title: Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. Chronic dietary fat intake modifies the postprandial response of hemostatic markers to a single fatty test meal. Effect on blood pressure of two diets differing in total fat but not in saturated and polyunsaturated fatty acids in healthy volunteers. Dose Response of Almonds on Coronary Heart Disease Risk Factors: Blood Lipids, Oxidized Low-Density Lipoproteins, Lipoprotein(a), Homocysteine, and Pulmonary Nitric Oxide: A Randomized, Controlled, Crossover Trial SFAs do not impair endothelial function and arterial stiffness123 Mediterranean-Style Diet Effect on the Structural Properties of the Erythrocyte Cell Membrane of Hypertensive Patients: The Prevencion con Dieta Mediterranea Study Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors Evidence for an Independent and Cumulative Effect of Postprandial Hypertriglyceridemia and Hyperglycemia on Endothelial Dysfunction and Oxidative Stress Generation: Effects of Short- and Long-Term Simvastatin Treatment Effects of a Diet Higher in Carbohydrate/Lower in Fat Versus Lower in Carbohydrate/Higher in Monounsaturated Fat on Postmeal Triglyceride Concentrations and Other Cardiovascular Risk Factors in Type 1 Diabetes Lack of effect on blood pressure by low fat diets with different fatty acid compositions A diet rich in high-oleic-acid sunflower oil favorably alters low-density lipoprotein cholesterol, triglycerides, and factor VII coagulant activity. Dietary Composition, Body Weight, and NIDDM: Comparison of high-fiber, high-carbohydrate, and modified-fat diets Effects on Blood Pressure, Glucose, and Lipid Levels of High-Monounsaturated Fat Diet Compared With a High-Carbohydrate Diet in NIDDM Subjects Effect of a high-carbohydrate versus a high--cis-monounsaturated fat diet on blood pressure in patients with type 2 diabetes. Replacement of saturated with unsaturated fats had no impact on vascular function but beneficial effects on lipid biomarkers, E-selectin, and blood pressure: results from the randomized, controlled Dietary Intervention and VAScular function (DIVAS) study. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study The effects of dietary lipid modification on blood pressure, cardiovascular reactivity and sympathetic activity in man 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease.
abstract: CONTEXT Reduced intake of saturated fat is widely recommended for prevention of cardiovascular disease . The type of macronutrient that should replace saturated fat remains uncertain . OBJECTIVE To compare the effects of 3 healthful diets , each with reduced saturated fat intake , on blood pressure and serum lipids . DESIGN , SETTING , AND PARTICIPANTS R and omized , 3-period , crossover feeding study ( April 2003 to June 2005 ) conducted in Baltimore , Md , and Boston , Mass. Participants were 164 adults with prehypertension or stage 1 hypertension . Each feeding period lasted 6 weeks and body weight was kept constant . INTERVENTIONS A diet rich in carbohydrates ; a diet rich in protein , about half from plant sources ; and a diet rich in unsaturated fat , predominantly monounsaturated fat . MAIN OUTCOME MEASURES Systolic blood pressure and low-density lipoprotein cholesterol . RESULTS Blood pressure , low-density lipoprotein cholesterol , and estimated coronary heart disease risk were lower on each diet compared with baseline . Compared with the carbohydrate diet , the protein diet further decreased mean systolic blood pressure by 1.4 mm Hg ( P = .002 ) and by 3.5 mm Hg ( P = .006 ) among those with hypertension and decreased low-density lipoprotein cholesterol by 3.3 mg/dL ( 0.09 mmol/L ; P = .01 ) , high-density lipoprotein cholesterol by 1.3 mg/dL ( 0.03 mmol/L ; P = .02 ) , and triglycerides by 15.7 mg/dL ( 0.18 mmol/L ; P<.001 ) . Compared with the carbohydrate diet , the unsaturated fat diet decreased systolic blood pressure by 1.3 mm Hg ( P = .005 ) and by 2.9 mm Hg among those with hypertension ( P = .02 ) , had no significant effect on low-density lipoprotein cholesterol , increased high-density lipoprotein cholesterol by 1.1 mg/dL ( 0.03 mmol/L ; P = .03 ) , and lowered triglycerides by 9.6 mg/dL ( 0.11 mmol/L ; P = .02 ) . Compared with the carbohydrate diet , estimated 10-year coronary heart disease risk was lower and similar on the protein and unsaturated fat diets . CONCLUSION In the setting of a healthful diet , partial substitution of carbohydrate with either protein or monounsaturated fat can further lower blood pressure , improve lipid levels , and reduce estimated cardiovascular risk . Clinical Trials Registration Clinical Trials.gov Identifier : NCT00051350 BACKGROUND Hemostasis is the result of a complex equilibrium between coagulation and fibrinolysis , and the influence of different dietary models on this equilibrium is not entirely known . OBJECTIVE The objective was to compare the effects of the chronic intake of different dietary models on postpr and ial hemostasis . DESIGN In a r and omized crossover design , 20 healthy men consumed for 28 d each diets rich in monounsaturated fatty acids ( MUFAs ) , saturated fatty acids ( SFAs ) , and carbohydrates plus n-3 fatty acids ( CHO/N3 ) .  Fasting and postpr and ial hemostatic factors ( factor VII coagulant activity , plasminogen activator inhibitor-1 , tissue-type plasminogen activator , d-dimer , and thromboxane B(2 ) ) were measured ; meal tests for the postpr and ial measures were based on butter , virgin olive oil , and walnuts for the SFA , MUFA , and CHO/N3 diets , respectively . RESULTS There were no differences in the fasting variables after the dietary periods . After the 3 fatty meals were consumed , we observed an increase in thromboxane B(2 ) and d-dimer and a reduction in tissue plasminogen activator , irrespective of the dietary model . The MUFA or CHO/N3 meals lowered postpr and ial concentrations of factor VII coagulant activity , although the reduction was greater after the MUFA-enriched meal . The concentration of plasminogen activator inhibitor-1 was greater after the SFA meal than after the other 2 meals . CONCLUSIONS The administration of a fatty meal induces a postpr and ial procoagulant tendency , irrespective of the type of fat consumed . However , the use of a dietary model rich in SFA creates a more procoagulant environment than does a model that includes MUFA or CHO/N3 as the source of fatty acids The effects of a low-fat , carbohydrate-rich and a high-fat , olive-oil-rich diet on blood pressure were studied under strict dietary control . Forty-seven healthy normotensive men and women were fed a diet high in saturated fatty acids ( 20 en% ) and total fat ( 38 en% ) for 17 d. Twenty-four subjects then received a low-fat , carbohydrate-rich diet ( total fat 22 en% ) and the other 23 a high-fat , olive-oil-rich diet ( oleic acid 24 en% , total fat 41 en% ) for 36 d. Both test diets had the same level of saturated fatty acids ( 7 - 10 en% ) and linoleic acid ( 4 en% ) . Systolic blood pressure fell by 2.3 and diastolic by 4.7 mm Hg in the carbohydrate group and by 2.7 and 4.4 mm Hg in the olive-oil group , respectively ( differences between diets groups not significant ) . These results suggest that a high-fat diet rich in monounsaturated fatty acids has no deleterious effect on blood pressure in healthy normotensive subjects in comparison with a low-fat , carbohydrate-rich diet Background —Although recent studies have indicated that nut consumption may improve levels of blood lipids , nuts are not generally recommended as snacks for hyperlipidemic subjects because of their high fat content . Furthermore , the effective dose is still unknown . Methods and Results —The dose-response effects of whole almonds , taken as snacks , were compared with low-saturated fat ( < 5 % energy ) whole-wheat muffins ( control ) in the therapeutic diets of hyperlipidemic subjects . In a r and omized crossover study , 27 hyperlipidemic men and women consumed 3  isoenergetic ( mean 423 kcal/d ) supplements each for 1 month . Supplements provided 22.2 % of energy and consisted of full-dose almonds ( 73±3 g/d ) , half-dose almonds plus half-dose muffins , and full-dose muffins  . Fasting blood , expired air , blood pressure , and body weight measurements were obtained at weeks 0 , 2 , and 4 . Mean body weights differed < 300 g between treatments . The full-dose almonds produced the greatest reduction in levels of blood lipids . Significant reductions from baseline were seen on both half- and full-dose almonds for LDL cholesterol ( 4.4±1.7 % , P = 0.018 , and 9.4±1.9 % , P < 0.001 , respectively ) and LDL : HDL cholesterol ( 7.8±2.2 % , P = 0.001 , and 12.0±2.1 % , P < 0.001 , respectively ) and on full-dose almonds alone for lipoprotein(a ) ( 7.8±3.5 % , P = 0.034 ) and oxidized LDL concentrations ( 14.0±3.8 % , P < 0.001 ) , with no significant reductions on the control diet . No difference was seen in pulmonary nitric oxide between treatments . Conclusions —Almonds used as snacks in the diets of hyperlipidemic subjects significantly reduce coronary heart disease risk factors , probably in part because of the nonfat ( protein and fiber ) and monounsaturated fatty acid components of the nut Background : It is uncertain whether saturated fatty acids ( SFAs ) impair endothelial function and contribute to arterial stiffening . Objective : We tested the effects of replacing SFAs with monounsaturated fatty acids ( MUFAs ) or carbohydrates on endothelial function and arterial stiffness . Design : With the use of a parallel- design ed r and omized controlled trial in 121 insulin-resistant men and women , we measured vascular function after 1 mo of consumption of a high-SFA ( HS ) diet and after 24 wk after r and om assignment to the HS diet or diets that contained < 10 % SFAs and were high in either MUFAs or carbohydrates . The primary outcome was a change in flow-mediated dilation ( FMD ) , and secondary outcomes were changes in carotid to femoral pulse wave velocity ( PWV ) and plasma 8-isoprostane F2α-III concentrations . Results : For 112 participants with data available for analysis on the specified outcomes , no significant differences were shown . FMD with the HS reference diet was 6.7 ± 2.2 % , and changes ( 95 % CIs ) after 6 mo of intervention were + 0.3 ( −0.4 , 1.1 ) , −0.2 ( −0.8 , 0.5 ) , and −0.1 ( −0.6 , 0.7 ) with HS , high-MUFA ( HM ) , and high-carbohydrate ( HC ) diets , respectively . After consumption of the HS reference diet , the geometric mean ( ±SD ) PWV was 7.67 ± 1.62 m/s , and mean percentages of changes ( 95 % CIs ) were −1.0 ( −6.2 , 4.3 ) with the HS diet , 2.7 ( −1.4 , 6.9 ) with the HM diet , and −1.0 ( −5.5 , 3.4 ) with the HC diet . With the HS reference diet , the geometric mean ( ±SD ) plasma 8-isoprostane F2α-III concentration was 176 ± 85 pmol/L , and mean percentage of changes ( 95 % CIs ) were 1 ( −12 , 14 ) with the HS diet , 6 ( −5 , 16 ) with the HM diet , and 4 ( −7 , 16 ) with the HC diet . Conclusion : The replacement of SFAs with MUFAs or carbohydrates in healthy subjects does not affect vascular function . This trial was registered at Current Controlled Trials ( http://www.controlled-trials.com/IS RCT N ) as IS RCT N 29111298 A currently ongoing r and omized trial has revealed that the Mediterranean diet , rich in virgin olive oil or nuts , reduces systolic blood pressure in high-risk cardiovascular patients . Here , we present a structural sub study to assess the effect of a Mediterranean-style diet supplemented with nuts or virgin olive oil on erythrocyte membrane properties in 36 hypertensive participants after 1 year of intervention .  Erythrocyte membrane lipid composition , structural properties of reconstituted erythrocyte membranes , and serum concentrations of inflammatory markers are reported . After the intervention , the membrane cholesterol content decreased , whereas that of phospholipids increased in all of the dietary groups ; the diminishing cholesterol : phospholipid ratio could be associated with an increase in the membrane fluidity . Moreover , reconstituted membranes from the nuts and virgin olive oil groups showed a higher propensity to form a nonlamellar inverted hexagonal phase structure that was related to an increase in phosphatidylethanolamine lipid class . These data suggest that the Mediterranean-style diet affects the lipid metabolism that is altered in hypertensive patients , influencing the structural membrane properties . The erythrocyte membrane modulation described provides insight in the structural bases underlying the beneficial effect of a Mediterranean-style diet in hypertensive subjects Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 mmol/L [ 160 mg/dL ] [ or treatment with hypolipidemic drugs ] , high-density lipoprotein [ HDL ] cholesterol level 1.04 mmol/L [ 40 mg/dL ] , body mass index [ BMI ] 25 kg/m2 , or a family history of premature CHD ) . Exclusion criteria were history of cardiovascular disease , any severe chronic illness , drug or alcohol addiction , history of allergy or intolerance to olive oil or nuts , or low predicted likelihood of changing dietary habits according to the stages-of-change model ( 18 ) . The primary care physicians based participants ' eligibility on review of clinical records and a screening visit . They obtained a list of c and i date s from computer-based records of patients who attended each participating center and review ed their clinical records to exclude those who did not meet eligibility criteria . They then invited suitable c and i date s by telephone to attend a screening visit . The visit included an interview with administration of a 26-item question naire to inquire about medical conditions and risk factors related to eligibility . Of the eligible c and i date s who met entry requirements , 95 % agreed to participate and provided informed consent . R and omization and Intervention After the screening visit , each center r and omly assigned eligible participants to 1 of 3 diet groups by using a computer-generated r and om-number sequence . The coordinating center constructed the r and omization table , and participants were r and omly assigned into blocks of 50 participants balanced by center , sex , and age group ( < 70 years and 70 years ) . We concealed allocation into the intervention groups by using closed envelopes with correlative numbers by prespecified subgroups of sex and age . The baseline examination included the administration of a 14-item question naire , an extension of a previously vali date d question naire ( 19 ) , that assessed the degree of adherence to the traditional Mediterranean diet . We assigned values of 0 or 1 to each item ( Appendix Table 1 ) . We also administered a 137-item vali date d food frequency question naire ( 20 ) ; the vali date d Spanish version ( 21 ) of the Minnesota Leisure Time Physical Activity Question naire ; and a 47-item question naire about education , lifestyle , history of illnesses , and medication use . We performed anthropometric and blood pressure measurements and obtained sample s of fasting blood and spot urine . We repeated all examinations at 3 months . The same dietitian delivered the interventions to the 3 r and omized groups in each center . On the basis of the assessment of individual Mediterranean diet scores , the dietitian gave personalized dietary advice during a 30-minute session to each participant , with recommendations on the desired frequency of intake of specific foods . We advised participants who were allocated to the low-fat diet to reduce intake of all types of fat , and we gave them a leaflet with written recommendations according to the American Heart Association guidelines ( 22 ) . For total fat intake , these recommendations were opposite to those given to participants in the 2 Mediterranean diet groups , who received instructions intended to increase the 14-item Mediterranean diet score , including increased consumption of vegetable fats and oils . We did not suggest any energy restriction . While the participants who were allocated to the low-fat diet did not receive further intervention , those assigned the 2 Mediterranean diet groups had access to more intense intervention in 2 ways . First , they were given a free provision of typical Mediterranean fatty foods ( olive oil or nuts ) . Depending on group assignment , participants were given either free virgin olive oil ( 15 L [ 1 L/wk ] for 3 months ) or free sachets of walnuts , hazelnuts , and almonds ( 1350 g of walnuts [ 15 g/d ] , 675 g of hazelnuts [ 7.5 g/d ] , and 675 g of almonds [ 7.5 g/d ] for 3 months ) . To improve adherence and account for family needs , participants in the corresponding Mediterranean diet groups were given excess olive oil or additional 1000-g packets of nuts . We analyzed the nutrient composition of the olive oil and nuts used in the study by st and ard methods in a reference laboratory ( Appendix Table 2 ) ) . Second , 1 week after inclusion , the dietitian delivered a 1-hour group session with up to 20 participants , with separate sessions for each Mediterranean diet group . Each group session consisted of informative talks and provision of written material s with elaborate descriptions of typical Mediterranean foods and seasonal shopping lists , meal plans , and cooking recipes . Throughout the study , all participants had free and continuous access to their center dietitian for advice and consultation . Measurements Trained personnel measured weight and height by using calibrated scales and a wall-mounted stadiometer , respectively ; waist circumference midway between the lowest rib and the iliac crest by using an anthropometric tape ; and blood pressure in triplicate with a vali date d semiautomatic oscillometer ( Omron HEM-705CP , Hoofddorp , the Netherl and s ) . We calculated energy and nutrient intake from Spanish food composition tables ( 23 ) . At the 3-month visit and when consulted by participants , dietitians assessed any adverse effects from the interventions by administering a checklist of symptoms and gave advice on how to remedy them . The checklist included mouth symptoms ; bloating , fullness , or indigestion ; altered bowel Background —Postpr and ial hypertriglyceridemia and hyperglycemia are considered risk factors for cardiovascular disease . Evidence suggests that postpr and ial hypertriglyceridemia and hyperglycemia induce endothelial dysfunction through oxidative stress ; however , the distinct role of these two factors is a matter of debate . Methods and Results —Thirty type 2 diabetic patients and 20 normal subjects ate 3 different meals : a high-fat meal ; 75 g glucose alone ; and high-fat meal plus glucose .  Glycemia , triglyceridemia , nitrotyrosine , and endothelial function were assayed during the tests . Subsequently , diabetics took 40 mg/d simvastatin or placebo for 12 weeks . The 3 tests were performed again at baseline , between 3 to 6 days after the start , and at the end of each study . High-fat load and glucose alone produced a decrease of endothelial function and an increase of nitrotyrosine in normal and diabetic subjects . These effects were more pronounced when high fat and glucose were combined . Short-term simvastatin treatment had no effect on lipid parameters but reduced the effect on endothelial function and nitrotyrosine observed during each different test . Long-term simvastatin treatment was accompanied by a lower increase in postpr and ial triglycerides , which was followed by smaller variations of endothelial function and nitrotyrosine during the tests . Conclusions —This study shows an independent and cumulative effect of postpr and ial hypertriglyceridemia and hyperglycemia on endothelial function , suggesting oxidative stress as common mediator of such effect . Simvastatin shows a beneficial effect on oxidative stress and endothelial dysfunction , which may be ascribed to a direct effect as well as the lipid-lowering action of the drug OBJECTIVE To compare the effects of a eucaloric diet higher in carbohydrate/lower in fat versus lower in carbohydrate/higher in monounsaturated fat on postmeal triglyceride ( TG ) concentrations and other cardiovascular disease risk factors in nonobese subjects with type 1 diabetes and in good glycemic control . RESEARCH DESIGN AND METHODS In a parallel group design study , 30 subjects were r and omly assigned and completed one of the two eucaloric diets . Assessment s included : BMI , blood pressure , A1C , plasma lipids , and markers of oxidation , thrombosis , and inflammation . At 6 months , subjects were hospitalized for 24 h to measure plasma TG excursions . RESULTS There were no significant differences between groups other than decreased plasminogen activator inhibitor 1 ( PAI-1 ) levels and weight gain in the lower-carbohydrate/higher – monounsaturated fat group . During the 24-h testing , the lower-carbohydrate/higher – monounsaturated fat group had a lower plasma TG profile . CONCLUSIONS A diet lower in carbohydrate/higher in monounsaturated fat could offer an appropriate choice for nonobese type 1 diabetic individuals with good metabolic and weight control We compared the effects on blood pressure ( BP ) of three isocaloric diets with reduced total fat and saturated fatty acid ( SAFA ) contents but with different proportions of monounsaturated ( MUFA ) and polyunsaturated fatty acids ( PUFA ) . Diet LF ( low fat ) provided 20 en% fat ( 7.9 % SAFA , 7.8 % MUFA , 3.0 % PUFA ) ; diet HP ( high PUFA ) 26 en% fat ( 7.5 % SAFA , 8.2 % MUFA , 8.1 % PUFA ) , and diet HM ( high MUFA ) 26 en% fat ( 7.3 % SAFA , 14.1 % MUFA , 3.2 % PUFA ) . The diets were consumed for 8 weeks ( intervention ) preceded by 2 weeks and followed by 8 weeks on a habitual diet ( baseline/ switchback ) with 33–34 en% fat ( 13–14 % SAFA , 12 % MUFA , 6 % PUFA ) . Forty-five free-living couples were r and omly allocated into the three diet groups , and 43 men and 44 women completed the study .  BP was measured weekly with an automatic device . Compliance to diet was monitored by repeated food records , serum fatty acid compositions , and weekly visits to a nutritionist . Both systolic BP ( SBP ) and diastolic BP ( DBP ) remained unchanged throughout the study in all three groups . The weight-adjusted mean ( s.e.m . ) BP values showed changes in SBP of + 1.7 ( 1.8 ) , −0.4 ( 1.7 ) , and + 1.9 ( 1.9 ) mm Hg on the LF , HP , and HM diets , respectively ( difference NS ) , and DBP of + 0.1 ( 1.0 ) , + 0.6 ( 1.0 ) , and −0.3 ( 1.0 ) mm Hg , respectively ( difference NS ) between the last 2 weeks of the baseline and intervention periods . The expected fatty acid intakes were achieved , and there were no between-group differences in change of body weight , intake of dietary fibre and potassium , and 24-h sodium excretion . A reduction in total fat and SAFA intake and changes in the proportions of dietary MUFA and PUFA did not affect the BP levels of this normotensive population with an adequate intake of PUFA at baseline OBJECTIVE To compare concentrations of factor VII coagulant activity ( factor VIIc ) , fibrinogen , plasminogen activator inhibitor-1 , and blood lipids on a saturated fat-rich diet with one rich in monounsaturated fat . DESIGN Subjects were r and omly allocated to two groups . The study design was an ABB/BAA extra-period crossover . One group consumed a diet rich in saturated fatty acid ( SFA ) with fat making up 20.8 % of total energy , for 5 weeks and then one rich in monounsaturated fatty acid ( MUFA ) , with fat making up 20.3 % of total energy for 10 weeks . The other group consumed the MUFA diet for 5 weeks followed by the SFA diet for 10 weeks . SUBJECTS/ SETTING Men and women aged 35 to 69 years who were nonsmokers with no chronic illness and not on any medication were recruited to participate . Eighteen subjects were recruited and 15 ( 5 men , 10 women ) completed the community-based study . INTERVENTION Blood was sample d at the beginning and end point of each 5-week diet period for analysis of coagulation and fibrinolysis factors and blood lipids . Subjects kept 3-day food diaries twice during each of the three diet periods and were weighed on each visit for blood collection . Analysis of plasma fatty acids was used to indicate dietary compliance . MAIN OUTCOME MEASURES Differences in fasting factor VIIc , fibrinogen , plasminogen activator inhibitor-1 , insulin , low-density lipoprotein cholesterol , high-density lipoprotein cholesterol , triglycerides , apolipoproteins A-1 and B , and plasma oleic acid levels while receiving the SFA diet vs MUFA diet . STATISTICAL ANALYSIS A general linear model allowing for the ABB/BAA extra-period crossover , was used for each of the outcome measures . RESULTS Factor VIIc was lower on the MUFA diet ( P < .05 ) but fibrinogen and insulin concentrations and plasminogen activator inhibitor-1 activity did not differ between diets . Low-density lipoprotein cholesterol ( P < .001 ) and triglyceride ( P < .01 ) levels were lower on the MUFA diet compared with the SFA diet . A significant increase in both plasma phospholipid and neutral lipid oleic acid ( P < .0001 ) occurred on the MUFA diet . CONCLUSIONS Substitution of foods rich in saturated fat with foods rich in high-oleic-acid sunflower oil and margarine has favorable outcomes on blood lipids and factor VIIc . This oil presents another useful source of MUFA for diets aim ed at prevention of heart disease OBJECTIVE To examine the effects of a high-carbohydrate low-fat ( HCLF ) and a modified-fat ( MF ) diet on body weight and metabolic control in subjects with non-insulin-dependent diabetes mellitus ( NIDDM ) living at home . RESEARCH DESIGN AND METHODS Twenty-four NIDDM patients followed HCLF and MF diets alternately and in r and om order for a 3-month period while at home , with a 1-month baseline and washout between diets . Before and after each diet , fasting glucose and lipids , HbAlc , blood pressure , and body weight were measured . Dietary preferences were assessed by question naire . RESULTS Subjects consumed 50 % of energy as carbohydrate and 23 % as fat on the HCLF diet and 40 % of energy as carbohydrate and 36 % as fat ( over half of which was monounsaturated fat ) on the MF diet . Subjects lost weight on both HCLF and MF diets ( mean loss 0.7 and 1.3 kg , respectively ) . Although the MF diet result ed in a small decrease in fasting glucose levels , there was no significant change in HbA1c . Similarly , there was no significant difference between the diets in changes in blood pressure or fasting blood lipids . Most subjects ( 65 % ) preferred the MF diet . CONCLUSIONS Although the MF diet is not a low-fat diet , it did not appear to facilitate weight gain in subjects with NIDDM living at home . The MF diet provides an alternative for individuals unable to comply with HCLF diets OBJECTIVE To compare the influence on blood pressure , glucose , and lipid levels of a diet rich in monounsaturated fatty acids with an isocaloric , highcarbohydrate diet in 15 NIDDM subjects . RESEARCH DESIGN AND METHODS A crossover design with diet interventions and wash-out periods of 3 wk was applied . The patients were r and omly assigned to a 3-wk treatment with a high-carbohydrate diet containing 50 % of energy as carbohydrate and 30 % of energy as fat ( 10 % of energy as monounsaturated fatty acids ) or an isocaloric diet with 30 % of energy as carbohydrate and 50 % of energy as fat ( 30 % of energy as monounsaturated fatty acids ) . On the last day of the two diets , 24-h ambulatory blood pressure was measured and day profiles of glucose , hormones , and lipids were performed to a test menu rich in carbohydrates . RESULTS The diet rich in monounsaturated fat reduced daytime systolic ( 131 ± 3 vs. 137 ± 3 mmHg , P < 0.04 ) and 24-h systolic blood pressure ( 126 ± 8 vs. 130 ± 10 mmHg , P < 0.03 ) as well as daytime diastolic ( 78 ± 2 vs. 84 ± 2 mmHg , P < 0.02 ) and diurnal diastolic blood pressure ( 75 ± 6 vs. 78 ± 5 mmHg , P < 0.03 ) as compared with the high-carbohydrate diet . Evidence of lowered blood glucose levels on the high-monounsaturated diet compared with the highcarbohydrate diet were found with lower fasting blood glucose ( 6.1 ± 0.3 vs. 6.8 ± 0.5 mM , P < 0.05 ) , lower average blood glucose levels ( 7.4 ± 0.5 vs. 8.2 ± 0.6 mM , P < 0.04 ) , and peak blood glucose responses ( 9.9 ± 0.6 vs. 11.3 ± 0.7 mM , P < 0.02 ) . The two diets had the same impact on lipid levels . CONCLUSIONS A diet rich in monounsaturated fat has beneficial effects on blood pressure and glucose metabolism , whereas no adverse effects on lipid composition in NIDDM subjects is detected OBJECTIVE To investigate whether blood pressure is different in type 2 diabetic patients on a diet rich in carbohydrates versus a diet rich in cis-monounsaturated fatty acids . Data on the dietary effects on these diets ' glucose and lipid metabolism have been previously published . RESEARCH DESIGN AND METHODS The study compared the effect of feeding 42 type 2 diabetic patients a carefully controlled isoenergic high-carbohydrate ( high-carb ; 55 % energy as carbohydrate , 30 % as fat , and 10 % as monounsaturated fat ) and high-monounsaturated fat ( high-mono ; 45 % energy as fat , 25 % as monounsaturated fat , and 40 % as carbohydrate ) diet for 6 weeks each in a four-center , r and omized , cross-over study on blood pressure . Twenty-one patients continued the diet they received during the second phase for an additional 8 weeks . RESULTS According to repeated- measures ANOVA , blood pressure during the last 3 days of each phase was similar after 6 weeks of the high-carb and high-mono diets ( systolic blood pressure : 128 + /- 16 vs. 127 + /- 15 mmHg , P = 0.9 ; diastolic blood pressure : 75 + /- 7 vs. 75 + /- 8 mmHg , P = 0.7 ) . However , after 14 weeks of the high-carb diet ( n = 13 ) , there was a significant increase in blood pressure compared with 6 weeks of the high-mono diet ( systolic blood pressure : 132 + /- 13 vs. 126 + /- 11 mmHg , P = 0.04 ; diastolic blood pressure : 83 + /- 6 vs. 76 + /- 7 mmHg , P = 0.002 ) . After 14 weeks of the high-mono diet ( n = 8) , the reduction in blood pressure was not significant compared with 6 weeks of the high-carb diet ( systolic blood pressure : 118 + /- 14 vs. 121 + /- 16 mmHg , P = 0.4 ; diastolic blood pressure : 71 + /- 8 vs. 75 + /- 10 mmHg , P = 0.3 ) . CONCLUSION Although the exchange of carbohydrates with monounsaturated fats may not affect blood pressure in the short term , long-term consumption of a high-carbohydrate diet may modestly raise blood pressure in type 2 diabetic patients BACKGROUND Public health strategies to lower cardiovascular disease ( CVD ) risk involve reducing dietary saturated fatty acid ( SFA ) intake to ≤10 % of total energy ( % TE ) . However , the optimal type of replacement fat is unclear . OBJECTIVE We investigated the substitution of 9.5 - 9.6%TE dietary SFAs with either monounsaturated fatty acids ( MUFAs ) or n-6 ( ω-6 ) polyunsaturated fatty acids ( PUFAs ) on vascular function and other CVD risk factors . DESIGN In a r and omized , controlled , single-blind , parallel-group dietary intervention , 195 men and women aged 21 - 60 y from the United Kingdom with moderate CVD risk ( ≥50 % above the population mean ) followed one of three 16-wk isoenergetic diets ( % TE target compositions , total fat : SFA : MUFA : n-6 PUFA ) that were rich in SFAs ( 36:17:11:4 , n = 65 ) , MUFAs ( 36:9:19:4 , n = 64 ) , or n-6 PUFAs ( 36:9:13:10 , n = 66 ) . The primary outcome measure was flow-mediated dilatation ; secondary outcome measures included fasting serum lipids , microvascular reactivity , arterial stiffness , ambulatory blood pressure , and markers of insulin resistance , inflammation , and endothelial activation . RESULTS Replacing SFAs with MUFAs or n-6 PUFAs did not affect the percentage of flow-mediated dilatation ( primary endpoint ) or other measures of vascular reactivity . Of the secondary outcome measures , substitution of SFAs with MUFAs attenuated the increase in night systolic blood pressure ( -4.9 mm Hg , P = 0.019 ) and reduced E-selectin ( -7.8 % , P = 0.012 ) . Replacement with MUFAs or n-6 PUFAs lowered fasting serum total cholesterol ( -8.4 % and -9.2 % , respectively ) , low-density lipoprotein cholesterol ( -11.3 % and -13.6 % ) , and total cholesterol to high-density lipoprotein cholesterol ratio ( -5.6 % and -8.5 % ) ( P ≤ 0.001 ) . These changes in low-density lipoprotein cholesterol equate to an estimated 17 - 20 % reduction in CVD mortality . CONCLUSIONS Substitution of 9.5 - 9.6%TE dietary SFAs with either MUFAs or n-6 PUFAs did not significantly affect the percentage of flow-mediated dilatation or other measures of vascular function . However , the beneficial effects on serum lipid biomarkers , blood pressure , and E-selectin offer a potential public health strategy for CVD risk reduction . This trial was registered at www . clinical trials.gov as NCT01478958 BACKGROUND The relationship between macronutrients and cardiovascular  disease and mortality is controversial . Most available data are from European and North American population s where nutrition excess is more likely , so their applicability to other population s is unclear . METHODS The Prospect i ve Urban Rural Epidemiology ( PURE ) study is a large , epidemiological cohort study of individuals aged 35 - 70 years ( enrolled between Jan 1 , 2003 , and March 31 , 2013 ) in 18 countries with a median follow-up of 7·4 years ( IQR 5·3 - 9·3 ) . Dietary intake of 135 335 individuals was recorded using vali date d food frequency question naires . The primary outcomes were total mortality and major cardiovascular events ( fatal cardiovascular disease , non-fatal myocardial infa rct ion , stroke , and heart failure ) . Secondary outcomes were all myocardial infa rct ions , stroke , cardiovascular disease mortality , and non-cardiovascular disease mortality . Participants were categorised into quintiles of nutrient intake ( carbohydrate , fats , and protein ) based on percentage of energy provided by nutrients . We assessed the associations between consumption of carbohydrate , total fat , and each type of fat with cardiovascular disease and total mortality . We calculated hazard ratios ( HRs ) using a multivariable Cox frailty model with r and om intercepts to account for centre clustering . FINDINGS During follow-up , we documented 5796 deaths and 4784 major cardiovascular disease events . Higher carbohydrate intake was associated with an increased risk of total mortality ( highest [ quintile 5 ] vs lowest quintile [ quintile 1 ] category , HR 1·28 [ 95 % CI 1·12 - 1·46 ] , ptrend=0·0001 ) but not with the risk of cardiovascular disease or cardiovascular disease mortality . Intake of total fat and each type of fat was associated with lower risk of total mortality ( quintile 5 vs quintile 1 , total fat : HR 0·77 [ 95 % CI 0·67 - 0·87 ] , ptrend<0·0001 ; saturated fat , HR 0·86 [ 0·76 - 0·99 ] , ptrend=0·0088 ; monounsaturated fat : HR 0·81 [ 0·71 - 0·92 ] , ptrend<0·0001 ; and polyunsaturated fat : HR 0·80 [ 0·71 - 0·89 ] , ptrend<0·0001 ) . Higher saturated fat intake was associated with lower risk of stroke ( quintile 5 vs quintile 1 , HR 0·79 [ 95 % CI 0·64 - 0·98 ] , ptrend=0·0498 ) . Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infa rct ion or cardiovascular disease mortality .  INTERPRETATION High carbohydrate intake was associated with higher risk of total mortality , whereas total fat and individual types of fat were related to lower total mortality . Total fat and types of fat were not associated with cardiovascular disease , myocardial infa rct ion , or cardiovascular disease mortality , whereas saturated fat had an inverse association with stroke . Global dietary guidelines should be reconsidered in light of these findings . FUNDING Full funding sources listed at the end of the paper ( see Acknowledgments ) Objectives : To examine the effect of dietary lipid modification on 24-h ambulatory blood pressure , cardiovascular reactivity and sympathetic activity in man Design : Twenty-four normal volunteers consumed either a high-fat or a low-fat diet for 2 weeks in an open , r and omized , crossover study of duration 6 weeks . Diets were isocaloric and balanced for sodium and potassium content Methods : Cardiovascular reactivity was assessed by measurement of blood pressure responses to incremental infusions of angiotensin II and noradrenaline , and to sympathetic reflex testing . Plasma noradrenaline spillover and clearance rates were estimated using [3H]-noradrenaline infusion Results : Total plasma cholesterol and low-density lipoprotein-cholesterol levels both fell significantly on the low-fat compared with the high-fat diet , as did heart rate and mean arterial pressure ( recorded by 24-h ambulatory monitoring ) . These changes were accompanied by reductions in blood pressure responses to cold pressor testing and to noradrenaline infusion on the low-fat diet . Plasma noradrenaline spillover and clearance rates did not change . Post hoc analysis showed an association between oral contraceptive use and increased noradrenaline sensitivity on the high-fat diet among the females tested . Conclusion : Dietary fat intake alters heart rate , blood pressure and cardiovascular reactivity to noradrenaline in man without changes in basal noradrenaline metabolism ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle – brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute C and esartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease : Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A R and omized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Sc and inavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Sc and inavian Cardiac Outcomes Trial — Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : C And esartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease — EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy C and esartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease  EXPLOR : Amlodipine – Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine – Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infa rct ion in 52 Countries INVEST : INternational VErapamil SR/T Tr and olapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention : an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : r and omized controlled trials RF : risk factor ROADMAP : R and omized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker C and esartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly : Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan R and omised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospect i ve Diabetes Study VADT : Veterans ' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization # # # 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension ( ESH ) and the European Society of Cardiology BACKGROUND & AIMS Non-alcoholic fatty liver disease ( NAFLD ) affects up to 30 % of the population and signifies increased risk of liver fibrosis and cirrhosis , type 2 diabetes , and cardiovascular disease . Therapies are limited . Weight loss is of benefit but is difficult to maintain . We aim ed at examining the effect of the Mediterranean diet ( MD ) , a diet high in monounsaturated fatty acids , on steatosis and insulin sensitivity , using gold st and ard techniques . METHODS Twelve non-diabetic subjects ( 6 Females/6 Males ) with biopsy-proven NAFLD were recruited for a r and omised , cross-over 6-week dietary intervention study . All subjects undertook both the MD and a control diet , a low fat-high carbohydrate diet ( LF/HCD ) , in r and om order with a 6-week wash-out period in- between . Insulin sensitivity was determined with a 3-h hyperinsulinemic-euglycemic clamp study and hepatic steatosis was assessed with localized magnetic resonance (1)H spectroscopy ( (1)H-MRS ) . RESULTS At baseline , subjects were abdominally obese with elevated fasting concentrations of glucose , insulin , triglycerides , ALT , and GGT . Insulin sensitivity at baseline was low ( M=2.7 ± 1.0 mg/kg/min(-1 ) ) . Mean weight loss was not different between the two diets ( p=0.22 ) . There was a significant relative reduction in hepatic steatosis after the MD compared with the LF/HCD : 39 ± 4 % versus 7 ± 3 % , as measured by (1)H-MRS ( p=0.012 ) . Insulin sensitivity improved with the MD , whereas after the LF/HCD there was no change ( p=0.03 between diets ) . CONCLUSIONS Even without weight loss , MD reduces liver steatosis and improves insulin sensitivity in an insulin-resistant population with NAFLD , compared to current dietary advice . This diet should be further investigated in subjects with NAFLD
target: Conclusions In the context of low SFAs , high-MUFA diets in isocaloric substitution for high-CHO diets did not affect blood pressure in individuals with and without hypertension .
background: Context Current dietary guidelines for cardiovascular disease risk management recommend restricting intake of saturated fatty acids ( SFAs ) .
  However , the optimal macronutrient profile , in the context of a low-SFA diet , remains controversial .
  The blood-pressure effect of replacing SFAs in diets with monounsaturated fatty acids ( MUFAs ) compared with carbohydrate has not been quantified to date .