Álvaro Hernáez1,2,3, Olga Castañer1,3, Alberto Goday1,3, Emilio Ros3,4, Xavier Pintó3,5, Ramón Estruch3,4, Jordi Salas-Salvadó3,6, Dolores Corella3,7, Fernando Arós3,8, Lluis Serra-Majem3,9, Miguel Ángel Martínez-González3,10, Miquel Fiol3,11, José Lapetra3,12, Rafael de la Torre1,3,13, M Carmen López-Sabater3,14, Montserrat Fitó1,3. 1. Cardiovascular Risk and Nutrition Research Group, REGICOR-Study Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. 2. PhD Program in Food Sciences and Nutrition, Universitat de Barcelona, Barcelona, Spain. 3. CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain. 4. Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Spain. 5. Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. 6. Human Nutrition Department, Institut d'Investigació Sanitaria Pere Virgili, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, Reus, Spain. 7. Department of Preventive Medicine, Universidad de Valencia, Valencia, Spain. 8. Department of Cardiology, Hospital Universitario de Álava, Vitoria, Spain. 9. Department of Clinical Sciences, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain. 10. Department of Preventive Medicine and Public Health, Universidad de Navarra, Pamplona, Spain. 11. Balearic Islands Institute for Health Research, Hospital Son Espases, Palma de Mallorca, Spain. 12. Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain. 13. Human Pharmacology and Neurosciences Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain. 14. Department of Nutrition and Bromatology, Faculty of Pharmacy, Universitat de Barcelona, Barcelona, Spain.
Abstract
SCOPE: Traditional Mediterranean diet (TMD) protects against cardiovascular disease through several mechanisms such as decreasing LDL cholesterol levels. However, evidence regarding TMD effects on LDL atherogenic traits (resistance against oxidation, size, composition, cytotoxicity) is scarce. METHODS AND RESULTS: We assessed the effects of a 1-year intervention with a TMD on LDL atherogenic traits in a random sub-sample of individuals from the PREDIMED study (N = 210). We compared two TMDs: one enriched with virgin olive oil (TMD-VOO, N = 71) and another with nuts (TMD-Nuts, N = 68), versus a low-fat control diet (N = 71). After the TMD-VOO intervention, LDL resistance against oxidation increased (+6.46%, p = 0.007), the degree of LDL oxidative modifications decreased (-36.3%, p<0.05), estimated LDL particle size augmented (+3.06%, p = 0.021), and LDL particles became cholesterol-rich (+2.41% p = 0.013) relative to the low-fat control diet. LDL lipoproteins became less cytotoxic for macrophages only relative to baseline (-13.4%, p = 0.019). No significant effects of the TMD-Nuts intervention on LDL traits were observed versus the control diet. CONCLUSION: Adherence to a TMD, particularly when enriched with virgin olive oil, decreased LDL atherogenicity in high cardiovascular risk individuals. The development of less atherogenic LDLs could contribute to explaining some of the cardioprotective benefits of this dietary pattern.
RCT Entities:
SCOPE: Traditional Mediterranean diet (TMD) protects against cardiovascular disease through several mechanisms such as decreasing LDL cholesterol levels. However, evidence regarding TMD effects on LDL atherogenic traits (resistance against oxidation, size, composition, cytotoxicity) is scarce. METHODS AND RESULTS: We assessed the effects of a 1-year intervention with a TMD on LDL atherogenic traits in a random sub-sample of individuals from the PREDIMED study (N = 210). We compared two TMDs: one enriched with virgin olive oil (TMD-VOO, N = 71) and another with nuts (TMD-Nuts, N = 68), versus a low-fat control diet (N = 71). After the TMD-VOO intervention, LDL resistance against oxidation increased (+6.46%, p = 0.007), the degree of LDL oxidative modifications decreased (-36.3%, p<0.05), estimated LDL particle size augmented (+3.06%, p = 0.021), and LDL particles became cholesterol-rich (+2.41% p = 0.013) relative to the low-fat control diet. LDL lipoproteins became less cytotoxic for macrophages only relative to baseline (-13.4%, p = 0.019). No significant effects of the TMD-Nuts intervention on LDL traits were observed versus the control diet. CONCLUSION: Adherence to a TMD, particularly when enriched with virgin olive oil, decreased LDL atherogenicity in high cardiovascular risk individuals. The development of less atherogenic LDLs could contribute to explaining some of the cardioprotective benefits of this dietary pattern.
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