The appropriate pattern of macronutrient distribution for dietary protocols aimed at treating or preventing obesity and its associated cardiovascular diseases is still a controversial topic of discussion. Recommendations considering a specific percentage or range for monounsaturated fatty acids (MUFA) are rare. It was the aim of this study to analyze long-term, randomized, controlled dietary intervention trials and to investigate the effects of MUFA on the biomarkers of obesity and cardiovascular risk factors. Dietary regimens with a high amount of MUFA (>12%) were compared to those with ≤12%. The biomarkers taken into account were weight, waist circumference, fat mass, total cholesterol, LDL cholesterol, HDL cholesterol, triacylglycerols, systolic and diastolic blood pressure, as well as C-reactive protein. A total of 12 studies met the inclusion criteria. Data analysis was performed using the Review Manager 5.0.25 software. Significant differences between high- and low-MUFA protocols could be observed with respect to fat mass [–1.94 kg (confidence interval –3.72, –0.17), p = 0.03], systolic blood pressure [–2.26 mm Hg (confidence interval –4.28, –0.25), p = 0.03] and diastolic blood pressure [–1.15 mm Hg (confidence interval –1.96, –0.34), p = 0.005] favoring the dietary protocols with >12% MUFA. Therefore, MUFA might represent a useful tool in the design of dietary regimens for obesity and cardiovascular disease.

Keywords:
Obesity, Cardiovascular risk, Monounsaturated fatty acids, Low fat
1.
Flegal KM, Carroll MD, Ogden CL, Curtin LR: Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010;303:235–241.
2.
Ford ES, Mokdad AH, Giles WH: Trends in waist circumference among US adults. Obes Res 2003;11:1223–1231.
3.
World Health Organization Consultation: Obesity: preventing and managing the global epidemic. World Health Organ Tech Rep Ser 2000;894:1–253.
4.
Jemal A, Ward E, Hao Y, Thun M: Trends in the leading causes of death in the USA, 1970–2002. JAMA 2005;294:1255–1259.
5.
Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB: Overweight and obesity as determinants of cardiovascular risk. Arch Intern Med 2002;162:1867–1872.
6.
Iqbal R, Anand S, Ounpuu S, Islam S, Zhang X, Rangarajan S, Chifamba J, Al-Hinai A, Keltai M, Yusuf S, INTERHEART Study Investigators: Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation 2008;118:1929–1937.
7.
Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, van der Schouw YT, Spencer E, Moons KG, Tjønneland A, Halkjaer J, Jensen MK, Stegger J, Clavel-Chapelon F, Boutron-Ruault MC, Chajes V, Linseisen J, Kaaks R, Trichopoulou A, Trichopoulos D, Bamia C, Sieri S, Palli D, Tumino R, Vineis P, Panico S, Peeters PH, May AM, Bueno-de-Mesquita HB, van Duijnhoven FJ, Hallmans G, Weinehall L, Manjer J, Hedblad B, Lund E, Agudo A, Arriola L, Barricarte A, Navarro C, Martinez C, Quirós JR, Key T, Bingham S, Khaw KT, Boffetta P, Jenab M, Ferrari P, Riboli E: General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008;359:2105–2120.
8.
Cooney MT, Dudina A, De Bacquer D, Wilhelmsen L, Sans S, Menotti A, De Backer G, Jousilahti P, Keil U, Thomsen T, Whincup P, Graham IM, SCORE investigators: HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk. Atherosclerosis 2009;206:611–616.
9.
Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J, Qizilbash N, Peto R, Collins R: Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007;370:1829–1839.
10.
Bayturan O, Tuzcu EM, Lavoie A, Hu T, Wolski K, Schoenhagen P, Kapadia S, Nissen SE, Nicholls SJ: The metabolic syndrome, its component risk factors, and progression of coronary atherosclerosis. Arch Intern Med 2010;170:478–484.
11.
Lloyd-Jones D, Adams R, Carnethon M, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Roger VL, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J, American Heart Association Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation 2010;121:e46–e215.
12.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM, Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393–403.
13.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish Diabetes Prevention Study Group: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–1350.
14.
Deckelbaum RJ, Fisher EA, Winston M, Kumanyika S, Lauer RM, Pi-Sunyer FX, St Jeor S, Schaefer EJ, Weinstein IB: Summary of a scientific conference on preventive nutrition: pediatrics to geriatrics. Circulation 1999;100:450–456.
15.
Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St Jeor S, Suttie J, Tribble DL, Bazzarre TL: AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000;102:2284–2299.
16.
Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, Franch HA, Franklin B, Kris-Etherton P, Harris WS, Howard B, Karanja N, Lefevre M, Rudel L, Sacks F, Van Horn L, Winston M, Wylie-Rosett J: Diet and lifestyle recommendations: revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 2006;114:82–96.
17.
Position of the American Dietetic Association and the Dietitians of Canada: Dietary Fatty Acids. J Am Diet Assoc 2007;107:1599–1611.
18.
US Department of Agriculture, US Department of Health and Human Services: Dietary Guidelines for Americans, 2010, ed. 7. Washington, US Government Printing Office, 2010.
19.
European Food Safety Authority (EFSA): Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans-fatty acids, and cholesterol. EFSA J 2010;8:1461.
20.
Clarke R, Frost C, Collins R, Appleby P, Peto R: Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ 1997;314:112–117.
21.
Mensink RP, Katan MB: Effect of dietary fatty acids on serum lipids and lipoproteins. A meta-analysis of 27 trials. Arterioscler Thromb 1992;12:911–919.
22.
Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, Smith WC, Jung RT, Campbell MK, Grant AM: Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004;8:1–182.
23.
Hession M, Rolland C, Kulkarni U, Wise A, Broom J: Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obes Rev 2009;10:36–50.
24.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1–12.
25.
Higgins JP, Thompson SG, Deeks JJ, Altman DG: Measuring inconsistency in metaanalyses. BMJ 2003;327:557–560.
26.
Esposito K, Maiorino MI, Ciotola M, Di Palo C, Scognamiglio P, Gicchino M, Petrizzo M, Saccomanno F, Beneduce F, Ceriello A, Giugliano D: Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: a randomized trial. Ann Intern Med 2009;151:306–314.
27.
Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ: Effects of exercise on glycemic control and body mass index in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2002;286:1218–1227.
28.
Brehm BJ, Lattin BL, Summer SS, Boback JA, Gilchrist GM, Jandacek RJ, D’Alessio DA: One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes. Diabetes Care 2009;32:215–220.
29.
Due A, Larsen TM, Mu H, Hermansen K, Stender S, Astrup A: Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-month randomized controlled trial. Am J Clin Nutr 2008;88:1232–1241.
30.
Elhayany A, Lustman A, Abel A, Attal-Singer J, Vinker S: A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab 2010;12:204–209.
31.
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D: Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004;292:1440–1446.
32.
Ferrara LA, Raimondi AS, d’ Episcopo L, Guida L, Dello Russo A, Marotta T: Olive oil and reduced need for antihypertensive medications. Arch Intern Med 2004;160:837–842.
33.
Jebb SA, Lovegrove JA, Griffin BA, Frost GS, Moore CS, Chatfield MD, Bluck LJ, Williams CM, Sanders TA, RISCK Study Group: Effect of changing the amount and type of fat and carbohydrate on insulin sensitivity and cardiovascular risk: the RISCK (Reading, Imperial, Surrey, Cambridge, and Kings) trial. Am J Clin Nutr 2010;92:748–758.
34.
Keogh JB, Luscombe-Marsh ND, Noakes M, Wittert GA, Clifton PM: Long-term weight maintenance and cardiovascular risk factors are not different following weight loss on carbohydrate-restricted diets high in either monounsaturated fat or protein in obese hyperinsulinaemic men and women. Br J Nutr 2007;97:405–410.
35.
McManus K, Antinoro L and Sacks F: A randomized controlled trial of a moderate fat, low-energy diet compared with a low fat, low-energy diet for weight loss in overweight adults. Int J Obes Relat Metab Disord 2001;25:1503–1511.
36.
Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Blüher M, Stumvoll M, Stampfer MJ, Dietary Intervention Randomized Controlled Trial (DIRECT) Group: Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008;359:229–241.
37.
Wien MA, Sabate JM, Ikle DN, Cole SE, Kandeel FR: Almonds vs. complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord 2003;27:1365–1362.
38.
Wolever TM, Gibbs AL, Mehling C, Chiasson JL, Connelly PW, Josse RG, Leiter LA, Maheux P, Rabasa-Lhoret R, Rodger NW, Ryan EA: The Canadian Trial of Carbohydrates in Diabetes (CCD): a 1-year controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr 2008;87:114–125.
39.
Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA: Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859–873.
40.
de Koning L, Merchant AT, Pogue J, Anand SS: Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J 2007;28:850–856.
41.
Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR: High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1997;62:707–714.
42.
Criqui MH: Triacyglycerol and cardiovascular disease: a focus on clinical trial. Eur Heart J 1998;19:A36–A39.
43.
Austin MA, Hokanson HE, Edwards KL: Hypertriacylglycerolemia as a cardiovascular risk factor. Am J Cardiol 1998;81:7B–12B.
44.
Yarnell JW, Patterson CC, Sweetman PM, Thomas HF, Bainton D, Elwood PC, Bolton CH, Miller NE: Do total and high density lipoprotein cholesterol and triglycerides act independently in the prediction of ischemic heart disease?. Ten-year follow-up of Caerphilly and Speedwell cohorts. Arterioscler Thromb Vasc Biol 2001;21:1340–1345.
45.
Whelton PK, He J, Appel LJ, Havas S, Kotchen TA, Roccella EJ, Stout R, Vallbona C, Winston MC, Karimbakas J, National High Blood Pressure Education Program Coordinating Committee: Primary prevention of hypertension: clinical and public health advisory from the National High Blood Pressure Education Program. JAMA 2002;288:1882–1888.
46.
Stamler R: Implications of the INTERSALT study. Hypertension 1991;17:I16–I20.
47.
Shah M, Adams-Huet B, Garg A: Effect of high-carbohydrate or high-cismonounsaturated fat diets on blood pressure: a meta-analysis of intervention trials. Am J Clin Nutr 2007;85:1251–1256.
48.
Mensink RP, Zock PL, Kester AD, Katan MB: Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77:1146–1155.
49.
Garg A: High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis. Am J Clin Nutr 1998;67:577–582.
50.
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A: Adherence to Mediterranean diet and health status: meta-analysis. BMJ 2008;337:a1344.
51.
Buckland G, Gonzalez CA, Agudo A, Vilardell M, Berenguer A, Amiano P, Ardanaz E, Arriola L, Barricarte A, Basterretxea M, Chirlaque MD, Cirera L, Dorronsoro M, Egües N, Huerta JM, Larrañaga N, Marin P, Martínez C, Molina E, Navarro C, Quirós JR, Rodriguez L, Sanchez MJ, Tormo MJ, Moreno-Iribas C: Adherence to the Mediterranean diet and risk of coronary heart disease in the Spanish EPIC cohort study. Am J Epidemiol 2009;170:1518–1529.
52.
Willett WC: Dietary fat plays a major role in obesity: no. Obes Rev 2002;3:59–68.
53.
Howard BV, Manson JE, Stefanick ML, Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, Rodabough RJ, Snetselaar L, Thomson C, Tinker L, Vitolins M, Prentice R: Low-fat dietary pattern and weight change over 7 years: the Women’s Health Initiative Dietary Modification Trial. JAMA 2006;295:39–49.
54.
Howard BV, Curb JD, Eaton CB, Howard BV, Curb JD, Eaton CB, Kooperberg C, Ockene J, Kostis JB, Pettinger M, Rajkovic A, Robinson JG, Rossouw J, Sarto G, Shikany JM, Van Horn L: Low-fat dietary pattern and lipoprotein risk factors: the Women’s Health Initiative Dietary Modification Trial. Am J Clin Nutr 2010;91:860–874.
© 2011 S. Karger AG, Basel
2011
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.