Reformulation initiative for partial replacement of saturated with unsaturated fats in dairy foods attenuates the increase in LDL cholesterol and improves flow-mediated dilatation compared with conventional dairy: the randomized, controlled REplacement of SaturatEd fat in dairy on Total cholesterol (RESET) study

Dafni Vasilopoulou, Oonagh Markey, Kirsty E Kliem, Colette C Fagan, Alistair S Grandison, David J Humphries, Susan Todd, Kim G Jackson, David I Givens, Julie A Lovegrove, Dafni Vasilopoulou, Oonagh Markey, Kirsty E Kliem, Colette C Fagan, Alistair S Grandison, David J Humphries, Susan Todd, Kim G Jackson, David I Givens, Julie A Lovegrove

Abstract

Background: Modifying dairy fat composition by increasing the MUFA content is a potential strategy to reduce dietary SFA intake for cardiovascular disease (CVD) prevention in the population.

Objectives: To determine the effects of consuming SFA-reduced, MUFA-enriched (modified) dairy products, compared with conventional dairy products (control), on the fasting cholesterol profile (primary outcome), endothelial function assessed by flow-mediated dilatation (FMD; key secondary outcome), and other cardiometabolic risk markers.

Methods: A double-blind, randomized, controlled crossover 12-wk intervention was conducted. Participants with a 1.5-fold higher (moderate) CVD risk than the population mean replaced habitual dairy products with study products (milk, cheese, and butter) to achieve a high-fat, high-dairy isoenergetic daily dietary exchange [38% of total energy intake (%TE) from fat: control (dietary target: 19%TE SFA; 11%TE MUFA) and modified (16%TE SFA; 14%TE MUFA) diet].

Results: Fifty-four participants (57.4% men; mean ± SEM age: 52 ± 3 y; BMI: 25.8 ± 0.5 kg/m2) completed the study. The modified diet attenuated the rise in fasting LDL cholesterol observed with the control diet (0.03 ± 0.06 mmol/L and 0.19 ± 0.05 mmol/L, respectively; P = 0.03). Relative to baseline, the %FMD response increased after the modified diet (0.35% ± 0.15%), whereas a decrease was observed after the control diet (-0.51% ± 0.15%; P< 0.0001). In addition, fasting plasma nitrite concentrations increased after the modified diet, yet decreased after the control diet (0.02 ± 0.01 μmol/L and -0.03 ± 0.02 μmol/L, respectively; P = 0.01).

Conclusions: In adults at moderate CVD risk, consumption of a high-fat diet containing SFA-reduced, MUFA-enriched dairy products for 12 wk showed beneficial effects on fasting LDL cholesterol and endothelial function compared with conventional dairy products. Our findings indicate that fatty acid modification of dairy products may have potential as a public health strategy aimed at CVD risk reduction. This trial was registered at clinicaltrials.gov as NCT02089035.

Keywords: cardiovascular disease risk; cholesterol profile; dairy fat; flow-mediated dilatation; food chain approach; monounsaturated fatty acids; reformulation; saturated fatty acids; vascular function.

Copyright © The Author(s) 2020.

Figures

FIGURE 1
FIGURE 1
Δ fasting cholesterol profile after 12-wk diets that incorporated modified and control dairy products. Values are unadjusted means ± SEMs. n = 54. Linear mixed-model analyses were used to calculate overall effect of treatment based on Δ values, with adjustments made for fixed effects of baseline values of the assessed variable, period, treatment sequence, gender, age, and BMI. Participant was included as a random effect. The Δ values after each 12-wk dietary intervention were calculated by subtracting week 0 from week 12 values; and week 20 from week 32 values. No period effects were observed in the model for any outcome measure. *P < 0.05. HDL-C, HDL cholesterol; LDL-C, LDL cholesterol; TC, total cholesterol; Δ, change-from-baseline.

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