Blood cholesterol and walnut consumption: a cross-sectional survey in France

Can different types of tree nuts and peanuts induce varied effects on specific blood lipid parameters? A systematic review and network meta-analysis

Tree nuts and peanuts have shown cardioprotective effects through the modulation of blood lipid levels. Despite the abundance of scientific evidence available, it remains uncertain whether the type of nut consumed influences these changes. The objective of this study was to evaluate and rank the effects of six types of nuts on total cholesterol (total-c), low-density lipoprotein (LDL-c), triglyceride (TG) and high-density lipoprotein (HDL-c) levels through a systematic search of randomized controlled trials (RCTs), a frequentist network meta-analysis (NMA), and the estimation of SUCRA values. A total of 76 RCTs were ultimately analyzed. The total c for pistachios, almond, and walnuts; LDL-c for cashews, walnuts, and almond; and TG for hazelnuts and walnuts significantly decreased, while only peanuts exhibited a significant increase in HDL-c levels. According to the rankings, the most effective type of nut for reducing total cholesterol was pistachio, cashew for LDL-c, hazelnut for TG, and peanut for increasing HDL-c levels. It should be noted that every type of nut analyzed exhibited a significant positive impact on some parameters, and specific types demonstrated enhanced advantages for particular blood lipids. These results endorse the use of personalized nutritional strategies to address and prevent dyslipidemia.Registration: PROSPERO database CRD42021270779.

Tree Nuts and Peanuts as a Source of Beneficial Compounds and a Threat for Allergic Consumers: Overview on Methods for Their Detection in Complex Food Products

Consumption of tree nuts and peanuts has considerably increased over the last decades due to their nutritional composition and the content of beneficial compounds. On the other hand, such widespread consumption worldwide has also generated a growing incidence of allergy in the sensitive population. Allergy to nuts and peanuts represents a global relevant problem, especially due to the risk of the ingestion of hidden allergens as a result of cross-contamination between production lines at industrial level occurring during food manufacturing. The present review provides insights on peanuts, almonds, and four nut allergens—namely hazelnuts, walnuts, cashew, and pistachios—that are likely to cross-contaminate different food commodities. The paper aims at covering both the biochemical aspect linked to the identified allergenic proteins for each allergen category and the different methodological approaches developed for allergens detection and identification. Attention has been also paid to mass spectrometry methods and to current efforts of the scientific community to identify a harmonized approach for allergens quantification through the detection of allergen markers.

HPLC Fingerprints for the Characterization of Walnuts and the Detection of Fraudulent Incidents

A high-pressure liquid chromatographic method coupled to diode array detector (HPLC-DAD) was developed for the determination of phenolic compounds that could be used as markers in authentication studies of walnuts belonging to the Chandler variety, originating from Bulgaria, Greece, and France. An ultrasound-assisted extraction (UAE) protocol applied in the extraction of phenolic compounds was optimized. The method was validated and the relative standard deviations (RSD%) of the within-day, and between-day assays was lower than 6.3 and 11.1, respectively, showing adequate precision, and good accuracy ranging from 86.4 (sinapic acid) to 98.4% (caffeic acid) for within-day assay, and from 90.1 (gallocatechin gallate) to 100.6% (gallic acid) for between-day assay. Eighteen phenolic compounds were determined belonging to the classes of phenolic acids and flavonoids. The quantification results were further processed with chemometrics, and a robust partial least square-discriminant analysis (PLS-DA) model was developed for the classification of the samples according to their geographical origin, proposing markers that could be used for the control of walnuts authenticity and the detection of fraudulent incidents.

Comparative Proteomic Analysis of Walnut (Juglans regia L.) Pellicle Tissues Reveals the Regulation of Nut Quality Attributes

Walnuts (Juglans regia L.) are a valuable dietary source of polyphenols and lipids, with increasing worldwide consumption. California is a major producer, with 'Chandler' and 'Tulare' among the cultivars more widely grown. 'Chandler' produces kernels with extra light color at a higher frequency than other cultivars, gaining preference by growers and consumers. Here we performed a deep comparative proteome analysis of kernel pellicle tissue from these two valued genotypes at three harvest maturities, detecting a total of 4937 J. regia proteins. Late and early maturity stages were compared for each cultivar, revealing many developmental responses common or specific for each cultivar. Top protein biomarkers for each developmental stage were also selected based on larger fold-change differences and lower variance among replicates, including proteins for biosynthesis of lipids and phenols, defense-related proteins and desiccation stress-related proteins. Comparison between the genotypes also revealed the common and specific protein repertoires, totaling 321 pellicle proteins with differential abundance at harvest stage. The proteomics data provides clues on antioxidant, secondary, and hormonal metabolism that could be involved in the loss of quality in the pellicles during processing for commercialization.

Recent advances in the use of walnut (Juglans regia L.) shell as a valuable plant-based bio-sorbent for the removal of hazardous materials

The effective use of agricultural by-products is definitely a major challenge in waste management. In the walnut fruit processing industry, large amounts of shells are produced as agricultural by-products and discarded or burned produced as fuel. Walnut (Juglans regia L.) is a valuable tree nut in the Juglandaceae family. The fruit is composed of four main parts: the kernel, the skin, the shell, and the husk. The importance of walnuts is mostly related to theirs valuable kernels. However, their shells are currently experiencing as much interest as their kernels due to the beneficial effects of the shells. In the past several years, walnut shell (WS) has been widely explored as a naturally inert plant-based biosorbent. In this review, we first highlight recent scientific literature regarding the development of adsorbents from WS in the form of carbon-based materials including unmodified/modified WS, and activated carbons (ACs). Next, we discuss the potential applications of WS-derived by-products as natural yet effective adsorbents for the removal of various hazardous materials including heavy metals (HMs), synthetic industrial dyes, and harmful chemicals.

The effective use of agricultural by-products is definitely a major challenge in waste management.

A Comprehensive Review on the Chemical Constituents and Functional Uses of Walnut (Juglans spp.) Husk

The walnut (Juglans spp.) is an appreciated nut that belongs to the Juglandaceae family. The fruit includes four main parts: the kernel, the skin, the shell, and the green husk. It is widely cultivated due to its edible kernel. In walnut production centers, high amounts of the husk as an agro-forest waste product are produced and discarded away. Recently, it has been demonstrated that the walnut green husk could be valued as a source of different natural bioactive compounds with excellent antioxidant and antimicrobial properties. Regarding this respect, in this contribution, the current scientific knowledge on the antioxidant and antiradical activities, various identified and isolated individual chemical constituents, as well as the functional applications of the walnut husk with more emphasis on the Persian walnut (Juglans regia L.) are reviewed.

A Comparative Review on the Extraction, Antioxidant Content and Antioxidant Potential of Different Parts of Walnut (Juglans regia L.) Fruit and Tree

As a valuable tree nut, walnut is a well-known member of the Juglandaceae family. The fruit is made up of an outer green shell cover or husk, the middle shell which must be cracked to release the kernel, a thin layer known as skin or the seed coat, and finally, the kernel or meat. The nutritional importance of walnut fruit is ascribed to its kernel. The shell and husk are burned as fuel or discarded away as waste products. In the past two decades, the evaluation of the phenolic content and antioxidant activity of different parts of walnut has received great interest. In this contribution, the recent reports on the extraction and quantification of phenolic content from each part of the walnut tree and fruit using different solvents were highlighted and comparatively reviewed. The current review paper also tries to describe the antioxidant content of phenolic extracts obtained from different parts of the walnut tree and fruit. Additionally, the antioxidant and antiradical activities of the prepared extracts have also been discussed.

¹H-NMR Profiling and Carbon Isotope Discrimination as Tools for the Comparative Assessment of Walnut (Juglans regia L.) Cultivars with Various Geographical and Genetic Origins-A Preliminary Study

The aim of the study was to investigate the differences between walnut genotypes of various geographical and genetic origins grown under the same or different environmental conditions. The biological material analyzed consisted in walnut kernels of 34 cultivars, nine advanced selections, and six hybrids harvested in 2015 and 2016, summing up to a total of 64 samples. The walnuts, walnut oil, and residue were characterized in respect to their chemical (proximate composition—fat, protein, nutritional value, fatty acids profile by ¹H-NMR) and carbon-13 isotopic composition. The data was used to statistically discriminate the cultivars according to composition, geographical area of origin, and year of harvest, comparing the Romanian cultivars, selections, and hybrids with the internationally available ones.

The Effect of Daily Walnut Consumption on Dyslipidemia

The aim of this study was to investigate the effect of daily walnut consumption on dyslipidemia in dietary. Within a year, the patients who have been suggested taking walnut or not in their individual dietary were scanned retrospectively and randomized into 2 groups. The first group consists of 72 cases (only those taken on the diet program) and the second group consists of 73 cases (walnut consumption in regulated diet). Baseline blood lipid parameters and anthropometric measurements were assessed in both groups and compared with values at 3rd month. p values < 0.05 were considered statistically significant. In addition, Maras 18 walnut cultivar was analyzed to determine the fatty acid profiles by chromatographic technique. When comparing lipid parameters at baseline and at the 3rd month, total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and triglyceride levels significantly decreased and high-density lipoprotein cholesterol levels significantly increased. As compared with the end of 3rd month values of the groups, the reduction in total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, triglyceride levels of the subjects group (walnut consumption in regulated diet) were significantly higher than the control group (only regulated diet). Also, there was no significant difference in increase on high-density lipoprotein cholesterol levels between the groups. The results showed that daily consumption of walnut improved blood lipid levels. However, more extensive studies are needed on therapeutic usage in dyslipidemia.

Walnut (Juglans regiaL.) shell pyroligneous acid: chemical constituents and functional applications

Upon the processing of different agricultural products, considerable amounts of by-products and bio-wastes are produced and discarded or burnt as fuel, which are a potential source of valuable compounds. Over the past several decades, plant by-products have been recognized as a source of nutraceutical components, including dietary fibers, phenolics, and many other useful compounds. The walnut is known as an important tree nut. The shell of a walnut is the middle part of the fruit and it is a waste product of walnut processing industries. Recently, pyroligneous acids from the walnut shell have been receiving much-increasing interest because of their excellent antimicrobial and antioxidant activities. Hence, this review deals with the recent scientific literature on walnut shell pyroligneous acids and their chemical composition as well as their functional applications.

Upon the processing of different agricultural products, considerable amounts of by-products and bio-wastes are produced and discarded or burnt as fuel, which are a potential source of valuable compounds.

Chemical composition, molecular weight distribution, secondary structure and effect of NaCl on functional properties of walnut (Juglans regia L) protein isolates and concentrates

Chemical composition, molecular weight distribution, secondary structure and effect of sodium chloride concentration on functional properties of walnut protein isolates, concentrates and defatted walnut flour were study. Compared with walnut protein concentrates (75.6%) and defatted walnut flour (52.5%), walnut protein isolates contain a relatively high amount of protein (90.5%). The yield of walnut protein isolates and concentrates was 43.2% and 76.6%, respectively. In molecular weight distribution study, Walnut protein isolates showed one peak with molecular weight of 106.33 KDa (100%) and walnut protein concentrates showed four peaks with molecular weight of 16,725 KDa (0.8%),104.943 KDa(63.9%), 7.3 KDa (11.4%), 2.6 KDa (23.9%). The secondary structure of walnut protein isolates was similar to that of walnut protein concentrates, but was differ from that of defatted walnut flour. The addition of sodium chloride (0 ~ 1 M) could improve the functionality of walnut protein concentrates, isolates and defatted walnut flour. The maximum solubility, water absorption capacity, emulsifying properties and foaming properties of walnut protein isolates, concentrates and defatted walnut flour were at sodium chloride solutions of 1.0 M, 0.6 M, 0.4 M, 0.6 M, respectively. The solubility of walnut protein concentrates (32.5%) in distilled water with 0 M sodium chloride was lower than that of walnut protein isolates (35.2%). The maximum solubility of walnut protein isolates, concentrates and defatted walnut flour in solution were 36.8%, 33.7% and 9.6% at 1.0 M sodium chloride solutions, respectively. As compared with other vegetable proteins, walnut protein isolates and concentrates exhibited better emulsifying properties and foam stability.

Walnut (Juglans regia L.): genetic resources, chemistry, by-products

Walnut (Juglans regia L.) is the most widespread tree nut in the world. There is a great diversity of genotypes differing in forestry, productivity, physical and chemical nut traits. Some of them have been evaluated as promising and may serve as germplasm sources for breeding. The nutritional importance of the nut is related to the seed (kernel). It is a nutrient-dense food mainly owing to its oil content (up to 740 g kg(-1) in some commercial varieties), which can be extracted easily by screw pressing and consumed without refining. Walnut oil composition is dominated largely by unsaturated fatty acids (mainly linoleic together with lesser amounts of oleic and linolenic acids). Minor components of walnut oil include tocopherols, phospholipids, sphingolipids, sterols, hydrocarbons and volatile compounds. Phenolic compounds, present at high levels in the seed coat but poorly extracted with the oil, have been extensively characterised and found to possess strong antioxidant properties. The oil extraction residue is rich in proteins (unusually high in arginine, glutamic and aspartic acids) and has been employed in the formulation of various functional food products. This review describes current scientific knowledge concerning walnut genetic resources and composition as well as by-product obtainment and characteristics.

Nuts and coronary heart disease: an epidemiological perspective

The epidemiological evidence for the cardio-protective effect of nut consumption is presented and reviewed. Four large prospective epidemiological studies of primary prevention of coronary heart disease are reviewed and discussed (Adventist Health Study, Iowa Women's Health Study, Nurses' Health Study and the Physicians' Health Study). Other studies of nuts and coronary heart disease risk are addressed. The combined evidence for a cardio-protective effect from nut consumption is summarized and presented graphically. The risk of coronary heart disease is 37 % lower for those consuming nuts more than four times per week compared to those who never or seldom consume nuts, with an average reduction of 8.3 % for each weekly serving of nuts. The evidence for a causal relationship between nut consumption and reduced risk of coronary heart disease is outlined using Hill's criteria for causality and is found to support a causal cardio-protective relationship.

EPR spin label study of walnut oil effects on phosphatidylcholine membranes

Effects of walnut oil (WO) on dynamic and thermodynamic properties of 0-50 wt% cholesterol (CH) containing dimyristoylphosphatidylcholine (DMPC) and 10 wt% CH containing dipalmitoylphosphatidylcholine (DPPC) membrane dispersions were studied by electron paramagnetic resonance (EPR), using 5-doxyl stearic acid (5-DSA) and 16-doxyl stearic acid (16-DSA). Incorporation of 10 wt% WO alone decreased the phase transition temperature and created depth-dependent effects at the gel phase. The order increased close to the head region and decreased in the hydrocarbon core of the DMPC bilayer. For DPPC, the order decreased both close to head region and in the hydrocarbon core. Ten weight percent WO did not have considerable effect at the fluid phase for both DMPC and DPPC. Incorporation of 40 wt% WO into DMPC created an abrupt decrease in the maximum hyperfine splitting values after 305 K. The effect of 10 wt% WO in CH containing DMPC dispersions was dependent on the CH concentration. An increase and a decrease in the order were observed at low and high CH concentrations, respectively. Incorporation of WO created different effects on fluidity of 10 wt% CH containing DMPC and DPPC dispersions. Close to the head group region, the order in DMPC increased both in the gel and fluid phases; but for DPPC, an opposite effect was observed in both of the phases. In the hydrocarbon core of the bilayer, addition of 10 wt% WO into 10 wt% CH containing DMPC decreased the order in the gel phase and WO did not affect the order in the fluid phase. For DPPC, WO effects were observed to alter with temperature. In the studied temperature range, order parameters, diffusion constants and effective tilt angles were obtained from simulations of the spectra using Microscopic Order Macroscopic Disorder (MOMD) and Vary Anisotropic Reorientation (VAR) models. For 16-DSA, spectra were also simulated using two domains with EPRSIM.

A Mediterranean-style diet and metabolic syndrome

A moderate increase in physical activity and a detailed and tailored Mediterranean-style diet reduce the prevalence of metabolic syndrome and associated cardiovascular risks through reducing systemic vascular inflammation and endothelium dysfunction, particularly in those patients who do not lose weight.

The impact of nuts on diabetes and diabetes risk

Nuts have many nutritional benefits: they are high in monounsaturated and polyunsaturated fats, fiber, vitamin, minerals, and phytonutrients. Population studies indicate that individuals who regularly consume nuts have reduced risk for cardiovascular disease and diabetes. In clinical trials, nuts appear to have a neutral effect on glucose and insulin, and a beneficial effect on lipid profile. Thus, nuts can be a healthy dietary component for individuals with diabetes or those at risk for diabetes, providing overall caloric intake is regulated to maintain a healthy body weight.

Study of the main constituents of some authentic walnut oils

This paper describes the composition of walnut oils obtained from nuts collected from seven countries that are major suppliers of walnut oil. Oils were extracted from the nuts using small-scale industry pressing equipment and analyzed using standard methods for fatty acids, fatty acids in the triacylglycerol 2-position, tocopherols and tocotrienols, triacylglycerols, sterols, steradienes, and iodine value. Values for the composition of the sterols, triacylglycerols, fatty acids, iodine value, and tocopherol composition were generally in good agreement with the results of previous similar surveys. Tocotrienols were not detected in any sample. Steradienes (stigmastadiene, campestadiene, stigmastatriene, and campestatriene) were not detected in any oil.

Almonds vs complex carbohydrates in a weight reduction program

OBJECTIVE

To evaluate the effect of an almond-enriched (high monounsaturated fat, MUFA) or complex carbohydrate-enriched (high carbohydrate) formula-based low-calorie diet (LCD) on anthropometric, body composition and metabolic parameters in a weight reduction program.

DESIGN

A randomized, prospective 24-week trial in a free-living population evaluating two distinct macronutrient interventions on obesity and metabolic syndrome-related parameters during weight reduction.

SUBJECTS

In total, 65 overweight and obese adults (age: 27-79 y, body mass index (BMI): 27-55 kg/m(2)).

INTERVENTION

A formula-based LCD enriched with 84 g/day of almonds (almond-LCD; 39% total fat, 25% MUFA and 32% carbohydrate as percent of dietary energy) or self-selected complex carbohydrates (CHO-LCD; 18% total fat, 5% MUFA and 53% carbohydrate as percent of dietary energy) featuring equivalent calories and protein.

MAIN OUTCOME MEASUREMENTS

Various anthropometric, body composition and metabolic parameters at baseline, during and after 24 weeks of dietary intervention.

RESULTS

LCD supplementation with almonds, in contrast to complex carbohydrates, was associated with greater reductions in weight/BMI (-18 vs -11%), waist circumference (WC) (-14 vs -9%), fat mass (FM) (-30 vs -20%), total body water (-8 vs -1%) and systolic blood pressure (-11 vs 0%), P=0.0001-0.05. A 62% greater reduction in weight/BMI, 50% greater reduction in WC and 56% greater reduction in FM were observed in the almond-LCD as compared to the CHO-LCD intervention. Ketone levels increased only in the almond-LCD group (+260 vs 0%, P<0.02). High-density lipoprotein cholesterol (HDL-C) increased in the CHO-LCD group and decreased in the almond-LCD group (+15 vs -6%, P=0.05). Glucose, insulin, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and LDL-C to HDL-C ratio decreased significantly to a similar extent in both dietary interventions. Homeostasis model analysis of insulin resistance (HOMA-IR) decreased in both study groups over time (almond-LCD: -66% and CHO-LCD: -35%, P<0.0001). Among subjects with type 2 diabetes, diabetes medication reductions were sustained or further reduced in a greater proportion of almond-LCD as compared to CHO-LCD subjects (96 vs 50%, respectively) [correction].

CONCLUSION

Our findings suggest that an almond-enriched LCD improves a preponderance of the abnormalities associated with the metabolic syndrome. Both dietary interventions were effective in decreasing body weight beyond the weight loss observed during long-term pharmacological interventions; however, the almond-LCD group experienced a sustained and greater weight reduction for the duration of the 24-week intervention. Almond supplementation of a formula-based LCD is a novel alternative to self-selected complex carbohydrates and has a potential role in reducing the public health implications of obesity.

Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes

BACKGROUND

Nuts appear to have cardiovascular benefits but their effect in diabetic patients is unclear.

OBJECTIVE

The objective was to assess effects of almond-enriched diets on insulin sensitivity and lipids in patients with normoglycemia or type 2 diabetes.

DESIGN

Study 1 assessed the effect of almonds on insulin sensitivity in 20 free-living healthy volunteers who received 100 g almonds/d for 4 wk. Study 2 was a randomized crossover study that compared 4 diets in 30 volunteers with type 2 diabetes: 1) high-fat, high-almond (HFA; 37% total fat, 10% from almonds); 2) low-fat, high-almond (LFA; 25% total fat, 10% from almonds); 3) high-fat control (HFC; 37% total fat, 10% from olive or canola oil); and 4) low-fat control (LFC; 25% total fat, 10% from olive or canola oil). After each 4-wk diet, serum lipids and oral glucose tolerance were measured.

RESULTS

In study 1, almond consumption did not change insulin sensitivity significantly, although body weight increased and total and LDL cholesterol decreased by 21% and 29%, respectively (P < 0.05). In study 2, total cholesterol was lowest with the HFA diet (4.46 +/- 0.14, 4.52 +/- 0.14, 4.63 +/- 0.14, and 4.63 +/- 0.14 mmol/L with the HFA, HFC, LFA, and LFC diets, respectively; P = 0.0004 for fat level). HDL cholesterol was significantly lower with the almond diets (P = 0.002); however, no significant effect of fat source on LDL:HDL was observed. Glycemia was unaffected.

CONCLUSIONS

Almond-enriched diets do not alter insulin sensitivity in healthy adults or glycemia in patients with diabetes. Almonds had beneficial effects on serum lipids in healthy adults and produced changes similar to high monounsaturated fat oils in diabetic patients.

The scientific evidence for a beneficial health relationship between walnuts and coronary heart disease

The author and four independent experts evaluated the intent and quality of scientific evidence for a potential beneficial health relationship between the intake of walnuts and the reduction and prevention of coronary heart disease. The report also addresses the supporting evidence for the health benefit of other tree nuts and selected legumes. Compared to most other nuts, which contain monounsaturated fatty acids, walnuts are unique because they are rich in n-6 (linoleate) and n-3 (linolenate) polyunsaturated fatty acids. Walnuts contain multiple health-beneficial components, such as having a low lysine:arginine ratio and high levels of arginine, folate, fiber, tannins, and polyphenols. Though walnuts are energy rich, clinical dietary intervention studies show that walnut consumption does not cause a net gain in body weight when eaten as a replacement food. Five controlled, peer-reviewed, human clinical walnut intervention trials, involving approximately 200 subjects representative of the 51% of the adult population in the United States at risk of coronary heart disease were reviewed. The intervention trials consistently demonstrated walnuts as part of a heart-healthy diet, lower blood cholesterol concentrations. None of these studies were of extended duration that would be essential for evaluation of the sustainability of the observed outcomes. These results were supported by several large prospective observational studies in humans, all demonstrating a dose response-related inverse association of the relative risk of coronary heart disease with the frequent daily consumption of small amounts of nuts, including walnuts.

Walnut polyphenolics inhibit in vitro human plasma and LDL oxidation

Recent epidemiologic studies have associated nut consumption with a reduced incidence of cardiovascular mortality. However, little is known about the contribution of nut polyphenols to antioxidant and cardiovascular protection. In this investigation, polyphenol-rich extracts from English walnuts (Juglans regia) were studied and compared with ellagic acid for their ability to inhibit in vitro plasma and LDL oxidation, as well as their effects on LDL alpha-tocopherol during oxidative stress. In addition, the Trolox equivalent antioxidant activity (TEAC) was determined and liquid chromatography electrospray detection mass spectrometry (LC-ELSD/MS) analyses of the walnut extracts were performed. 2,2'-Azobis'(2-amidino propane) hydrochloride (AAPH)-induced LDL oxidation was significantly inhibited by 87 and 38% with the highest concentration (1.0 micromol/L) of ellagic acid and walnut extract, respectively. In addition, copper-mediated LDL oxidation was inhibited by 14 and 84% in the presence of ellagic acid and walnut extract, respectively, with a modest, significant LDL alpha-tocopherol sparing effect observed. Plasma thiobarbituric acid reacting substance (TBARS) formation was significantly inhibited by walnut extracts and ellagic acid in a dose-dependent manner, and the extracts exhibited a TEAC value greater than that of alpha-tocopherol. LC-ELSD/MS analysis of the walnut extracts identified ellagic acid monomers, polymeric ellagitannins and other phenolics, principally nonflavonoid compounds. These results demonstrate that walnut polyphenolics are effective inhibitors of in vitro plasma and LDL oxidation. The polyphenolic content of walnuts should be considered when evaluating their antiatherogenic potential.

Hyperlipidemia

Coronary heart disease (CHD) is prevalent and often related to an unhealthy diet and hyperlipidemia. The diagnosis of hyperlipidemia should be carefully made, using more than one measurement in the manner described. An assessment of risks allows one to decide whom to treat. Patients with CHD should be treated aggressively but it is less clear how aggressive to be with patients without CHD. Diet and exercise recommendations are appropriate for almost all patients. For those for whom the benefit is greater than the potential risks, statins are first-line drug therapy and they appear to have beneficial effects aside from their lipid-lowering properties.