Adding monounsaturated fatty acids to a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia

Abstract

Strategies that combine cholesterol-lowering foods or food components such as viscous fibres and plant sterols have been recommended to enhance the effectiveness of therapeutic diets low in saturated fat and cholesterol.1,2 Such dietary combinations (known as dietary portfolios) have resulted in substantial reductions in low-density lipoprotein (LDL) cholesterol 3 and its apolipoprotein (apolipoprotein B), but the beneficial effects on high-density lipoprotein (HDL) cholesterol and its apolipoprotein (apolipoprotein AI) have been less apparent. 4 Low concentrations of HDL cholesterol and apolipoprotein AI in the plasma and an elevated ratio of total to HDL cholesterol are recognized risk factors for cardiovascular disease.5−9 Thus, dietary strategies that both lower total and LDL cholesterol and raise HDL cholesterol should have broad application. One method for increasing HDL cholesterol appears to be the use of monounsaturated fat, a key constituent of the Mediterranean diet, particularly when monounsaturated fat replaces dietary carbohydrates.10,11 Furthermore, increased intake of monounsaturated fat, through increased consumption of nuts and vegetable oil, has been associated with a reduced incidence of cardiovascular disease in cohort studies. 12,13We compared the effect on serum lipids of substituting 13.0% of total calories as carbohydrate with monounsaturated fatty acid in a dietary portfolio that has previously been shown, under controlled conditions, to be effective in lowering LDL cholesterol (by 28%) and the ratio of total to HDL cholesterol (by 24%).3 These reductions are similar to those seen with lovastatin 20 mg/d taken with the control diet. Background: Higher intake of monounsaturated fat may raise high-density lipoprotein (HDL) cholesterol without raising low-density lipoprotein (LDL) cholesterol. We tested whether increasing the monounsaturated fat content of a diet proven effective for lowering LDL cholesterol (dietary portfolio) also modified other risk factors for cardiovascular disease, specifically by increasing HDL cholesterol, lowering serum triglyceride and further reducing the ratio of total to HDL cholesterol.

Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial

“…5,12 Dietary recommendations were based on components of the Mediterranean and Portfolio dietary regimes. 13,14 Examples of prescriptions for natural health products included omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid, 12,15 The Framingham algorithm is a tool designed to estimate an individual's level of cardiovascular disease risk. The algorithm predicts the 10-year risk of a cardiovascular event based on a comp osite score of risk factors, including age, HDL, total cholesterol, systolic blood pressure, smoking status and diabetes status.…”

Evidence-Based Guideline of the German Nutrition Society: Fat Intake and Prevention of Selected Nutrition-Related Diseases

“…Jenkins et al [155] (LOE Ib) did not observe any differences in blood pressure between MUFA or carbohydrate-rich diets in patients with hypercholesterolaemia.…”

Dietary Approaches to the Treatment of Obesity

“…5 Recent studies that have compared MF (i.e., 35%-46% fat) and LF (i.e., 25%-30%) diets have reported similar 26,27 to slightly better 28 weight losses with MF diets (Table 1). These diets were similar to Mediterranean diets in that they contained a high proportion of monounsaturated fatty acids (MUFAs), primarily from MUFA rich oils, and emphasized high intake of plant foods (i.e., fruits, vegetables, whole grains, legumes, and nuts) and fiber and limited amounts of saturated fat from animal foods.…”

“…29 Of the studies included in the meta analysis that reported fat intake, only one study reported total fat intake as less than 35% fat (i.e., 30% fat). Compared to LF diets, higher fat, Mediterranean style diets have also been shown to be superior in increasing HDL and reducing atherogenic index (i.e., ratio of total to HDL cholesterol) and C-reactive protein in individuals with hyperlipidemia 27 or coronary heart disease. 28 They also are comparable in improving blood pressure, HDL, HbA 1C , and fasting glucose and insulin in individuals with type 2 diabetes.…”