title: Poly is more effective than monounsaturated fat for dietary management in the metabolic syndrome: The muffin study.
abstract: The metabolic syndrome (MetS) is highly prevalent and associated with an increased risk for type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Lifestyle recommendations to treat MetS often include the replacement of saturated fats (SFAs) and monosaccharides with unsaturated fat. However, it is unclear whether metabolic parameters will improve more when the saturated fat in American Heart Association (AHA) diets is replaced with higher concentrations of monounsaturated or polyunsaturated fatty acids (MUFA or PUFA).
  
  
  
  To test the hypothesis that an AHA diet enriched in MUFA improves lipoprotein lipids, insulin resistance, inflammation, and endothelial function to a greater extent than a diet enriched in PUFA in middle-aged men and women with MetS.
  
  
  
  A prospective, open-label, parallel group design with randomization to a hypocaloric MUFA or PUFA-enriched diet after weight stabilization on an AHA step I diet. Participants consumed 3 MUFA-enriched or PUFA-enriched muffins daily with additional supplementation as required to ensure 25%-50% increases in dietary fat intake from these sources at the expense of SFA and the opposing unsaturated fat. Changes in MetS components were measured at baseline and after 6 months of dietary intervention.
  
  
  
  Thirty-nine participants (mean age, 60.8 years; 79% African-American, 60% women) with MetS completed the 6-month study. Compared to baseline, assignment to either MUFA (n = 23) or PUFA (n = 16) both were associated with weight loss (MUFA: -2.3 ± 1 kg, P = .06; PUFA: -4.6 ± 2 kg; P = .002), but PUFA was also associated with reductions in triglycerides (TG) (-30 ± 18 mg/dL, P = .02), systolic blood pressure (BP) (-7 ± 3 mm Hg, P = .01), diastolic BP (DBP) (-4 ± 2 mm Hg, P = .01) and improved flow mediated dilation (FMD) (7.1% ± 1.8% vs 13.6% ± 2%, absolute increase; P = .0001). When compared to MUFA treatment, PUFA intervention was associated with reduced TG (P = .04) and DBP (P = .07) as well as increased FMD (P = .04) even after adjustment for changes in weight. There was no effect on total cholesterol, low-density lipoprotein cholesterol, glucose, high-sensitivity C-reactive protein (hs-CRP), or other inflammatory proteins. Overall, 25% (4 of 16) assigned to PUFA and 13% (3 of 23) to MUFA converted to non-MetS status.
  
  
  
  Substitution of SFA with PUFA in patients with MetS is associated with greater reductions in TG and improvement in endothelial function than MUFA that is independent of weight loss. These preliminary findings raise the possibility that PUFA may be the unsaturated fat of choice to reduce cardiometabolic risk in patients with MetS.
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, USA. Electronic address: mmiller@medicine.umaryland.edu.
authors: Michael
authors: M
authors: Miller
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: John D
authors: JD
authors: Sorkin
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Laura
authors: L
authors: Mastella
authors: University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Aimee
authors: A
authors: Sutherland
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Division of Cardiology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Jeffrey
authors: J
authors: Rhyne
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Patrick
authors: P
authors: Donnelly
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Kathy
authors: K
authors: Simpson
authors: Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, USA; Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Andrew P
authors: AP
authors: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D004042:Dietary Fats, Unsaturated / Q000494:pharmacology* / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000187:drug effects / Q000473:pathology; D005229:Fatty Acids, Monounsaturated / Q000494:pharmacology* / Q000627:therapeutic use; D005231:Fatty Acids, Unsaturated / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008074:Lipoproteins / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood / Q000150:complications / Q000178:diet therapy* / Q000473:pathology; D008875:Middle Aged; D050177:Overweight / Q000150:complications
chemical_list: D004042:Dietary Fats, Unsaturated; D005229:Fatty Acids, Monounsaturated; D005231:Fatty Acids, Unsaturated; D008074:Lipoproteins
keywords: African Americans; Diet; Endothelial function; FMD; Lipoproteins; MUFA; Metabolic syndrome; Muffins; PUFA; Triglyceride