This report summarizes how monounsaturated fatty acids (MUFAs) affect risk for cardiovascular disease (CVD). This is a topic that has attracted considerable scientific interest, in large part because of uncertainty regarding whether MUFA or carbohydrate should be substituted for saturated fatty acids (SFAs) and the desirable quantity of MUFA to include in the diet.

ABSTRACT: Because nuts have favorable fatty acid and nutrient profiles, there is growing interest in evaluating their role in a heart-healthy diet. Nuts are low in saturated fatty acids and high in monounsaturated and polyunsaturated fatty acids. In addition, emerging evidence indicates that there are other bioactive molecules in nuts that elicit cardioprotective effects. These include plant protein, dietary fiber, micronutrients such as copper and magnesium, plant sterols, and phytochemicals. Few feeding studies have been conducted that have incorporated different nuts into the test diets to determine the effects on plasma lipids and lipoproteins. The total- and lipoprotein-cholesterol responses to these diets are summarized in this article. In addition, the actual cholesterol response was compared with the predicted response derived from the most current predictive equations for blood cholesterol. Results from this comparison showed that when subjects consumed test diets including nuts, there was an 25% greater cholesterol-lowering response than that predicted by the equations. These results suggest that there are non–fatty acid constituents in nuts that have additional cholesterol-lowering effects. Further studies are needed to identify these constituents and establish their relative cholesterol-lowering potency. 1999(suppl);70:504S–11S.

ABSTRACT: Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-µmol/L increase is associated with an 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater. Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease. 
This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide 100% of the recommended dietary allowances for 23 micronutrients, including folate. Mean folate intakes at 10 wk were 601 ± 143 µg/d with the PMP and 270 ± 107 µg/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 ± 5.8 to 9.3 ± 4.9 µmol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD. The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease.

ABSTRACT: Low-fat diets increase plasma triacylglycerol and decrease HDL-cholesterol concentrations, thereby potentially adversely affecting cardiovascular disease (CVD) risk. High&ndash;monounsaturated fatty acid (MUFA), cholesterol-lowering diets do not raise triacylglycerol or lower HDL cholesterol, but little is known about how peanut products, a rich source of MUFAs, affect CVD risk. The present study compared the CVD risk profile of an Average American diet (AAD) with those of 4 cholesterol-lowering diets: an American Heart Association/National Cholesterol Education Program Step II diet and 3 high-MUFA diets [olive oil (OO), peanut oil (PO), and peanuts and peanut butter (PPB)]. A randomized, double-blind, 5-period crossover study design (n = 22) was used to examine the effects of the diets on serum lipids and lipoproteins: AAD [34% fat; 16% saturated fatty acids (SFAs), 11% MUFAs], Step II (25% fat; 7% SFAs, 12% MUFAs), OO (34% fat; 7% SFAs, 21% MUFAs), PO (34% fat; 7% SFAs, 17% MUFAs), and PPB (36% fat; 8% SFAs, 18% MUFAs). The high-MUFA diets lowered total cholesterol by 10% and LDL cholesterol by 14%. This response was comparable with that observed for the Step II diet. Triacylglycerol concentrations were 13% lower in subjects consuming the high-MUFA diets and were 11% higher with the Step II diet than with the AAD. The high-MUFA diets did not lower HDL cholesterol whereas the Step II diet lowered it by 4% compared with the AAD. The OO, PO, and PPB diets decreased CVD risk by an estimated 25%, 16%, and 21%, respectively, whereas the Step II diet lowered CVD risk by 12%. A high-MUFA, cholesterol-lowering diet may be preferable to a low-fat diet because of more favorable effects on the CVD risk profile.

ABSTRACT: Epidemiologic studies have consistently demonstrated beneficial effects of nut consumption on coronary heart disease (CHD) morbidity and mortality in different population groups. Clinical studies have reported total and low-density lipoprotein cholesterol-lowering effects of heart-healthy diets that contain various nuts or legume peanuts. It is evident that the favorable fatty acid profile of nuts (high in unsaturated fatty acids and low in saturated fatty acids) contributes to cholesterol lowering and, hence, CHD risk reduction. Dietary fibre and other bioactive constituents in nuts may confer additional cardioprotective effects.

ABSTRACT: To evaluate the diet quality of free-living men, women and children choosing peanuts and peanut products. Using data reported in the Continuing Survey of Food Intake by Individuals and Diet and Health Knowledge Survey (CSFII/DHKS) from 1994&ndash;1996, food codes were used to sort respondents by use or nonuse of peanuts. A nationally representative sample of 4751 men, 4572 women, and 4939 children (boys and girls, 2&ndash;19 yrs) who completed 2-day intake records. The two-sample t test was used to analyze differences between peanut users and nonusers for energy, nutrient intakes, Health Eating Index (HEI) scores, and body mass index (BMI). Peanut users (24% of CSFII/DHKS) had higher intakes (p < 0.001) of protein, total fat, polyunsaturated fat (PUFA), monounsaturated fat, (MUFA) (p < 0.01), fiber, vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron. Percent of energy from saturated fat was not significantly different for men, women or girls and was slightly lower (p < 0.01) for boys. Dietary cholesterol of peanut users was lower for all population groups; this decrease was significant for both men (p < 0.01) and children (p < 0.001). The HEI was calculated as a measure of overall nutrient profile of the diets and was significantly greater for peanut users (men 61.4, women, 65.1, children 66.8) compared to nonusers (men 59.9, women 64.1, children 64.7) for men (p = 0.0074) and children (p < 0.001). Energy intake was significantly higher in all population groups of peanut users (p < 0.001; boys: p < 0.01); however mean BMI for peanut users was lower for all gender/age categories (women: p < 0.05; children: p < 0.001). These results demonstrate improved diet quality of peanut users, indicated by the higher intake of the micronutrients vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron and dietary fiber, and by the lower intake of saturated fat and cholesterol. Despite a higher energy intake over a two-day period, peanut consumption was not associated with a higher BMI. 

ABSTRACT: Little evidence of the effects of moderate-fat (from monounsaturated fat) weight-loss diets on risk factors for cardiovascular disease exists because low-fat diets are typically recommended. Previous studies in weight-stable persons showed that a moderate-fat diet results in a more favorable lipid and lipoprotein profile (ie, lower serum triacylglycerol and higher HDL cholesterol) than does a low-fat diet. We evaluated the effects of energy-controlled, low-fat and moderate-fat diets on changes in lipids and lipoproteins during weight loss and subsequent weight maintenance. We conducted a parallel-arm study design in overweight and obese [body mass index (in kg/m2): 29.8 ± 2.4] healthy men and women (n = 53) assigned to consume a low-fat (18% of energy) or moderate-fat (33% of energy) diet for 6 wk to achieve weight loss, which was followed by 4 wk of weight maintenance. All foods were provided and body weight was monitored to ensure equal weight loss between groups. 
The moderate-fat diet elicited favorable changes in the lipoprotein profile. Compared with baseline, HDL cholesterol was unchanged, whereas triacylglycerol and the ratios of total and non-HDL cholesterol to HDL cholesterol were lower at the end of the weight-maintenance period in the moderate-fat diet group. Despite similar weight loss, triacylglycerol rebounded, HDL cholesterol decreased, and the ratios of total and non-HDL cholesterol to HDL cholesterol did not change during the 10-wk interval in the low-fat diet group. A moderate-fat weight-loss and weight-maintenance diet improves the cardiovascular disease risk profile on the basis of favorable changes in lipids and lipoproteins. There is merit in recommending a moderate-fat weight-loss diet.

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