Abstract 048: Effects of Replacing Solid Fats and Added Sugars with Avocado in Adults with Elevated Cardiometabolic Risk: A Randomized Controlled Trial

Background: Limited high-quality evidence exists from randomized controlled trials on the impact of an avocado-containing diet on cardiometabolic risk factors. Objective: The purpose of this randomized, double-blind, outpatient, controlled feeding, crossover study (NCT04990817) in adults with increased cardiometabolic risk was to assess the effects of replacing energy from solid fats and added sugars with energy from one avocado on blood lipids and other indicators of cardiometabolic health. Methods: For two 3-week periods separated by a 2-week washout, 42 healthy adults with elevated triglycerides (TG, 135-499 mg/dL) consumed a typical American diet that included either one avocado (~180 g/day, ~300 kcal/day) or approximately 300 kcal/day from saturated fats and added sugars. The same study products (muffins, granola bites, dressing, salsa, marinade, pesto) delivered the avocado or control ingredients, and green food dye was added to the control study products to facilitate the double-blinding of the conditions. Non-high-density lipoprotein cholesterol (non-HDL-C, the primary outcome), other blood lipids, fasting and postprandial glucose, insulin and blood pressure were measured at baseline and at the end of each diet condition. Linear mixed models were used to generate estimates for the percent change in outcomes. Results: Of the 42 participants, 37 completed the avocado condition and 39 completed the control condition. An intention-to-treat analysis showed significantly greater percent changes from baseline during the avocado vs. control conditions for non-HDL-C: -4.6%, 95% CI -9.0, -0.1%, P=0.047; TG: -17.4%, 95% CI -25.0, -9.0%, P<0.001; and total cholesterol:HDL-C ratio: -6.6%, -95% CI -12.0, -0.8%, P=0.028. Total cholesterol change from baseline during the avocado vs. control condition was: -3.1%, 95% CI -6.3, 0.1%, P=0.060. Other blood lipids, fasting and postprandial glucose, insulin and blood pressure did not significantly differ (P>0.1). Conclusions: Replacing solid fats and added sugars in the typical American diet with avocado improves the lipoprotein lipid profile in adults with elevated triglycerides.