(P06-23-26) Effects of Replacing Solid Fats and Added Sugars With Avocado on Plasma Lipoprotein Lipids: An Exploratory Analysis by Baseline Lipid Phenotype

Objectives: Results of a randomized, double-blind, controlled-feeding, crossover trial demonstrated a significant decrease in non-high-density lipoprotein (non-HDL) cholesterol when energy from solid fats and added sugars (SoFAs) was replaced with energy from 1 avocado/d in an average American diet. Exploratory post-hoc analyses evaluated the lipid response to replacing SoFAs with energy from avocado by baseline (BL) lipoprotein lipid phenotype.

Methods: Adults with elevated triglycerides (TG; 135-499 mg/dL) were randomized to two 3-wk dietary interventions with a 2-wk washout: control (CON, average American diet) or AVO (energy from SoFAs replaced with 1 avocado [~300 kcal/d]). Green food dye was added to the CON study foods for blinding. Lipoprotein lipids were measured at BL and end of condition. Linear mixed models were used to calculate least squares mean (LSM) values by condition, with BL as a covariate, as well as differences between conditions and 95% confidence intervals (CI). Exploratory analyses were completed by clinical thresholds of BL levels of non-HDL cholesterol (< or ≥160 mg/dL), low-density lipoprotein (LDL) cholesterol (< or ≥130 mg/dL), and TG (< or ≥150 mg/dL).

Results: Forty-two participants were randomized. Intention-to-treat analyses with multiple imputation showed significant LSM differences (95% CI) for AVO - CON at end of condition for total [-6.5 mg/dL (-12.8, -0.2); P = 0.043] and non-HDL cholesterol [-7.2 mg/dL (-13.8, -0.6); P = 0.033] and TG [-12.7 mg/dL (-19.4, -6.1); P = 0.001] but not for LDL cholesterol [-2.3 mg/dL (-7.5, 3.0); P = 0.388] or HDL cholesterol [-0.2 mg/dL (-2.0, 1.6); P = 0.813]. The effects of AVO vs CON on LDL cholesterol depended on BL LDL cholesterol and TG levels, but no other significant interactions were present. LSM LDL cholesterol was lower during AVO vs CON when BL LDL cholesterol was ≥130 mg/dL [-5.9 mg/dL (-12.9, 1.0)] but higher with BL LDL cholesterol < 130 mg/dL [3.5 mg/dL (-6.4, 13.4)], P-interaction = 0.039. LSM LDL cholesterol was lower during AVO vs CON when BL TG was < 150 mg/dL [-6.6 mg/dL (-15.7, 2.4)] but higher with BL TG ≥150 mg/dL [1.4 mg/dL (-5.1, 7.9)], P-interaction = 0.045.

Conclusions: These results suggest that the LDL cholesterol response to replacement of SoFAs with avocado varies by BL lipoprotein lipid phenotype.

Funding Sources: The Avocado Nutrition Center of the Hass Avocado Board funded this research.