Nut consumption and risk of metabolic syndrome and overweight/obesity: a meta-analysis of prospective cohort studies and randomized trials

We got nuts! use deep neural networks to classify images of common edible nuts

BACKGROUND

Nuts are nutrient-dense foods that contribute to healthier eating. Food image datasets enable artificial intelligence (AI) powered diet-tracking apps to help people monitor daily eating patterns.

AIM

This study aimed to create an image dataset of commonly consumed nut types and use it to build an AI computer vision model to automate nut type classification tasks.

METHODS

iPhone 11 was used to take photos of 11 nut types-almond, brazil nut, cashew, chestnut, hazelnut, macadamia, peanut, pecan, pine nut, pistachio, and walnut. The dataset contains 2200 images, 200 per nut type. The dataset was randomly split into the training (60% or 1320 images), validation (20% or 440 images), and test sets (20% or 440 images). A neural network model was constructed and trained using transfer learning and other computer vision techniques-data augmentation, mixup, normalization, label smoothing, and learning rate optimization.

RESULTS

The trained neural network model correctly predicted 338 out of 440 images (40 per nut type) in the validation set, achieving 99.55% accuracy. Moreover, the model classified the 440 images in the test set with 100% accuracy.

CONCLUSION

This study built a nut image dataset and used it to train a neural network model to classify images by nut type. The model achieved near-perfect accuracy on the validation and test sets, demonstrating the feasibility of automating nut type classification using smartphone photos. Being made open-source, the dataset and model can assist the development of diet-tracking apps that facilitate users' adoption and adherence to a healthy diet.

Association between nut consumption and metabolic syndrome in Korean adults: results from the Korean Genome and Epidemiology Study-Health Examinees

Background

The epidemiological evidence regarding nut consumption and metabolic diseases focuses on Western populations. Nut consumption among Koreans is relatively low, and the prevalence of metabolic syndrome is rapidly increasing, highlighting the need for more focused studies in this population. This cross-sectional study aimed to investigate the relationship between nut consumption and metabolic syndrome in Korean adults.

Methods

A total of 112,501 adults (39,481 men and 73,020 women) aged 40-79 years were selected from baseline data of the Korean Genome and Epidemiology Study-Health Examinees. Nut consumption was assessed using a validated semi-quantitative food frequency questionnaire and categorized as non-consumers, <1 serving/week, ≥1 to <2 servings/week, or ≥2 servings/week (15 g per serving). Metabolic syndrome and its components were defined according to the Korean Society of CardioMetabolic Syndrome criteria. Associations between nut consumption and metabolic syndrome and its components were examined using multiple logistic regression with adjustments for potential confounders.

Results

In the study population, the prevalence of metabolic syndrome was 21.4% (26.9% in men and 18.4% in women), and the mean nut intake was 0.8 serving/week (0.7 serving/week in men and 0.8 serving/week in women). After adjusting for confounders, higher nut consumption was associated with a lower odds ratio (OR) of metabolic syndrome in individuals consuming ≥2 servings/week compared with non-consumers [OR = 0.85, 95% confidence interval (CI) = 0.80-0.91, p for trend <0.001]. Specifically, in men, this level of consumption was associated with a 14% reduction in the OR of metabolic syndrome (OR = 0.86, 95% CI = 0.77-0.95, p for trend = 0.028). In women, a similar reduction of 14% was observed (OR = 0.86, 95% CI = 0.80-0.93, p for trend <0.001). Among the metabolic syndrome components, nut consumption was inversely associated with abdominal obesity, low high-density lipoprotein-cholesterol, and elevated triglycerides in men and women, whereas no associations were observed for elevated blood pressure or elevated fasting blood glucose.

Conclusion

Our findings suggest that higher nut consumption is inversely associated with metabolic syndrome and its components in Korean adults. Further studies are needed to examine the longitudinal association between nut consumption and metabolic diseases in this population.

Build Deep Neural Network Models to Detect Common Edible Nuts from Photos and Estimate Nutrient Portfolio

Nuts are nutrient-dense foods and can be incorporated into a healthy diet. Artificial intelligence-powered diet-tracking apps may promote nut consumption by providing real-time, accurate nutrition information but depend on data and model availability. Our team developed a dataset comprising 1380 photographs, each in RGB color format and with a resolution of 4032 × 3024 pixels. These images feature 11 types of nuts that are commonly consumed. Each photo includes three nut types; each type consists of 2-4 nuts, so 6-9 nuts are in each image. Rectangular bounding boxes were drawn using a visual geometry group (VGG) image annotator to facilitate the identification of each nut, delineating their locations within the images. This approach renders the dataset an excellent resource for training models capable of multi-label classification and object detection, as it was meticulously divided into training, validation, and test subsets. Utilizing transfer learning in Python with the IceVision framework, deep neural network models were adeptly trained to recognize and pinpoint the nuts depicted in the photographs. The ultimate model exhibited a mean average precision of 0.7596 in identifying various nut types within the validation subset and demonstrated a 97.9% accuracy rate in determining the number and kinds of nuts present in the test subset. By integrating specific nutritional data for each type of nut, the model can precisely (with error margins ranging from 0.8 to 2.6%) calculate the combined nutritional content-encompassing total energy, proteins, carbohydrates, fats (total and saturated), fiber, vitamin E, and essential minerals like magnesium, phosphorus, copper, manganese, and selenium-of the nuts shown in a photograph. Both the dataset and the model have been made publicly available to foster data exchange and the spread of knowledge. Our research underscores the potential of leveraging photographs for automated nut calorie and nutritional content estimation, paving the way for the creation of dietary tracking applications that offer real-time, precise nutritional insights to encourage nut consumption.

Consumption of Tree Nuts as Snacks Reduces Metabolic Syndrome Risk in Young Adults: A Randomized Trial

Metabolic syndrome (MetSx) and its chronic disease consequences are major public health concerns worldwide. Between-meal snacking may be a modifiable risk factor. We hypothesized that consuming tree nuts as snacks, versus typical carbohydrate snacks, would reduce risk for MetSx in young adults. A prospective, randomized, 16-week parallel-group diet intervention trial was conducted in 84 adults aged 22-36 with BMI 24.5 to 34.9 kg/m2 and ≥1 MetSx clinical risk factor. Tree nuts snacks (TNsnack) were matched to carbohydrate snacks (CHOsnack) for energy (kcal), protein, fiber, and sodium content as part of a 7-day eucaloric menu. Difference in change between groups was tested by analysis of covariance using general linear models. Multivariable linear regression modeling assessed main effects of TNsnack treatment and interactions between TNsnack and sex on MetSx score. Age, BMI, and year of study enrollment were included variables. There was a main effect of TNsnack on reducing waist circumference in females (mean difference: -2.20 ± 0.73 cm, p = 0.004) and a trend toward reduced visceral fat (-5.27 ± 13.05 cm2, p = 0.06). TNsnack decreased blood insulin levels in males (-1.14 ± 1.41 mIU/L, p = 0.05) and multivariable modeling showed a main effect of TNsnack on insulin. Main effects of TNsnack on triglycerides and TG/HDL ratio were observed (p = 0.04 for both) with TG/HDL ratio reduced ~11%. A main effect of TNsnack (p = 0.04) and an interaction effect between TNsnack and sex (p < 0.001) on total MetSx score yielded 67% reduced MetSx score in TNsnack females and 42% reduced MetSx score in TNsnack males. To our knowledge, this is the first randomized parallel-arm study to investigate cardiometabolic responses to TNsnacks versus typical CHOsnacks among young adults at risk of MetSx. Our study suggests daily tree nut consumption reduces MetSx risk by improving waist circumference, lipid biomarkers, and/or insulin sensitivity-without requiring caloric restriction.

U.S. Consumers' Tree Nut Food Safety Knowledge, Perceptions, and Handling Practices across Demographic Groups

Tree nuts are often perceived as presenting a low risk for foodborne illness, despite their association with several foodborne outbreaks and recalls in recent years. An online survey was designed to assess how consumers' food safety knowledge, perception of risks and benefits, and preferred sources for food safety information influence their tree nut handling behavior. Participants (n = 981) who soaked tree nuts or prepared nut-based dairy analogs (NBDAs) at home completed the survey. Their responses indicated insufficient knowledge about potential contaminations of tree nuts. Only 25% of participants had heard of a tree nut-related outbreak or recall. Few (30%) participants perceived a risk of contracting a foodborne illness from tree nuts. The participants were more concerned with the health benefits than potential microbial risks of raw tree nuts and preferred government agencies for tree nut food safety information. Based on a cluster analysis, demographics with lower food safety knowledge and risk perceptions (ages 18-24 or 45 and above, female, suburban and rural communities, have less than a bachelor's degree, and earned less than USD 100,000 annually) tended to engage in risky tree nut handling practices (p < 0.05). The findings of this study support the development of audience-targeted food safety extension materials for tree nuts.

U.S. Consumer Practices of Homemade Nut-based Dairy Analogs and Soaked Nuts

Tree nuts, a low-moisture food, are typically perceived as being a low risk for foodborne illness. In the past five decades, the consumption of tree nuts (dry, soaked, or as nut-based dairy analogs [NBDA]) has increased along with corresponding foodborne illness outbreaks and recalls associated with these products. We developed an online survey to assess tree nut handling practices of U.S. consumers, and to select study participants who have soaked tree nuts and/or made NBDA at home. We distributed our initial survey questions in October 2021 to a convenience sample (n = 12) to test for clarity and comprehension. In January 2022, participants (n = 981) who met the criteria completed the survey. The most popular soaked tree nuts were almonds (54%), followed by cashews (36%), walnuts (32%), and pistachios (22%). Participants soaked tree nuts for direct consumption (67%) and during the preparation of NBDA (80%). Participants soaked tree nuts under refrigerated conditions for 1-24 h (22%), on the countertop at room temperature (est. 65-75°F [18-24°C]) for 1-5 h (21%), or at room temperature for 12 h or more (6%); 16% used a hot or boiling water, short time treatment. Some participants added acid (28%) or salt (25%) to the soaking water. Among those participants who dried their tree nuts after soaking (63%), 89% reported drying at a temperature lower than 46°C (115°F). Some participants (34%) used their tree nuts to make fermented dairy analogs (e.g., "cheese" or "yogurt") by adding "probiotics" (56-86%) or a yogurt starter culture (37-99%), respectively, and then, most frequently, holding at or below 20°C (68°F) for 12 h or less (29%). The safety of many of these practices has not been adequately investigated, but the findings of this study will inform future risk assessment and risk modeling studies on tree nut food safety in home kitchen settings.

Adherence to a healthy diet and odds of metabolic syndrome: A cross-sectional study

INTRODUCTION

Metabolic syndrome (MetS) is a major health concern around the world. Dietary factors, including diet quality, play a significant role in its pathophysiology. Healthy Eating Index (HEI) is a tool used as a valid measurement of the individual's diet quality. We aimed at investigating the relationship between diet quality as assessed by HEI-2015 and the risk of MetS and its components in a cross-sectional sample of suburban individuals from PERSIAN Kavar cohort study (PKCS), Fars province, Iran.

METHODS

2225 individuals meeting the eligibility criteria participated in the study. The relevant data were obtained from the baseline phase of PKCS. MetS was defined according to cut-offs presented by the National Cholesterol Education Program Adult Treatment Panel III (ATP III). HEI-2015 was calculated for the included individuals. Odds ratios were estimated. P-values <0.05 were considered as significant.

RESULTS

The overall prevalence of MetS was 27.3%. Individuals with lower HEI-2015 scores had higher odds for MetS and its components. We observed that those who were categorized as the top HEI-2015 tertile had 42% (OR: 0.58; 95% CI: 0.38-0.90) lower odds of high blood pressure in the overall population. Also, the odds of high serum triacylglycerol was lower (OR: 0.72; 95% CI: 0.57-0.90) in those with the highest HEI-2015 scores.

CONCLUSION

We found that higher dietary quality measured by HEI will decrease the risk of developing MetS, hypertension, and hypertriglyceridemia among Iranian adults. However, future interventional studies are required to further elucidate the issue.

Nuts and berries from agroforestry systems in temperate regions can form the foundation for a healthier human diet and improved outcomes from diet-related diseases

Agroforestry is a specific type of agroecosystem that includes trees and shrubs with the potential to yield nutrient-rich products that contribute to human health. This paper reviews the literature on the human health benefits of tree nut and berry species commonly associated with agroforestry systems of the United States, considering their potential for preventing certain diet-related diseases. Emphasis is placed on those diseases that are most closely associated with poor outcomes from COVID-19, as they are indicators of confounding health prognoses. Results indicate that tree nuts reduce the risk of coronary heart disease, and walnuts (Juglans species) are particularly effective because of their unique fatty acid profile. Berries that are grown on shrubs have the potential to contribute to mitigation of hypertension, prevention of Type II diabetes, and reduced risk of cardiovascular disease. To optimize human health benefits, plant breeding programs can focus on the traits that enhance the naturally-occurring phytochemicals, through biofortification. Value-added processing techniques should be selected and employed to preserve the phytonutrients, so they are maintained through the point of consumption. Agroforestry systems can offer valuable human health outcomes for common diet-related diseases, in addition to providing many environmental benefits, particularly if they are purposefully designed with that goal in mind. The food system policies in the U.S. might be reoriented to prioritize these food production systems based on the health benefits.

Intra-Amniotic Administration of Cashew Nut (Anacardium occidentale L.) Soluble Extract Improved Gut Functionality and Morphology In Vivo (Gallus gallus)

Cashew nuts are rich in dietary fibers, monounsaturated fatty acids, carotenoids, tocopherols, flavonoids, catechins, amino acids, and minerals that offer benefits for health. However, the knowledge of its effect on gut health is lacking. In this way, cashew nut soluble extract (CNSE) was assessed in vivo via intra-amniotic administration in intestinal brush border membrane (BBM) morphology, functionality, and gut microbiota. Four groups were evaluated: (1) no injection (control); (2) H₂O injection (control); (3) 10 mg/mL CNSE (1%); and (4) 50 mg/mL CNSE (5%). Results related to CNSE on duodenal morphological parameters showed higher Paneth cell numbers, goblet cell (GC) diameter in crypt and villi, depth crypt, mixed GC per villi, and villi surface area. Further, it decreased GC number and acid and neutral GC. In the gut microbiota, treatment with CNSE showed a lower abundance of Bifidobacterium, Lactobacillus, and E. coli. Further, in intestinal functionality, CNSE upregulated aminopeptidase (AP) gene expression at 5% compared to 1% CNSE. In conclusion, CNSE had beneficial effects on gut health by improving duodenal BBM functionality, as it upregulated AP gene expression, and by modifying morphological parameters ameliorating digestive and absorptive capacity. For intestinal microbiota, higher concentrations of CNSE or long-term intervention may be necessary.

A Review of Ketogenic Dietary Therapies for Epilepsy and Neurological Diseases: A Proposal to Implement an Adapted Model to Include Healthy Mediterranean Products

Based on the growing evidence of the therapeutic role of high-fat ketogenic dietary therapies (KDTs) for neurological diseases and on the protective effect of the Mediterranean diet (MD), it could be important to delineate a Mediterranean version of KDTs in order to maintain a high ketogenic ratio, and thus avoid side effects, especially in patients requiring long-term treatment. This narrative review aims to explore the existing literature on this topic and to elaborate recommendations for a Mediterranean version of the KDTs. It presents practical suggestions based on MD principles, which consist of key elements for the selection of foods (both from quantitative and qualitative prospective), and indications of the relative proportions and consumption frequency of the main food groups that constitute the Mediterranean version of the KDTs. We suggest the adoption of a Mediterranean version of ketogenic diets in order to benefit from the multiple protective effects of the MD. This translates to: (i) a preferential use of olive oil and vegetable fat sources in general; (ii) the limitation of foods rich in saturated fatty acids; (iii) the encouragement of high biological value protein sources; (iv) inserting fruit and vegetables at every meal possible, varying their choices according to seasonality.

Composition of Nuts and Their Potential Health Benefits-An Overview

The possibility that nut intake may defend human health is an interesting point of view and has been investigated worldwide. Consequently, nuts are commonly promoted as healthy. In recent decades, the number of investigations proposing a correlation between nut consumption and a decrease in the risk of key chronic diseases has continued to increase. Nuts are a source of intake of fiber, and dietary fiber is associated with a reduced occurrence of obesity and cardiovascular diseases. Nuts likewise provide minerals and vitamins to the diet and supply phytochemicals that function as antioxidant, anti-inflammatory, and phytoestrogens agents and other protective mechanisms. Therefore, the main goal of this overview is to summarize current information and to describe the utmost new investigation concerning the health benefits of certain nuts.

Nut-enriched energy restricted diet has potential to decrease hunger in women at cardiometabolic risk: a randomized controlled trial (Brazilian Nuts Study)

Successful weight management represents a challenge to obesity control. Evidence suggests that nut consumption promotes a prolonged satiety response. Therefore, we hypothesize that nuts could be associated with greater weight loss in comparison to a control group, and we evaluate the acute and long-term effects of Brazilian nuts (BN: 15 g of Brazil nuts + 30 g of cashew nuts) included in an energy-restricted intervention on food intake, appetite, and peptide hormones. We conducted an 8-week, randomized, open-label, controlled, parallel-arm clinical trial with 28 women at cardiometabolic risk who received an energy-restricted diet containing BN or an energy-restricted nut-free diet (control). At baseline and after 8 weeks of intervention, subjective postprandial appetite ratings were assessed using a visual analog scale (VAS) before and after consumption (0, 10, 60, 120, 180, and 240 minutes) of a 437-kcal nut-enriched (BN group) or nut-free (control) breakfast meal. Subsequently, an ad libitum lunch was served, and the participants completed another VAS at 280 minutes. Plasma concentrations of ghrelin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and leptin were measured at fasting and postprandially at 60, 120, and 240 minutes. Last, subsequent reported 24-hour energy intake was assessed in a free-living setting. BN consumption did not have acute effects on food intake, appetite, or peptide hormones. However, after an 8-week intervention, postprandial ghrelin (difference between post- and preintervention area under the curve) decreased in the BN group in comparison to the control (mean difference, 1978 pg/mL/min, 95% CI, 27-3929 pg/mL/min; P = .047) and therefore, an energy-restricted diet containing demonstrated potential to decrease hunger in cardiometabolic risk women.

Consumption of Nuts and Seeds and Health Outcomes Including Cardiovascular Disease, Diabetes and Metabolic Disease, Cancer, and Mortality: An Umbrella Review

Consumption of nuts and seeds is associated with a range of health outcomes. Summarizing the best evidence on essential health outcomes from the consumption of nuts is essential to provide optimal recommendations. Our objective is to comprehensively assess health outcome associations related to the consumption of nuts and seeds, using a culinary definition including tree nuts and peanuts (registered in PROSPERO: CRD42021258300). Health outcomes of interest include cardiovascular disease, cancer, diabetes, obesity, respiratory disease, mortality, and their disease biomarkers. We present associations for high compared with low consumption, per serving, and dose-response relations. MEDLINE, Embase, Cochrane, and Epistemonikos were searched and screened for systematic reviews and meta-analyses. Evidence was extracted from 89 articles on the consumption of nuts and relevant health outcomes, including 23 articles with meta-analysis on disease and mortality, 66 articles on biomarkers for disease, and 9 articles on allergy/adverse outcomes. Intake of nuts was associated with reduced risk of cardiovascular diseases and related risk factors, with moderate quality of evidence. An intake of 28 g/d nuts compared with not eating nuts was associated with a 21% RR reduction of cardiovascular disease (including coronary heart disease incidence and mortality, atrial fibrillation, and stroke mortality), an 11% risk reduction of cancer deaths, and 22% reduction in all-cause mortality. Nut consumption was also inversely associated with mortality from respiratory diseases, infectious diseases, and diabetes; however, associations between nut consumption and diabetes incidence were mixed. Meta-analyses of trials on biomarkers for disease generally mirrored meta-analyses from observational studies on cardiovascular disease, cancers, and diabetes. Allergy and related adverse reactions to nuts were observed in 1-2% of adult populations, with substantial heterogeneity between studies. Overall, the current evidence supports dietary recommendations to consume a handful of nuts and seeds per day for people without allergies to these foods.

Inverse association of a traditional Korean diet composed of a multigrain rice-containing meal with fruits and nuts with metabolic syndrome risk: The KoGES

Background

Hansik, a traditional Korean diet, may have a beneficial impact on metabolic syndrome (MetS) risk as dietary westernization increases its prevalence. We examined the hypothesis that adherence to the hansik diet may be inversely associated with the risk of MetS and its components and sought to understand the gender differences in 58,701 men and women aged over 40.

Materials and methods

Hansik was defined using 14 components from which the Korean dietary pattern index (K_diet-index) was generated by summing their scores. Low-hansik intake was defined as the K_diet-index with <8. MetS was categorized based on the 2005 revised NCEP-ATP III criteria modified for Asians.

Results

The K_diet-index score was negatively associated with the dietary inflammation index and showed that the high intake of a meal with multigrain rice, fruits, and their products, and nuts, and low intake of fried foods were inversely associated with MetS by 0.707, 0.864, 0.769, and 0.918 times, respectively, after adjusting for covariates. More women and participants with more educated and lower income belonged to the high-hansik group, and participants with high self-rated health scores consumed more hansik. All participants on a high-hansik diet were associated with a 0.87 time lower risk of MetS. Specifically, the association between hansik intake and MetS risk was not significant among men following stratification by gender. Body composition, including the body mass index, waist circumference, and fat mass, was inversely associated with hansik intake, while the skeletal muscle mass index was positively associated with the hansik intake in each gender and all participants. In all the participants in the high-hansik group, no significant changes were seen in the serum glucose and HDL concentration. However, a high-hansik intake showed lower blood pressure and serum LDL and triglyceride concentrations only in men and a higher glomerular filtration rate in both genders.

Conclusions

Hansik intake might improve MetS risk, with its primary beneficial effects on body composition, dyslipidemia, and blood pressure gender-dependently.

The effect of walnut consumption on cardiometabolic profiles of individuals with abnormal glucose homoeostasis: a systematic review and meta-analysis of clinical trials

Findings on the effect of walnut consumption on cardiometabolic profiles in individuals with abnormal glucose homoeostasis are conflicting. We summarised earlier data in this regard. A systematic literature search of relevant reports published in Medline/PubMed, ISI web of Science, EMBASE, SCOPUS and Google Scholar up to October 2020 was conducted. Randomised trials that enrolled individuals with abnormal glucose homoeostasis in which the main intervention was walnut consumption were included. Abnormal glucose homoeostasis was defined as a spectrum of impaired glucose tolerance or pre-diabetic status that is associated with insulin resistance. Twelve studies were included in systematic review and eight in meta-analysis. No significant effect of walnut consumption on anthropometric measures, including weighted mean difference (WMD: -0·13; 95 % CI -0·64, 0·39 kg), BMI (-0·08; 95 % CI -0·47, 0·32 kg/m²) and waist circumference (0·01; 95 % CI -0·50, 0·52 cm) was observed. Although walnut intake did not influence on lipid profiles (including TAG, total- and HDL-cholesterol levels), individuals in the intervention group tended to have lower levels of LDL-cholesterol than those in the control group (-0·10; 95 % CI -0·20, 0·01 mmol/l; P = 0·06). Other cardiometabolic factors including markers of glycaemic control (fasting blood glucose and HbA1C levels), blood pressure and stimulus-adjusted response measure (a parameter of endothelial function) were not significantly affected. However, walnut consumption resulted in a significant increase in flow-mediated dilation (FMD) (0·93 %; 95 % CI 0·16, 1·71 %). Summarising earlier evidence, we found that walnut consumption might influence FMD and LDL-cholesterol levels in individuals with abnormal glucose homoeostasis. It did not affect other cardiometabolic profiles in these individuals.

Community-based lifestyle intervention improves metabolic syndrome and related markers among Kenyan adults

Purpose

Metabolic syndrome (MetS) is a major risk factor for cardiovascular diseases and type-2 diabetes. The study aimed to establish the efficacy of a community-based lifestyle intervention on MetS in Kenyan adults using randomized control trial involving a 15-months follow up.

Methods

A randomized controlled trial involving 352 (18-64 years old) adults with MetS spanning 15-months duration. Participants were recruited from a Nairobi based Mission-led outpatient clinic, randomly assigned equally into intervention and control groups. The intervention group was exposed to a community-based health education on lifestyle modification, while control group was subjected to hospital-led routine care involving treatment and general lifestyle advice. The study was structured into baseline, intervention and evaluation phases with inbuilt data collection in each phase. Physiologic, anthropometric, and clinical parameters as well lifestyle characteristics were measured at baseline, midline and end-line. The parameters were compared across the groups and between the time points during analyses using chi-square test, binary logistic, independent t-test and paired t-test.

Results

Proportion of participants with MetS declined significantly (p < 0.001) with marked (p < 0.05) improvement in markers of MetS (elevated BP, raised sugars, cholesterols, central obesity) in intervention compared to control group. The rates of consumption of fruits, vegetables, legumes, nuts and uptake of physical activity significantly (p < 0.05) improved in the intervention group. However, the intake of processed/fast foods, salt, sugar, and alcohol significantly (p < 0.05) declined in the intervention compared to controls by the end-line.

Conclusion

One in three adults under the community-based lifestyle intervention had improvement in physiologic, anthropometrics and clinical markers relevant to definition of MetS. Additionally, an improved adherence to the recommended dietary intake and increased uptake of physical activity in adults with MetS was observed. These findings underscore the feasibility, effectiveness and proof of concept for community-based lifestyle approach as a viable strategic intervention for addressing premorbid risk factors for cardiovascular CVDs and diabetes before evolving into full blown conditions in low-income settings.

Changes in body weight in response to pecan-enriched diets with and without substitution instructions: a randomised, controlled trial

Substantial evidence suggests that regular tree nut consumption does not lead to changes in body weight (BW). However, these studies used a variety of dietary substitution instructions which may confound the interpretation of prior BW outcomes. The purpose of the present study was to examine the impact of daily pecan consumption, with or without isocaloric substitution instructions, on BW and composition. This was an 8-week randomised, controlled trial with three treatments: a nut-free control group (n 32) and two pecan groups. ADD (n 30) consumed pecans (68 g/d) as part of a free-living diet, and SUB (n 31) substituted the pecans (68 g/d) for isocaloric foods from their habitual diet. BW and total body fat percentage (BF) were measured, and theoretical changes in these outcomes if pecans were consumed without compensation were determined. BW increased in all groups across the intervention, and there was a trend (P = 0⋅09) for an increase in ADD (1⋅1 ± 0⋅2 kg) and SUB (0⋅9 ± 0⋅3 kg) compared to control (0⋅3 ± 0⋅2 kg). In addition, there was increased BF in SUB (1⋅0 ± 0⋅3 %; P = 0⋅005) but not ADD (0⋅1 ± 0⋅2 %) or control (−0⋅2 ± 0⋅3 %) There was a large difference in the actual v. theoretical change in BW regardless of pecan treatment (actual: 1⋅1 ± 0⋅2 and 0⋅9 ± 0⋅3 v. theoretical: 3⋅3 ± 0⋅0 and 3⋅2 ± 0⋅0 kg in ADD and SUB, respectively; P < 0⋅001). Furthermore, there was a difference in actual v. theoretical change in BF in ADD (0⋅1 ± 0⋅2 v. 1⋅2 ± 0⋅1 %; P = 0⋅002) but not SUB or control. In conclusion, daily pecan consumption for 8 weeks did not result in significant weight gain, regardless of dietary substitution instructions.

Microwave-Assisted Extraction Coupled to HPLC-UV Combined with Chemometrics for the Determination of Bioactive Compounds in Pistachio Nuts and the Guarantee of Quality and Authenticity

Two novel microwave-assisted extraction (MAE) methods were developed for the isolation of phenols and tocopherols from pistachio nuts. The extracts were analyzed by reversed-phase high-pressure liquid chromatography coupled with a UV detector (RP-HPLC-UV). In total, eighteen pistachio samples, originating from Greece and Turkey, were analyzed and thirteen phenolic compounds, as well as α-tocopherol, (β + γ)-tocopherol, and δ-tocopherol, were identified. The analytical methods were validated and presented good linearity (r² > 0.990) and a high recovery rate over the range of 82.4 to 95.3% for phenols, and 93.1 to 96.4% for tocopherols. Repeatablility was calculated over the range 1.8–5.8%RSD for intra-day experiments, and reproducibility over the range 3.2–9.4%RSD for inter-day experiments, respectively. Principal component analysis (PCA) was employed to analyze the differences between the concentrations of the bioactive compounds with respect to geographical origin, while agglomerative hierarchical clustering (AHC) was used to cluster the samples based on their similarity and according to the geographical origin.

Specific Dietary Protein Sources Are Associated with Cardiometabolic Risk Factors in the Boston Puerto Rican Health Study

BACKGROUND

Puerto Rican adults residing in the US mainland experience a high prevalence of metabolic syndrome (MetS). A diet containing healthy protein-rich sources may help control risk factors for MetS.

OBJECTIVE

This study aimed to evaluate 2-year longitudinal associations between intake of various protein-rich foods and changes in the six MetS components.

DESIGN

This is a secondary analysis of a longitudinal cohort study using data from the baseline (2004-2007) and 2-year follow-up visits (2006-2011) in the Boston Puerto Rican Health Study.

PARTICIPANTS/SETTING

Participants were self-identified Puerto Ricans, aged 45 to 75 years, residing in Boston, Massachusetts, or the surrounding area (n = 1,126).

MAIN OUTCOME MEASURES

MetS components were fasting glucose, high-density lipoprotein (HDL) cholesterol, triglycerides, systolic and diastolic blood pressures, and waist circumference.

STATISTICAL ANALYSIS

Baseline intake of foods reported in a semiquantitative food frequency questionnaire were expressed as servings/day, and protein-rich foods were categorized as unprocessed white meat, unprocessed red meat, processed meat, milk and yogurt, cheese, fish and seafood, beans, nuts, and eggs. Associations between each continuous protein food group and continuous 2-year change in MetS components were assessed using linear mixed models adjusted for socioeconomic and behavioral factors, and other dietary sources.

RESULTS

The top contributors to total protein intake were unprocessed red meat (13.3%) and unprocessed poultry (13.0%), and the lowest were eggs (2.92%) and nuts (0.91%). Higher intake of processed meats was associated with an increase in waist circumference over 2 years (β = 1.28; standard error [SE] = 0.63), whereas higher intake of fish and seafood was associated with a decrease in waist circumference (β = -3.47; SE = 1.39). Intake of unprocessed poultry was associated with a decrease in triglycerides (β = -24.5; SE = 9.13). No other significant associations were observed between protein sources and 2-year changes in MetS components.

CONCLUSIONS

Consuming less processed meat and more fish and seafood and unprocessed poultry was associated with decreases in waist circumference and triglycerides among US mainland Puerto Ricans. Other dietary protein sources were not related to cardiometabolic health.

Adherence to a Plant-Based Diet and Consumption of Specific Plant Foods-Associations with 3-Year Weight-Loss Maintenance and Cardiometabolic Risk Factors: A Secondary Analysis of the PREVIEW Intervention Study

Plant-based diets are recommended by dietary guidelines. This secondary analysis aimed to assess longitudinal associations of an overall plant-based diet and specific plant foods with weight-loss maintenance and cardiometabolic risk factors. Longitudinal data on 710 participants (aged 26–70 years) with overweight or obesity and pre-diabetes from the 3-year weight-loss maintenance phase of the PREVIEW intervention were analyzed. Adherence to an overall plant-based diet was evaluated using a novel plant-based diet index, where all plant-based foods received positive scores and all animal-based foods received negative scores. After adjustment for potential confounders, linear mixed models with repeated measures showed that the plant-based diet index was inversely associated with weight regain, but not with cardiometabolic risk factors. Nut intake was inversely associated with regain of weight and fat mass and increments in total cholesterol and LDL cholesterol. Fruit intake was inversely associated with increments in diastolic blood pressure, total cholesterol, and LDL cholesterol. Vegetable intake was inversely associated with an increment in diastolic blood pressure and triglycerides and was positively associated with an increase in HDL cholesterol. All reported associations with cardiometabolic risk factors were independent of weight change. Long-term consumption of nuts, fruits, and vegetables may be beneficial for weight management and cardiometabolic health, whereas an overall plant-based diet may improve weight management only.

Plant-based snacking: research and practical applications of pistachios for health benefits

Pistachio nuts are a nutrient-dense source of good quality plant protein, commonly consumed as a minimally processed snack food or ingredient. The present paper is based on a symposium held during the 13th FENS (Federation of European Nutrition Societies) 2019 conference in Dublin that explored recent research and practical applications of pistachios as a plant-based snack, in particular, for appetite control and healthy weight management; and for glycaemic control during pregnancy. Individual nut types, whilst similar in nutritional composition, have unique characteristics which may have a significant impact on potential health effects. Recognising this, the further purpose here is to explore future research needs for pistachios, based on work completed to date and the discussion that ensued among researchers at this event, in order to advance the full scope of health benefits from pistachios, in particular, taking into account of both sustainability and nutritional health.

Physical activity and metabolic syndrome severity among older adults at cardiovascular risk: 1-Year trends

BACKGROUND AND AIMS

Modifiable lifestyle factors, such as physical activity (PA) and Mediterranean diet (MD), decrease metabolic syndrome (MetS). The aim was to assess 1-year changes of leisure-time physical activity (LTPA), sedentary behavior, and diet quality according to MetS severity in older population at high cardiovascular risk.

METHODS AND RESULTS

Prospective analysis of 55-75-year-old 4359 overweight/obese participants with MetS (PREDIMED-Plus trial) categorized in tertiles according to 1-year changes of a validated MetS severity score (MetSSS). Anthropometrics, visceral adiposity index, triglycerides and glucose index, dietary nutrient intake, biochemical marker levels, dietary inflammatory index, and depression symptoms were measured. Diet quality was assessed by 17-item MD questionnaire. PAs were self-reported using the Minnesota-REGICOR Short Physical Activity Questionnaire and 30-s chair stand test. Sedentary behaviors were measured using the Spanish version of the Nurses' Health Study questionnaire. After 1-year follow-up, decreasing MetSSS was associated with an anti-inflammatory dietary pattern, high intake of vegetables, fruits, legumes, nuts, whole grain cereals, white fish, and bluefish and low intake of refined cereals, red and processed meat, cookies/sweets, and snacks/ready-to-eat-meals. It resulted in high intake of polyunsaturated fatty acids, omega-3 fatty acids, protein, fiber, vitamins B1, B6, B9, C, D, potassium, magnesium, and phosphorus and low glycemic index and saturated fatty acid, trans fatty acid, and carbohydrates intake. Regarding PA and sedentary behavior, decreasing MetSSS was associated with increased moderate-to-vigorous LTPA, chair stand test, and decreased sedentary and TV-viewing time.

CONCLUSION

Decreasing MetSSS was associated with an anti-inflammatory dietary pattern, high LTPA, high MD adherence, low sedentary time, and low depression risk.

The association between insulin resistance and the consumption of nut including peanut, pine nut and almonds in working-aged Korean population

OBJECTIVE

Studies have reported that nuts intake is potentially beneficial to cardiometabolic health. However, there have been heterogeneous results regarding the association between nut intake/consumption and the risk of diabetes mellitus (DM). Insulin resistance (IR) is a major pathophysiology of DM. Thus, this study was to assess the association between nuts consumption and IR.

DESIGN

A retrospective cross-sectional study.

SETTING

Multivariable-adjusted OR and 95 % CI for increased IR (adjusted OR (95 % CI)) were calculated according to the frequency of consuming one serving dose (15 g) of nuts including peanut, pine nut and almond (< 1/month, 1/month-1/week, 1-3/week, 3-5/week, ≥ 5/week). Elevated IR was defined in homoeostasis model assessment-insulin resistance corresponding to the fourth quartile levels within each study group. Subgroup analysis was conducted for gender, glycaemic status (normal, prediabetes and DM) and age (≥ and < 40 years).

PARTICIPANTS

379 310 Koreans who received health check-up.

RESULTS

Compared with nut consumption < 1/month (reference), nuts consumption ≥ 1/month had the lower OR and 95 % CI for elevated IR (1/month-1/week: 0·90 (95 % CI 0·89, 0·92), 1-3/week: 0·90 (95 % CI 0·87, 0·92), 3-5/week: 0·94 (95 % CI 0·89, 0·98) and ≥ 5/week: 0·90 (95 % CI 0·86, 0·94)). This association was more remarkable in women, normal glycaemic group and young age group (< 40 years). However, men, prediabetes, DM and old age group did not show the significant association.

CONCLUSION

Nuts consumption ≥ 1/month was less associated with elevated IR. Increased nuts consumption may have a favourable effect on IR.

Nut consumption, body weight, and adiposity in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

CONTEXT

It seems that nut consumption does not lead to weight gain in the general population. However, fewer studies have explored this relationship in individuals with type 2 diabetes (T2D).

PURPOSE

To synthesize evidence on the effects of nut (specifically, tree nuts and peanuts) consumption on adiposity-related measures in individuals diagnosed with T2D.

DATA SOURCES AND STUDY SELECTION

Four databases were searched up to December 31, 2020. Randomized controlled trials that examined the effects of nut consumption vs a control diet on body weight, body mass index, waist circumference, and percent body fat were included.

DATA EXTRACTION

The pooled effect sizes (p-ESs) and 95%CIs of nut consumption were estimated using random effects models.

DATA SYNTHESIS

A total of 15 randomized controlled trials including 899 individuals were included. No significant effects of nut-enriched interventions were found for body weight (p-ES = -0.04; 95%CI: -0.16 to 0.08), body mass index (p-ES = -0.05; 95%CI: -0.17 to 0.08), waist circumference (p-ES = -0.02; 95%CI: -0.20 to 0.15), or percent body fat (p-ES = -0.03; 95%CI: -0.28 to 0.21).

CONCLUSION

Nut consumption has no effect, positive or negative, on weight or adiposity parameters in people with T2D.

The Relationship of Tree Nuts and Peanuts with Adiposity Parameters: A Systematic Review and Network Meta-Analysis

The network meta-analysis and systematic review conducted aim to comparatively assess the effects of tree nuts and peanuts on body weight (BW), body mass index (BMI), waist circumference (WC), and body fat percentage (BF%). A systematic search up to 31 December 2020 was performed. A random-effects network meta-analysis was conducted following the PRISMA-NMA statement. A total of 105 randomized controlled trials (RCTs) with measures of BW (n = 6768 participants), BMI (n = 2918), WC (n = 5045), and BF% (n = 1226) were included. The transitivity assumption was met based on baseline characteristics. In the comparisons of nut consumption versus a control diet, there was no significant increase observed in any of the adiposity-related measures examined except for hazelnut-enriched diets, which raised WC. Moreover, almond-enriched diets significantly reduced WC compared to the control diet and to the pistachio-, mixed nuts-, and hazelnut-enriched diets. In subgroup analyses with only RCTs, designed to assess whether nut consumption affected weight loss, almonds were associated with reduced BMI and walnuts with reduced %BF. The evidence supports that: (1) tree nut and peanut consumption do not influence adiposity, and (2) compared to a control diet, the consumption of almond-enriched diets was associated with a reduced waist circumference.

A Comprehensive Review of Almond Clinical Trials on Weight Measures, Metabolic Health Biomarkers and Outcomes, and the Gut Microbiota

This comprehensive narrative review of 64 randomized controlled trials (RCTs) and 14 systematic reviews and/or meta-analyses provides an in-depth analysis of the effect of almonds on weight measures, metabolic health biomarkers and outcomes, and the colonic microbiota, with extensive use of figures and tables. Almonds are a higher energy-dense (ED) food that acts like a lower ED food when consumed. Recent systematic reviews and meta-analyses of nut RCTs showed that almonds were the only nut that had a small but significant decrease in both mean body mass and fat mass, compared to control diets. The biological mechanisms for almond weight control include enhanced displacement of other foods, decreased macronutrient bioavailability for a lower net metabolizable energy (ME), upregulation of acute signals for reduced hunger, and elevated satiety and increased resting energy expenditure. The intake of 42.5 g/day of almonds significantly lowered low-density lipoprotein cholesterol (LDL-C), 10-year Framingham estimated coronary heart disease (CHD) risk and associated cardiovascular disease (CVD) medical expenditures. Diastolic blood pressure (BP) was modestly but significantly lowered when almonds were consumed at >42.5 g/day or for >6 weeks. Recent RCTs suggest possible emerging health benefits for almonds such as enhanced cognitive performance, improved heart rate variability under mental stress, and reduced rate of facial skin aging from exposure to ultraviolet (UV) B radiation. Eight RCTs show that almonds can support colonic microbiota health by promoting microflora richness and diversity, increasing the ratio of symbiotic to pathogenic microflora, and concentrations of health-promoting colonic bioactives. Almonds are a premier healthy snack for precision nutrition diet plans.

Health Benefits Related to Tree Nut Consumption and Their Bioactive Compounds

Long-term studies with regular tree nut consumption have indicated positive outcomes for multiple health benefits. Here, we review the beneficial effects of tree nuts, highlighting the impact on glucose modulation, body weight management, cardiovascular risk, inflammation, oxidative stress, cognitive performance, and gut microbiota. Nuts are important sources of nutrients and phytochemicals, which, together with a healthy lipid profile, could help prevent certain chronic diseases, protect against oxidative stress and inflammation, and improve cognitive performance, thus reducing the impact of aging and neurodegeneration.

The effect of almond intake on anthropometric indices: a systematic review and meta-analysis

This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of almond intake on anthropometric indices in adult subjects. We searched PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar databases until January 2020 to identify relevant RCTs. Data were reported as weighted mean differences (WMDs) and standard deviations (SDs) to show the magnitude of effects of almond on body weight (BW), body mass index (BMI), waist circumference (WC), fat mass (FM), and fat-free mass (FFM). Out of 2983 reports, 28 RCTs (37 arms) were eligible for including in our meta-analysis. The pooled results, obtained using a random-effects model, showed that almond intake significantly decreased BW (WMD: -0.38 kg, 95% CI: -0.65, -0.10, p = 0.007, I2 = 30.5%) and FM (WMD: -0.58 kg, 95% CI: -0.87, -0.28, p < 0.001, I2 = 4.9%). However, we found no significant effect of almond administration on BMI (WMD: -0.30 kg m-2, 95% CI: -0.67, 0.06, p = 0.101, I2 = 62.6%), WC (WMD: -0.60 cm, 95% CI: -1.28, 0.06, p = 0.078, I2 = 0.0%), and FFM (WMD: 0.23 kg, 95% CI: -0.04, 0.50, p = 0.097, I2 = 49.5%). Overall, the current meta-analysis demonstrated that resveratrol almond intake significantly reduced weight and FM, but did not affect BMI, WC, and FFM. Further studies are still required to confirm our results.

Intake of Nuts or Nut Products Does Not Lead to Weight Gain, Independent of Dietary Substitution Instructions: A Systematic Review and Meta-Analysis of Randomized Trials

Several clinical interventions report that consuming nuts will not cause weight gain. However, it is unclear if the type of instructions provided for how to incorporate nuts into the diet impacts weight outcomes. We performed a systematic review and meta-analysis of published nut-feeding trials with and without dietary substitution instructions to determine if there are changes in body weight (BW) or composition. PubMed and Web of Science were searched through 31 December 2019 for clinical trials involving the daily consumption of nuts or nut-based snacks/meals by adults (≥18 y) for >3 wk that reported BW, BMI, waist circumference (WC), or total body fat percentage (BF%). Each study was categorized by whether or not it contained dietary substitution instructions. Within these 2 categories, an aggregated mean effect size and 95% CI was produced using a fixed-effects model. Quality of studies was assessed through the Cochrane risk-of-bias tool. Fifty-five studies were included in the meta-analysis. In studies without dietary substitution instructions, there was no change in BW [standardized mean difference (SMD): 0.01 kg; 95% CI: -0.07, 0.08; I2 = 0%] or BF% (SMD: -0.05%; 95% CI: -0.19, 0.09; I2 = 0%). In studies with dietary substitution instructions, there was no change in BW (SMD: -0.01 kg; 95% CI: -0.11, 0.09; I2 = 0%); however, there was a significant decrease in BF% (SMD: -0.32%; 95% CI: -0.61%, -0.03%; I2 = 35.4%; P < 0.05). There was no change in BMI or WC for either category of studies. Nut-enriched diet interventions did not result in changes in BW, BMI, or WC in studies either with or without substitution instructions. Slight decreases in BF% may occur if substitution instructions are used, but more research is needed. Limitations included varying methodologies between included studies and the frequency of unreported outcome variables in excluded studies.

Socioeconomic and lifestyle factors modifies the association between nut consumption and metabolic syndrome incidence

BACKGROUND & AIMS

The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS.

METHODS

We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (<median and ≥ median) and risk of MetS was assessed by Cox regression.

RESULTS

Nut consumption was inversely associated with MetS risk in multivariable-adjusted models. The highest tertiles of the constituents of nuts including fiber, polyphenol, MUFA and PUFA reduced MetS risk compared with the lowest tertiles, after adjustment for confounders. Among various types of nuts, the multivariable-adjusted HRs of MetS were 0.78 (0.63-0.96) for walnuts, and 0.77 (0.63-0.94) for pistachios, compared with the lowest intake. Among adult population, consuming nuts higher than the median and having moderate to high physical activity levels resulted in significant reduction in the MetS risk (HRs: 0.74, CI: 0.55-0.98 for moderate and HRs: 0.63, CI: 0.47-0.86 for high physical activity level). Participants who did not smoke had lower risk of MetS regardless of their amount of nuts consumption (HRs: 0.67, CI: 0.47-0.94 for intakes < median and HRs: 0.71, CI: 0.53-0.93 for intakes ≥ median). Stratification based on education status resulted in reduction in the risk of MetS in participants consuming nuts ≥ median in both educated and not-educated group (HRs: 0.81, CI: 0.66-0.98 for the non-educated group and HRs: 0.63, CI: 0.47-0.84 for the educated group).

CONCLUSIONS

Incorporating nuts, especially walnuts, into dietary patterns reduced the risk of MetS, especially among individuals with more physical activity levels.

Total Nut, Tree Nut, and Peanut Consumption and Metabolic Status in Southern Italian Adults

Background: Nut consumption has been associated with cardio-metabolic health benefits. However, studies conducted in the Southern Italian population, where adherence to the Mediterranean diet has been reported being relatively high, are rather scarce. The aim of this study was to test the association between consumption of total and specific types of nuts and metabolic status among adults living in Sicily, Southern Italy. Methods: Demographic and dietary characteristics of 2044 adults living in Southern Italy were analyzed. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between nut consumption and metabolic status adjusting for potential confounding factors. Results: The energy-adjusted model revealed that higher nut intake was inversely associated with occurrence of hypertension, type-2 diabetes, and dyslipidemia. However, the association did not remain significant for the latter after adjusting for the main background characteristics, while an inverse association was stably confirmed for hypertension (OR = 0.61, 95% CI: 0.46–0.80 and OR = 0.44, 95% CI: 0.26–0.74, respectively) even after adjusting for adherence to the Mediterranean diet. Among individual nut types, most of the associations were null except for higher almond intake, which was inversely associated with occurrence of hypertension (OR = 0.70, 95% CI: 0.49–0.99). Conclusions: Higher nut consumption is associated with overall better metabolic status in individuals living in the Mediterranean area.

Nut consumption and the prevalence and severity of non-alcoholic fatty liver disease

BACKGROUND

Nut consumption has been associated with reduced inflammation, insulin resistance, and oxidative stress. However, the influence on the prevalence and severity of non-alcoholic fatty liver disease (NAFLD) has yet to be evaluated.

METHODS

4655 subjects were included as part of a colorectal carcinoma screening program (SAKKOPI) between 07/2010 and 07/2019 and analyzed 2020. Patients were characterized using biochemical and metabolic parameters, as well as a detailed questionnaire on dietary habits. The diagnosis of NAFLD was established using abdominal ultrasound. Consumption of nuts was graded as: no consumption or <1 time/week, 1-6 times/week, 1 time/day and ≥2 times/day.

RESULTS

Mean age was 58.5±9.8years with a mean BMI of 26.5±4.7kg/m2. 2058 (44.2%) patients suffered from the metabolic syndrome, 2407 (51.6%) had arterial hypertension, 2287 (49.1%) showed prediabetes/diabetes, 1854 (39.4%) had dyslipidemia and 1984 patients (43.5%) were diagnosed with NAFLD. Prevalence of metabolic syndrome (1219 [48.7%] vs. 605 [40.2%] vs. 189 [37.4%] vs. 45 [31.7%], p<0.001) and NALFD (1184 [48.1%] vs. 594 [40.7%] vs. 158 [31.7%] vs. 48 [34.0%], p<0.001). On multivariable logistic regression analysis adjusting for potential confounders and dietary patterns, nut consumption ≥1time/day was inversely associated with NAFLD in the overall cohort (adjusted Odds ratio[aOR]: 0.719 [95%CI:0.558-0.926], p = 0.011). However, following subgroup analysis, this inverse association was only confirmed in male patients (aOR: 0.589 [95%CI: 0.411-0.844], p = 0.004) but not in females (aOR: 0.886 [95%CI: 0.616-1.275], p = 0.515). Moreover, patients who consumed nuts 1-6 times/week had a significantly lower prevalence of advanced fibrosis (Fib-4 score >2.67: aOR: 0.551 [95%CI: 0.338-0.898], p = 0.017; Forns-Index >6.9: aOR: 0.585 [95%CI: 0.402-0.850], p = 0.005).

CONCLUSIONS

Nut consumption might exert beneficial effects on the prevalence of NAFLD in males. The negative association with advanced fibrosis warrants further investigation.

Metabolic Syndrome Features and Excess Weight Were Inversely Associated with Nut Consumption after 1-Year Follow-Up in the PREDIMED-Plus Study

BACKGROUND

High nut consumption has been previously associated with decreased prevalence of metabolic syndrome (MetS) regardless of race and dietary patterns.

OBJECTIVES

The aim of this study was to assess whether changes in nut consumption over a 1-y follow-up are associated with changes in features of MetS in a middle-aged and older Spanish population at high cardiovascular disease risk.

METHODS

This prospective 1-y follow-up cohort study, conducted in the framework of the PREvención con DIeta MEDiterránea (PREDIMED)-Plus randomized trial, included 5800 men and women (55-75 y old) with overweight/obesity [BMI (in kg/m2) ≥27 and <40] and MetS. Nut consumption (almonds, pistachios, walnuts, and other nuts) was assessed using data from a validated FFQ. The primary outcome was the change from baseline to 1 y in features of MetS [waist circumference (WC), glycemia, HDL cholesterol, triglyceride (TG), and systolic and diastolic blood pressure] and excess weight (body weight and BMI) according to tertiles of change in nut consumption. Secondary outcomes included changes in dietary and lifestyle characteristics. A generalized linear model was used to compare 1-y changes in features of MetS, weight, dietary intakes, and lifestyle characteristics across tertiles of change in nut consumption.

RESULTS

As nut consumption increased, between each tertile there was a significant decrease in WC, TG, systolic blood pressure, weight, and BMI (P < 0.05), and a significant increase in HDL cholesterol (only in women, P = 0.044). The interaction effect between time and group was significant for total energy intake (P < 0.001), adherence to the Mediterranean diet (MedDiet) (P < 0.001), and nut consumption (P < 0.001). Across tertiles of increasing nut consumption there was a significant increase in extra virgin olive oil intake and adherence to the MedDiet; change in energy intake, on the other hand, was inversely related to consumption of nuts.

CONCLUSIONS

Features of MetS and excess weight were inversely associated with nut consumption after a 1-y follow-up in the PREDIMED-Plus study cohort. This trial was registered at isrctn.com as ISRCTN89898870.

Effects of Pistachio Consumption in a Behavioral Weight Loss Intervention on Weight Change, Cardiometabolic Factors, and Dietary Intake

Epidemiological studies have linked regular nut consumption with lower body mass index and reduced likelihood of weight gain in adulthood. Nuts can displace other foods in the diet, and thus, promote a healthier dietary pattern. The purpose of this study was to examine the effect of pistachio nut consumption in overweight/obese adults. This randomized controlled study enrolled non-diabetic overweight/obese adults (n = 100) assigned to a 4-month behavioral weight loss intervention only group (controls) or also prescribed 1.5 oz/day (42 g/day) of pistachios (pistachio group). Outcomes were change in body weight, cardiometabolic factors, and dietary intake. Percent weight change was similar in the two groups (−5.1 [0.5] (mean [SE])% in the control group and −4.9 [0.6]% in the pistachio group, and body mass index (BMI) and waist circumference were reduced in both groups (time effect p ≤ 0.05). The pistachio group (but not the control group) exhibited a significant reduction in both systolic and diastolic blood pressure (time effect p = 0.01). Plasma alpha-carotene, beta-carotene, and lutein concentrations increased significantly in the pistachio group (time effect p < 0.05). Pistachio consumption was associated with increased dietary fiber intake and decreased consumption of sweets. Regular consumption of pistachios was associated with a comparable degree of weight loss, and similar reductions in BMI and waist circumference, in overweight/obese men and women compared to controls, and favorable changes in the diet, in the context of a behavioral weight loss intervention.

Effect of viscous fiber supplementation on obesity indicators in individuals consuming calorie-restricted diets: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Dietary fiber has played a consistent role in weight management, with efficacy potentially attributed to increased viscous fiber consumption.

PURPOSE

To summarize the effects of viscous fiber on body weight and other anthropometric parameters, along with a calorie-deficient diet, through a systematic review and meta-analysis.

METHODS

MEDLINE, EMBASE, and the Cochrane library were searched through July 24, 2019 for randomized controlled trials that assessed the effect of viscous fiber supplementation as part of a restricted calorie diet for ≥ 4 weeks relative to comparator diets. Data were pooled using the generic inverse-variance method with random-effects models and expressed as mean differences with 95% confidence intervals. Inter-study heterogeneity was assessed using Cochran's Q and quantified with I². The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall certainty of evidence.

RESULTS

Findings from 15 studies (n = 1347) showed viscous fiber supplementation significantly decreased body weight (- 0.81 kg [- 1.20, - 0.41]; p < 0.0001), BMI (- 0.25 kg/m² [- 0.46, - 0.05]; p = 0.01), and body fat (- 1.39% [- 2.61, - 0.17]; p = 0.03), compared to control. No effect on waist circumference was found. The certainty of evidence was graded as "moderate" for body weight, BMI, and body fat based on downgrades for imprecision. Waist circumference was graded "low" for downgrades of inconsistency and imprecision.

CONCLUSION

Viscous fiber within a calorie-restricted diet significantly improved body weight and other markers of adiposity in overweight adults and those with additional risk factors for cardiovascular disease. This trial is registered at www.clinicaltrials.gov as NCT03257449.

REGISTRATION

ClinicalTrials.gov identifier: NCT03257449.

Bioactives and health benefits of nuts and dried fruits

Nuts and dried fruits have been part of the human diet since prehistoric times. They are nutrient-rich foods and constitute an excellent means to deliver health-promoting bioactive compounds. As such, they serve as important healthful snack items, besides being part of many traditional and new recipes of gastronomy worldwide. Frequent consumption of nuts and/or dried fruits is highly recommended to obtain the full benefit of the nutrients, bioactives, and antioxidants that they contain, together with their desirable flavour. The macronutrients, micronutrients, and other health-promoting bioactive compounds contained in nuts and dried fruits may synergistically contribute to modulate the risk of cardiometabolic and other non-communicable diseases through various mechanisms. Experimental research, prospective studies, and human clinical trials have reported beneficial effects of nut consumption on various health outcomes. The benefits of dried fruits, however, have been less explored. This review summarizes recent findings on bioactive constituents, health claims, and health benefits of nuts and dried fruits and also discusses their great potential as healthy foods to benefit a number of diseases afflicting human beings.

Does Nut Consumption Reduce Mortality and/or Risk of Cardiometabolic Disease? An Updated Review Based on Meta-Analyses

Aim We aimed to determine if nut consumption decreases mortality and/or the risk of cardiometabolic diseases based on updated meta-analyses of epidemiological and intervention studies. Methods. An updated electronic search was conducted in PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library databases for original meta-analyses to investigate the effects of nut consumption on cardiometabolic disease in humans. Results. Seven new meta-analyses were included in this updated review. Findings similar to our previous review were observed, showing that nut consumption significantly decreased cardiovascular disease (CVD) mortality (−19% to −25%; n = 4), coronary heart disease (CHD) mortality (−24% to −30%; n = 3), stroke mortality (−17% to −18%; n = 3), CVD incidence (−15% to −19 %; n = 4), CHD [or coronary artery disease (CAD)] incidence (−17% to −34%; n = 8), and stroke incidence (−10% to −11%; n = 6) comparing high with low categories of nut consumption. Fasting glucose levels (0.08 to 0.15 mmol/L; n = 6), total cholesterol (TC; 0.021 to 0.30 mmol/L; n = 10), and low-density lipoprotein cholesterol (LDL-C; 0.017 to 0.26 mmol/L; n = 10) were significantly decreased with nut consumption compared with control diets. Body weight and blood pressure were not significantly affected by nut consumption. Conclusion. Nut consumption appears to exert a protective effect on cardiometabolic disease, possibly through improved concentrations of fasting glucose, total cholesterol, and LDL-C.

Health Benefits of Nut Consumption in Middle-Aged and Elderly Population

Aging is considered the major risk factor for most chronic disorders. Oxidative stress and chronic inflammation are two major contributors for cellular senescence, downregulation of stress response pathways with a decrease of protective cellular activity and accumulation of cellular damage, leading in time to age-related diseases. This review investigated the most recent clinical trials and cohort studies published in the last ten years, which presented the influence of tree nut and peanut antioxidant diets in preventing or delaying age-related diseases in middle-aged and elderly subjects (≥55 years old). Tree nut and peanut ingestion has the possibility to influence blood lipid count, biochemical and anthropometric parameters, endothelial function and inflammatory biomarkers, thereby positively affecting cardiometabolic morbidity and mortality, cancers, and cognitive disorders, mainly through the nuts' healthy lipid profile and antioxidant and anti-inflammatory mechanisms of actions. Clinical evidence and scientific findings demonstrate the importance of diets characterized by a high intake of nuts and emphasize their potential in preventing age-related diseases, validating the addition of tree nuts and peanuts in the diet of older adults. Therefore, increased consumption of bioactive antioxidant compounds from nuts clearly impacts many risk factors related to aging and can extend health span and lifespan.

The association between metabolic syndrome and peanuts, pine nuts, almonds consumption: The Ansan and Ansung Study

BACKGROUND

Previous studies reported an inverted relationship between nut consumption and the incidence of metabolic syndrome (MetS). The present study investigated the incidental risk for MetS according to peanut, almond, and fine nut consumption in the Korean population.

METHODS

In a community-based Korean cohort, 5306 Korean adults were divided into four groups according to their peanut, almond, and fine nut intake (<1/month, 1/month-0.5/week, 0.5-1/week, and ≥1/week, in which one serving = 15 g) and were followed-up for 10 years. A Cox proportional hazard model was used to evaluate the hazard ratios (HRs) with confidence intervals (CI) for MetS in each study group. Age subgroup (≥50 or <50 years) analysis was also conducted.

RESULTS

The age and multivariable-adjusted HRs with 95% CIs for MetS showed a significant inverse dose-response relationship between peanut, almond, and fine nut intake and the incidence of MetS in men and women (multivariable-adjusted HRs [95% CI] in men; 0.91 [0.76-1.09] in 1/month-0.5/week, 1.03 [0.80-1.31] in 0.5-1/week, 0.72 [0.56-0.93] in ≥1/week and in women; 0.81 [0.65-1.003] in 1/month-0.5/week, 0.76 [0.54-1.07] in 0.5-1/week, 0.57 [0.41-0.79] ≥1/week)). Subgroup analysis showed a significant difference in middle-aged men (≥1/week) and old-aged women (≥0.5/week).

CONCLUSION

The results of the present study suggested that peanut, almond, and fine nut intake (≥15 g/week) may be inversely related to incidence risk of MetS in the Korean general population. Additionally, the association between nut consumption and MetS incidence risk may differ in sex and age subgroups.

Perspective: Public Health Nutrition Policies Should Focus on Healthy Eating, Not on Calorie Counting, Even to Decrease Obesity

Calorie-focused policies, such as calorie menu labeling, seem to result in minor shifts toward healthier choices and public health improvement. This paper discusses the (lack of) relations between energy intake and healthy eating and the rationale for shifting the focus of public health nutrition policies to healthier foods and meals. We argue that the benefits of reducing caloric intake from low-quality foods might not result from the calorie reduction but rather from the reduced consumption of low-quality foods. It is better to consume a given number of calories from high-quality foods than a smaller number of calories from low-quality foods. It is not possible to choose a healthy diet solely based on the caloric value of foods because calories are not equal; they differ in nutritional quality according to their source. Foods are more than just a collection of calories and nutrients, and nutrients interact differently when presented as foods. Different subtypes of a macronutrient, although they have the same caloric value, are metabolized and influence health in different ways. For instance, industrial trans fats increase lipogenesis and the risk of heart diseases, whereas monounsaturated fats have the opposite effect. Food processing and cooking methods also influence the nutritional value of foods. Thus, public health nutrition policies should stop encouraging people to focus mainly on calorie counting to fight noncommunicable diseases. Instead, policies should focus on ingredients, dietary sources, and food processing and cooking methods.

Risk assessment and prediction for toxic heavy metals in chestnut and growth soil from China

BACKGROUND

Toxic heavy metals (THMs) cause severe environmental hazards and threaten human health through various consumption of food stuff. However, little is known of THMs in chestnuts. In this study, the risk assessment and prediction of THMs [lead (Pb), arsenic (As), chromium (Cr), cadmium (Cd) and mercury (Hg)] in chestnuts and growth soils from China were investigated.

RESULTS

The main detected THMs in chestnuts and growth soils were As and Cd. The total pollution levels of the five THMs (Nemerow pollution indexes, NPIs) were 0.062 and 1.06, respectively. The dietary risks for children were higher than those of adults, especially short-term non-carcinogenic risk. The main combined risks from the relationships between THMs were Pb-Cr (r = 0.85, P < 0.01) in chestnuts and Pb-As (r = 0.59, P < 0.01) in growth soils. The risk source was found to be the uptake effect of THMs from soil to chestnut, with the highest bioaccumulation factors (BCFs) of Cd (0.254). Several comprehensive risk models were established with the highest coefficient of determination (R² ) of 0.79. In addition, the main contribution rates of different soil parameters to comprehensive risk of THMs uptake were 49.8% (Cd), 23.4% (pH), 13.8% (Cr) and 13.0% (organic carbon).

CONCLUSION

The total pollution levels of THMs fell outside of the safety domain in growth soils. Furthermore, more attention needs to be paid to Cd pollution owing to its low environment background value and high accumulation ability. Three main soil parameters (Cr content, pH, organic carbon) played important roles in the formations and accumulations of THMs in chestnuts. © 2019 Society of Chemical Industry.

Food and Food Products on the Italian Market for Ketogenic Dietary Treatment of Neurological Diseases

The ketogenic diet (KD) is the first line intervention for glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and is recommended for refractory epilepsy. It is a normo-caloric, high-fat, adequate-protein, and low-carbohydrate diet aimed at switching the brain metabolism from glucose dependence to the utilization of ketone bodies. Several variants of KD are currently available. Depending on the variant, KDs require the almost total exclusion, or a limited consumption of carbohydrates. Thus, there is total avoidance, or a limited consumption of cereal-based foods, and a reduction in fruit and vegetable intake. KDs, especially the more restrictive variants, are characterized by low variability, palatability, and tolerability, as well as by side-effects, like gastrointestinal disorders, nephrolithiasis, growth retardation, hyperlipidemia, and mineral and vitamin deficiency. In recent years, in an effort to improve the quality of life of patients on KDs, food companies have started to develop, and commercialize, several food products specific for such patients. This review summarizes the foods themselves, including sweeteners, and food products currently available for the ketogenic dietary treatment of neurological diseases. It describes the nutritional characteristics and gives indications for the use of the different products, taking into account their metabolic and health effects.

A Randomized Controlled Pilot Study to Assess Effects of a Daily Pistachio (Pistacia Vera) Afternoon Snack on Next-Meal Energy Intake, Satiety, and Anthropometry in French Women

Including nuts in the diet improves appetite control and does not lead to weight gain. However, for pistachios, evidence from randomized intervention studies is limited and there are no data on the effect of pistachios on satiety. The objective of this study was to assess the effect of daily consumption of pistachios as an afternoon snack on satiety, self-reported energy, self-reported nutrient intake, body weight, and body composition. This randomized controlled pilot study included two parallel groups of 30 healthy French women, in a free-living setting. For four weeks, groups were instructed to consume either 56 g (1318 kJ) of pistachios or 56 g of isoenergetic/equiprotein savory biscuits as an afternoon snack. Evening energy intake, changes in anthropometric measures, and daily intake of energy and selected nutrients were assessed. Visual analogue scales (VAS) were used to rate hunger, fullness, desire to eat, and prospective consumption. Satiety effects were not different between groups, as assessed by evening energy intake or VAS scores. Consuming pistachios or biscuits had no impact on body weight. Thiamin, vitamin B6, copper, and potassium intakes were significantly higher in the pistachio group. Consuming pistachios or biscuits as an afternoon snack resulted in similar post-snack food intake and subjective feelings of satiety. A daily pistachio snack for a month did not affect body weight or composition but it did improve micronutrient intake.

Relationship Between Nut Consumption and Metabolic Syndrome: A Meta-Analysis of Observational Studies

Objective: Our aim was to examine the relationship between nut consumption and metabolic syndrome (MetS). Methods: The electronic databases of PubMed, Web of Science, and Embase were searched up to November 2018 for observational studies on the relationship between nut consumption and MetS. The pooled relative risk (RR) of MetS for the highest versus lowest category of nut consumption, as well as their corresponding 95% confidence intervals (CIs) were calculated. Results: A total of 11 observational studies (6 cross-sectional and 5 prospective cohort studies), which involved a total of 89,224 participants, were identified for this meta-analysis. The overall multivariable adjusted RR showed that nut consumption was negatively associated with MetS (RR = 0.84; 95% CI, 0.76-0.92; p < 0.001). Of interest, subgroup analysis confirmed that such findings existed in tree nuts (RR = 0.97; 95% CI, 0.94-1.00; p = 0.04), but not in peanuts (RR = 1.01; 95% CI, 0.96-1.06; p = 0.68). Conclusions: The existing evidence suggested that nut consumption was negatively associated with MetS. However, such an inverse relationship only existed in tree nuts, not in peanuts. More well-designed studies with detailed specifications of nut varieties are needed to further elaborate the issues examined in this study.

Nuts and Cardio-Metabolic Disease: A Review of Meta-Analyses

OBJECTIVES

Accumulating epidemiological and intervention evidence suggest that nut consumption is associated with reduced incidence of some cardiometabolic diseases. However, to date no review of meta-analyses of epidemiological and intervention studies has evaluated the effects of nut consumption on cardiometabolic disease. Design/Results: Electronic searches for meta-analyses of epidemiological and intervention studies were undertaken in PubMed®/MEDLINE®. Meta-analyses of prospective studies show that nut consumption appears to be associated with reduced all-cause mortality by 19⁻20% (n = 6), cardiovascular disease (CVD) incidence (19%; n = 3) and mortality (25%; n = 3), coronary heart disease (CHD) incidence (20⁻34%; n = 2) and mortality (27⁻30%; n = 2) and stroke incidence (10⁻11%; n = 7) and mortality (18%; n = 2). No association between nut consumption and the risk of type 2 diabetes mellitus (T2DM) was observed in meta-analyses of prospective studies, whereas a decrease in fasting blood glucose ranging from 0.08 to 0.15 mmol/L was observed in 3 meta-analyses of intervention studies. In the interventions, nut consumption also had favorable effects on total cholesterol (0.021 to 0.28 mmol/L reduction from 8 meta-analyses of interventions) and low-density lipoprotein cholesterol (0.017 to 0.26 mmol/L reduction from 8 meta-analyses of interventions) and endothelial function (0.79 to 1.03% increase in flow-mediated dilation from 4 meta-analyses of interventions). Nut consumption did not significantly affect body weight. Nut consumption had no effect on inflammatory markers in intervention studies. The effect on blood pressure was inconsistent. A higher nut consumption was associated with a lower incidence of hypertension in prospective studies, while nut consumption did not improve blood pressure in intervention studies.

CONCLUSIONS

Nut consumption appeared to be associated with lower all-cause mortality and CVD and CHD mortality. There was no association between nut consumption and the incidence of T2DM although fasting blood glucose is decreased in intervention studies. In intervention studies nuts lower total cholesterol and low-density lipoprotein cholesterol (LDL-C).

Effect of nuts on energy intake, hunger, and fullness, a systematic review and meta-analysis of randomized clinical trials

Despite high energy content, nut consumption has not been associated with weight gain in epidemiological and clinical investigations. Since a satiety effect a decreased sense of hunger in the following meals has been proposed as the mechanism of nuts against obesity, the present meta-analysis was performed to examine how nut consumption affects "energy intake", "hunger", and "fullness". "Weight" was not included among the search terms but weight data were extracted from the collected articles in order to help interpreting the results. A total of 1048 trials were found, of which 31 passed the eligibility process. Daily energy intake was mostly assessed by 3-day food records, and hunger and fullness were estimated by visual analog scale (VAS). Nut consumption was associated with increased energy intake (mean difference (MD) (nuts - control) = 76.3 kcal; 95% CI: 22.7, 130 kcal; P = 0.005). In contrast, hunger suppressed following nut consumption (MD = -6.54 mm VAS; 95% CI: -12.7, -0.42 mm VAS; P = 0.03). Nuts did not affect sense of fullness and weight in the overall estimate. Subgroup analysis based on participants' BMI revealed that energy intake of overweight/obese individuals was increased following nut consumption while such effect was not observed in normal weight participants. In conclusion, pooled estimates of available clinical trials showed increased energy intake following nut consumption in overweight/obese individuals but not in persons with normal weight. Nut consumption was associated with decreased hunger but no effect was observed on fullness and weight.