title: Effects of exchanging carbohydrate or monounsaturated fat with saturated fat on inflammatory and thrombogenic responses in subjects with abdominal obesity: A randomized controlled trial.
abstract: Modification of the amount and type of dietary fat has diverse effects on cardiovascular risk.
  
  
  
  We recruited 54 abdominally obese subjects to participate in a prospective cross-over design, single-blind trial comparing isocaloric 2000 kcal MUFA or carbohydrate-enriched diet with SFA-enriched diet (control). The control diet consisted of 15E% protein, 53E% carbohydrate and 32E% fat (12E% SFA, 13E% MUFA). A total of ∼7E% of MUFA or refined carbohydrate was exchanged with SFA in the MUFA-rich and carbohydrate-rich diets respectively for 6-weeks. Blood samples were collected at fasting upon trial commencement and at week-5 and 6 of each dietary-intervention phase to measure levels of cytokines (IL-6, IL-1β), C-reactive protein (CRP), thrombogenic markers (E-selectin, PAI-1, D-dimer) and lipid subfractions. Radial pulse wave analysis and a 6-h postprandial mixed meal challenge were carried out at week-6 of each dietary intervention. Blood samples were collected at fasting, 15 and 30 min and hourly intervals thereafter till 6 h after a mixed meal challenge (muffin and milkshake) with SFA or MUFA (872.5 kcal, 50 g fat, 88 g carbohydrates) or CARB (881.3 kcal, 20 g fat, 158 g carbohydrates)- enrichment corresponding to the background diets.
  
  
  
  No significant differences in fasting inflammatory and thrombogenic factors were noted between diets (P > 0.05). CARB meal was found to increase plasma IL-6 whereas MUFA meal elevated plasma D-dimer postprandially compared with SAFA meal (P < 0.05). Comparing the 3 meals, there were similar postprandial elevations in IL-6 and D-dimer and postprandial reductions in PAI-1, augmentation index and pressure (time effect: P < 0.05). CARB diet was found to reduce HDL3by 7.8% and increase small dense HDL (sdHDL) by 8.6% compared with SFA diet (P < 0.05). SFA diet increased large HDL subfractions compared with both CARB and MUFA diets by 4.9% and 6.6% (P < 0.05), respectively.
  
  
  
  Overall, the evidence presented in this study suggests that the replacement of SFA with MUFA or refined carbohydrates may not improve inflammatory and thrombogenic markers in abdominally overweight individuals. Indeed increased refined carbohydrates consumption adversely impacts fasting HDL subfractions. This trial was registered under ClinicalTrials.gov. Identifier no. NCT01665482.
authors.affiliation: Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia. Electronic address: kimtiu@mpob.gov.my.
authors.forename: Kim-Tiu
authors.initials: KT
authors.lastname: Teng
authors.affiliation: Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia; Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia.
authors.forename: Lin Faun
authors.initials: LF
authors.lastname: Chang
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603 Kuala Lumpur, Malaysia.
authors.forename: Shireene Ratna
authors.initials: SR
authors.lastname: Vethakkan
authors.affiliation: Product Development and Advisory Services Division, Malaysian Palm Oil Board, 6, Persiaran Institusi, Bandar Baru Bangi, 43000 Kajang, Selangor, Malaysia.
authors.forename: Kalanithi
authors.initials: K
authors.lastname: Nesaretnam
authors.affiliation: Diabetes and Nutritional Sciences Research Division, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
authors.forename: Tom A B
authors.initials: TAB
authors.lastname: Sanders
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D018592:Cross-Over Studies; D016207:Cytokines / Q000097:blood; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D019040:E-Selectin / Q000097:blood; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D056128:Obesity, Abdominal / Q000097:blood / Q000178:diet therapy*; D010349:Patient Compliance; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D019518:Postprandial Period; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D016207:Cytokines; D004040:Dietary Carbohydrates; D019040:E-Selectin; D005229:Fatty Acids, Monounsaturated; D005338:Fibrin Fibrinogen Degradation Products; D007328:Insulin; D017395:Plasminogen Activator Inhibitor 1; C546936:SELE protein, human; D014280:Triglycerides; C036309:fibrin fragment D; D002097:C-Reactive Protein; D002784:Cholesterol
keywords: Abdominal obesity; Carbohydrate; Inflammation; Monounsaturated fat; Saturated fat; Thrombogenesis