title: Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study.
abstract: BACKGROUND
  Public health strategies to lower cardiovascular disease (CVD) risk involve reducing dietary saturated fatty acid (SFA) intake to ≤10% of total energy (%TE). However, the optimal type of replacement fat is unclear.
  
  
  OBJECTIVE
  We investigated the substitution of 9.5-9.6%TE dietary SFAs with either monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on vascular function and other CVD risk factors.
  
  
  METHODS
  In a randomized, controlled, single-blind, parallel-group dietary intervention, 195 men and women aged 21-60 y from the United Kingdom with moderate CVD risk (≥50% above the population mean) followed one of three 16-wk isoenergetic diets (%TE target compositions, total fat:SFA:MUFA:n-6 PUFA) that were rich in SFAs (36:17:11:4, n = 65), MUFAs (36:9:19:4, n = 64), or n-6 PUFAs (36:9:13:10, n = 66). The primary outcome measure was flow-mediated dilatation; secondary outcome measures included fasting serum lipids, microvascular reactivity, arterial stiffness, ambulatory blood pressure, and markers of insulin resistance, inflammation, and endothelial activation.
  
  
  RESULTS
  Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation (primary endpoint) or other measures of vascular reactivity. Of the secondary outcome measures, substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure (-4.9 mm Hg, P = 0.019) and reduced E-selectin (-7.8%, P = 0.012). Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol (-8.4% and -9.2%, respectively), low-density lipoprotein cholesterol (-11.3% and -13.6%), and total cholesterol to high-density lipoprotein cholesterol ratio (-5.6% and -8.5%) (P ≤ 0.001). These changes in low-density lipoprotein cholesterol equate to an estimated 17-20% reduction in CVD mortality.
  
  
  CONCLUSIONS
  Substitution of 9.5-9.6%TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function. However, the beneficial effects on serum lipid biomarkers, blood pressure, and E-selectin offer a potential public health strategy for CVD risk reduction. This trial was registered at www.clinicaltrials.gov as NCT01478958.
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.
authors.forename: Katerina
authors.initials: K
authors.lastname: Vafeiadou
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.
authors.forename: Michelle
authors.initials: M
authors.lastname: Weech
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.
authors.forename: Hana
authors.initials: H
authors.lastname: Altowaijri
authors.affiliation: Department of Mathematics and Statistics, University of Reading, Reading, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Todd
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.
authors.forename: Parveen
authors.initials: P
authors.lastname: Yaqoob
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and.
authors.forename: Kim G
authors.initials: KG
authors.lastname: Jackson
authors.affiliation: Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, and j.a.lovegrove@reading.ac.uk.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Lovegrove
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002319:Cardiovascular System / Q000187:drug effects; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D004041:Dietary Fats / Q000008:administration & dosage; D019040:E-Selectin / Q000097:blood*; D042783:Endothelial Cells / Q000187:drug effects / Q000378:metabolism; D005227:Fatty Acids / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D016037:Single-Blind Method; D014280:Triglycerides / Q000097:blood; D006113:United Kingdom; D055105:Waist Circumference; D055815:Young Adult
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D004041:Dietary Fats; D019040:E-Selectin; D005227:Fatty Acids; D005231:Fatty Acids, Unsaturated; D014280:Triglycerides
keywords: blood pressure; dietary fatty acids; flow-mediated dilatation; lipids; vascular function