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Randomised trial of coconut oil, olive oil or butter on blood lipids and other cardiovascular risk factors in healthy men and women
  1. Kay-Tee Khaw1,
  2. Stephen J Sharp2,
  3. Leila Finikarides3,4,
  4. Islam Afzal5,
  5. Marleen Lentjes1,
  6. Robert Luben1,
  7. Nita G Forouhi2
  1. 1 Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2 Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
  3. 3 BBC Television ‘Trust Me I’m a Doctor’, BBC Glasgow, Glasgow, UK
  4. 4 Winton Centre for Evidence Communication, University of Cambridge, Cambridge, UK
  5. 5 Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
  1. Correspondence to Professor Kay-Tee Khaw; kk101{at}medschl.cam.ac.uk and Professor Nita G Forouhi; nita.forouhi{at}mrc-epid.cam.ac.uk

Abstract

Introduction High dietary saturated fat intake is associated with higher blood concentrations of low-density lipoprotein cholesterol (LDL-C), an established risk factor for coronary heart disease. However, there is increasing interest in whether various dietary oils or fats with different fatty acid profiles such as extra virgin coconut oil may have different metabolic effects but trials have reported inconsistent results. We aimed to compare changes in blood lipid profile, weight, fat distribution and metabolic markers after four weeks consumption of 50 g daily of one of three different dietary fats, extra virgin coconut oil, butter or extra virgin olive oil, in healthy men and women in the general population.

Design Randomised clinical trial conducted over June and July 2017.

Setting General community in Cambridgeshire, UK.

Participants Volunteer adults were recruited by the British Broadcasting Corporation through their websites. Eligibility criteria were men and women aged 50–75 years, with no known history of cancer, cardiovascular disease or diabetes, not on lipid lowering medication, no contraindications to a high-fat diet and willingness to be randomised to consume one of the three dietary fats for 4 weeks. Of 160 individuals initially expressing an interest and assessed for eligibility, 96 were randomised to one of three interventions; 2 individuals subsequently withdrew and 94 men and women attended a baseline assessment. Their mean age was 60 years, 67% were women and 98% were European Caucasian. Of these, 91 men and women attended a follow-up assessment 4 weeks later.

Intervention Participants were randomised to extra virgin coconut oil, extra virgin olive oil or unsalted butter and asked to consume 50 g daily of one of these fats for 4 weeks, which they could incorporate into their usual diet or consume as a supplement.

Main outcomes and measures The primary outcome was change in serum LDL-C; secondary outcomes were change in total and high-density lipoprotein cholesterol (TC and HDL-C), TC/HDL-C ratio and non-HDL-C; change in weight, body mass index (BMI), waist circumference, per cent body fat, systolic and diastolic blood pressure, fasting plasma glucose and C reactive protein.

Results LDL-C concentrations were significantly increased on butter compared with coconut oil (+0.42, 95% CI 0.19 to 0.65 mmol/L, P<0.0001) and with olive oil (+0.38, 95% CI 0.16 to 0.60 mmol/L, P<0.0001), with no differences in change of LDL-C in coconut oil compared with olive oil (−0.04, 95% CI −0.27 to 0.19 mmol/L, P=0.74). Coconut oil significantly increased HDL-C compared with butter (+0.18, 95% CI 0.06 to 0.30 mmol/L) or olive oil (+0.16, 95% CI 0.03 to 0.28 mmol/L). Butter significantly increased TC/HDL-C ratio and non-HDL-C compared with coconut oil but coconut oil did not significantly differ from olive oil for TC/HDL-C and non-HDL-C. There were no significant differences in changes in weight, BMI, central adiposity, fasting blood glucose, systolic or diastolic blood pressure among any of the three intervention groups.

Conclusions and relevance Two different dietary fats (butter and coconut oil) which are predominantly saturated fats, appear to have different effects on blood lipids compared with olive oil, a predominantly monounsaturated fat with coconut oil more comparable to olive oil with respect to LDL-C. The effects of different dietary fats on lipid profiles, metabolic markers and health outcomes may vary not just according to the general classification of their main component fatty acids as saturated or unsaturated but possibly according to different profiles in individual fatty acids, processing methods as well as the foods in which they are consumed or dietary patterns. These findings do not alter current dietary recommendations to reduce saturated fat intake in general but highlight the need for further elucidation of the more nuanced relationships between different dietary fats and health.

Trial registration number NCT03105947; Results.

  • blood lipids
  • dietary fats
  • randomized trial
  • coconut oil
  • olive oil

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors K-TK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: KT-K, NGF, LF. Acquisition of data: KT-K, NGF, LF, IA, RL, ML. Analysis and interpretation of the data: KT-K, NGF, LF. Drafting of the manuscript: KT-K. Critical revision of the manuscript for important intellectual content: NGF, SJS, IA, LF, RL, ML. Obtaining funding: KT-K, NGF, LF. Administrative, technical or material support: KT-K, NGF, LF, IA, RL, SJS, ML.

  • Funding This work was supported by the British Broadcasting Corporation, a National Institute of Health Research Senior Investigator Award to K-TK and core MRC Epidemiology support (MC UU 12015/5).

  • Disclaimer The lead author and guarantor K-TK affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was given for the study by the University of Cambridge Human Biology Research Ethics committee HBREC 2017.05.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available. Please contact corresponding author.

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