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

      Article info

      Publication history

      Accepted: December 19, 2022
      Received in revised form: December 6, 2022
      Received: May 9, 2022

      Publication stage

      In Press Accepted Manuscript

      Footnotes

      Author Contributions: GJM, GH and WS developed the study design. GJM and PB conducted the screening and data extraction. GJM conducted the data analysis and all authors contributed to the interpretation of results. GJM wrote the first draft with contributions from PB, WS and GH. All authors reviewed and commented on subsequent drafts of the manuscript.

      Financial Support: This project was funded by Hort Innovation, using the avocado research and development levy and contributions from the Australian Government. Hort Innovation is the grower-owned, not-for-profit research and development corporation for Australian horticulture. The funder did not have a role in the study selection, quality assessment, data synthesis, or manuscript preparation.

      Conflict of Interest: The authors declare no conflicts of interest.

      Acknowledgements: The authors thank Darren Jones, of CSIRO Library Services, for developing and executing the literature search strategy.

      Permission was obtained for the acknowledgment.

      Research snapshot

      Research question: Does regular avocado consumption improve markers of cardiometabolic health among adults?

      Key findings: This systematic review identified 10 studies published up to November 2021. Daily avocado consumption reduced total- and LDL-cholesterol in adults with elevated baseline cholesterol levels. There was no between group difference in HDL-cholesterol or triglycerides. Due to study limitations, certainty in the findings was graded as low to very low. Furthermore, consuming avocado, in amounts well above current usual intakes, did not result in unfavourable changes in body weight or composition.

      Identification

      DOI: https://doi.org/10.1016/j.jand.2022.12.008

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      © 2022 by the Academy of Nutrition and Dietetics.

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