Effects of Increasing Total Fruit Intake With Avocado and Mango on Endothelial Function and Cardiometabolic Risk Factors in Adults With Prediabetes

Background Low fruit intake is a global risk factor for cardiometabolic diseases. This study sought to investigate vascular and metabolic effects of increasing total and select fruit intake in adults with prediabetes. Methods This randomized, 2‐arm parallel, partially controlled feeding study provided participants (n=82, aged 45±15 years, 30±6 kg/m 2 ) weekly diets (1500 [women] or 1750 kcal/d [men]) incorporating 1 avocado and 1 cup of mango (avocado–mango diet) daily for 8 weeks or energy‐matched low‐fat, low‐fiber foods (control diet). Flow‐mediated vasodilation was the primary end point. Central and brachial blood pressure; pulse‐wave velocity; metabolic, inflammatory, and kidney function markers; and dietary intake were secondary end points. Change (Δ) data were analyzed by mixed model ANCOVA or Wilcoxon rank‐sum test, and postprandial and dietary intake data by repeated‐measures ANOVA using SAS 9.4 (SAS Institute, Cary, NC). Results Changes in percentage of flow‐mediated vasodilation were significantly different between interventions (effect, −2.11±0.77%; P =0.008), increasing ≈1% on the avocado–mango diet and decreasing on the control diet, as were changes in central and brachial diastolic blood pressure ( P =0.07 and P =0.03, respectively), specifically in men. Other end points were generally not different between diets ( P >0.05), although select lipids and kidney markers were marginally different ( P <0.1). Total fruit, dietary fiber, vitamin C, and monounsaturated fat intake significantly increased during the avocado–mango diet compared with the control diet ( P <0.05). Conclusions In adults with prediabetes, daily inclusion of avocado and mango increases fruit consumption, diversifies nutrient composition, and improves vascular function associated with cardiovascular health. REGISTRATION URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05353790.