Aceite de oliva y peso corporal. Revisión sistemática y metaanálisis de ensayos controlados aleatorizados

Zamora Zamora, Francisca; Martínez Galiano, Juan Miguel; Gaforio Martínez, Jose Juan; Delgado Rodríguez, Miguel

RESUMEN

Fundamentos:

El aceite de oliva, grasa fundamental de la dieta mediterránea, ha contribuido a un descenso de la obesidad en diversos estudios epidemiológicos. Se desconoce si por sí mismo puede disminuir el peso con independencia de la dieta utilizada. El objetivo de este trabajo fue determinar la eficacia del aceite de oliva en la reducción ponderal.

Métodos:

Revisión sistemática con metaanálisis de ensayos controlados aleatorizados (ECA) de al menos 12 semanas de intervención sobre adultos sin eventos cardiovasculares previos, para estimar el efecto de una dieta enriquecida con aceite de oliva sobre el peso, cintura e índice de masa corporal. La búsqueda se realizó en PubMed, Embase, Cochrane plus, Web of Science, Ovid, Scopus, Biblioteca Virtual en Salud (BVS), Tesis Doctorales en Red (TDR), hasta diciembre de 2016. No se restringió idioma, sexo ni patología de base. Utilizamos Stata14 SE para la síntesis de datos.

Resultados:

Se identificaron 490 estudios, de ellos sólo 11 estudios cumplieron los criterios de inclusión. Una dieta enriquecida con aceite de oliva redujo más el peso que una dieta control -0,92 kg, IC 95% (-1,16,-0,67), p heterogeneidad =0,1; disminuyó la cintura en -0,60 cm, IC 95% ( -1,17,-0,04), p heterogeneidad = 0,6; y descendió el IMC en -0,90, IC 95% (-0,91, -0,88), p heterogeneidad < 0,001. El efecto favorable fue cuando el aceite se suplementó de forma líquida y no con cápsulas.

Conclusiones:

Una dieta enriquecida con aceite de oliva puede ser una importante estrategia de control ponderal en personas sin eventos cardiovasculares previos.

Palabras clave:
Aceite de oliva; Índice de masa corporal; Obesidad; Peso corporal; Sobrepeso

ABSTRACT

Background:

Olive oil, as fundamental fat in the Mediterranean diet, has contributed to a decrease in obesity in several epidemiological studies. It is unknown whether olive oil itself can decrease the weight independently of the diet used. The objective of this work was to determine the efficacy of olive oil in reducing weight.

Methods:

Systematic review of meta-analysis of randomized controlled trials (RCTs) of at least 12 weeks of intervention on adults without previous cardiovascular events to estimate the effect of an olive-enriched diet on weight, waist and body mass index. The search was performed in PubMed, Embase, Cochrane plus, Web of Science, Ovid, Scopus, Virtual Health Library (BVS), Theses and Dissertations Online (TDX) until December 2016. No language, gender or underlying pathology was restricted. We used Stata14 SE for data synthesis.

Results:

490 studies were identified, of which only 11 studies met the inclusion criteria. A diet enriched in olive oil reduced weight more than control diet: -0.92 kg, 95% CI (-1.16, -0.67), p heterogeneity = 0.1; decreased waist circumference in -0.60 cm, 95% CI (-1.17, -0.04), p heterogeneity = 0.6; and diminished BMI in -0.90, 95% CI (-0.91, -0.88), p heterogeneity < 0.001. The benefits were seen when olive oil was supplemented in its natural state and not when capsules were given.

Conclusions:

A diet enriched with olive oil can be an important weight control strategy in people without previous cardiovascular events.

Keywords:
Body mass index; Body weight; Olive oil; Obesity; Overweight

INTRODUCCIÓN

En 2014 la OMS estimó que entre las personas adultas existían más de 600 millones de obesos y que el 39% tenían sobrepeso¹1. World Health Organization:Obesity and overweight. Fact sheet nº 311. June 2016; [consultado el 30/07/2017]. Disponible en: http://www.who.int/mediacentre/factsheets/fs311/en/
http://www.who.int/mediacentre/factsheet... . El exceso de peso es una epidemia en el mundo desarrollado y está estrechamente relacionado con la enfermedad cardiovascular y la mortalidad²2. García-Ríos A, Delgado-Lista J, Alcalá-Díaz JF, López-Miranda J, Perez-Martinez P. Nutraceuticals and coronary heart disease. Curr Opin Cardiol. 2013; 28(4): 475-82.^,³3. Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016; 133(7): 639-49.. Algunas sociedades científicas todavía recomiendan una dieta baja en grasa para perder peso⁴4. González-Campoy JM, St Jeor ST, Castorino K, Ebrahim A, Hurley D, Jovanovic L, et al; American Association of Clinical Endocrinologists; American College of Endocrinology and the Obesity Society. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013; 19 Suppl 3: 1-82., mientras que el Departamento de Salud de EE.UU.⁵5. USDA and US Department of Health and Human Services. Dietary Guidelines Advisory Committee. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Advisory Report to the Secretary of Health and Human Services and The Secretary of Agriculture.Washington (DC): USDA and US Department of Health and Human Services. 2015; [consultado el 30/07/2017]. Disponible en: http://www.health.gov/dietaryguidelines/2015-scientific-report/
http://www.health.gov/dietaryguidelines/... desaconseja una dieta baja en grasa y alta en carbohidratos, al demostrarse en varios ensayos controlados que una dieta alta en grasa reduce el riesgo de eventos cardiovasculares⁶6. Appel LJ, Sacks FM, Carey VJ, Obarzanek E, Swain JF, Miller ER 3rd, et al; OmniHeart Collaborative Research Group. Effects of protein, monounsaturated fat, and carbohydrate intake on blood pressure and serum lipids: results of the OmniHeart randomized trial. JAMA. 2005; 294 (19): 2455-64.. Según el ensayo PREDIMED (PREvención con Dieta MEDiterránea), el consumo de dieta mediterránea enriquecida con aceite de oliva o nueces reduce los eventos cardíacos, cerebrovasculares y las muertes de causa cardiovascular⁷7. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368 (14): 1279-90..

La dieta mediterránea se caracteriza por un 37% de energía dedicada a la grasa⁸8. Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean Diet; a Literature Review. Nutrients. 2015; 7(11): 9139-53.. En diversos estudios epidemiológicos se relaciona el cumplimiento de la dieta mediterránea con un descenso de obesidad y sobrepeso⁹9. Buckland G, Bach A, Serra-Majem L. Obesity and the Mediterranean diet: a systematic review of observational and intervention studies. Obes Rev. 2008; 9(6):582-93.^,¹⁰10. Schröder H, Marrugat J, Vila J, Covas MI, Elosua R. Adherence to the traditional mediterranean diet is inversely associated with body mass index and obesity in a spanish population. J Nutr. 2004; 134 (12): 3355-61.^,¹¹11. Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, et al. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003; 289 (14): 1799-804.^,¹²12. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004; 292 (12): 1440-6., aparte de reducir otros factores de riesgo cardiovascular, sobre todo en diabéticos¹³13. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008; 359(3): 229-41.^,¹⁴14. Qian F, Korat AA, Malik V, Hu FB. Metabolic Effects of Monounsaturated Fatty Acid-Enriched Diets Compared With Carbohydrate or Polyunsaturated Fatty Acid-Enriched Diets in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2016; 39 (8): 1448-57.. En la cohorte EPIC-PANACEA, en 373.803 individuos, los cumplidores con la dieta mediterránea presentaron una menor probabilidad de desarrollar obesidad y sobrepeso¹⁵15. Trichopoulou A, Naska A, Orfanos P, Trichopoulos D. Mediterranean diet in relation to body mass index and waist-to-hip ratio: the Greek European Prospective Investigation into Cancer and Nutrition Study. Am J Clin Nutr. 2005; 82 (5): 935-40.^,¹⁶16. Mendez MA, Popkin BM, Jakszyn P, Berenguer A, Tormo MJ, Sanchéz MJ, et al. Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity. J Nutr. 2006; 136 (11): 2934-8.^,¹⁷17. Romaguera D, Norat T, Vergnaud AC, Mouw T, May AM, Agudo A, et al. Mediterranean dietary patterns and prospective weight change in participants of the EPIC-PANACEA project. Am J Clin Nutr. 2010; 92 (4): 912-21.. Lo mismo se observó en la cohorte SUN de Navarra, los consumidores de aceite de oliva tuvieron a lo largo de cuatro años menor aumento ponderal¹⁸18. Bes-Rastrollo M, Sánchez-Villegas A, de la Fuente C, de Irala J, Martinez JA, Martínez-González MA. Olive oil consumption and weight change: the SUN prospective cohort study. Lipids. 2006; 41(3): 249-56.^,¹⁹19. Beunza JJ, Toledo E, Hu FB, Bes-Rastrollo M, Serrano-Martínez M, Sánchez-Villegas A, et al. Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr. 2010; 92(6): 1484-93.. Los trabajos anteriores se sintetizan en varios metaanálisis en los que se muestra que la dieta mediterránea reduce el peso, el índice de masa corporal (IMC), y el riesgo cardiovascular en diabéticos¹³13. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008; 359(3): 229-41.^,¹⁴14. Qian F, Korat AA, Malik V, Hu FB. Metabolic Effects of Monounsaturated Fatty Acid-Enriched Diets Compared With Carbohydrate or Polyunsaturated Fatty Acid-Enriched Diets in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2016; 39 (8): 1448-57., sobre todo cuando se asocia a restricción calórica²⁰20. Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D. Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord. 2011; 9(1): 1-12..

El aceite de oliva constituye la principal fuente de grasa dietética de la dieta mediterránea²¹21. Trichopoulou A, Dilis V. Olive oil and longevity. Mol Nutr Food Res. 2007; 51(10): 1275- 8.^,²²22. Pérez-Jiménez F, Ruano J, Perez-Martinez P, Lopez-Segura F, Lopez-Miranda J. The influence of olive oil on human health: not a question of fat alone. Mol Nutr Food Res. 2007; 51(10): 1199-208. y es la característica fundamental de esta dieta. Al aceite de oliva se le considera parcialmente responsable de los beneficios cardiovasculares⁷7. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368 (14): 1279-90. y antioxidantes de la dieta mediterránea²³23. Fitó M, Guxens M, Corella D, Sáez G, Estruch R, de la Torre R, et al; PREDIMED Study Investigators. Effect of a traditional Mediterranean diet on lipoprotein oxidation: a randomized controlled trial. Arch Intern Med. 2007; 167(11): 1195-203.. Se ha encontrado una relación entre el consumo de dieta mediterránea enriquecida en aceite de oliva virgen extra (AOVE) con la capacidad antioxidante del plasma y la reducción de peso en individuos seguidos durante tres años²⁴24. Razquin C, Martínez JA, Martínez-González MA, Mitjavila MT, Estruch R, Marti A. A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain. Eur J Clin Nutr. 2009; 63 (12): 1387-93.. Así mismo en una cohorte malacitana, los consumidores de aceite de oliva tuvieron una menor incidencia de obesidad a lo largo de 6 años²⁵25. Soriguer F, Almaraz MC, Ruiz-de-Adana MS, Esteva I, Linares F, García-Almeida JM, et al. Incidence of obesity is lower in persons who consume olive oil. Eur J Clin Nutr. 2009; 63 (11): 1371-4.. La prevalencia de obesidad en un estudio transversal malagueño fue menor en los consumidores de aceite de oliva²⁶26. Soriguer F, Rojo-Martínez G, Goday A, Bosch-Comas A, Bordiú E, Caballero-Díaz F, et al. Olive oil has a beneficial effect on impaired glucose regulation and other cardiometabolic risk factors. Di@bet.es study. Eur J Clin Nutr. 2013; 67(9): 911-6.. Sin embargo, es difícil determinar si el efecto se debe a la dieta mediterránea asociada al aceite de oliva o si el aceite de oliva posee propiedades por sí mismo que reducen el peso, la obesidad o los eventos cardiovasculares. En un ensayo clínico de corta duración, la sustitución de la grasa saturada por monoinsaturada (aceite de oliva y frutos secos) redujo el peso y el colesterol total durante cuatro semanas²⁷27. Piers LS, Walker KZ, Stoney RM, Soares MJ, O’Dea K. Substitution of saturated with monounsaturated fat in a 4-week diet affects body weight and composition of overweight and obese men. Br J Nutr. 2003; 90(3): 717-27.. Sería interesante comprobar si este efecto se mantiene en el tiempo y si se debe al aceite de oliva con independencia de la dieta utilizada.

El objetivo de este estudio fue valorar si el consumo de aceite de oliva reduce el peso de individuos adultos sin eventos cardiovasculares previos.

MATERIAL Y MÉTODOS

Diseño. Se realizó una revisión sistemática con metaanálisis siguiendo las recomendaciones establecidas por la declaración PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses²⁸28. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097..

Criterios de inclusión. Se han utilizaron los siguientes criterios de inclusión: a) población adulta con al menos 18 años, independientemente de su sexo, sin eventos cardiovasculares previos; b) intervención: dieta enriquecida con aceite de oliva durante al menos 12 semanas; c) comparador: dieta enriquecida con otra grasa; d) efectos: peso, IMC o perímetro abdominal; y d) diseño de estudios incluidos: ensayos clínicos aleatorizados (ECA).

Criterios de exclusión. Se excluyeron estudios en los que la intervención se llevó a cabo en pacientes cardiovasculares por experimentar éstos un cambio profundo en su estilo de vida, incluida la dieta, no comparable con los sujetos sanos o con otro tipo de enfermedades.

Búsqueda en bases de datos. Los estudios fueron seleccionados a partir del título y resumen, obteniéndose a texto completo para un análisis más detallado. La búsqueda se desarrolló en las bases de datos PubMed (desde 1966), Embase (desde 1974), Cochrane plus (desde 1993), Web of Science (desde 1990), Ovid (desde 1946), Scopus (desde 1960), BVS (desde 1980), TDR (desde 1976) hasta el 9 de diciembre de 2016. La estrategia de búsqueda se realizó mediante la combinación de palabras clave relacionadas con ingesta de aceite de oliva ('olive oil'), la obesidad ('obesity', 'overweight', 'body weight', 'obesity abdominal', 'body mass index'), el diseño de estudios adecuados para inclusión ('randomized controlled trial', 'systematic review', 'meta-analysis'), y operadores booleanos ('OR','AND'). No se restringió el idioma. Se realizó una búsqueda manual inversa con recuperación secundaria de artículos y literatura gris de grupos de trabajo de sociedades científicas y bases de datos como TDR²⁹29. Consenso FESNAD-SEEDO. Recomendaciones nutricionales basadas en la evidencia para la prevención y el tratamiento del sobrepeso y la obesidad en adultos. Rev Esp Obes. 2011;10 (Supl 1): 1-78..

Evaluación de la validez. La selección de los artículos candidatos a ser identificados se hizo por dos investigadores de manera independiente; en caso de discrepancia un tercer investigador tomó la decisión. Cada artículo recuperado se evaluó por dos revisores independientes, y en caso de discordancia un tercer investigador fue consultado. Para la evaluación del riesgo de sesgo se utilizó la herramienta Cochrane³⁰30. Centro Cochrane Iberoamericano, traductores. Manual Cochrane de Revisiones Sistemáticas de Intervenciones, versión 5.1.0 [actualizada en marzo de 2011] [Internet]. Barcelona: Centro Cochrane Iberoamericano; 2012. Disponible en http://www.cochrane.es/?q=es/node/269.
http://www.cochrane.es/?q=es/node/269... . Para cada estudio se consideró si tenían alto riesgo, bajo o riesgo poco claro de sesgo, mediante la valoración de los siete dominios: generación de la secuencia, ocultación de la asignación, cegamiento de participantes, personal y evaluadores, datos de resultados incompletos, notificación selectiva de los resultados y otros sesgos. Los estudios incluidos tras el análisis de validez se muestran en la tabla 1.

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Tabla 1
Características de estudios incluidos en la revisión sistemática

Extracción de datos. Se han extraído los siguientes datos de cada estudio: autores, año de publicación, país de realización, duración, cantidad de aceite de oliva ingerido y control utilizado, características y número de participantes en cada intervención aplicada, resultados de peso, índice de masa corporal, y perímetro abdominal, energía consumida y actividad física realizada (tabla 1). La extracción de datos se realizó por dos autores independientemente, mediante un formato estándar.

Síntesis de datos. La medida de efecto estimado ha sido la diferencia de medias con su error estándar. La estadística se ha hecho con el programa Stata 14 SE (College Station, TX, EE.UU.). Se han utilizado los modelos de efectos fijos y aleatorios ponderando por el inverso de la varianza. Para el análisis de la heterogeneidad se ha estimado la Q de Cochran resultando significativa si p < 0,1. Se cuantificó la proporción de heterogeneidad con el estadístico I²⁽³¹31. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414): 557-60.. Se realizó metarregresión para determinar si las diferentes dosis de aceite de oliva administrado justificaban la variabilidad de los resultados cuando hubo heterogeneidad. Para determinar la posible existencia de sesgo de publicación se aplicó el método de Egger.

RESULTADOS

Búsqueda bibliográfica. La búsqueda identificó 490 estudios, 89 estudios en Pub Med, 60 en Embase, 29 en la Biblioteca Cochrane Plus, 120 estudios en Web of Science, 32 estudios en Ovid, 30 en Scopus, 24 fueron en BVS y 106 estudios de literatura gris de TDR y búsqueda manual e inversa. Después de la exclusión de los duplicados se valoraron 378 estudios. Posteriormente se excluyeron los registros que no cumplían los criterios de inclusión. 34 estudios fueron revisados a texto completo. 8 estudios se excluyeron para no duplicar los participantes²⁴24. Razquin C, Martínez JA, Martínez-González MA, Mitjavila MT, Estruch R, Marti A. A 3 years follow-up of a Mediterranean diet rich in virgin olive oil is associated with high plasma antioxidant capacity and reduced body weight gain. Eur J Clin Nutr. 2009; 63 (12): 1387-93.^,³³33. Álvarez-Pérez J, Sánchez-Villegas A, Díaz-Benítez EM, Ruano-Rodríguez C, Corella D, Martínez-González MÁ, et al; PREDIMED Study Investigators. Influence of a Mediterranean Dietary Pattern on Body Fat Distribution: Results of the PREDIMED-Canarias Intervention Randomized Trial. J Am Coll Nutr. 2016; 35(6): 568-580.^,³⁴34. Casas R, Sacanella E, Urpí-Sardà M, Chiva-Blanch G, Ros E, Martínez-González MA, et al. The effects of the mediterranean diet on biomarkers of vascular wall inflammation and plaque vulnerability in subjects with high risk for cardiovascular disease. A randomized trial. PLoS One. 2014; 9(6): e100084.^,³⁵35. Babio N, Toledo E, Estruch R, Ros E, Martínez-González MA, Castañer O, et al; PREDIMED Study Investigators. Mediterranean diets and metabolic syndrome status in the PREDIMED randomized trial. CMAJ. 2014; 186(17): E649-57.^,³⁶36. Lasa A, Miranda J, Bulló M, Casas R, Salas-Salvadó J, Larretxi I, et al. Comparative effect of two Mediterranean diets versus a low-fat diet on glycaemic control in individuals with type 2 diabetes. Eur J Clin Nutr. 2014; 68 (7): 767-72.^,³⁷37. Salas-Salvadó J, Bulló M, Babio N, Martínez-González MA, Ibarrola-Jurado N, Basora J, et al; PREDIMED Study Investigators. Reduction in the incidence of type 2 diabetes with the Mediterranean diet: results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011; 34(1):14-9.^,³⁸38. Razquin C, Martínez JA, Martínez-González MA, Salas-Salvadó J, Estruch R, Marti A. A 3-year Mediterranean-style dietary intervention may modulate the association between adiponectin gene variants and body weight change. Eur J Nutr. 2010; 49 (5): 311-9.^,³⁹39. Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, et al; PREDIMED Study Investigators. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008; 168 (22): 2449-58., lo cual llevó a la inclusión de 11 estudios³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴²4. González-Campoy JM, St Jeor ST, Castorino K, Ebrahim A, Hurley D, Jovanovic L, et al; American Association of Clinical Endocrinologists; American College of Endocrinology and the Obesity Society. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013; 19 Suppl 3: 1-82.^,4,³3. Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016; 133(7): 639-49.^,⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., por las razones mencionadas en la figura 1.

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Figura 1
Diagrama de flujo de estudios incluidos en revisión sistemática y metaanálisis

Características de los estudios incluidos en revisión sistemática.

Características generales de estudios incluidos: Once estudios se incluyeron en la revisión sistemática y metaanálisis³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴²4. González-Campoy JM, St Jeor ST, Castorino K, Ebrahim A, Hurley D, Jovanovic L, et al; American Association of Clinical Endocrinologists; American College of Endocrinology and the Obesity Society. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013; 19 Suppl 3: 1-82.^,4,³3. Aune D, Sen A, Norat T, Janszky I, Romundstad P, Tonstad S, et al. Body Mass Index, Abdominal Fatness, and Heart Failure Incidence and Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Circulation. 2016; 133(7): 639-49.^,⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83.. En la tabla 1 se muestra un resumen de la información extraída de los estudios incluidos. Los diseños empleados por los estudios fueron: cuatro estudios ECA doble ciego⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., uno de ellos cruzado⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9. y siete estudios ECA abiertos³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., de los cuales, cuatro eran de brazos múltiples³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.. Los periodos de seguimiento fueron desde 12 semanas⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.

48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^-⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., 16 semanas⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6., 6 meses⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60., 1 año⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231., hasta 4,8 años de mediana³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.. Los países en los que se desarrollaron los estudios fueron España³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9., Colombia⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54., EE.UU.⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28., India⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61., Australia⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231., Reino Unido⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12., Noruega⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60. y Suecia⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83..
Población de los estudios incluidos: Los 11 estudios incluidos en el metaanálisis totalizaron 8.117 sujetos. De ellos 2.845 participantes habían ingerido aceite de oliva y 2.762 la dieta control; se han descartado del presente análisis las ramas con dieta mediterránea y nueces³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., aceite de soja/cártamo⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61., y dieta hipocalórica más pescado⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.. Los participantes de los estudios eran adultos que presentaban factores de riesgo cardiovascular, como diabetes⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., consumo de tabaco, hipertensión TA >140/90 mmHg, elevación de LDL (≥4,14 mmol/L), HDL (<1,04 mmol/L en hombres y <1,30 mmol/L en mujeres), sobrepeso u obesidad (IMC ≥ 25 kg/m²) o historia familiar de enfermedad coronaria prematura³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.. La media del IMC fue > 25 kg/m² en la mayoría de los estudios ⁴⁰⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83.. En Estruch et al³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11. el 90% tenían obesidad o sobrepeso.
Intervención realizada en los estudios: El aceite de oliva se administró en cápsulas de 1-6 g/día⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., y en forma líquida, entre 20 g y 53 g, como AOVE ³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9. o aceite de oliva ⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^). A los controles se les administraron otras dietas: basada en aceite de palma (25 ml/día)⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54., aceite de maíz, aceite de soja y mantequilla más dieta americana (41 ± 8 g/día⁾⁽⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28., aceite de canola (20 g/día⁾⁽⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61., dieta hipocalórica más pescado y ácidos grasos de cadena larga n-3⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231., aceite de triglicéridos de cadena media más dieta hipocalórica (18-24 g/día)⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6., ácido linoleico conjugado (3-4,5 g/día)⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., dieta baja en grasa ³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., y dieta alta en carbohidratos⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.. La dieta administrada fue adecuada a los requerimientos energéticos, salvo en Tapsell et al 2013⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231. y St-Onge y Bosarge 2008³⁹39. Salas-Salvadó J, Fernández-Ballart J, Ros E, Martínez-González MA, Fitó M, Estruch R, et al; PREDIMED Study Investigators. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one-year results of the PREDIMED randomized trial. Arch Intern Med. 2008; 168 (22): 2449-58., en los que se administró dieta hipocalórica. En Tapsell et al 2013⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231. se consumieron 1750 ± 417 kcal y 1600 ± 355 kcal en los grupos de aceite de oliva y control respectivamente con un descenso significativo en el trascurso del estudio sin diferencias entre grupos. En St-Onge y Bosarge 2008⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6. se consumieron 1500 kcal en mujeres y 1800 kcal en hombres. La energía consumida en Estruch et al³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76. fue mayor para el grupo de aceite de oliva, un exceso de 141 kcal, IC 95% (97-185), p < 0,001, respecto al grupo de dieta baja en grasa, mientras que en Taylor et al 2006⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12. no se hizo este análisis. La actividad física fue similar entre grupos y no se restringió. En algunos estudios se recomendó mantener un nivel similar de actividad física⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9. o dar paseos⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231..
Calidad de los estudios incluidos: La figura 2 sintetiza el riesgo de sesgo para todos los dominios y todos los estudios. El método de generación aleatoria de la secuencia fue descrito adecuadamente en siete estudios³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.^,⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.

48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^-⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83.. Cuatro estudios explicaron de manera adecuada la ocultación de la asignación a la intervención, por lo que se identificaron como de bajo riesgo de sesgo³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., mientras que sólo dos estudios⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83., se consideraron como de bajo riesgo de sesgo a causa de conocer los participantes o el personal la intervención asignada. 4 estudios³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^), fueron considerados de bajo riesgo de sesgo de detección, debido a una explicación adecuada de cegamiento de los evaluadores a los resultados. Diez estudios se vaoloraron como de bajo riesgo de sesgo de desgaste ³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁰⁴¹41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.^,⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.^,⁴³43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.^,⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^,⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83.. Más del 75% de estudios incluyeron todos los resultados esperados y parecían estar libres de otras fuentes de sesgo⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54.

41. Rozati M, Barnett J, Wu D, Handelman G, Saltzman E, Wilson T, et al. Cardio-metabolic and immunological impacts of extra virgin olive oil consumption in overweight and obese older adults: a randomized controlled trial. Nutr Metab (Lond). 2015; 12: 28.

42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.

43. Tapsell LC, Batterham MJ, Charlton KE, Neale EP, Probst YC, O’Shea JE, et al. Foods, nutrients or whole diets: effects of targeting fish and LCn3PUFA consumption in a 12mo weight loss trial. BMC Public Health. 2013; 13:1231.

44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6.

45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12.^-⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60.^,⁴⁸48. Rodríguez-Villar C, Pérez-Heras A, Mercadé I, Casals E, Ros E. Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus. Diabet Med. 2004; 21 (2): 142-9.^,⁴⁹49. Risérus U, Vessby B, Arnlöv J, Basu S. Effects of cis-9, trans-11 conjugated linoleic acid supplementation on insulin sensitivity, lipid peroxidation, and proinflammatory markers in obese men. Am J Clin Nutr. 2004; 80 (2): 279-83.. La energía consumida en Estruch et al³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76. fue mayor para el grupo de aceite de oliva, mientras que el grupo control pudo haber tomado aceite de oliva³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., lo que puede considerarse una limitación de este estudio.
Resultados obtenidos de los estudios incluidos: La estrategia más beneficiosa fue la administración de 20 gr al día de aceite de oliva, que consiguió reducir el peso, la cintura y el IMC de manera significativa⁴²42. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male Asian Indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014; 16 (4): 255-61.. Cuando se tomaron de 18-24 gr de aceite de oliva junto a una dieta hipocalórica⁴⁴44. St-Onge MP, Bosarge A. Weight-loss diet that includes consumption of medium-chain triacylglycerol oil leads to a greater rate of weight and fat mass loss than does olive oil. Am J Clin Nutr. 2008; 87(3): 621-6. y 50 ml de AOVE junto a dieta mediterránea³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76., se logró bajar de peso. El IMC se redujo con la ingesta de 25 ml de AOVE⁴⁰40. Lucci P, Borrero M, Ruiz A, Pacetti D, Frega NG, Diez O, et al. Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns. Food Funct. 2016; 7(1):347-54. y 50 ml de AOVE⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., mientras que cápsulas de aceite de oliva (54 cal/día) respecto a la ingesta de ácido linoleico conjugado, aumentó el IMC en individuos con sobrepeso⁴⁵45. Taylor JS, Williams SR, Rhys R, James P, Frenneaux MP. Conjugated linoleic acid impairs endothelial function. Arterioscler Thromb Vasc Biol. 2006; 26 (2): 307-12..

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Figura 2
Riesgo de sesgo de estudios incluidos

No se han declarado eventos adversos en los estudios incluidos. Sólo en Gaullier et al 2007⁴⁶46. Gaullier JM, Halse J, Høivik HO, Høye K, Syvertsen C, Nurminiemi M, et al. Six months supplementation with conjugated linoleic acid induces regional-specific fat mass decreases in overweight and obese. Br J Nutr. 2007; 97 (3): 550-60., un participante abandonó el estudio por cáncer de mama y otro por infarto de miocardio. En el grupo control un individuo indicó estreñimiento, mientras que en el grupo de aceite de oliva un individuo sufrió una hernia. Los estudios incluidos no indicaron otros eventos.

Resultados del metaanálisis. El modelo de efectos fijos muestra una mayor reducción de peso en los que tomaron aceite de oliva, frente a las dietas control, de -0,92 kg, IC 95% (-1,16, -0,67), con una heterogeneidad moderada (I²= 39,6 %, p heterogeneidad = 0,1). Se ha optado por el modelo de efectos fijos, aunque el modelo de efectos aleatorios mostró resultados muy parecidos, estadísticamente significativos, un descenso de -0.87 kg, IC 95% (-1,53, -0,21); p =0,01 (figura 3).

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Figura 3
Pérdida de peso en dietas enriquecidas con aceite de oliva frente a dietas control

Se ha realizado un análisis de subgrupos para determinar el tipo de administración de aceite de oliva que aporta más beneficios. El modelo de efectos fijos revela que el aceite de oliva líquido desciende el peso casi 1 kg, -0.95 kg, IC 95% (-1,20, -0.70); I² =43,5%, p heterogeneidad = 0,13 (figura 3), mientras que no hubo reducción significativa con cápsulas.

En el caso del perímetro de la cintura el modelo de efectos fijos encuentra que el aceite de oliva la redujo en -0,6 cm, IC 95% (-1,17,-0,04), p= 0,03, sin heterogeneidad I²= 0%, p heterogeneidad = 0,61 (figura 4). Con el suplemento de aceite en forma líquida se observó disminución de cintura, -0,62 cm (IC 95%: -1,18, -0,05), y no con el suplemento en cápsulas (figura 4).

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Figura 4
Metaanálisis de cintura con dietas enriquecidas con aceite de oliva frente a dietas control

En el efecto de IMC, el modelo de efectos fijos muestra una bajada significativa con el aceite de oliva en -0,90 kg/m²(IC 95%: -0.91,-0.88), con una heterogeneidad muy significativa (p < 0.001), en el subgrupo de suplementos con aceite de oliva líquido (figura 5). El análisis de la figura 5 indica que el responsable de la asociación es Estruch et al 2006⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11. que tiene una gran diferencia de tamaño de muestra con los restantes, y un peso superior al 95% del total.

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Figura 5
Descenso de IMC en dietas enriquecidas con aceite de oliva frente a dietas control

Para indagar en las causas de la heterogeneidad de los estudios en el IMC se realizó una metarregresión usando como variable independiente la cantidad en gramos de aceite de oliva. No se encontró ninguna asociación relevante.

Se realizó un análisis de sensibilidad mediante la eliminación de cada uno de los estudios para los diferentes efectos de peso, cintura e IMC. Los resultados fueron similares, salvo en el caso del IMC, en el que la supresión del estudio Estruch et al 2006⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11. ocasionó que no hubiese beneficio y que la significación estadística desapareciera.

En cuanto al sesgo de publicación, el procedimiento de Egger mostró valores de p de 0,276 y 0,249 para la pérdida de peso y perímetro de cintura, respectivamente. Sin embargo, el valor de p para el IMC alcanzó un valor significativo p = 0,01.

DISCUSIÓN

Los resultados de esta revisión sugieren que con el consumo de aceite de oliva se puede disminuir el peso, el perímetro de cintura y el IMC, sobre todo cuando el aceite se consume en su presentación líquida.

Nos hemos centrado en estudios aleatorizados con al menos 12 semanas de intervención para homogeneizar los resultados. En algunos estudios no incluidos en la presente revisión, también se ha observado que el aceite de oliva produce una reducción en el peso, -1,22 ± 0,35 kg (p < 0,01) comparado con otros aceites enriquecidos en fitoesteroles y triglicéridos de cadena media⁵⁰50. Rudkowska I, Roynette CE, Nakhasi DK, Jones PJ. Phytosterols mixed with medium-chain triglycerides and high-oleic canola oil decrease plasma lipids in overweight men. Metabolism. 2006; 55 (3): 391-5., o respecto al consumo de aceite de linaza y mantequilla⁵¹51. Kontogianni MD, Vlassopoulos A, Gatzieva A, Farmaki AE, Katsiougiannis S, Panagiotakos DB, et al. Flaxseed oil does not affect inflammatory markers and lipid profile compared to olive oil, in young, healthy, normal weight adults. Metabolism. 2013; 62 (5): 686-93.^,⁵²52. Anderson-Vasquez HE, Pérez-Martínez P, Ortega Fernández P, Wanden-Berghe C. Impact of the consumption of a rich diet in butter and it replacement for a rich diet in extra virgin olive oil on anthropometric, metabolic and lipid profile in postmenopausal women. Nutr Hosp. 2015; 31 (6): 2561-70.. Así mismo en el estudio de cohortes Three-City Study⁵³53. Samieri C, Féart C, Proust-Lima C, Peuchant E, Tzourio C, Stapf C, et al. Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study. Neurology. 2011; 77 (5): 418-25. se observaron diferencias significativas en el IMC cuando se tomaba aceite de oliva para cocinar y aderezar, además de observar una menor incidencia de eventos cerebrovasculares.

Nuestro metaanálisis es el primero que se realiza con ECA sobre el efecto del aceite de oliva en el peso. En la misma dirección que nuestros resultados un metaanálisis comparó la dieta baja en grasa con respecto a la dieta con alto contenido graso, y no favoreció a la primera para la pérdida de peso⁵⁴54. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of low-fat diet interventions versus other diet interventions on long-term weight change in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015; 3 (12): 968-79.. Otra revisión sistemática, que combinó nueces, semillas y otros aceites no reveló cambios destacables sobre el peso, aunque se incluyeron pocos estudios con aceite de oliva⁵⁵55. De Lira-García C, Bacardí-Gascón M, Jiménez-Cruz A. Efectiveness of long-term consumption of nuts, seeds and seeds' oil on glucose and lipid levels; systematic review. Nutr Hosp. 2012; 27 (4):964-70.. Martínez-González et al 2012⁵⁶56. Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, et al; PREDIMED Study Investigators. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012; 7 (8): e43134. encontraron una asociación negativa entre el grado de cumplimiento de la dieta PREDIMED con la obesidad.

Se ha sugerido que un aumento de 25 g en el consumo de aceite de oliva disminuye el riesgo de eventos cardiovasculares⁷7. Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368 (14): 1279-90.^,⁵⁷57. Martínez-González MA, Dominguez LJ, Delgado-Rodríguez M. Olive oil consumption and risk of CHD and/or stroke: a meta-analysis of case-control, cohort and intervention studies. Br J Nutr. 2014; 112 (2): 248-59.. La European Food Safety Autority⁵⁸58. EFSA Panel on Dietetic Products. Nutrition and allergies (NDA). Scientific opinion on the substantiation of health claims related to polyphenols in olive oil and protection of LDL particles from oxidative damage. EFSA Journal. 2011; 9: 2033; [consultado el 23/07/2017]. Disponible en: http://www.efsa.europa.eu/en/efsajournal/pub/2033.
http://www.efsa.europa.eu/en/efsajournal... apoya el consumo de aceite de oliva, por ejercer una protección antiinflamatoria y antioxidante, por cada 20 g de consumo diario.

El estudio ANIBES, un estudio transversal antropométrico sobre 1655 adultos de 18 a 64 años representativo de la población española, muestra que cada año de edad incrementa el IMC y el riesgo de obesidad⁵⁹59. López-Sobaler AM, Aparicio A, Aranceta-Bartrina J, Gil Á, González-Gross M, Serra-Majem L, et al. Overweight and General and Abdominal Obesity in a Representative Sample of Spanish Adults: Findings from the ANIBES Study. Biomed Res Int. 2016; 2016: 8341487.^). En el estudio PREDIMED, realizado en una población con una edad media de 67 años, se ha observado un descenso de peso con una dieta enriquecida en aceite de oliva, por lo que es posible paliar en un futuro los resultados preocupantes del estudio ANIBES con nuestra alimentación tradicional. Hay que destacar además que en Estruch et al 2016³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76. la dieta se mantuvo durante cinco años. El éxito podría deberse a la facilidad de cumplimiento de la dieta con aceite de oliva, en función de la palatabilidad y la sensación de saciedad que implica el aceite de oliva⁶⁰60. Mennella I, Savarese M, Ferracane R, Sacchi R, Vitaglione P. Oleic acid content of a meal promotes oleoylethanolamide response and reduces subsequent energy intake in humans. Food Funct. 2015; 6 (1): 204-10..

La percepción de la grasa como no saludable ha conseguido que se consuma menos grasa a favor de los carbohidratos y ello podría influir negativamente sobre el exceso de peso. La frecuencia de sobrepeso u obesidad en los estadounidenses ha aumentado del 42% en 1971 al 66% en 2011⁶¹61. Cohen E, Cragg M, deFonseka J, Hite A, Rosenberg M, Zhou B. Statistical review of US macronutrient consumption data, 1965-2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition. 2015; 31(5) :727-32., después de mucho tiempo de recomendar las sociedades científicas que se redujera el consumo de grasas. La principal recomendación para la disminución de la obesidad ha consistido hasta ahora en restringir las calorías y la grasa de la dieta, y aumentar el ejercicio físico, mientras que nuestro metaanálisis sugiere que una dieta con aceite de oliva, sin restricción calórica, puede ser beneficiosa en la reducción de peso y perímetro de la cintura (indicador de obesidad abdominal, un factor de riesgo cardiovascular⁶²62. Millán J, Mantilla T, Aranceta J, Fozd M, Gil B, Jover E, et al; Sección de Obesidad de la Sociedad Española de Arteriosclerosis (SEA) y grupo de estudio DORICA (Dislipemia, Obesidad y RIesgo Cardiovascular). Parámetros antropométricos asociados al riesgo cardiovascular en España. Estudio DORICA. Clin Invest Arterioscl. 2007; 19(2): 61-9.). No obstante, la mayoría de los estudios incluidos en nuestra revisión tienen un seguimiento corto, menor a un año. Se necesitan estudios aleatorizados con un seguimiento más prolongado para definitivamente comprobar los beneficios del aceite de oliva sobre una de las epidemias del siglo XXI, la obesidad, y especificar el tipo de aceite de oliva que se utiliza. La ocultación de la asignación o el cegamiento de participantes y personal durante los estudios, no están claramente determinados y han podido condicionar el resultado final de los estudios. En los estudios de alimentos, como el aceite de oliva, es una tarea ardua, ya que el sabor es fácilmente reconocible y más aún en los países mediterráneos, cuyo consumo es frecuente. Es conocido que el metaanálisis de efectos aleatorios aumenta la importancia de los estudios pequeños frente a los de gran tamaño de muestra. Cuando no hay grandes diferencias entre los tamaños de muestra de los estudios, no suele ser un problema, pero en el presente caso está Estruch et al³²32. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, et al; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016; 4 (8): 666-76.^,⁴⁷47. Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Ruiz-Gutiérrez V, Covas MI, et al; PREDIMED Study Investigators. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145 (1):1-11., cuya población supone más del 50% de la de todos los estudios restantes. Los efectos aleatorios suponen empequeñecer a este estudio, por lo que se optó por el metaanálisis de efectos fijos como modelo de elección. Otra limitación es que, existen pocos estudios en los que se ha administrado AOVE. Los aceites refinados, desprovistos de muchas de las propiedades del AOVE, también se denominan ‘aceite de oliva’, y sus efectos podrían ser diferentes a los del AOVE.

Estos resultados hay que interpretarlos con cautela debido a las restricciones metodológicas de los estudios incluidos. En conclusión, una dieta enriquecida con aceite de oliva seguida durante al menos tres meses puede disminuir el peso, el perímetro de la cintura y el IMC, en individuos sin eventos cardiovasculares previos.

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⁵²
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⁵³
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⁵⁴
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⁵⁵
De Lira-García C, Bacardí-Gascón M, Jiménez-Cruz A. Efectiveness of long-term consumption of nuts, seeds and seeds' oil on glucose and lipid levels; systematic review. Nutr Hosp. 2012; 27 (4):964-70.
⁵⁶
Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, et al; PREDIMED Study Investigators. A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One. 2012; 7 (8): e43134.
⁵⁷
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⁵⁸
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» http://www.efsa.europa.eu/en/efsajournal/pub/2033
⁵⁹
López-Sobaler AM, Aparicio A, Aranceta-Bartrina J, Gil Á, González-Gross M, Serra-Majem L, et al. Overweight and General and Abdominal Obesity in a Representative Sample of Spanish Adults: Findings from the ANIBES Study. Biomed Res Int. 2016; 2016: 8341487.
⁶⁰
Mennella I, Savarese M, Ferracane R, Sacchi R, Vitaglione P. Oleic acid content of a meal promotes oleoylethanolamide response and reduces subsequent energy intake in humans. Food Funct. 2015; 6 (1): 204-10.
⁶¹
Cohen E, Cragg M, deFonseka J, Hite A, Rosenberg M, Zhou B. Statistical review of US macronutrient consumption data, 1965-2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition. 2015; 31(5) :727-32.
⁶²
Millán J, Mantilla T, Aranceta J, Fozd M, Gil B, Jover E, et al; Sección de Obesidad de la Sociedad Española de Arteriosclerosis (SEA) y grupo de estudio DORICA (Dislipemia, Obesidad y RIesgo Cardiovascular). Parámetros antropométricos asociados al riesgo cardiovascular en España. Estudio DORICA. Clin Invest Arterioscl. 2007; 19(2): 61-9.

Cita sugerida:
Zamora Zamora F, Martínez Galiano JM, Gaforio Martínez JJ, Delgado Rodríguez M. Aceite de oliva y peso corporal. Revisión sistemática y metaanálisis de ensayos controlados aleatorizados.2018;92:21 de noviembre e201811083.

Fechas de Publicación

Publicación en esta colección
26 Oct 2020
Fecha del número
2018

Histórico

Recibido
20 Set 2017
Acepto
30 Oct 2018

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Aceite de oliva y peso corporal. Revisión sistemática y metaanálisis de ensayos controlados aleatorizados

Olive Oil and Body Weight. Systematic Review and Meta-Analysis of Randomized Controlled Trials

RESUMEN

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Conclusiones:

ABSTRACT

Background:

Methods:

Results:

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INTRODUCCIÓN

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