A Whole-Diet Approach Affects Not Only Fasting but Also Postprandial Cardiometabolic Risk Markers in Overweight and Obese Adults: A Randomized Controlled Trial

Background: Current dietary recommendations for cardiovascular disease (CVD) prevention focus more on dietary patterns than on single nutrients. However, randomized controlled trials using whole-diet approaches to study effects on both fasting and postprandial CVD risk markers are limited.

Objective: This randomized parallel trial compared the effects of a healthy diet (HD) with those of a typical Western diet (WD) on fasting and postprandial CVD risk markers in overweight and obese adults.

Methods: After a 2-wk run-in period, 40 men and women (50-70 y; BMI: 25-35 kg/m(2)) consumed the HD (high in fruit and vegetables, pulses, fibers, nuts, fatty fish, polyunsaturated fatty acids; low in salt and high-glycemic carbohydrates; n = 19) or the WD (less fruit, vegetables, and fibers; no nuts and fatty fish; and more saturated fatty acids and simple carbohydrates; n = 21) for 6 wk. Fasting and postprandial cardiometabolic risk markers were assessed as secondary outcome parameters during a 5-h mixed-meal challenge, and a per protocol analysis was performed using 1-factor ANCOVA or linear mixed models.

Results: Differences in diet-induced changes are expressed relative to the HD group. Changes in fasting plasma total cholesterol (-0.57 +/- 0.12 mmoVL, P <0.001), LDL cholesterol (-0.41 +/- 0.12 mmoVL, P <0.01), apolipoprotein B100 (-0.09 +/- 0.03 g/L, P <0.01), and apolipoprotein Al (-0.06 +/- 0.03 g/L, P = 0.05) were significantly different between the diet groups. Changes in postprandial plasma triacylglycerol (diet x time, P <0.001) and apolipoprotein B48 (P <0.01) differed significantly between the groups with clear improvements on the HD, although fasting triacylglycerols (-0.24 +/- 0.13 mmoVL, P = 0.06) and apolipoprotein B48 (1.04 +/- 0.67 mg/L, P = 0.40) did not. Significant differences between the diets were also detected in fasting systolic (-6.9 +/- 3.1 mmHg, P <0.05) and 24-h systolic (-5.0 +/- 1.7 mmHg, P <0.01) and diastolic (-3.3 +/- 1.1 mmHg, P <0.01) blood pressure.

Conclusion: A whole-diet approach targeted multiple fasting and postprandial CVD risk markers in overweight and obese adults. In fact, the postprandial measurements provided important additional information to estimate CVD risk.