Mediterranean diet, energy restriction, physical activity, and atherogenicity of very-low density lipoproteins: findings from two randomized controlled trials

Abstract

Scope: Some very-low density lipoprotein (VLDL) properties may render themmore pro-atherogenic. We aimed to assess whether a Mediterranean diet(MedDiet) or an energy-reduced MedDiet with increased physical activityimproves them.Methods and results: In a sample of the PREvención con DIeta MEDiterránea(PREDIMED) study, a 1-year intervention with MedDiet with extra-virgin oliveoil (n = 89) or nuts (MedDiet-Nuts; n = 79) is compared with a low-fat diet(n = 90). In the PREDIMED-Plus study, a 1-year intervention withenergy-reduced MedDiet and physical activity (n = 103) is compared with anad libitum MedDiet (n = 101). VLDL levels of apolipoprotein C-I, C-III,triglycerides, and cholesterol; the apolipoprotein E-/C-I ratio; and VLDLex-vivo triglyceride transfer are measured. In PREDIMED participants in bothMedDiet groups combined, VLDL apolipoprotein C-III levels are nominallyreduced (−0.023 SD units, 95% CI −0.44 to −0.014, p = 0.037). VLDLtriglyceride transfer is nominally increased in the MedDiet-Nuts group (+0.39SD units, 95% CI 0.012–0.78, p = 0.045). In PREDIMED-Plus, no inter-groupdifferences are detected.Conclusions: In older adults at high cardiovascular risk, MedDiet isassociated with lower VLDL atherogenicity versus a low-fat diet. Nodifferences are seen after an energy-reduced MedDiet with physical activity.