Effects of Increasing Total Fruit Intake With Avocado and Mango on Endothelial Function and Cardiometabolic Risk Factors in Adults With Prediabetes.

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• Daily intake of one avocado and one mango may help improve cardiovascular health in adults with prediabetes.

• Adding more fruit such as avocado and mango to dietary interventions, may help increase fruit consumption and improve nutrient intake in adults with prediabetes.

Introduction
The study aimed to assess the effect of increasing total and selected fruit intake (avocado and mango) on vascular function and metabolic health in adults with prediabetes.

Method

This was an 8-week single-blinded, randomised, 2-arm, partially controlled study. Participants (n=82: 43 men and 39 women) were randomly assigned (1:1) into 1 of 2 dietary interventions: experimental (avocado-mango diet: adding one avocado and one cup of fresh mango daily) vs control intervention (replaced the avocado and mango options with equicaloric carbohydrate food alternatives). Calorie target for female participants was 1500 kcal/d, whereas for males it was 1750 kcal/d.

The primary outcome was flow-mediated vasodilation (FMD). Secondary end points included: central and brachial blood pressure; pulse‐wave velocity; metabolic, inflammatory, and kidney function markers; and diet intake.

Results

• Total fruit intake increased in both groups. However, after 8 weeks, the avocado-mango diet significantly increased intake from 0.9 cups/day at baseline to approximately 3 cups/day.

• After 8 weeks, %FMD decreased to 4.6±0.5 in the control group but increased to 6.7±0.6 in the avocado–mango group. This resulted in a significant effect between the control and intervention (−2.11±0.77%, P=0.008).

• In both groups, FMD increased after the breakfast meal (effect of time: P=0.0525, marginally significant) and remained consistently higher in the avocado-mango group compared to the control group (effect of the intervention: P=0.002).

• Increasing avocado-mango improved endothelial function and helped prevent the increase in diastolic blood pressure observed in the control group. They also slightly increased the estimated glomerular filtration rate (P=0.08) and decreased plasma creatinine P=0.06).

• No significant differences were observed between groups for fasting glucose, insulin, systolic blood pressure (P>0.05) and body weight.

• The avocado-mango group showed nonsignificant improvements in lipid profile levels namely reductions in total and low-density lipoprotein cholesterol (P=0.09).

Conclusion

Increasing fruit intake, specifically 1 avocado and 1 cup of mango per day , into the diet of adults with prediabetes resulted in vascular function changes that are important in cardiovascular health.

• Healthcare professionals may encourage adults with prediabetes to increase their daily whole fruit intake, such as 1 avocado and 1 cup of mango per day, as part of a balanced diet to support cardiovascular health.

• When supporting adults with prediabetes, dietary interventions may benefit from emphasising dietary quality and fruit variety, as improvements in endothelial function were observed despite no significant changes in fasting glucose, insulin, or body weight.

• Longer trials with larger sample sizes are needed to better understand how different individuals have different responses to dietary interventions and identify challenges in adoption long term.

• Future studies should have specific biomarkers of food intake and nitric oxide bioavailability, as this may help to further strengthen the study results.