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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^1,2,3

¹ From the Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY (LB, HNG, and RR); the Division of Nutrition and Chronic Disease, Pennington Biomedical Research Center, Baton Rouge, LA (ML); the Nutrition Department, Pennsylvania State University, University Park, PA (PMK-E); the Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, MN (PJE); the Department of Biostatistics, Collaborative Studies Coordinating Center (PWS) and the Department of Nutrition, School of Public Health and School of Medicine (BHD), The University of North Carolina at Chapel Hill, Chapel Hill, NC; the Division of Cardiovascular Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (AE); the Research Institute, Mary Imogene Bassett Hospital, Cooperstown, NY (TAP and RR); the Department of Physiology, Louisiana State University Medical School, New Orleans, LA (PSR); and the Department of Biochemistry, Virginia Polytechnic Institute and State University, Blacksburg, VA (KS and KMP)

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.

Design: Fifty-two men and 33 women, selected to have any combination of HDL cholesterol 30th percentile, triacylglycerol 70th percentile, or insulin 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.

Key Words: Diet • nutrition • fatty acids • lipids • lipoproteins