HYPERLIPIDEMIA (HYPERLIPIDAEMIA) 3183

Hygiene See Cleaning Procedures in the Factory: Types of Detergent; Types of Disinfectant; Overall
Approach; Modern Systems; Food Poisoning: Classification; Tracing Origins and Testing; Statistics; Economic
Implications; Contamination of Food; Escherichia coli: Occurrence; Detection; Food Poisoning; Occurrence and
Epidemiology of Species other than Escherichia coli; Food Poisoning by Species other than Escherichia coli;
Effluents from Food Processing: On-Site Processing of Waste; Microbiology of Treatment Processes; Disposal of
Waste Water; Composition and Analysis; Food Safety; Salmonella: Properties and Occurrence; Detection;
Salmonellosis; Saponins; Spoilage: Chemical and Enzymatic Spoilage; Bacterial Spoilage; Fungi in Food – An
Overview; Molds in Spoilage; Yeasts in Spoilage

Hyperglycemia (Hyperglycaemia) See Diabetes Mellitus: Etiology; Chemical Pathology;

Treatment and Management; Problems in Treatment; Secondary Complications

HYPERLIPIDEMIA (HYPERLIPIDAEMIA)
J P D Reckless and J M Lawrence, University of
Bath, Combe Park, Bath, UK
Copyright 2003, Elsevier Science Ltd. All Rights Reserved.
Lipids
0001 Lipids are a heterogeneous group of substances that
play key roles in normal physiology. Two groups are
important – that where a main component includes
one or more fatty acids (such as triglycerides and
phospholipids) and that where the main component
is a steroid nucleus (such as cholesterol and steroid
hormones). Both groups are relatively insoluble in
water. The lipoprotein transport system carries these
hydrophobic compounds through the aqueous
medium of blood plasma to their site of use, in a
carefully regulated process. Lipoproteins consist of a
package of triglycerides, cholesterol (free and esteri-
Pathological hyperlipidemia results from disordered
metabolism of the lipoproteins with either excess
production, altered clearance, or both. It is most
commonly multifactorial, involving both environ-
mental and intrinsic factors. Many genetic disorders
are now well recognized, causing various degrees of
hyperlipidemia or dyslipidemia (altered compos-
ition). Genetic studies have helped the understanding
of lipoprotein metabolism.
This review discusses normal lipoprotein metab- 0003
olism, focusing on hyperlipidemia. As treating
hyperlipidemia has significant benefits in terms of
long-term health, having an understanding of normal
and abnormal lipoprotein metabolism is becoming
increasingly important.
The Intestine
Most dietary fats are triglycerides. These are hydro- 0004

fied), phospholipids, and apolipoproteins, with a
hydrophilic shell and a hydrophobic core (Figure 1).
The sites of synthesis are the gut and liver. The main
lipoproteins are high (HDL), low (LDL), and very
low (VLDL) density lipoproteins, and chylomicron7s.
Each has a different group of surface apolipo-
proteins, pivotal in determining the site, mechanism,
and speed of lipoprotein metabolism. The precise
molecular composition in each lipoprotein class
varies considerably.
0002 Hyperlipidemia means high levels of fats in the
blood, which may be physiological postprandially.
lyzed to mono- and diacylglycerols, nonesterified
fatty acids (NEFA) and glycerol by pancreatic or gut
lipases, and absorbed as mixed micelles in the small
intestine. In the intestinal cells, triglycerides are
reformed and interact with apolipoprotein B-48
(apoB48) to form chylomicrons. ApoB48 is the struc-
tural protein for chylomicrons. Each chylomicron
has one molecule of apoB48 and carries very large
numbers of triglyceride molecules. Precise numbers
vary widely, as does the chylomicron size, depending
on the diet (diameter 100–1000 nm). Chylomicrons
also accommodate any dietary cholesterol absorbed