Comparison of monounsaturated fat with carbohydrates as a replacement for saturated fat in subjects with a high metabolic risk profile: studies in the fasting and postprandial states.
BACKGROUND
In subjects with a high prevalence of metabolic risk abnormalities, the preferred replacement for saturated fat is unresolved.


OBJECTIVE
The objective was to study whether carbohydrate or monounsaturated fat is a preferred replacement for saturated fat.


METHODS
Fifty-two men and 33 women, selected to have any combination of HDL cholesterol < or = 30th percentile, triacylglycerol > or = 70th percentile, or insulin > or = 70th percentile, were enrolled in a 3-period, 7-wk randomized crossover study. The subjects consumed an average American diet (AAD; 36% of energy from fat) and 2 additional diets in which 7% of energy from saturated fat was replaced with either carbohydrate (CHO diet) or monounsaturated fatty acids (MUFA diet).


RESULTS
Relative to the AAD, LDL cholesterol was lower with both the CHO (-7.0%) and MUFA (-6.3%) diets, whereas the difference in HDL cholesterol was smaller during the MUFA diet (-4.3%) than during the CHO diet (-7.2%). Plasma triacylglycerols tended to be lower with the MUFA diet, but were significantly higher with the CHO diet. Although dietary lipid responses varied on the basis of baseline lipid profiles, the response to diet did not differ between subjects with or without the metabolic syndrome or with or without insulin resistance. Postprandial triacylglycerol concentrations did not differ significantly between the diets. Lipoprotein(a) concentrations increased with both the CHO (20%) and MUFA (11%) diets relative to the AAD.


CONCLUSIONS
In the study population, who were at increased risk of coronary artery disease, MUFA provided a greater reduction in risk as a replacement for saturated fat than did carbohydrate.
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA. lars.berglund@ucdmc.ucdavis.edu
Lars
L
Berglund
Michael
M
Lefevre
Henry N
HN
Ginsberg
Penny M
PM
Kris-Etherton
Patricia J
PJ
Elmer
Paul W
PW
Stewart
Abby
A
Ershow
Thomas A
TA
Pearson
Barbara H
BH
Dennis
Paul S
PS
Roheim
Rajasekhar
R
Ramakrishnan
Roberta
R
Reed
Kent
K
Stewart
Katherine M
KM
Phillips
D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D018592:Cross-Over Studies; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism; D004041:Dietary Fats / Q000008:administration & dosage* / Q000378:metabolism; D004042:Dietary Fats, Unsaturated / Q000008:administration & dosage* / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D014280:Triglycerides / Q000097:blood; D014527:Uric Acid / Q000097:blood
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004042:Dietary Fats, Unsaturated; D007328:Insulin; D017270:Lipoprotein(a); D014280:Triglycerides; D014527:Uric Acid; D002784:Cholesterol