Avocado Juice and Changes in Total Cholesterol and Triglyceride Levels among Depot Medroxyprogesterone Acetate Contraceptive Acceptors: A Quasi-Experimental Study
Abstract
Introduction: Depot medroxyprogesterone acetate (DMPA) is a widely used progestin only injectable contraceptive that has been associated with changes in lipid profiles and a potential increase in cardiovascular risk among women of reproductive age. Avocado is a nutrient dense fruit rich in monounsaturated fatty acids, fibre, and phytosterols, which may improve blood lipids and support cardiovascular health. This study aimed to explore the short term association between avocado juice consumption and changes in total cholesterol and triglyceride levels among women using progestin based injectable contraceptives.
Methods: A quasi experimental pretest–posttest control group design was used. DMPA users were allocated to an intervention group that received avocado juice plus a high-cholesterol diet, or to a control group that received only the high-cholesterol diet, for 14 consecutive days. Total cholesterol and triglyceride levels were measured before and after the intervention. Data were analysed using normality tests, followed by paired t-tests and independent t-tests, and between-group comparisons were based on changes from baseline.
Results: After 14 days, the intervention group showed a greater reduction in mean total cholesterol than the control group, indicating a possible association between avocado juice consumption and lower total cholesterol among DMPA users. In contrast, triglyceride levels decreased in both groups but did not differ significantly between them, and most triglyceride values remained within the normal range. The observed between group differences were modest and should be interpreted cautiously in light of the quasi experimental, non randomized, short term, and unblinded design.
Conclusion: In this exploratory study, avocado juice consumption was associated with a short term reduction in total cholesterol levels among DMPA injectable contraceptives acceptors, whereas triglyceride levels did not change significantly between groups. These preliminary findings require confirmation in larger randomized controlled studies with longer follow up, stricter dietary control, and baseline adjusted analyses before firm conclusions can be drawn.
References
Indonesian Ministry of Health. Indonesian Health Profile [Internet]. Jakarta; 2023 [cited 2025 Nov 25]. Available from: https://kemkes.go.id/id/profil-kesehatan-indonesia-2023
Ferdous S, Amir M, Chowdhury SB, Nasrin B, Hamid F, Banu S. Effects of Long-Term Use of Depotmedroxy Progesterone Acetate on Serum Lipids. Bangladesh Journal of Obstetrics & Gynaecology. 2019 Sep 30;34(2):106–11. https://doi.org/10.3329/bjog.v34i2.58277
Dilshad H, Yousuf RI, Shoaib MH, Jamil S, Khatoon H. Cardiovascular Disease Risk Associated With the Long-term Use of Depot Medroxyprogesterone Acetate. Am J Med Sci. 2016 Nov;352(5):487–92. https:/doi.org//10.1016/j.amjms.2016.08.007
Wang L. The effects of monounsaturated fatty acid-enriched diets with and without avocados on cardio-metabolic risk factors. [Pennsylvania]: The Pennsylvania State University; 2015. https:/doi.org/10.1161/JAHA.114.001355
Silva Caldas AP, Chaves LO, Linhares Da Silva L, De Castro Morais D, Gonçalves Alfenas R de C. Mechanisms involved in the cardioprotective effect of avocado consumption: A systematic review. Int J Food Prop. 2017 Jul 20;1–11. https://doi.org/10.1080/10942912.2017.1352601
Salgado JM, Bin C, Mansi DN, Souza A. Efeito do abacate (Persea americana Mill) variedade hass na lipidemia de ratos hipercolesterolêmicos. Ciência e Tecnologia de Alimentos. 2008 Dec;28(4):922–8. https://doi.org/10.1590/S0101-20612008000400025
Octavio Rodiles-López J, González-Montoya M, Eduardo Martínez-Flores H, Zamora-Vega R. The Effect of Diets Enriched with Avocado (Persea americana cv Hass) on Cholesterol and Triglyceride Decrease Evaluated in Hamsters. Journal of Food and Nutrition Research. 2020 Nov 27;8(11):670–4. https://doi.org/10.12691/jfnr-8-11-7
Candeloro BM, Barbalho SM, Laurindo LF, Raimundo RD, Stevanato BL, Assumpção MCB, et al. Is avocado beneficial for lipid profiles? An umbrella review of systematic reviews and meta-analyses. Clin Nutr ESPEN. 2025 Oct 1;69:673–85. https://doi.org/10.1016/j.clnesp.2025.08.019
Mostafazadeh P, Etesamnia S, Nasiraei-Moghadam M, Jahan-mihan A, Haghighi A, Zendedel A, et al. Exploring the effect of avocado on lipid profile modulation: a systematic review and dose–response and meta-analysis of clinical trials. Crit Rev Food Sci Nutr. 2025 Aug;1–11. https://doi.org/10.1080/10408398.2025.2531222
Odelola O, Akadri A. Depot-medroxyprogesterone acetate: lipid profile changes and associated cardiovascular risks among recipients in Sagamu, South West Nigeria. J Public Health Afr. 2023 Nov 30;14(11):9. https://doi.org/10.4081/jphia.2023.1664
Ester AVH, Soralys C, Rosa L, Coromoto ónzalez IL. Efecto del consumo de aguacate (Persea Americana Mill) sobre el perfil lipídico en adultos con dislipidemia. Anales Venezolanos de Nutrición. 2009;22(2):84–9. https://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0798-07522009000200005
Brechtel L, Poupore N, Stoikov T, Roley LT, Emerson JF, Nathaniel T. Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients. Medicine. 2020 Dec 24;99(52):e23870. https://doi.org/10.1097/MD.0000000000023870
Mahmassani HA, Avendano EE, Raman G, Johnson EJ. Avocado consumption and risk factors for heart disease: a systematic review and meta-analysis. Am J Clin Nutr. 2018 Apr;107(4):523–36. https://doi.org/10.1093/ajcn/nqx078
Peou S, Milliard-Hasting B, Shah SA. Impact of avocado-enriched diets on plasma lipoproteins: A meta-analysis. J Clin Lipidol. 2016 Jan 1;10(1):161–71. https://doi.org/10.1016/j.jacl.2015.10.011
Wien M, Haddad E, Oda K, Sabaté J. A randomized 3×3 crossover study to evaluate the effect of Hass avocado intake on post-ingestive satiety, glucose and insulin levels, and subsequent energy intake in overweight adults. Nutr J. 2013 Nov 27;12(1). https://doi.org/10.1186/1475-2891-12-155
Padmanabhan M, Arumugam G. Effect of Persea americana (avocado) fruit extract on the level of expression of adiponectin and PPAR-? in rats subjected to experimental hyperlipidemia and obesity. J Complement Integr Med. 2014 Jun 1;11(2):107–19. https://doi.org/10.1515/jcim-2013-0053
Candeloro BM, Barbalho SM, Laurindo LF, Raimundo RD, Stevanato BL, Assumpção MCB, et al. Is avocado beneficial for lipid profiles? An umbrella review of systematic reviews and meta-analyses. Clin Nutr ESPEN. 2025 Oct; 69:673–85. https://doi.org/10.1016/j.clnesp.2025.08.019
Peou S, Milliard-Hasting B, Shah SA. Impact of avocado-enriched diets on plasma lipoproteins: A meta-analysis. J Clin Lipidol. 2016 Jan;10(1):161–71. https://doi.org/10.1016/j.jacl.2015.10.011
Wang L, Tao L, Hao L, Stanley TH, Huang KH, Lambert JD, et al. A Moderate-Fat Diet with One Avocado per Day Increases Plasma Antioxidants and Decreases the Oxidation of Small, Dense LDL in Adults with Overweight and Obesity: A Randomized Controlled Trial. J Nutr. 2020 Feb;150(2):276–84. https://doi.org/10.1093/jn/nxz231
Díaz-Perilla M, Andrea Toro C. Efecto de la adición de aguacate a la alimentación habitual sobre los niveles de lípidos en personas con dislipidemia. Univ Sci (Bogota). 2004;9(2):49–58. https://revistas.javeriana.edu.co/index.php/scientarium/article/view/4930
Pieterse, Zelda, Jerling, Johann, Oosthuizen, Welma. Avocados (monounsaturated fatty acids), weight loss and serum lipids. 2003. https://doi.org/10.1016/j.nut.2004.09.010
Dreher ML, Davenport AJ. Hass Avocado Composition and Potential Health Effects. Crit Rev Food Sci Nutr. 2013 Jan;53(7):738–50. https://doi.org/10.1080/10408398.2011.556759
Li H, Zuo Y, Qian F, Chen S, Tian X, Wang P, et al. Triglyceride-glucose index variability and incident cardiovascular disease: a prospective cohort study. Cardiovasc Diabetol. 2022 Dec 10;21(1):105. https://doi.org/10.1186/s12933-022-01541-5
Balaban Yucesan F, Demir EN, Ozer Yaman S, Orem A, Dokuz Murat B, Bilgin B. Short-Term Standard Diet Consumption Prior to the Oral Fat Tolerance Test Modulates the Postprandial Triglyceride Response. Metabolites. 2023 Sep 17;13(9):1019. https://doi.org/10.3390/metabo13091019
S. Alagu Thangam, S. Vilma Veronica, G. Suresh, S. Hemalatha. Prognosis of Hyper Triglycerides Using Data Science and Machine Learning. Int J Sci Res Sci Eng Technol. 2023 Oct 11;229–39.
Hamednia S, Shouhani Z, Tavakol S, Montazeri N, Amirkhan?Dehkordi M, Karimi MA, et al. Effects of Avocado Products on Cardiovascular Risk Factors in Adults: A GRADE?Assessed Systematic Review and Meta?Analysis. Food Sci Nutr. 2025 Jul 2;13(7). https://doi.org/10.1002/fsn3.70547
Tarigan TJE, Khumaedi AI, Wafa S, Johan M, Abdullah M, Surono IS, et al. Determinant of postprandial triglyceride levels in healthy young adults. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019 May;13(3):1917–21. https://doi.org/10.1016/j.dsx.2019.04.027
Mikkelsen M, Wilsgaard T, Grimsgaard S, Hopstock LA, Hansson P. Associations between postprandial triglyceride concentrations and sex, age, and body mass index: cross-sectional analyses from the Tromsø study 2015–2016. Front Nutr. 2023 Jun 15;10. https://doi.org/10.3389/fnut.2023.1158383
Yadav BK, Gupta RK, Gyawali P, Shrestha R, Poudel B, Sigdel M, et al. Effects of Long-term Use of Depo-medroxyprogesterone Acetate on Lipid Metabolism in Nepalese Women. Ann Lab Med. 2011 Apr 1;31(2):95–7. https://doi.org/10.3343/kjlm.2011.31.2.95
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