Effect of a Moderate Fat Diet With and Without Avocados on Lipoprotein Particle Number, Size and Subclasses in Overweight and Obese Adults: A Randomized, Controlled Trial

BACKGROUND: Avocados are a nutrient‐dense source of monounsaturated fatty acids (MUFA) that can be used to replace saturated fatty acids (SFA) in a diet to lower low density lipoprotein cholesterol (LDL‐C). Well‐controlled studies are lacking on the effect of avocado consumption on cardiovascular disease (CVD) risk factors. METHODS AND RESULTS: A randomized, crossover, controlled feeding trial was conducted with 45 overweight or obese participants with baseline LDL‐C in the 25th to 90th percentile. Three cholesterol‐lowering diets (6% to 7% SFA) were fed (5 weeks each): a lower‐fat diet (LF: 24% fat); 2 moderate‐fat diets (34% fat) provided similar foods and were matched for macronutrients and fatty acids: the avocado diet (AV) included one fresh Hass avocado (136 g) per day, and the moderate‐fat diet (MF) mainly used high oleic acid oils to match the fatty acid content of one avocado. Compared with baseline, the reduction in LDL‐C and non‐high‐density lipoprotein (HDL) cholesterol on the AV diet (−13.5 mg/dL, −14.6 mg/dL) was greater (P<0.05) than the MF (−8.3 mg/dL, −8.7 mg/dL) and LF (−7.4 mg/dL, −4.8 mg/dL) diets. Furthermore, only the AV diet significantly decreased LDL particle number (LDL‐P, −80.1 nmol/L, P=0.0001), small dense LDL cholesterol (LDL(3+4), −4.1 mg/dL, P=0.04), and the ratio of LDL/HDL (−6.6%, P<0.0001) from baseline. CONCLUSIONS: Inclusion of one avocado per day as part of a moderate‐fat, cholesterol‐lowering diet has additional LDL‐C, LDL‐P, and non‐HDL‐C lowering effects, especially for small, dense LDL. Our results demonstrate that avocados have beneficial effects on cardio‐metabolic risk factors that extend beyond their heart‐healthy fatty acid profile. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01235832.