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Session: Predictors of Diet Quality Across the Lifespan (Oral 17)

(OR17-05-23) Effect of Daily Incorporation of One Avocado on Diet Quality Assessed by the Healthy Eating Index-2015: A Randomized Trial

Monday, July 24, 2023
10:48 AM – 11:00 AM ET
Location:  Constitution B
Disclosure(s):
Kristina S. Petersen, PhD, APD, FAHA: No relevant financial relationship(s) with ineligible companies to disclose.
Alice H. Lichtenstein, DSc: Hass avocado Board: Grant/Research Support (Terminated)
Nirupa R. Matthan, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Zhaoping Li, MD, PhD: WiseCode Nutrition Institute: Advisory Committee/Board Member (Ongoing)
Joan Sabaté, MD, DrPH: No relevant financial relationship(s) with ineligible companies to disclose.
Penny M. Kris-Etherton, PhD: No relevant financial relationship(s) with ineligible companies to disclose.
Objectives: Few clinical trials have evaluated diet quality change as a predictor of intervention effectiveness. We examined changes in the Healthy Eating Index-2015 (HEI) in response to a single food-based intervention. The association between HEI change and intervention effects on cardiometabolic risk-related trial outcomes was also assessed.

Methods: The Habitual Diet and Avocado Trial was a multicenter, randomized, controlled parallel-arm study that included 1008 participants aged ≥25 years with elevated waist circumference (women ≥35 inches; men ≥40 inches). The Avocado Supplemented Diet (AVO) group was given and asked to consume one avocado per day, and the Habitual Diet (HD) Group continued their usual diet. Dietary intake was assessed by 24-hour recalls at baseline and 8, 16, and 26 weeks.

Results: At baseline, the HEI score was suboptimal for both groups (AVO: 53.3±15.1 points; HD: 54.0±14.5 points). At 26 weeks, the HEI score was 4.7 points (95% CI 2.9, 6.5) higher in the AVO group compared to the HD Group. The AVO Group had higher scores, compared to the HD group, for the following HEI components: Total Vegetables (mean difference 0.99 points; 95% CI 0.77, 1.21), Fatty Acid Ratio (2.25 points; 95% CI 1.74, 2.77), Sodium (1.03 points; 95% CI 0.52, 1.55), Refined Grains (0.82 points; 95% CI 0.32, 1.31), and Added Sugars (0.84 points; 95% CI 0.49, 1.19). Subgroup analyses showed no difference in HEI improvement by race, ethnicity, BMI category, age group and study site. The HEI effect differed by sex (p=0.002). In the AVO vs. the HD group, HEI was increased in women (6.5 points; 95% CI 4.39, 8.62), but not men (0.02 points; 95% CI -3.44, 3.48). Median HEI change was not associated with intervention effects for the primary outcome (visceral adipose tissue volume), secondary outcomes (hepatic fat fraction, hsCRP and metabolic syndrome criteria), or additional outcomes (lipids/lipoproteins, insulin, weight).

Conclusions: Intake of one avocado per day as part of usual intake for 6 months in free-living individuals with elevated waist circumference modestly increased diet quality. Small improvements in diet quality over a long period of time may result in improved long-term cardiometabolic outcomes.

Funding Sources: Avocado Nutrition Center