Effect of Daily Avocado Intake on Cardiovascular Health Assessed by Life's Essential 8: An Ancillary Study of HAT, a Randomized Controlled Trial.

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• Dietary approach to improve overall nutrient status and achieve healthy body weight should ideally be a first-line approach to minimise cardiovascular disease risk.

• This study showed that the inclusion of 1 avocado per day is a viable option in improving some cardiovascular disease markers.

• Improved physical activity, sleep, blood glucose balance, blood pressure, and reduction of nicotine exposure are additional components that require specific attention to help prevent and address one of the leading causes of death, cardiovascular disease.

Introduction

Cardiovascular disease remains the leading cause of global mortality. This study aimed to assess the effect of the addition of 1 avocado per day over 26 weeks on the American Heart Association’s (AHA) cardiovascular health score, Life’s Essential 8 (LE8) in US adults with abdominal obesity. Health factors included in the LE8 are healthy weight, blood pressure, blood lipids and glucose, healthy diet, physical activity, nicotine avoidance, and sleep.

Methods

This 26-week USA based multicentre, investigator-blinded, RCT included participants (n=969) aged ≥25 years, with waist circumference ≥35 inches for women and ≥40 inches for men, and self-reported low intake of avocados (≤2 per month). Data to calculate the LE8 was collected at baseline and 26-weeks using mixed methods of laboratory assessments, self-reported questionnaires and 24-hour dietary recall. The Avocado-Supplemented Diet Group (n=484, 137 M; 347 F; n=400 at 26-wks) was given 1 avocado per day and the Habitual Diet Group (n=485, 126 M; 359 F; n=406 at 26-wks) continued with their regular diet.

Results

No significant between group LE8 score difference for participants with >1 LE8 component was observed from baseline to the 26-week mark (0.79 points [95% CI, −0.41 to 2.00]). Similar results were obtained for participants who had complete LE8 data points (0.80 points [95% CI, −0.42 to 2.02]). An increase in the LE8 score was noted from baseline to 26 weeks when physical activity scores were omitted (1.34 points [95% CI, 0.29–2.39]) in the avocado-supplemented group. Primary analysis showed greater LE8 score increases in the supplemented cohort for diet (3.53 points [95% CI, 1.38–5.68]), sleep health (3.20 points [95% CI, 0.38–6.02]), and blood lipids (3.46 points [95% CI, 1.03–5.90]) compared to the habitual diet group.

Conclusion

This study concluded that the addition of 1 avocado per day in a standard US diet in a cohort with abdominal obesity did not significantly affect the total AHA’s cardiovascular health score LE8. However, there was a noted improvement in diet quality, sleep, and blood lipids.

• Dietary intervention is one of many components needed to improve cardiovascular health, both in affected populations and as a preventative strategy.

• Given the potential of notable improvement of three of the eight markers of the American Heart Association’s cardiovascular health scores, the addition of 1 avocado in the diet is a relatively small and manageable dietary strategy.

• Trials with larger, more geographically diverse and cultural representative, equally distributed male to female cohorts, and longer intervention periods are needed to confirm the potential scale of effect of one single food product inclusion on overall cardiovascular health outcomes.

• This study showed that one dietary component is not enough to address all cardiovascular health markers. Therefore, assessment of required minimal intervention combinations needed to improve all - or the majority - of cardiovascular health components remain to be elucidated.