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Cited by 92Lipoproteins and Cardiovascular HealthNutritional Studies and DietFatty Acid Research and Health

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

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Jenkins, D. J. A., Chiavaroli, L., Wong, J. M. W., Kendall, C., Lewis, G. F., Vidgen, E., Connelly, P. W., Leiter, L. A. +2 more·2010·Canadian Medical Association Journal
DOI 10.1503/cmaj.092128PMC PMC3001502
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Abstract

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. METHODS: Twenty-four patients with hyperlipidemia consumed a therapeutic diet very low in saturated fat for one month and were then randomly assigned to a dietary portfolio low or high in monounsaturated fatty acid for another month. We supplied participants' food for the two-month period. Calorie intake was based on Harris-Benedict estimates for energy requirements. RESULTS: For patients who consumed the dietary portfolio high in monounsaturated fat, HDL cholesterol rose, whereas for those consuming the dietary portfolio low in monounsaturated fat, HDL cholesterol did not change. The 12.5% treatment difference was significant (0.12 mmol/L, 95% confidence interval [CI] 0.05 to 0.21, p = 0.003). The ratio of total to HDL cholesterol was reduced by 6.5% with the diet high in monounsaturated fat relative to the diet low in monounsaturated fat (-0.28, 95% CI -0.59 to -0.04, p = 0.025). Patients consuming the diet high in monounsaturated fat also had significantly higher concentrations of apolipoprotein AI, and their C-reactive protein was significantly lower. No treatment differences were seen for triglycerides, other lipids or body weight, and mean weight loss was similar for the diets high in monounsaturated fat (-0.8 kg) and low in monounsaturated fat (-1.2 kg). INTERPRETATION: Monounsaturated fat increased the effectiveness of a cholesterol-lowering dietary portfolio, despite statin-like reductions in LDL cholesterol. The potential benefits for cardiovascular risk were achieved through increases in HDL cholesterol, further reductions in the ratio of total to HDL cholesterol and reductions in C-reactive protein. (ClinicalTrials.gov trial register no. NCT00430430.).

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  • The LDL-C lowering effect of the Portfolio dietary pattern components was additive when combined as part of the dietary pattern.

    “Controlled feeding trials of the portfolio dietary pattern demonstrated that each of the components had a low-density lipoprotein cholesterol (LDL-C) lowering effect of 5-10% [14][15][16][17][18] and that the effect was additive when combined as part of this dietary pattern.[8][9][10][11][12][13]”

    From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [12]

    The Abstract (page not provided) says that combining cholesterol-lowering foods in a dietary portfolio produced substantial LDL-cholesterol reductions, and the Blood lipids and C-reactive protein section reports reductions with both portfolios. Neither passage establishes that the components’ individual LDL-lowering effects were additive when combined. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The LDL-C lowering effect of 5-10% of each of the 4 core food components can be considered additive.

    “These data provide confirmation that the LDL-C lowering effect of 5-10% [14][15][16][17][18] of each of the 4 core food components can be considered additive, [8][9][10][11][12][13]”

    From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [12]

    The Abstract says that combining cholesterol-lowering foods in a dietary portfolio produces substantial LDL-C reductions, and the Diets section identifies four components: plant sterols, viscous fibre, soy protein and almonds (page numbers unavailable). The paper does not give a 5–10% LDL-C reduction for each component or establish that their individual effects are additive. (LLM, conf=0.83)

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Authors
Jenkins, D. J. A., Chiavaroli, L., Wong, J. M. W., Kendall, C., Lewis, G. F., Vidgen, E., Connelly, P. W., Leiter, L. A., Josse, R. G., & Lamarche, B.
Affiliations
St. Michael's Hospital (CA)
Corresponding author
Kendall, C.
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Joule Inc.
Published
2010-11-01
Volume
182
Issue
18
Pages
1961-1967
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.092128
PMC
PMC3001502
OpenAlex
W2107227474
Cited by
92
References
42
Citations by year
2026: 3 · 2025: 11 · 2024: 12 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 3 · 2014: 7 · 2013: 5 · 2012: 8
FWCI
7.09
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
Keywords
monounsaturated fatty acids, hypercholesterolemia, hyperlipidemia, HDL cholesterol, LDL cholesterol, TC/HDL-C ratio, apolipoprotein A-I, C-reactive protein, serum triglycerides, cardiovascular risk, weight loss
MeSH terms
Adult, Aged, Cardiovascular Diseases, Fatty Acids, Monounsaturated, Female, Follow-Up Studies, Food, Humans, Hypercholesterolemia, Cholesterol, HDL, Cholesterol, LDL, Male, Middle Aged, Retrospective Studies, Triglycerides, Treatment Outcome

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