Avocado Consumption for 12 Weeks and Cardiometabolic Risk Factors: A Randomized Controlled Trial in Adults with Overweight or Obesity and Insulin Resistance

Xuhuiqun Zhang, Di Xiao, Gabriela Guzman, Indika Edirisinghe, Britt Burton-Freeman, Xuhuiqun Zhang, Di Xiao, Gabriela Guzman, Indika Edirisinghe, Britt Burton-Freeman

Abstract

Background: Diets emphasizing unsaturated fat and high fiber are associated with reducing cardiometabolic risk factors. Avocados are rich in MUFA and PUFA fats and fiber.

Objectives: Assess replacement of carbohydrate energy with avocado energy for 12 wk on glucose homeostasis and cardiometabolic risk factors in self-selecting free-living adults who are overweight or with obesity and have insulin resistance.

Methods: In a single-center, randomized, 2-arm, controlled, 12-wk parallel trial, adults [n = 93; male/female: 39/54; mean ± SD age: 42 ± 12 y; BMI: 32.6 ± 3.9 (in kg/m2); HOMA-IR: 2.7 ± 1.7] were counseled to exchange avocado (AV) or control food (C; low fat, low fiber, energy matched) for carbohydrate food in their usual diet for 12 wk. The primary outcome was the change in Matsuda Insulin Sensitivity Index (MISI) after 12-wk interventions. Secondary outcomes were changes in fasting and post-oral glucose tolerance test glycemic variables, fasting lipids, endothelial activation and inflammation markers. Automated Self-Administered 24-h Dietary Assessment Tool captured weekly dietary intake. Intervention effects were mainly determined by ANCOVA using PC-SAS version 9.4.

Results: Dietary total, MUFA, and PUFA fat; fiber; and vegetable intake were higher in the AV group compared with the C group (P < 0.05), and no change in body weight or composition was observed (P > 0.05). Differences between the changes in MISI after AV compared with C were not different (Δ0-12 wk, P = 0.1092). Differences in fasting insulin (Δ0-12 wk, P = 0.0855) and improved glycated hemoglobin (Δ0-12 wk, P = 0.0632) after AV compared with C were suggested. C-reactive protein was significantly lower after AV compared with C at 12 wk (P = 0.0418). Select biomarkers of endothelial activation and lipoproteins by NMR were also influenced by AV compared with C food intake.

Conclusions: Avocado intake was associated with a healthier dietary pattern and trends favoring improved glucose control and reduced biomarkers of cardiometabolic risk when replacing avocado energy for carbohydrate energy in free-living adults who are overweight or with obesity and have insulin resistance. This trial was registered at clinicaltrials.gov as NCT02695433.

Keywords: HbA1c; Matsuda Insulin Sensitivity Index; avocado; cardiovascular risk factors; insulin resistance.

© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Study design schema.
FIGURE 2
FIGURE 2
CONSORT flow diagram of the study. Adverse event (AE), ; COVID-19, coronavirus disease 2019; HbA1c, glycated hemoglobin; hsCRP, high-sensitivity C-reactive protein; ICAM-1, intercellular adhesion molecule 1; MCP-1, monocyte chemoattractant protein 1; OGTT, oral glucose tolerance test; VCAM-1, vascular cell adhesion molecule 1.
FIGURE 3
FIGURE 3
Box-and-whisker plots illustrate the distribution of the Matsuda Insulin Sensitivity Index (MISI) (A) and glycated hemoglobin (HbA1c) (B) values before and after 12-wk avocado or control intervention in adults who are overweight or with obesity and have insulin resistance. The line in the middle of the box is plotted at the median, and the inferior and superior limits of the box correspond to the 25th and the 75th percentiles, respectively. Bars represent mean change after 12-wk avocado or control food intervention with their standard errors; n = 49 and 44 for avocado and control groups, respectively. ANCOVA using the GLM procedure via PC-SAS was performed on the MISI and HbA1c to test the main effects of the intervention (avocado compared with control) after 12 wk with baseline (week 0) as the covariate. †Marginal statistical effects were acknowledged at P = 0.05–0.1. GLM, general linear model.
FIGURE 4
FIGURE 4
Plasma glucose (A) and insulin (B) responses over 2 h after the oral glucose tolerance test before and after the 12-wk avocado or control intervention in adults who are overweight or with obesity and have insulin resistance. Data are means ± SEMs; n = 49 and 44 for avocado and control groups, respectively. Mixed-model analysis of repeated measures using the MIXED procedure via PC-SAS was performed on glucose and insulin concentrations to test the main effects of the intervention (avocado compared with control), week (week 0 compared with week 12), and hour (0, 0.5, 1, 1.5, 2 h) and the respective 2-factor and 3-factor interactions (i.e., intervention × time, week × time, intervention × week, intervention × time × week) with repeated effect of the participant. No significant effects were observed.

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