In two separate studies, the cholesterol-lowering efficacy of a diet high in monounsaturated fatty acids (MUFA) was evaluated by means of a randomized crossover trial. In both studies subjects were randomized to receive either a high-MUFA diet or the control diet first, which they followed for a period of 8 weeks; following a washout period of 4–6 weeks they were transferred onto the opposing diet for a further period of 8 weeks. In one study subjects were healthy middle-aged men (n 30), and in the other they were young men (n 23) with a family history of CHD recruited from two centres (Guildford and Dublin). The two studies were conducted over the same time period using identical foods and study designs. Subjects consumed 38 % energy as fat, with 18 % energy as MUFA and 10 % as saturated fatty acids (MUFA diet), or 13 % energy as MUFA and 16 % as saturated fatty acids (control diet). The polyunsaturated fatty acid content of each diet was 7 %. The diets were achieved by providing subjects with manufactured foods such as spreads, ‘ready meals’, biscuits, puddings and breads, which, apart from their fatty acid compositions, were identical for both diets. Subjects were blind to which of the diets they were following on both arms of the study. Weight changes on the diets were less than 1 kg. In the groups combined (n 53) mean total and LDL-cholesterol levels were significantly lower at the end of the MUFA diet than the control diet by 0·29 (sd 0·61) mmol/l (P < 0·001) and 0·38 (sd 0·64) mmol/l (P < 0·0001) respectively. In middle-aged men these differences were due to a mean reduction in LDL-cholesterol of – 11 (sd 12) % on the MUFA diet with no change on the control diet (−1·1 (sd 10) %). In young men the differences were due to an increase in LDL-cholesterol concentration on the control diet of +6·2 (sd 13) % and a decrease on the MUFA diet of −7·8 (sd 20) %. Differences in the responses of middle-aged and young men to the two diets did not appear to be due to differences in their habitual baseline diets which were generally similar, but appeared to reflect the lower baseline cholesterol concentrations in the younger men. There was a moderately strong and statistically significant inverse correlation between the change in LDL-cholesterol concentration on each diet and the baseline fasting LDL-cholesterol concentration (r – 0·49; P < 0·0005). In conclusion, diets in which saturated fat is partially replaced by MUFA can achieve significant reductions in total and LDL-cholesterol concentrations, even when total fat and energy intakes are maintained. The dietary approach used to alter fatty acid intakes would be appropriate for achieving reductions in saturated fat intakes in whole populations.
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