Effects of replacing solid fats and added sugars with avocado in adults with elevated cardiometabolic risk: a randomized, double-blind, controlled feeding, crossover trial.
- 2026-02
- The American journal of clinical nutrition 123(2)
- Nana Gletsu-Miller
- Meredith L Wilcox
- Lisa A Spence
- Amy J Wright
- Liana L Guarneiri
- Muhammad M Nadeem
- Mark J Hutter
- Karen L Sprague
- Andrew W Brown
- Allon N Friedman
- Carol F Kirkpatrick
- Kevin C Maki
- PubMed: 41397527
- DOI: 10.1016/j.ajcnut.2025.101137
Study Design
- Type
- Randomized Controlled Trial (RCT)
- Population
- healthy adults with elevated triglycerides (TG, 135-499 mg/dL)
- Methods
- randomized, double-blind, free-living, controlled feeding, crossover study; replacing energy from solid fats and added sugars with equivalent energy from 1 avocado daily for two 3-wk periods separated by a 2-wk washout
- Blinding
- Double-blind
- Duration
- 3 wk
- Funding
- Unclear
Background
Limited high-quality evidence exists from controlled trials on the impact of avocado-containing diets on cardiometabolic risk factors.Objectives
The purpose of this randomized, double-blind, free-living, controlled feeding, crossover study in adults with increased cardiometabolic risk was to assess the effects of replacing energy from solid fats and added sugars with equivalent energy from 1 avocado daily on cardiometabolic risk factors.Methods
For two 3-wk periods, separated by a 2-wk washout, healthy adults with elevated triglycerides (TG, 135-499 mg/dL) consumed an average American diet or a diet in which 1 avocado (∼180 g/d, ∼300 kcal/d) replaced energy from saturated fatty acids and added sugars. The same study products (muffins, granola bites, dressing, salsa, marinade, and pesto) delivered the avocado or control ingredients. Green food dye was added to the control study products to facilitate double blinding. Non-high-density lipoprotein (non-HDL) cholesterol (primary outcome), other lipoprotein lipids, fasting glucose and insulin, and fasting and postprandial blood pressures were measured at baseline and end of condition. Linear mixed models were used to generate estimates for percentage changes.Results
Of 42 randomly assigned participants, 37 completed the avocado condition and 39 completed the control condition. An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for non-HDL cholesterol (-4.65%; 95% CI: -9.01%, -0.08%; P = 0.047), very-low-density lipoprotein cholesterol (-9.30%; 95% CI: -15.3%, -2.82%; P = 0.007); TG (-17.4%; 95% CI: -25.0%, -8.99%; P < 0.001), small low-density lipoprotein subfraction cholesterol (-13.9%; 95% CI: -23.2%, -3.49%; P = 0.012), and total cholesterol:HDL cholesterol ratio (-6.56%; 95% CI: -12.0%, -0.79%; P = 0.028). Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.Conclusions
Replacing solid fats and added sugars with avocado in a typical American diet improves the lipoprotein lipid profile in adults with elevated TG. This trial was registered at clinicaltrials.gov as NCT04990817 (https://clinicaltrials.gov/study/NCT04990817).Research Insights
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for ... very-low-density lipoprotein cholesterol (-9.30%; 95% CI: -15.3%, -2.82%; P = 0.007)
- Effect
- Beneficial
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for non-HDL cholesterol (-4.65%; 95% CI: -9.01%, -0.08%; P = 0.047)
- Effect
- Beneficial
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for ... small low-density lipoprotein subfraction cholesterol (-13.9%; 95% CI: -23.2%, -3.49%; P = 0.012)
- Effect
- Beneficial
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
Percentage changes for other lipoprotein lipids, glucose, insulin, and blood pressures did not significantly differ (P > 0.05) between conditions.
- Effect
- Neutral
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for ... total cholesterol:HDL cholesterol ratio (-6.56%; 95% CI: -12.0%, -0.79%; P = 0.028)
- Effect
- Beneficial
- Effect size
- Small
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)
An intention-to-treat analysis showed significantly larger percentage changes, 95% confidence intervals (CIs), from baseline after the avocado condition, compared with after the control condition, for ... TG (-17.4%; 95% CI: -25.0%, -8.99%; P < 0.001)
- Effect
- Beneficial
- Effect size
- Moderate
- Dose
- 1 avocado (∼180 g/d, ∼300 kcal/d)