Abstract
Abstract Objectives High-fat diets are associated with endothelial dysfunction, the first step in the progression to atherosclerosis and cardiovascular disease. We aimed to determine the postprandial endothelial response (flow-mediated dilation (FMD)) to a high-fat meal in various populations and define how the response varies by conducting a systematic review of the literature. Methods Six electronic databases were systematically searched for original research published from database inception to May 2020. Eligible studies measured both fasting and postprandial FMD following consumption of a meal containing ≥ 30 g fat or ≥ 40% energy from fat. A random-effects model was used to analyse the pooled effect size change from the fasting FMD, presented as mean difference. Moderator variables were analysed by meta-regression. Results One-hundred and twenty articles reporting on 3821 adults were included in the review. High fat meal consumption significantly attenuated FMD at 2 hours (MD: −1.61; 95% CI −2.02 −1.19, p < 0.001), 3 hours (−1.73; −2.30 −1.17, p < 0.001) and 4 hours (−1.54; −1.88 −1.20, p < 0.001), though heterogeneity (I2) was > 90%. Meta-regression revealed that fasting FMD significantly impacted the reported effect size (p < 0.0001) at all postprandial timepoints. Age and BMI were inversely correlated with FMD response at 2 and 4 hours (p < 0.0001). Conclusions Younger, healthy-weight participants exhibited a larger postprandial reduction in FMD compared to older, heavier groups after a high-fat meal. Vulnerable populations could be more likely to exhibit endothelial dysfunction, as evident through lower fasting FMD, together with impaired metabolic flexibility. A single high fat meal adversely impacts endothelial function and the magnitude of the impact on postprandial FMD was influenced by fasting FMD, participant age, and BMI. Funding Sources Monash University
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