Association Between ApoE Polymorphism in Obesity Markers in Healthy Adults Who Follow the Greek Orthodox Fasting Rules


  • Alexandra A Koulouri
  • Sousana K Papadopoulou
  • Dimitrios Loukovitis
  • Nikolaos Rodopaios
  • Eleni Vasara
  • Maria Hassapidou
  • Fani Biskanaki
  • Dimitrios Tasoulas
  • Elias Tassoulas
  • Andrew Coats Editor-in-Chief, Academic Vice-President, Monash University, Australia and University of Warwick, UK
  • Anthony Kafatos



diet, fasting, obesity


Aim: To examine the association between ApoE genetic polymorphisms and BMI.

Methods: This case control study of randomly selected, free living individuals from North Greece investigated whether traditional Greek Orthodox dietary practices could affect obesity markers independent of genetic influences, by examining the   Waist circumference (WC), waist hip ratio (WHR) and % fat mass (% FM), were measured in healthy adults who follow the rules of Greek Orthodox fasting compared to those who did not. 382 subjects (246 women and 136 men) were included in the analysis, 161 fasters and 220 non-fasters as a control group. 

Results: Age affected obesity markers in all participants with more obesity in the older subjects. ApoE alleles did not differ between fasting and controls. When fasters where classified as obese and non-obese, there was no association with age (p>0,077). In the control group, BMI and WC were associated with age and gender and WHR with apoE alleles (p<0.001). In the fasting group these correlations are not observed (p=0.545 and p=0.365 respectively).  Interactions between independent variables (sex, age apoE alleles and fasting status) and their influence on BMI, %BF and WHR. ApoE alleles and age significantly influence WHR (p=0.014). 

Conclusions: In the present study we found that the effect of ApoE alleles on adiposity was associated with age.  In conclusion, even if genetic risks factor influence the susceptibility to obesity and cardiometabolic disorders, lifestyle changes may ameliorate these effects.

Author Biography

Andrew Coats, Editor-in-Chief, Academic Vice-President, Monash University, Australia and University of Warwick, UK

Andrew holds a MB and BChir from Cambridge, an MA and DM from Oxford, a DSc. from Imperial College, and an MBA from London Business School. Andrew served as the Inaugural Viscount Royston Professor of Cardiology at the National Heart and Lung Institute in London, as Director of Cardiology of the Royal Brompton and Harefield NHS trust as Head of Clinical Cardiology at Imperial College, as Dean of Medicine at the University of Sydney, as Deputy Vice-Chancellor of Sydney, and as CEO of the Norwich Research Park. He is presently Academic Vice-President of Monash University, Australia and the University of Warwick, UK and Director of the Monash-Warwick Alliance.

Andrew has published in excess of 1400 publications and has more than 52,000 career citations, and a personal H-index of 106. He has been Editor-in-Chief of the International Journal of Cardiology since 1999 and has received the Linacre Medal of the Royal College of Physicians and the inaugural Michael L Pollock award of the American Heart Association. He has been Chairman or Committee member of the following major Cardiovascular Trials: CHRISTMAS, CHARM, COPERNICUS, OXAM, OPTIMAAL, OVERTURE, REPLACE and SENIORS. Andrew also has more than 20 patents, and has two successful spin-out companies which have generated more than £30Million in investment.  

Andrew has more than 30 board years of experience as a director across the health and biotechnology, sectors (including Myotec, PsiOxus, Cardiodirect, Primary Heart Care, Lone Star Heart Inc, the Harley Street Group) and in the not-for-profit sector (including the George Institute, the Centenary Institute, ANZAC Institute of Medical Research, Sydney Cancer Centre Foundation, Colney Innovations Limited, and the Woolcock Institute of Medical Research).


Smolková B, Bonassi S, Buociková V, et al. Genetic determinants of quantitative traits associated with cardiovascular disease risk. Mutat Res 2015; 778:18-25. DOI: 10.1016/j.mrfmmm.2015.05.005

Echouffo-Tcheugui JB, Caleyachetty R, Muennig PA, Narayan KM, Golden SH. Cumulative social risk and type 2 diabetes in US adults: The National Health and Nutrition Examination Survey (NHANES) 1999-2006. Eur J Prev Cardiol. 2016 Aug;23(12):1282-8. doi: 10.1177/2047487315627036.

Wildman RP, Gu D, Reynolds K, et al. Are waist circumference and body mass index independently associated with cardiovascular disease risk in Chinese adults? ,Am J Clin Nutr. 2005; 82(6): 1195-202. DOI: 10.1093/ajcn/82.6.1195

Rankinen T, Bouchard C. Genetics of food intake and eating behavior phenotypes in humans, Annu Rev Nutr 2006; 26:413-34. DOI: 10.1146/annurev.nutr.26.061505.111218

Torres-Perez E, Ledesma M, Garcia-Sobreviela MP, et al. Apolipoprotein E4 association with metabolic syndrome depends on body fatness. Atherosclerosis 2016; 245: 35-42. DOI: 10.1016/j.atherosclerosis.2015.11.029

Kolovou G, Damaskos D, Anagnostopoulou K, Cokkinos DV. Apolipoprotein E gene polymorphism and gender. Ann Clin Lab Sci 2009; 39(2): 120-33.

Bennet AM, Angelantonio E, Ye Z, Wensley F, et al. Association of apolipoprotein E genotypes with lipid levels and coronary risk. JAMA 2007; 298(11): 1300-11. DOI: 10.1001/jama.298.11.1300

Dergunov AD. Apolipoprotein E genotype as a most significant predictor of lipid response at lipid-lowering therapy: mechanistic and clinical studies. Biomed Pharmacother. 2011 Dec;65(8):597-603. doi: 10.1016/j.biopha.2011.04.003.

Kumar A. Changing trends of cardiovascular risk factors among Indians: a review of emerging risks. Asian Pac J Trop Biomed 2014; 4(12): 1001-8. Doi : 10.12980/APJTB.4.201414B401

Rodríguez-Carmona Y, Pérez-Rodríguez M, Gámez-Valdez E, et al Association between Apolipoprotein E Variants and Obesity-Related Traits in Mexican School Children,. J Nutrigenet Nutrigenomics 2014; 7(4-6):243-51. doi: 10.1159/000381345

Sing CF, Davignon J. Role of the apolipoprotein E polymorphism in determining normal plasma lipid and lipoprotein variation. Am J Hum Genet 1985; 37: 268–85.

Wauters M, Considine R, Löfgren A, et al. Associations of leptin with body fat distribution and metabolic parameters in non-insulin-dependent diabetic patients: no effect of apolipoprotein E polymorphism, Metabolism 2000; 49(6): 724-30. DOI: 10.1053/meta.2000.6255

Zarkesh M, Daneshpour MS, Faam B, et al. Is there any association of apolipoprotein E gene polymorphism with obesity status and lipid profiles? Tehran Lipid and Glucose Study (TLGS). Gene. 2012; 509(2): 282-5. DOI: 10.1016/j.gene.2012.07.048

Koopal C, van der Graaf Y, Asselbergs FW, Westerink J, Visseren FL; SMART study group. Influence of APOE-2 genotype on the relation between adiposity and plasma lipid levels in patients with vascular disease. Int J Obes (Lond). 2015 Feb;39(2):265-9. doi: 10.1038/ijo.2014.105.

Trepanowski JF, Bloomer RJ. The impact of religious fasting on human health. Nutr J 2010; 22: 9:57. doi: 10.1186/1475-2891-9-57

Sarri KO, Tzanakis NE, Linardakis MK, et al. Effects of Greek Orthodox Christian Church fasting on serum lipids and obesity. BMC Public Health 2003; 3(1), 1. doi: 10.1186/1471-2458-3-16

Lock DR, Varhol A, Grimes S, et al. Apolipoprotein E levels in vegetarians. Metabolism 1982; 31(9): 917-21.

Tejedor MT, Garcia-Sobreviela MP, Ledesma M, Arbones-Mainar JM. The apolipoprotein E polymorphism rs7412 associates with body fatness independently of plasma lipids in middle aged men. PLoS One 2014; 30;9(9): e108605. doi: 10.1371/journal.pone.0108605

Moreno M, Puig J, Moreno-Navarrete JM, et al. Lean mass, and not fat mass, is an independent determinant of carotid intima media thickness in obese subjects. Atherosclerosis 2015; 243(2):493-8. DOI: 10.1016/j.atherosclerosis.2015.09.012

Hassapidou M. Papadopoulou S.K., Vlahavas G., Kapantais E., Kaklamanou D., Pagkalos I., Tzotzas T. (2013). The Associations Of Physical Activity And Leisure-Time Activity Patterns with obesity and Cardiometabolic Co Morbidities In Greek Adults: Data from the National Epidemiological Survey. Hormones, 12(2), 265-274

Papadopoulou S.K., Laparidis K., Hassapidou M. (2005). Relation of Smoking, Physical Activity and Living Residence to Body Fat and Fat Distribution in Elderly men in Greece. International Journal of Food Sciences and Nutrition, 56(8), 561-566. DOI: 10.1080/09637480500439266

Liberopoulos E, Miltiadous G, Hatzivassiliou M et al. Apolipoprotein E polymorphism in northwestern Greece: frequency and effect on lipid parameters. Ann Clin Lab Sci 2004; 34(3): 347-54.

Davignon J, Gregg RE, Sing CF. Apolipoprotein E polymorphism and atherosclerosis. Arteriosclerosis 1988; 8(1): 1-21.

Tao MH, Liua JW, LaMonteb MJ, et al. Different associations of apolipoprotein E polymorphism with metabolic syndrome by sex in an elderly Chinese population. Metabolism Clinical and Exprimenta 2011; 60: 1488–96. DOI: 10.1016/j.metabol.2011.03.004

Thifault E, Cormier H, Bouchard-Mercier A, et al. Effects of age, sex, body mass index and APOE genotype on cardiovascular biomarker response to an n-3 polyunsaturated fatty acid supplementation. J Nutrigenet Nutrigenomics 2013; 6(2): 73-82. DOI: 10.1159/000350744

Gerdes LU, Klausen IC, Sihm I, Faergeman O. Apolipoprotein E polymorphism in a Danish population compared to findings in 45 other study populations around the world. Genet Epidemiol 1992; 9:155–67.

Virtanen JK, Mursu J, Virtanen HEK, et al. Associations of egg and cholesterol intakes with carotid intima-media thickness and risk of incident coronary artery disease according to apolipoprotein E phenotype in men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 2016; 103: 895–901. DOI: 10.3945/ajcn.115.122317

Tzotzas T, Vlahavas G, Papadopoulou SK, et al. Marital status and educational level associated to obesity in Greek adults: Data from the National Epidemiological Survey. BMC Public Health 2010; 10, 732. doi: 10.1186/1471-2458-10-732

Zeljko HM, Škarić-Jurić T, Narančić NS, et al. E2 allele of the apolipoprotein E gene polymorphism is predictive for obesity status in Roma minority population of Croatia. Lipids Health Dis 2011; 10:9. doi: 10.1186/1476-511X-10-9

Poirier P, Giles TD, Bray GA, Hong YL, Stern JS, Pi-Sunyer FX, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. AHA summary statement. Arterioscler Thromb Vasc Biol 2006; 26: 968-976. DOI: 10.1161/CIRCULATIONAHA.106.171016

Fragasso G. Deranged Cardiac Metabolism and the Pathogenesis of Heart Failure. Card Fail Rev. 2016 May;2(1):8-13. doi: 10.15420/cfr.2016:5:2.

Targher G, Dauriz M, Laroche C, Temporelli PL, Hassanein M, Seferovic PM, Drozdz J, Ferrari R, Anker S, Coats A, Filippatos G, Crespo-Leiro MG, Mebazaa A, Piepoli MF, Maggioni AP, Tavazzi L; ESC-HFA HF Long-Term Registry investigators. In-hospital and 1-year mortality associated with diabetes in patients with acute heart failure: results from the ESC-HFA Heart Failure Long-Term Registry. Eur J Heart Fail. 2017 Jan;19(1):54-65. doi: 10.1002/ejhf.679.

Joshi PP. Why is coronary heart diseases increasing in Indians? Cardiovascular risk factors in the Indian scenario. South Asian J Prev Cardiol 2003; 7: 4.

Sai RA, Dhamodaran V, Thiagarajan P. Role of genetic variants in development of cardiovascular diseases. Int J Pharm Sci Health Care 2012; 1(2): 45-53.

Torres-Perez E, Valero M, Garcia-Rodriguez B., et al. The fat expandability (FATe) Project: biomarkers to determine the limit of expansion and the complications of obesity, Cardiovasc Diabetol 2015; 14(1): 40. doi: [10.1186/s12933-015-0203-6]

Cramer H, Langhorst J, Dobos G, Lauche R. Yoga for metabolic syndrome: A systematic review and meta-analysis. Eur J Prev Cardiol. 2016 Dec;23(18):1982-1993. doi: 10.1177/2047487316665729.

De Backer G, De Bacquer D, Rydén L, Kotseva K, Gaita D, Georgiev B, Gotcheva N, Mancas S, Miličić D, Pająk A, Reiner Ž, Wood D; EUROASPIRE investigators. Lifestyle and risk factor management in people at high cardiovascular risk from Bulgaria, Croatia, Poland, Romania and the United Kingdom who participated in both the EUROASPIRE III and IV primary care surveys. Eur J Prev Cardiol. 2016 Oct;23(15):1618-27. doi: 10.1177/2047487316645474

Shewan LG, Coats AJS, Henein MY. Authors’ Responsibilities and Ethical Publishing. International Cardiovascular Forum Journal 2018;13:3-4, DOI: 10.17987/icfj.v13i0.525






Original Article