 ± 0.94A||26.56 ± 0.9AB|
|Non-Dislipidemic||Male||25 ± 7||62.74 ± 2.08A||60.93 ± 2.04A||19.96 ± 0.41CD||19.85 ± 0.42D||63.06 ± 0.8A||63.07 ± 0.8A||7.48±0.25A||7.48 ± 0.25A||40.29± 0.37A||40.29 ± 0.37A||23.64 ± 0.78AB||22.96 ± 0.77B|
|Female||25 ± 7||59.09 ± 1.77A||57.68 ± 1.69A||22.35 ± 0.34C||22.3± 0.34C||60.3± 0.83A||60.31 ± 0.83A||6.14±0.28A||6.14 ± 0.28A||36.16± 0.25B||36.16 ± 0.25B||24.8 ± 0.79AB||24.19 ± 0.75AB|
PS: Physiological Status
Non-significant values found in days and in genders of cereals while high significant in PS. Same trend found in fruits, vegetables and meat. Non-dyslipidemic male and female was taking more fruits as compared to dyslipidemia. In case of comparison between genders in both groups showed that in non dyslipidemic group male were taking less fruits as compared to female. In second group male were taking more fruits with comparison to female. Intake of fruit and vegetables according to the USDA recommendation helps to remove cholesterol revealed the result of their study that, level of LDL was 6-7% lesser in those volunteers who were taking enough fruits and vegetables as compared to those who were not taking enough fruits. This might be due to the presence of dietary fibers in fruits which helps in absorption and removal of cholesterol from the blood. Dyslipidemic volunteers (in male and female) were taking less vegetable as compared to non-dyslipidemic (male and female. According to means values dyslipidemic volunteers were taking high intake of meat and meat products as compared to non-dyslipidemic but days wise non-significant (Table 2) .
|Table 2: Daily dietary intakes at entry and after concoction.|
|PS||Gender||Cereals||Fruits||Vegetables||Meat and Meat Products||Milk and Milk Products||Fats and Oil||Junk and Snacks|
|0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days|
|Dislipidemic||Male||5.22 ± 0.26B||5.22± 0.26B||1.22± 0.13BC||1.29 ± 0.12B||1.78± 0.17BC||1.80 ± 0.1BC||4.33 ± 0.33A||4.35 ± 0.29A||4 ± 0.31A||4.04 ± 0.25A||4.61 ± 0.27A||4.61 ± 0.14B||4.06 ± 0.36A||4.07 ± 0.18B|
|Female||5.43 ± 0.23B||5.48 ± 0.23B||0.99± 0.1C||1 ± 0.1B||1.83± 0.1C||1.86 ± 0.07B||4.05 ± 0.2A||4.1± 0.16A||4.17 ± 0.2A||4.18 ± 0.16A||3.67 ± 0.17B||3.67 ± 0.13B||4.05 ± 0.18A||4.05 ± 0.13B|
|Non-Dislipidemic||Male||7.55 ± 0.25A||7.55 ± 0.25A||4.07± 0.22A||4.1± 0.21A||3.9 ± 0.19A||3.95 ± 0.16A||3.9± 0.29A||3.93 ± 0.28A||3.48 ± 0.22A||3.48 ± 0.22A||1.83 ± 0.13C||1.84 ± 0.12C||1.34 ± 0.15C||1.37 ± 0.11C|
|Female||7.87 ± 0.28A||7.87 ± 0.28A||4.06± 0.16A||4.08 ± 0.16A||4.13± 0.18A||4.20 ± 0.16A||3.52 ± 0.26A||3.55 ± 0.24A||4.32 ± 0.26A||4.32 ± 0.26A||1.9± 0.15C||1.91 ± 0.14C||1.48 ± 0.17C||1.49 ± 0.15C|
PS: Physiological Status
Non-significant means value found in among physiological status and in days but significant in gender of milk and milk product. In fat and oils only significant values found in days of male. Also same trend found in junk and snacks. Junk food or any fried food increase the cholesterol level might be due to the presence of trans-fat in them. Frequent consumption of such food ultimately causes many diseases like dyslipidemia [16-21].
Level of TC: Highly significant results were obtained among treatments and days while non-significant results were obtained among gender. That the cholesterol levels were increased in the respondents following treatment T0, while the cholesterol levels were decreased significantly in Treatment T8 and were decreased highly significantly in Treatment T4. Gingerly is the chief bioactive component of ginger which increases the level of pancreatic lipase. It also enhances the activity of hepatic cholesterol-7-hydroxylase which converts cholesterol into bile acid and eventually removes it from body.
TGs: Highly significant results were obtained among treatments and days while non-significant results were obtained among gender. TGs levels were increased in the respondents following treatment T0, while the TGs levels were decreased significantly in treatment T8 and were decreased highly significantly in treatment T4 (Table 3). By obstructing enzymes called diacylglycerol acyltransferase in liver cells, niacin inhibits the aggregation of triglyceride deposition from adipose cells. Since this enzyme is active in the HMG-CoA reductase pathway in cholesterol synthesis
|Table 3: Effect of concoction on dyslipidemia.|
|Gender||TC (mg/dL)||TGs (mg/dL)||LDL (mg/dL)||HDL (mg/dL)||Urea (mg/dL)||Uric Acid (mg/dL)||Creatinine (mg/dL)|
|Treatments||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days||0 Days||120 Days|
|T0||Male||214.25 ± 0.85 B||233.25 ± 2.36A||213.25 ± 13.4B||251.25 ± 7.74A||149.25 ± 1.31B||151 ± 3.19B||45 ± 0.91C||40 ± 0.82D||13.34 ± 0.6CDE||15.42 ± 0.6AB||5.93± 0.06CD||6.13 ± 0.03A||1.02 ± 0.01C||1.15 ± 0.02A|
|Female||215 ± 1.28B||229.63 ± 1.75A||212.25 ± 4.7B||250.94 ± 4.14A||151.25 ± 1.28B||158.81 ± 1.92A||44.94 ± 0.54C||36.69 ± 0.88E||14.63 ± 0.27B||16.29 ± 0.23A||5.93± 0.03CD||6.09 ± 0.02AB||1.02 ± 0.01C||1.08 ± 0.01B|
|T4||Male||210.43 ± 2.26B||178.86 ± 2.78E||216.75 ±5.41B||143.75 ± 6.88E||151.75 ± 0.48B||132.5 ± 1.5D||45.75 ± 1.44C||52 ± 0.82A||14.41 ± 0.21BCDE||13.11 ± 0.23DE||5.99 ± 0.03C||5.91 ± 0.02D||1.01 ± 0.02C||0.98 ± 0.01C|
|Female||212 ± 2.15B||188 ± 2.79D||203.81 ± 4.83B||149.56 ± 4.31E||149.94 ± 0.89B||131.44 ± 0.48D||45.19 ± 0.43C||49.63 ± 0.67AB||14.93 ± 0.33B||13.17 ± 0.22D||6.02 ± 0.07ABCD||5.88 ± 0.04CD||1.02 ± 0.01C||1 ± 0.01C|
|Ts||Male||211 ± 1.58B||198.75 ± 4.73C||202.14 ± 8.52BC||185± 6.55CD||150.57 ± 2.16B||139.14 ± 1.18C||46 ± 0.82C||48.71 ± 0.57B||14.7 ± 0.42BC||14.3 ± 0.64BCE||6.01 ± 0.07ABC||6 ± 0.04BCD||1.01 ± 0.02C||0.99 ± 0.01C|
|Female||212.44 ± 1.77B||197.75 ± 1.6C||208.15 ± 4.52B||174.23 ± 5.57D||149.31± 1.16B||138.31 ± 1.25C||44.54 ± 0.57C||48.54 ± 0.63B||14.51 ± 0.34BC||14.21 ± 0.38BCE||6.01± 0.07ABC||6 ± 0.04BCD||1.01 ± 0.01C||1.02 ± 0.01C|
T0= Placebo (Distilled water with lemon flavour and yellow colour), T4= Concoction stored in glass bottle at refrigerated temperature, T8= Market product stored in glass bottle.
LDL: Highly significant results were obtained among treatments and days but non-significant results were obtained among gender. Garlic reduces the amount of Low-Density Lipoprotein (LDL) and triglycerides. But increases the amount of High Density Lipoprotein (HDL). Garlic also lowers down the activity of HMG-CoA reductase (3- hydroxy-3-methyl-glutaryl-coenzyme a reductase) that is involved in cholesterol formation.
HDL and Urea: Both parameters have highly significant results were obtained among treatments and non-significant results were obtained among days of intervention. But significant in gender of HDL. The level of HDL were decreased in the respondents following treatment T0, while the HDL levels were increased significantly in treatment T8 and were increased highly significantly in treatment T4 (Table 3). Lemon (Citrus Aurantifolia L.) produces vitamin C which stimulates a-hydroxylase enzyme 7, which increases the modification of blood cholesterol to bile acid, resulting in a decrease of blood cholesterol levels. Adequate vitamin C intake (1 mL/kg/day) lowers cholesterol and LDL blood triglycerides and raises blood HDL concentrations elucidated that; consumption of garlic averts the rise in serum urea, while producing a prominent decrease in serum urea level. Intake of ginger reduces gluconeogenesis through proteolysis which ultimately reduces the level of serum urea and creatinine [22-25].
Uric acid: Non-significant values found in gender and days while significant in treatments. Uric acid levels were decreased slightly in the respondents following treatment T0, while the uric acid levels remained unchanged treatment T8 and were decreased slightly in treatment T4 (Table 3). The level of uric acid decreases meaningfully with the intake of ginger.
Creatinine: High significant values found in treatments, significant in days while non-significant in gender. Creatinine levels were increased in the respondents following treatment T0, while the creatinine levels were decreased in treatment T8 and were decreased in treatment T4 (Table 3) [26-32].
Observed in study that, serum creatinine was remarkably lowered with the intake of garlic due to its defensive action against nephrotoxicity. In study of El-Shenawy and Hassan, garlic reduced increased serum creatinine level to its normal. Intake of ginger regulates gluconeogenesis through proteolysis which ultimately reduces the level of serum urea and creatinine.
T4 illustrated significant improvement in the dyslipidemic related biomarker like it reduces TC (210-178 mg/dL), TGs (216-143 mg/dL), LDL (157-132 mg/dL) and improve the level of HDL (45-52 mg/dL). T4 also improved other biomarkers like it decreases urea, uric acid, creatinine and increase level of Hb. It is generalize that concoction is appropriate and cost effective for the treatment of dyslipidemia.
- Abd Elwahab AH, Ali FI. Mitigation of alloxane-induced renal damage by Zingiber officinale (ginger) root in rats: an impact on oxidative stress, inflammatory cytokines and tissue damage. Al-Azhar Assiut Med J. 2015;13:158.
- Afzal ΜD, Al-Hadidi Menon M, Pesek J, Dhami MSI. Ginger: an ethnomedical, chemical and pharmacological review. Drug Metabol Drug Interact. 2001;18:159-190.
- Alagwu EA, Okwara JE, Nnel RO, Osim EE. Effect of honey intake on serum cholesterol, triglycerides and lipoprotein levels in albino rats and potential benefits on risks of coronary heart disease. Niger J Physiol Sci. 2011;26:161-165.
- Ballesteros MN, Cabrera RM, Saucedo MS, Yepiz-Plascencia GM, Ortega MI, Valencia ME. Dietary fiber and lifestyle influence serum lipids in free living adult men. J Am Coll Nutr. 2001;20:649-655.
- Bansal SJ, Buring E, Rifai N, Mora S, Sacks FM, Ridker PM. Fasting compared with nonfasting triglycerides and risk of cardiovascular events in women. Jama. 2007; 298:309-316.
- Brown LB, Rosner WW, Willett FM, Sacks. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69:30-42.
- Bruce BG, Spiller A, KlevayLM, Gallagher SK. A diet high in whole and unrefined foods favorably alters lipids, antioxidant defenses, and colon function. J Am Coll Nutr. 2000;19:61-67.
- Drummond KE, Brefere LM (2001) Nutrition for foodservice and culinary professionals. Wiley and Sons, 4th Ed.1-406.
- El-Shenawy SM, Hassan NS. Comparative evaluation of the protective effect of selenium and garlic against liver and kidney damage induced by mercury chloride in the rats. Pharmacol Rep. 2008;60:199-208.
- Fatahalla MF, Mahmood FF. A Practical Guide for Health Researchers, WHO Regional Publications Eastern Mediterranean Series. WHO Regional Publications Publisher Stylus Pub Llc. 2004;30:234.
- Fornés NS, Martins IS, Hernan M, Velásquez-Meléndez G, Ascherio A. Food frequency consumption and lipoproteins serum levels in the population of an urban area. Brazil. Revista de saude publica. 2000; 34:380-387.
- Hagande B, Asp NG, Efendić S, Nilsson-Ehle P, Scherstén B. Dietary fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients. Am J Clin Nutr. 1988;47:852-858.
- Hongbao M, Kuan-Jiunn S. Cholesterol and Human Health. J Nature Science 2006; 2:1-8.
- Jabbari AH, Argani A, Ghorbanihaghjo Mahdavi R. Comparison between swallowing and chewing of garlic on levels of serum lipids, cyclosporine, creatinine and lipid peroxidation in renal transplant recipients. Lipids Health Dis. 2005;4:11.
- Jana AK. Interventions for promoting the initiation of breastfeeding. RHL commentary. 2009.
- Kim MJ, Kim HK. Effect of garlic on high fat induced obesity. Acta Biol Hung. 2011;62:244–254.
- MacMahon B, Trichopoulos D Epidemiology: Principles and Methods. Lippincott Williams and Wilkins. 2nd ed.1996;1-288.
- Mushtaq R, Mushtaq R, Khan ZT. Effects of natural honey on lipid profile and body weight in normal weight and obese adults: a randomized clinical trial. Pakistan J Zool. 2011;43:161-169.
- Naseem E, Shamim M, Khan NI. Cardioprotective effects of herbal mixture (ginger, garlic, lemon, apple cider vinegar and honey) in experimental animal models of hyperlipidemia. Int J Biol Res. 2016;4:28-33.
- Platel K, Srinivasan K. Influence of dietary spices and their active principles on pancreatic digestive enzymes in albino rats. Nahrung. 2000;44:42-46.
- Ramakrishna RR, K Platel, Srinivasan K. In vitro influence of spices and spice-active principles on digestive enzymes of rat pancreas and small intestine. Nahrung. 2003;47:408-412.
- Mishra KL, Sangma D. Quality attributes, phytochemical profile and storage stability studies of functional ready to serve (RTS) drink made from blend of Aloe vera, sweet lime, amla and ginger. J Food Sci Technol. 2017;54:761-769.
- Shanmugam KR, Mallikarjuna K, Nishanth K, Kuo CH, Reddy KS. Protective effect of dietary ginger on antioxidant enzymes and oxidative damage in experimental diabetic rat tissues. Food Chem. 2011;124:1436-1442.
- Shokr EA, Mohamed EM. Effect of ginger on some hematological aspects and immune system in nile tilapia. Abbassa Int J Aqua. 2019;12:1-18.
- Singh RB, Rastogi VSS, Rastogi MA, Niaz R, Beegom. Effect of diet and moderate exercise on central obesity and associated disturbances, myocardial infarction and mortality in patients with and without coronary artery disease. J Am Coll Nutr. 1996;15:592-601.
- Sprecher DL, Pearce GL, Fiber-multivitamin combination therapy: a beneficial influence on low-density lipoprotein and homocysteine. Metabolism. 2002;51:1166-1170.
- Srinivasan K, Sambaiah K. The effect of spices on cholesterol 7 alpha-hydroxylase activity and on serum and hepatic cholesterol levels in the rat. Int J Vitam Nutr Res. 1991;61:364-369.
- Steel RGD, Torrie JH, Dickey DA (1997) Principles and procedures of statistics: A biometrical approach. 3rd ed. McGraw Hill Book Co. New York, USA.1-666.
- Svennerholm L. The nomenclature of lipids. IUPAC-IUB Commission on Biochemical Nomenclature (CBN). Chem Phys Lipid. 1968;2:156-167.
- Tajoda HN, Kurian JC, Bredenkamp MB. Reduction of cholesterol and triglycerides in volunteers using lemon and apple. Int J Humanit Soc Sci. 2013;3:60-65.
- Utsumi KM, Kawabe A, Hirama K, Ueda Y, Kamada, K, Arii Y, et al. Effects of selective LDL apheresis on plasma concentrations of ICAM-1, VCAM-1 and P-selectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis. Clin Chim Acta. 2007;377:198-200.
- Zwald ML, Akinbami TH, Fakhouri, Fryar CD. Prevalence of low high-density lipoprotein cholesterol among adults, by physical activity: United States, 2011–2014. Natl Health Stat. 2017;20: 39.