Mediterranean Diet, Energy Restriction, Physical Activity, and Atherogenicity of Very‐Low Density Lipoproteins: Findings from Two Randomized Controlled Trials

SCOPE: Some very‐low density lipoprotein (VLDL) properties may render them more pro‐atherogenic. We aimed to assess whether a Mediterranean diet (MedDiet) or an energy‐reduced MedDiet with increased physical activity improves them. METHODS AND RESULTS: In a sample of the PREvención con DIeta MEDiterránea (PREDIMED) study, a 1‐year intervention with MedDiet with extra‐virgin olive oil (n = 89) or nuts (MedDiet‐Nuts; n = 79) is compared with a low‐fat diet (n = 90). In the PREDIMED‐Plus study, a 1‐year intervention with energy‐reduced MedDiet and physical activity (n = 103) is compared with an ad libitum MedDiet (n = 101). VLDL levels of apolipoprotein C‐I, C‐III, triglycerides, and cholesterol; the apolipoprotein E‐/C‐I ratio; and VLDL ex‐vivo triglyceride transfer are measured. In PREDIMED participants in both MedDiet groups combined, VLDL apolipoprotein C‐III levels are nominally reduced (−0.023 SD units, 95% CI −0.44 to −0.014, p = 0.037). VLDL triglyceride transfer is nominally increased in the MedDiet‐Nuts group (+0.39 SD units, 95% CI 0.012–0.78, p = 0.045). In PREDIMED‐Plus, no inter‐group differences are detected. CONCLUSIONS: In older adults at high cardiovascular risk, MedDiet is associated with lower VLDL atherogenicity versus a low‐fat diet. No differences are seen after an energy‐reduced MedDiet with physical activity.