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Avocado consumption and cardiometabolic disease risk factors: a systematic review and meta-analysis

Open AccessPublished:December 21, 2022DOI:https://doi.org/10.1016/j.jand.2022.12.008
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      Abstract

      Background

      Avocados are a rich source of unsaturated fats and bioactives, however, their role in altering cardiometabolic risk factors is unclear.

      Objective

      To review the effects of consuming diets containing avocado compared to control diets containing no or low amounts of avocado on cardiometabolic risk factors in adults who were healthy, had clinical CVD or were at increased risk of CVD.

      Methods

      Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest and a Clinical Trials Registry) along with Google Scholar to identify studies published between January 1990 and November 10, 2021. Randomised controlled trials (RCT) ≥ 3 weeks and prospective cohort studies were included. Ten studies, nine RCTs (n=503 participants) and one prospective observational study (n=55,407), met the inclusion criteria. Outcomes assessed by meta-analysis were: LDL-C (primary), total cholesterol (TC), HDL-C and triglycerides. Outcomes assessed by narrative review were: TC to HDL-C ratio, non-HDL-C, apolipoprotein B, blood pressure, body weight, BMI, waist circumference, waist-to-hip ratio, body composition, blood glucose and insulin concentrations. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool and Newcastle-Ottawa Scale, and quality of evidence examined using the GRADE method. Random-effects models meta-analyses were performed where there was ≥ 3 studies of the same design (i.e. RCT) and reporting the same outcome. Statistical heterogeneity was assessed by calculating Chi2 and I2 statistics, and publication bias by funnel plots.

      Results

      Overall there was a small, significant reduction in TC (-5.08 mg/dL (-9.29, -0.87 mg/dL), p = 0.02) in avocado vs. control groups and no significant difference in LDL-C, HDL-C or triglycerides. Subgroup analysis demonstrated significant reductions in LDL-C (-9.4 mg/dl (-10.84, -7.95 mg/dL) p <0.00001) and TC (-7.54 mg/dL (-9.40, -5.68 mg/dL), p < 0.00001) in avocado vs. control groups in hypercholesterolaemic populations while no differences were seen in normocholesterolaemic populations. However, the certainty in the findings was graded as low to very low. Body weight and composition were not negatively affected by avocado consumption.

      Conclusions

      Avocado consumption may reduce TC and LDL-C in people with hypercholesterolaemia. Avocado consumption does not negatively impact body weight. Larger, well-conducted studies are needed to have greater confidence in the role of avocado consumption on CVD risk factors.

      Key words