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Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study.

Abstract

BACKGROUND

Public health strategies to lower cardiovascular disease (CVD) risk involve reducing dietary saturated fatty acid (SFA) intake to ≤10% of total energy (%TE). However, the optimal type of replacement fat is unclear.

OBJECTIVE

We investigated the substitution of 9.5-9.6%TE dietary SFAs with either monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on vascular function and other CVD risk factors.

DESIGN

In a randomized, controlled, single-blind, parallel-group dietary intervention, 195 men and women aged 21-60 y from the United Kingdom with moderate CVD risk (≥50% above the population mean) followed one of three 16-wk isoenergetic diets (%TE target compositions, total fat:SFA:MUFA:n-6 PUFA) that were rich in SFAs (36:17:11:4, n = 65), MUFAs (36:9:19:4, n = 64), or n-6 PUFAs (36:9:13:10, n = 66). The primary outcome measure was flow-mediated dilatation; secondary outcome measures included fasting serum lipids, microvascular reactivity, arterial stiffness, ambulatory blood pressure, and markers of insulin resistance, inflammation, and endothelial activation.

RESULTS

Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation (primary endpoint) or other measures of vascular reactivity. Of the secondary outcome measures, substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure (-4.9 mm Hg, P = 0.019) and reduced E-selectin (-7.8%, P = 0.012). Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol (-8.4% and -9.2%, respectively), low-density lipoprotein cholesterol (-11.3% and -13.6%), and total cholesterol to high-density lipoprotein cholesterol ratio (-5.6% and -8.5%) (P ≤ 0.001). These changes in low-density lipoprotein cholesterol equate to an estimated 17-20% reduction in CVD mortality.

CONCLUSIONS

Substitution of 9.5-9.6%TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function. However, the beneficial effects on serum lipid biomarkers, blood pressure, and E-selectin offer a potential public health strategy for CVD risk reduction. This trial was registered at www.clinicaltrials.gov as NCT01478958.

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  • Authors+Show Affiliations

    ,

    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.

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    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.

    ,

    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.

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    Department of Mathematics and Statistics, University of Reading, Reading, United Kingdom.

    ,

    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.

    ,

    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.

    Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and j.a.lovegrove@reading.ac.uk.

    Source

    MeSH

    Adult
    Biomarkers
    Blood Pressure
    Body Mass Index
    Cardiovascular Diseases
    Cardiovascular System
    Cholesterol, HDL
    Cholesterol, LDL
    Dietary Fats
    E-Selectin
    Endothelial Cells
    Fatty Acids
    Fatty Acids, Unsaturated
    Feeding Behavior
    Female
    Humans
    Male
    Middle Aged
    Patient Compliance
    Single-Blind Method
    Triglycerides
    United Kingdom
    Waist Circumference
    Young Adult

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    26016869

    Citation

    Vafeiadou, Katerina, et al. "Replacement of Saturated With Unsaturated Fats Had No Impact On Vascular Function but Beneficial Effects On Lipid Biomarkers, E-selectin, and Blood Pressure: Results From the Randomized, Controlled Dietary Intervention and VAScular Function (DIVAS) Study." The American Journal of Clinical Nutrition, vol. 102, no. 1, 2015, pp. 40-8.
    Vafeiadou K, Weech M, Altowaijri H, et al. Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Am J Clin Nutr. 2015;102(1):40-8.
    Vafeiadou, K., Weech, M., Altowaijri, H., Todd, S., Yaqoob, P., Jackson, K. G., & Lovegrove, J. A. (2015). Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. The American Journal of Clinical Nutrition, 102(1), pp. 40-8. doi:10.3945/ajcn.114.097089.
    Vafeiadou K, et al. Replacement of Saturated With Unsaturated Fats Had No Impact On Vascular Function but Beneficial Effects On Lipid Biomarkers, E-selectin, and Blood Pressure: Results From the Randomized, Controlled Dietary Intervention and VAScular Function (DIVAS) Study. Am J Clin Nutr. 2015;102(1):40-8. PubMed PMID: 26016869.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. AU - Vafeiadou,Katerina, AU - Weech,Michelle, AU - Altowaijri,Hana, AU - Todd,Susan, AU - Yaqoob,Parveen, AU - Jackson,Kim G, AU - Lovegrove,Julie A, Y1 - 2015/05/27/ PY - 2014/08/01/received PY - 2015/04/03/accepted PY - 2015/5/29/entrez PY - 2015/5/29/pubmed PY - 2015/9/12/medline KW - blood pressure KW - dietary fatty acids KW - flow-mediated dilatation KW - lipids KW - vascular function SP - 40 EP - 8 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 102 IS - 1 N2 - BACKGROUND: Public health strategies to lower cardiovascular disease (CVD) risk involve reducing dietary saturated fatty acid (SFA) intake to ≤10% of total energy (%TE). However, the optimal type of replacement fat is unclear. OBJECTIVE: We investigated the substitution of 9.5-9.6%TE dietary SFAs with either monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on vascular function and other CVD risk factors. DESIGN: In a randomized, controlled, single-blind, parallel-group dietary intervention, 195 men and women aged 21-60 y from the United Kingdom with moderate CVD risk (≥50% above the population mean) followed one of three 16-wk isoenergetic diets (%TE target compositions, total fat:SFA:MUFA:n-6 PUFA) that were rich in SFAs (36:17:11:4, n = 65), MUFAs (36:9:19:4, n = 64), or n-6 PUFAs (36:9:13:10, n = 66). The primary outcome measure was flow-mediated dilatation; secondary outcome measures included fasting serum lipids, microvascular reactivity, arterial stiffness, ambulatory blood pressure, and markers of insulin resistance, inflammation, and endothelial activation. RESULTS: Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation (primary endpoint) or other measures of vascular reactivity. Of the secondary outcome measures, substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure (-4.9 mm Hg, P = 0.019) and reduced E-selectin (-7.8%, P = 0.012). Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol (-8.4% and -9.2%, respectively), low-density lipoprotein cholesterol (-11.3% and -13.6%), and total cholesterol to high-density lipoprotein cholesterol ratio (-5.6% and -8.5%) (P ≤ 0.001). These changes in low-density lipoprotein cholesterol equate to an estimated 17-20% reduction in CVD mortality. CONCLUSIONS: Substitution of 9.5-9.6%TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function. However, the beneficial effects on serum lipid biomarkers, blood pressure, and E-selectin offer a potential public health strategy for CVD risk reduction. This trial was registered at www.clinicaltrials.gov as NCT01478958. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/26016869/full_citation L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.114.097089 DB - PRIME DP - Unbound Medicine ER -