Effects of Replacing Solid Fats and Added Sugars with Avocado in Adults with Elevated Cardiometabolic Risk: A Randomized, Double-Blind, Controlled Feeding, Crossover Trial

Background:

Limited high-quality evidence exists from controlled trials on the impact of avocado-containing diets on cardiometabolic risk factors.

Objective:

The purpose of this randomized, double-blind, free-living, controlled feeding, crossover study in adults with increased cardiometabolic risk was to assess the effects of replacing energy from solid fats and added sugars with equivalent energy from one avocado daily on cardiometabolic risk factors.

Methods:

For two 3-week periods, separated by a 2-week washout, healthy adults with elevated triglycerides (TG, 135-499 mg/dL) consumed an average American diet or a diet in which one avocado (∼180 g/day, ∼300 kcal/day) replaced energy from SFA and added sugars. The same study products (muffins, granola bites, dressing, salsa, marinade, pesto) delivered the avocado or control ingredients. Green food dye was added to the control study products to facilitate double blinding. Non-high-density lipoprotein (non-HDL) cholesterol (primary outcome), other lipoprotein lipids, fasting glucose and insulin, and fasting and postprandial blood pressures were measured at baseline and end-of-condition. Linear mixed models were used to generate estimates for percentage changes.

Results:

Of 42 randomized, 37 completed the avocado condition and 39 completed the control condition. An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CI), from baseline after the avocado condition, compared to after the control condition, for non-HDL cholesterol (-4.65%; 95% CI: -9.01%, -0.08%; P = 0.047), VLDL cholesterol (-9.30%; -15.3%, -2.82%; P = 0.007); TG (-17.4%; -25.0%, -8.99%; P < 0.001), small LDL subfraction cholesterol (-13.9%; -23.2%, -3.49%; P = 0.012), and total cholesterol:HDL cholesterol ratio (-6.56%; -12.0%, -0.79%; P = 0.028). Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.

Conclusions:

Replacing solid fats and added sugars with avocado in a typical American diet improved the lipoprotein lipid profile in adults with elevated TG.

This trial was registered at ClinicalTrials.gov as NCT04990817 (https://clinicaltrials.gov/study/NCT04990817).