Background
The Metabolic Syndrome (MetS) is highly prevalent and associated with an increased risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Lifestyle recommendations to treat MetS often include the replacement of saturated fats (SFA) and monosacharides with unsaturated fat. However, it is unclear whether metabolic parameters will improve more when the saturated fat in American Heart Association (AHA) diets is replaced with higher concentrations of mono or poly-unsaturated fatty acids (MUFA, PUFA).
Objective
To test the hypothesis that an AHA diet enriched in MUFA improves lipoprotein lipids, insulin resistance, inflammation and endothelial function to a greater extent than a diet enriched in PUFA in middle-aged men and women with MetS.
Methods
A prospective, open-label, parallel group design with randomization to a hypocaloric MUFA or PUFA enriched diet following weight stabilization on an AHA Step I diet. Participants consumed 3 MUFA or PUFA enriched muffins daily with additional supplementation as required to ensure 25-50% increases in dietary fat intake from these sources at the expense of SFA and the opposing unsaturated fat. Changes in MetS components were measured at baseline and after 6 months of dietary intervention.
Results
Thirty-nine participants (mean age 60.8 years, 79% African-American, 60% women) with MetS completed the 6-month study. Compared to baseline, assignment to either MUFA (n=23) or PUFA (n=16) both were associated with weight loss (WL) (MUFA: −2.3±1 kg, P=0.06; PUFA: −4.6±2 kg; P=0.002), but PUFA was also associated with reductions in triglycerides (TG) (−30±18 mg/dL, P=0.02), systolic blood pressure (BP) (−7±3 mmHg, P=0.01), diastolic BP (DBP) (−4±2 mmHg, P=0.01) and improved flow mediated dilation (FMD) (7.1±1.8% vs. 13.6±2%, absolute increase; P=0.0001). When compared to MUFA treatment, PUFA intervention was associated with reduced TG (P=0.04) and DBP (P=0.07) as well as increased FMD (P=0.04) even after adjustment for changes in weight. There was no effect on total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, high-sensitivity C-reactive protein (hs-CRP) or other inflammatory proteins. Overall, 25% (4 of 16) assigned to PUFA and 13% (3 of 23) to MUFA converted to non-MetS status.
Conclusion
Substitution of SFA with PUFA in patients with MetS is associated with greater reductions in TG and improvement in endothelial function than MUFA that is independent of WL. These preliminary findings raise the possibility that PUFA may be the unsaturated fat of choice to reduce cardiometabolic risk in patients with MetS.