One Avocado per Day as Part of Usual Intake Improves Diet Quality: Exploratory Results from a Randomized Controlled Trial

Kristina S Petersen; Sydney Smith; Alice H Lichtenstein; Nirupa R Matthan; Zhaoping Li; Joan Sabate; Sujatha Rajaram; Gina Segovia-Siapco; David M Reboussin; Penny M Kris-Etherton

doi:10.1016/j.cdnut.2024.102079

One Avocado per Day as Part of Usual Intake Improves Diet Quality: Exploratory Results from a Randomized Controlled Trial

Curr Dev Nutr. 2024 Jan 11;8(2):102079. doi: 10.1016/j.cdnut.2024.102079. eCollection 2024 Feb.

Affiliations

¹ Department of Nutritional Sciences, Pennsylvania State University, State College, PA, United States.
² Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, Unite States.
³ Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Medford, MA, United States.
⁴ Center for Human Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
⁵ Center for Nutrition, Healthy Lifestyle and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, CA, United States.

Abstract

Background: Few clinical trials have evaluated diet quality change as a predictor of intervention effectiveness.

Objectives: The aim of this study was to examine changes in the Healthy Eating Index (HEI)-2015 after a food-based intervention, and assess the associations between HEI-2015 change and intervention effects on cardiometabolic risk-related outcomes.

Methods: The Habitual Diet and Avocado Trial was a 26-wk, multicenter, randomized, controlled parallel-arm study. Participants were 1008 individuals aged ≥25 y with abdominal obesity (females ≥ 35 inches; males ≥ 40 inches). The avocado-supplemented diet group was provided 1 avocado per day, and the habitual diet group maintained their usual diet. Change in diet quality was assessed using the HEI-2015 from a single 24-h recall conducted at 4 time points. Mixed models were used for analysis.

Results: The avocado-supplemented diet group had a greater increase in the HEI-2015 (4.74 points; 95% CI: 2.93, 6.55) at 26 wk than the habitual diet group. Compared with the habitual diet group, the avocado-supplemented diet group had greater increases in the following HEI-2015 components from baseline: total vegetables (0.99 points; 95% CI: 0.77, 1.21), fatty acid ratio (2.25 points; 95% CI: 1.74, 2.77), sodium (1.03 points; 95% CI: 0.52, 1.55), refined grains (0.82 points; 95% CI: 0.32, 1.31), and added sugars (0.84 points; 95% CI: 0.49, 1.19). No differences in HEI-2015 improvements were observed by race, ethnicity, study site, body mass index, or age category. In the avocado-supplemented diet compared with the habitual diet group, the HEI-2015 increased in females (6.50 points; 95% CI: 4.39, 8.62) but not in males (0.02 points; 95% CI: -3.44, 3.48). Median HEI-2015 change was not associated with intervention-related changes in cardiometabolic disease risk factors.

Conclusions: Intake of 1 avocado per day for 26 wk in adults with abdominal obesity increased adherence to the Dietary Guidelines for Americans. Changes in diet quality did not predict changes in risk factors for cardiometabolic disease.This trial was registered at clinicaltrials.gov as NCT03528031 (https://clinicaltrials.gov/study/NCT03528031).

Keywords: 24-hour recall; Healthy Eating Index; abdominal obesity; avocado; cardiometabolic disease; clinical trial; diet quality; elevated waist circumference; randomized controlled trial.

Associated data

ClinicalTrials.gov/NCT03528031