Effect of Incorporating 1 Avocado Per Day Versus Habitual Diet on Visceral Adiposity: A Randomized Trial

Alice H Lichtenstein, Penny M Kris-Etherton, Kristina S Petersen, Nirupa R Matthan, Samuel Barnes, Mara Z Vitolins, Zhaoping Li, Joan Sabaté, Sujatha Rajaram, Shilpy Chowdhury, Kristin M Davis, Jean Galluccio, Cheryl H Gilhooly, Richard S Legro, Jason Li, Laura Lovato, Letitia H Perdue, Gayle Petty, Anna M Rasmussen, Gina Segovia-Siapco, Rawiwan Sirirat, April Sun, David M Reboussin, Alice H Lichtenstein, Penny M Kris-Etherton, Kristina S Petersen, Nirupa R Matthan, Samuel Barnes, Mara Z Vitolins, Zhaoping Li, Joan Sabaté, Sujatha Rajaram, Shilpy Chowdhury, Kristin M Davis, Jean Galluccio, Cheryl H Gilhooly, Richard S Legro, Jason Li, Laura Lovato, Letitia H Perdue, Gayle Petty, Anna M Rasmussen, Gina Segovia-Siapco, Rawiwan Sirirat, April Sun, David M Reboussin

Abstract

Background Excess visceral adiposity is associated with increased risk of cardiometabolic disorders. Short-term well-controlled clinical trials suggest that regular avocado consumption favorably affects body weight, visceral adiposity, and satiety. Methods and Results The HAT Trial (Habitual Diet and Avocado Trial) was a multicenter, randomized, controlled parallel-arm trial designed to test whether consuming 1 large avocado per day for 6 months in a diverse group of free-living individuals (N=1008) with an elevated waist circumference compared with a habitual diet would decrease visceral adiposity as measured by magnetic resonance imaging. Secondary and additional end points related to risk factors associated with cardiometabolic disorders were assessed. The primary outcome, change in visceral adipose tissue volume during the intervention period, was not significantly different between the Avocado Supplemented and Habitual Diet Groups (estimated mean difference (0.017 L [-0.024 L, 0.058 L], P=0.405). No significant group differences were observed for the secondary outcomes of hepatic fat fraction, hsCRP (high-sensitivity C-reactive protein), and components of the metabolic syndrome. Of the additional outcome measures, modest but nominally significant reductions in total and low-density lipoprotein cholesterol were observed in the Avocado Supplemented compared with the Habitual Diet Group. Changes in the other additional and post hoc measures (body weight, body mass index, insulin, very low-density lipoprotein concentrations, and total cholesterol:high-density lipoprotein cholesterol ratio) were similar between the 2 groups. Conclusions Addition of 1 avocado per day to the habitual diet for 6 months in free-living individuals with elevated waist circumference did not reduce visceral adipose tissue volume and had minimal effect on risk factors associated with cardiometabolic disorders. Registration URL: https://ichgcp.net/clinical-trials-registry/NCT03528031" title="See in ClinicalTrials.gov">NCT03528031.

Keywords: avocado; habitual diet; randomized clinical trial; risk factors for cardiometabolic disorders; visceral fat.

Figures

Figure 1. Consolidated Standards of Reporting Trials…
Figure 1. Consolidated Standards of Reporting Trials (CONSORT) diagram.
MRI indicates magnetic resonance imaging.
Figure 2. Visceral adipose tissue by subgroup.
Figure 2. Visceral adipose tissue by subgroup.
For each subgroup, the estimated difference of the 6‐month effects on VAT between the Avocado Supplemented Diet group and the Habitual Diet group is shown as a solid square with a horizontal line showing its 95% CI. At the right, the estimated 6‐month effect on VAT from the mixed effects model is shown for each group along with a P value for the interaction terms, except for Overall, which is the P value for the difference. HEI indicates Healthy Eating Index (range from 0 to 100); Kcal, kilocalories; NonH White, Non‐Hispanic White; and VAT, visceral adipose tissue volume (in liters).

References

    1. Kim D, Hou W, Wang F, Arcan C. Factors affecting obesity and waist circumference among US adults. Prev Chronic Dis. 2019;16:E02. doi: 10.5888/pcd16.180220
    1. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752. doi: 10.1161/CIRCULATIONAHA.105.169404
    1. Zhang C, Rexrode KM, van Dam RM, Li TY, Hu FB. Abdominal obesity and the risk of all‐cause, cardiovascular, and cancer mortality: sixteen years of follow‐up in US women. Circulation. 2008;117:1658–1667. doi: 10.1161/CIRCULATIONAHA.107.739714
    1. Song X, Jousilahti P, Stehouwer CD, Söderberg S, Onat A, Laatikainen T, Yudkin JS, Dankner R, Morris R, Tuomilehto J, et al. Comparison of various surrogate obesity indicators as predictors of cardiovascular mortality in four European populations. Eur J Clin Nutr. 2013;67:1298–1302. doi: 10.1038/ejcn.2013.203
    1. Lassale C, Tzoulaki I, Moons KGM, Sweeting M, Boer J, Johnson L, Huerta JM, Agnoli C, Freisling H, Weiderpass E, et al. Separate and combined associations of obesity and metabolic health with coronary heart disease: a pan‐European case‐cohort analysis. Eur Heart J. 2018;39:397–406. doi: 10.1093/eurheartj/ehx448
    1. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, Santos RD, Arsenault B, Cuevas A, Hu FB, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol. 2020;16:177–189. doi: 10.1038/s41574-019-0310-7
    1. Lassale C, Fezeu L, Andreeva VA, Hercberg S, Kengne AP, Czernichow S, Kesse‐Guyot E. Association between dietary scores and 13‐year weight change and obesity risk in a French prospective cohort. Int J Obes. 2012;36:1455–1462. doi: 10.1038/ijo.2011.264
    1. Paradis AM, Godin G, Pérusse L, Vohl MC. Associations between dietary patterns and obesity phenotypes. Int J Obes. 2009;33:1419–1426. doi: 10.1038/ijo.2009.179
    1. Schwingshackl L, Hoffmann G, Kalle‐Uhlmann T, Arregui M, Buijsse B, Boeing H. Fruit and vegetable consumption and changes in anthropometric variables in adult populations: a systematic review and meta‐analysis of prospective cohort studies. PLoS One. 2015;10:e0140846. doi: 10.1371/journal.pone.0140846
    1. Fulgoni V III, O'Neil CE, Nicklas TA. Avocado consumption by adults is associated with better nutrient intake, diet quality, and some measures of adiposity: National Health and Nutrition Examination Survey, 2001–2012. Intern Med Rev. 2017;3:2–23. doi: 10.18103/imr.v3i4.422
    1. Fulgoni VL III, Dreher M, Davenport AJ. Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: results from the National Health and Nutrition Examination Survey (NHANES) 2001–2008. Nutr J. 2013;12:1. doi: 10.1186/1475-2891-12-1
    1. Wien M, Haddad E, Oda K, Sabaté J. A randomized 3×3 crossover study to evaluate the effect of Hass avocado intake on post‐ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults. Nutr J. 2013;12:155. doi: 10.1186/1475-2891-12-155
    1. Henning SM, Yang J, Woo SL, Lee RP, Huang J, Rasmusen A, Carpenter CL, Thames G, Gilbuena I, Tseng CH, et al. Hass avocado inclusion in a weight‐loss diet supported weight loss and altered gut microbiota: a 12‐week randomized, parallel‐controlled trial. Curr Dev Nutr. 2019;3:nzz068. doi: 10.1093/cdn/nzz068
    1. Khan NA, Edwards CG, Thompson SV, Hannon BA, Burke SK, Walk ADM, Mackenzie RWA, Reeser GE, Fiese BH, Burd NA, et al. Avocado consumption, abdominal adiposity, and oral glucose tolerance among persons with overweight and obesity. J Nutr. 2021;151:2513–2521. doi: 10.1093/jn/nxab187
    1. Reboussin DM, Kris‐Etherton PM, Lichtenstein AH, Li Z, Sabate J, Matthan NR, Petersen K, Rajaram S, Vitolins M, Ford N. The design and rationale of a multi‐center randomized clinical trial comparing one avocado per day to usual diet: the Habitual Diet and Avocado Trial (HAT). Contemp Clin Trials. 2021;110:106565. doi: 10.1016/j.cct.2021.106565
    1. National Cancer Institute Division of Cancer Control and Population Sciences . ASA24 resources related to the Healthy Eating Index (HEI). Available at: . Accessed December 17, 2021.
    1. Stewart A, Ware J. Measuring Functioning and Well‐Being: The Medical Outcomes Study Approach. Duke University Press; 1992. doi: 10.7249/CB361
    1. So R, Sasai H, Matsuo T, Tsujimoto T, Eto M, Saotome K, Tanaka K. Multiple‐slice magnetic resonance imaging can detect visceral adipose tissue reduction more accurately than single‐slice imaging. Eur J Clin Nutr. 2012;66:1351–1355. doi: 10.1038/ejcn.2012.147
    1. d'Assignies G, Ruel M, Khiat A, Lepanto L, Chagnon M, Kauffmann C, Tang A, Gaboury L, Boulanger Y. Noninvasive quantitation of human liver steatosis using magnetic resonance and bioassay methods. Eur Radiol. 2009;19:2033–2040. doi: 10.1007/s00330-009-1351-4
    1. Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470–475. doi: 10.1093/clinchem/20.4.470
    1. Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem. 1973;19:476–482. doi: 10.1093/clinchem/19.5.476
    1. Stein M. Clinical methods of enzymatic analysis. Vol 117. Academic Press; 1965:435–452.
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low‐density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502. doi: 10.1093/clinchem/18.6.499
    1. Babson A. The cirrus IMMULITE automated immunoassay system. J Clin Immunoassay. 1991;14:83–88.
    1. Bowen KJ, Kris‐Etherton PM, Shearer GC, West SG, Reddivari L, Jones PJH. Oleic acid‐derived oleoylethanolamide: a nutritional science perspective. Prog Lipid Res. 2017;67:1–15. doi: 10.1016/j.plipres.2017.04.001
    1. Paniagua JA, Gallego de la Sacristana A, Romero I, Vidal‐Puig A, Latre JM, Sanchez E, Perez‐Martinez P, Lopez‐Miranda J, Perez‐Jimenez F. Monounsaturated fat‐rich diet prevents central body fat distribution and decreases postprandial adiponectin expression induced by a carbohydrate‐rich diet in insulin‐resistant subjects. Diabetes Care. 2007;30:1717–1723. doi: 10.2337/dc06-2220
    1. Kien CL, Bunn JY, Ugrasbul F. Increasing dietary palmitic acid decreases fat oxidation and daily energy expenditure. Am J Clin Nutr. 2005;82:320–326. doi: 10.1093/ajcn/82.2.320
    1. Piers LS, Walker KZ, Stoney RM, Soares MJ, O'Dea K. Substitution of saturated with monounsaturated fat in a 4‐week diet affects body weight and composition of overweight and obese men. Br J Nutr. 2003;90:717–727. doi: 10.1079/BJN2003948
    1. Neeland IJ, Grundy SM, Li X, Adams‐Huet B, Vega GL. Comparison of visceral fat mass measurement by dual‐X‐ray absorptiometry and magnetic resonance imaging in a multiethnic cohort: the Dallas Heart Study. Nutr Diabetes. 2016;6:e221. doi: 10.1038/nutd.2016.28
    1. Dias KA, Ramos JS, Wallen MP, Davies PSW, Cain PA, Leong GM, Ingul CB, Coombes JS, Keating SE. Accuracy of longitudinal assessment of visceral adipose tissue by dual‐energy X‐ray absorptiometry in children with obesity. J Obes. 2019;2019:2193723–2193712. doi: 10.1155/2019/2193723
    1. Taylor JL, Holland DJ, Coombes JS, Keating SE. Accuracy of dual‐energy x‐ray absorptiometry for assessing longitudinal change in visceral adipose tissue in patients with coronary artery disease. Int J Obes. 2021;45:1740–1750. doi: 10.1038/s41366-021-00840-3
    1. Marlett JA, Cheung TF. Database and quick methods of assessing typical dietary fiber intakes using data for 228 commonly consumed foods. J Am Diet Assoc. 1997;97:1139–1148, 1151; quiz 1149‐1150. doi: 10.1016/S0002-8223(97)00275-7
    1. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol‐lowering effects of dietary fiber: a meta‐analysis. Am J Clin Nutr. 1999;69:30–42. doi: 10.1093/ajcn/69.1.30
    1. Salazar‐López NJ, Domínguez‐Avila JA, Yahia EM, Belmonte‐Herrera BH, Wall‐Medrano A, Montalvo‐González E, González‐Aguilar GA. Avocado fruit and by‐products as potential sources of bioactive compounds. Food Res Int. 2020;138:109774. doi: 10.1016/j.foodres.2020.109774
    1. Peou S, Milliard‐Hasting B, Shah SA. Impact of avocado‐enriched diets on plasma lipoproteins: a meta‐analysis. J Clin Lipidol. 2016;10:161–171. doi: 10.1016/j.jacl.2015.10.011
    1. Mahmassani HA, Avendano EE, Raman G, Johnson EJ. Avocado consumption and risk factors for heart disease: a systematic review and meta‐analysis. Am J Clin Nutr. 2018;107:523–536. doi: 10.1093/ajcn/nqx078
    1. Pacheco LS, Li Y, Rimm EB, Manson JE, Sun Q, Rexrode K, Hu FB, Guasch‐Ferré M. Avocado consumption and risk of cardiovascular disease in US adults. J Am Heart Assoc. 2022;11:e024014. doi: 10.1161/JAHA.121.024014
    1. Dhurandhar NV, Schoeller D, Brown AW, Heymsfield SB, Thomas D, Sørensen TI, Speakman JR, Jeansonne M, Allison DB. Energy balance measurement: when something is not better than nothing. Int J Obes. 2015;39:1109–1113. doi: 10.1038/ijo.2014.199
    1. Conceição AR, Fraiz GM, Rocha DMUP, Bressan J. Can avocado intake improve weight loss in adults with excess weight? A systematic review and meta‐analysis of randomized controlled trials. Nutr Res. 2022;102:45–58. doi: 10.1016/j.nutres.2022.03.005

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera