Dietary Almonds Increase Serum HDL Cholesterol in Coronary Artery Disease Patients in a Randomized Controlled Trial

Effects of polyphenol-rich seed foods on lipid and inflammatory markers in patients with coronary heart disease: a systematic review

Background

Coronary heart disease (CHD) is a prevalent cardiovascular condition, with its incidence and mortality rates steadily rising over time, posing a significant threat to human health. Studies have indicated that polyphenols exhibit a certain degree of protective effect against coronary heart disease. However, the findings regarding the impact of polyphenol-rich seed foods on patients with CHD have yielded inconsistent results.

Objective

This study investigated the effects of polyphenol-rich seed foods on blood lipids and inflammatory markers in patients with coronary heart disease.

Methods

The China National Knowledge Network, China Science and Technology Journal Database, China Biomedical Literature Database, Wanfang Database, PubMed, Cochrane Library, Embase, and Web of Science were searched for articles from the self-built database until March 16, 2024. The quality of the included studies was assessed using Edition 2 of the Cochrane Randomized Trials Risk Bias Tool, and data analysis was conducted using RevMan 5.4.

Results

The study encompassed seven articles, with a total participation of 324 patients diagnosed with coronary heart disease. The study incorporated three seed foods abundant in polyphenols: Brazil nut, almond, and flaxseed. The meta-analysis findings revealed a significant reduction in triglyceride levels [MD = -20.03, 95% CI (-32.25, -17.44), p < 0.00001] among patients diagnosed with coronary heart disease who incorporated seed-based foods abundant in polyphenols into their diet regimen. Furthermore, a notable enhancement was observed in HDL cholesterol levels [MD = 3.14, 95% CI (1.55, 4.72), p = 0.0001]. Moreover, the type of intervention substance influenced the observed effects. The consumption of almonds has been demonstrated to significantly reduce total cholesterol [MD = -15.53, 95% CI (-21.97, -9.1), p < 0.00001] and LDL cholesterol [MD = -14.62, 95% CI (-20.92, -8.33), p < 0.00001] in patients diagnosed with coronary heart disease. Additionally, the incorporation of flaxseed into the diet has shown an enhanced effect on reducing C-reactive protein levels.

Conclusion

The consumption of polyphenol-rich seed foods can moderately improve TG and HDL-C levels in patients with coronary heart disease, while incorporating flaxseed into their diet can effectively improve inflammatory markers.

Effect of nut consumption on blood lipids: An updated systematic review and meta-analysis of randomized controlled trials

AIMS

Nuts are nutrient-dense foods touted for their health-promoting effects, especially regarding cardiovascular health, yet inconsistencies in the literature remain in relation to their effect on blood lipids. Hence, a systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of nut intake on blood lipids.

DATA SYNTHESIS

MEDLINE-PubMed and Cochrane databases were searched. 113 unique trials met eligibility criteria (n = 8060 adults with various health status) assessing the effect of a median daily dose of 45.5 g/d of nuts compared to a non-nut control on blood lipid outcomes met inclusion criteria. Overall, nut consumption resulted in moderate reductions in total cholesterol (mean difference, -0.14 mmol/L [95 % confidence interval, -0.18 to -0.10 mmol/L]) and LDL-C (-0.12 mmol/L [-0.14 to -0.09 mmol/L]), with small reductions in triglycerides (-0.05 mmol/L [-0.07 to -0.03 mmol/L]), TC:HDL-C (-0.11 [-0.16 to -0.06]), LDL-C:HDL-C (-0.19 [-0.24 to -0.12]), and apolipoprotein B (-0.04 g/L [-0.06 to -0.02 g/L]). There was no significant impact on HDL-cholesterol or other assessed measures. Certainty of evidence was high for apolipoprotein A, and generally moderate/low for all other outcomes. Sensitivity analysis did not change the evidence on the main outcomes. Significant effect modifications in subgroup analysis were shown for most of the lipid parameters assessed. None of these subgroup effects altered the evidence of heterogeneity for any primary outcome.

CONCLUSIONS

Current evidence provides a good indication that consuming nuts may advantageously affect blood lipids in adults with a mix of health status.

PROSPERO REGISTRATION

PROSPERO identifier, CRD42022358688.

Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial

BACKGROUND

Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction.

METHODS

DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality.

RESULTS

After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study.

CONCLUSION

Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259-8105.

Effect of nuts on lipid profile and inflammatory biomarkers in atherosclerotic cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Nut-enriched diets are related to improve lipid and inflammatory biomarkers in meta-analyses in the context of primary cardiovascular prevention. However, primary studies on secondary cardiovascular prevention are scarce and controversial. This systematic review and meta-analysis aimed to evaluate the effect of nut supplementation on lipid and inflammatory profiles in individuals with atherosclerotic cardiovascular disease, and the frequency of adverse events.

METHODS

Six databases were used for research: PubMed, EMBASE, BVS, Cochrane Library, Web of Science, and ClinicalTrials.gov, until February 2023, with no language restrictions. We performed random-effects meta-analyses to compare nut-enriched diets vs. control diets for pre-post intervention changes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system assessed the evidence's certainty.

RESULTS

From the 5187 records identified, eight publications containing data referring to five randomized clinical trials involving 439 participants were included in the final analyses. The nuts evaluated were almonds, pecans, Brazil nuts, and mixed nuts, with doses ranging between 5 g and 85 g (median: 30 g/day). The intervention time varied between 6 and 12 weeks. Compared to nut-free diets, nut intake did not have a statistically significant effect on lipid profile biomarkers, except on the atherogenic index (MD: -0.32 [95% CI -0.58 to -0.06], I2 = 0% - moderate certainty of the evidence). Similarly, there was no effect of nuts on inflammatory profile biomarkers. It was not possible to aggregate data on adverse events.

CONCLUSIONS

Nut supplementation did not change lipid and inflammatory profiles in the secondary cardiovascular prevention setting.

Effect of Nuts on Anthropometric and Glycemic Indexes and Blood Pressure in Secondary Cardiovascular Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials

CONTEXT

Nut-enriched diets have a positive impact on cardiovascular risk factors, such as body mass, blood pressure, and fasting blood glucose. However, studies in individuals undergoing secondary cardiovascular prevention show controversial results.

OBJECTIVE

This systematic review with meta-analysis assessed the effect of nut supplementation on anthropometric, glycemic, and blood pressure indices in patients with atherosclerotic cardiovascular disease, as well as the frequency of adverse events.

DATA SOURCES

Six databases were used for the search-PubMed, Cochrane Library, EMBASE, BVS (Biblioteca Virtual da Saude), Web of Science, and ClinicalTrials.gov-until February 2023, with no language restrictions.

DATA EXTRACTION

The Cochrane Handbook for Systematic Reviews of Interventions methodology and the PICOS (Population, Intervention, Comparison, Outcome, Setting/design) strategy were used. Seven independent reviewers were involved in data extraction and resolution of disagreements. Certainty of the evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

DATA ANALYSIS

From 5187 records identified, 6 publications containing data referring to 5 randomized clinical trials (n = 436) were included in the final analyses. The nuts evaluated were almonds, pecans, Brazil nuts, and mixed nuts, with portions that varied between 5 g and 85 g (median: 30 g/day). The intervention period varied between 6 and 12 weeks. The nuts had no effect on fasting glucose and anthropometric indices, although the certainty of the evidence for most of these outcomes was low or very low. They also had no effect on systolic (mean difference [MD]: -1.16 mmHg [95% CI, -5.68 to 3.35], I2 = 0%-moderate certainty of evidence) or diastolic (MD: 0.10 mmHg [95% CI, -2.30 to 2.51], I2 = 0%-high certainty of evidence) blood pressure. It was not possible to aggregate data on adverse events.

CONCLUSION

Nut supplementation had no effect on blood pressure, fasting glucose, or anthropometric profile in the context of atherosclerotic cardiovascular disease.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020163456.

Almond supplementation on appetite measures, body weight, and body composition in adults: A systematic review and dose-response meta-analysis of 37 randomized controlled trials

BACKGROUND AND OBJECTIVE

Almond consumption has an inverse relationship with obesity and factors related to metabolic syndrome. However, the results of available clinical trials are inconsistent. Therefore, we analyzed the results of 37 randomized controlled trials (RCTs) and evaluated the association of almond consumption with subjective appetite scores and body compositions.

METHODS

Net changes in bodyweight, body mass index (BMI), waist circumference (WC), fat mass (FM), body fat percent, fat-free mass (FFM), waist-to-hip ratio (WHR), visceral adipose tissue (VAT), and subjective appetite scores were used to calculate the effect size, which was reported as a weighted mean differences (WMD) and 95% confidence interval (CI).

RESULTS

This meta-analysis was performed on 37 RCTs with 43 treatment arms. The certainty in the evidence was very low for appetite indices, body fat percent, FFM, VAT, and WHR, and moderate for other parameters as assessed by the GRADE evidence profiles. Pooled effect sizes indicated a significant reducing effect of almond consumption on body weight (WMD: -0.45 kg, 95% CI: -0.85, -0.05, p = 0.026), WC (WMD: -0.66 cm, 95% CI: -1.27, -0.04, p = 0.037), FM (WMD: -0.66 kg, 95% CI: -1.16, -0.17, p = 0.009), and hunger score (WMD: -1.15 mm, 95% CI: -1.98, -0.32, p = 0.006) compared with the control group. However, almond did not have a significant effect on BMI (WMD: -0.20 kg m-2, 95% CI: -0.46, 0.05, p = 0.122), body fat percent (WMD: -0.39%, 95% CI: -0.93, 0.14, p = 0.154), FFM (WMD: -0.06, 95% CI: -0.47, 0.34, p = 0.748), WHR (WMD: -0.04, 95% CI: -0.12, 0.02, p = 0.203), VAT (WMD: -0.33 cm, 95% CI: -0.99, 0.32), fullness (WMD: 0.46 mm, 95% CI: -0.95, 1.88), desire to eat (WMD: 0.98 mm, 95% CI: -4.13, 2.23), and prospective food consumption (WMD: 1.08 mm, 95% CI: -2.11, 4.28). Subgroup analyses indicated that consumption of ≥50 g almonds per day resulted in a significant and more favorable improvement in bodyweight, WC, FM, and hunger score. Body weight, WC, FM, body fat percent, and hunger scores were decreased significantly in the trials that lasted for ≥12 weeks and in the subjects with a BMI < 30 kg/m2. Furthermore, a significant reduction in body weight and WC was observed in those trials that used a nut-free diet as a control group, but not in those using snacks and other nuts. The results of our analysis suggest that almond consumption may significantly improve body composition indices and hunger scores when consumed at a dose of ≥50 g/day for ≥12 weeks by individuals with a BMI < 30 kg/m2.

CONCLUSION

However, further well-constructed randomized clinical trials are needed in order ascertain the outcome of our analysis.

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 Nut and Peanut Consumption and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cardiovascular disease (CVD) is the leading cause of death globally. Habitual consumption of tree nuts and peanuts is associated with cardioprotective benefits. Food-based dietary guidelines globally recommend nuts as a key component of a healthy diet. This systematic review and meta-analysis were conducted to examine the relationship between tree nut and peanut consumption and risk factors for CVD in randomized controlled trials (RCTs) (PROSPERO: CRD42022309156). MEDLINE, PubMed, CINAHL, and Cochrane Central databases were searched up to 26 September, 2021. All RCT studies that assessed the effects of tree nut or peanut consumption of any dose on CVD risk factors were included. Review Manager software was used to conduct a random effect meta-analysis for CVD outcomes from RCTs. Forest plots were generated for each outcome, between-study heterogeneity was estimated using the I2 test statistic and funnel plots and Egger's test for outcomes with ≥10 strata. The quality assessment used the Health Canada Quality Appraisal Tool, and the certainty of the evidence was assessed using grading of recommendations assessment, development, and evaluation (GRADE). A total of 153 articles describing 139 studies (81 parallel design and 58 cross-over design) were included in the systematic review, with 129 studies in the meta-analysis. The meta-analysis showed a significant decrease for low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), triglycerides (TG), TC:high-density lipoprotein (HDL) cholesterol, LDL cholesterol:HDL cholesterol, and apolipoprotein B (apoB) following nut consumption. However, the quality of evidence was "low" for only 18 intervention studies. The certainty of the body of evidence for TC:HDL cholesterol, LDL cholesterol:HDL cholesterol, and apoB were "moderate" because of inconsistency, for TG were "low," and for LDL cholesterol and TC were "very low" because of inconsistency and the likelihood of publication bias. The findings of this review provide evidence of a combined effect of tree nuts and peanuts on a range of biomarkers to create an overall CVD risk reduction.

A Review of the Anti-Obesity Effects of Wild Edible Plants in the Mediterranean Diet and Their Active Compounds: From Traditional Uses to Action Mechanisms and Therapeutic Targets

Obesity is a long-term condition resulting from a continuous imbalance between the amount of energy consumed and expended. It is associated with premature mortality and contributes to a large portion of the global chronic disease burden, including diabesity, cardiovascular disease, hypertension, and some cancers. While lifestyle changes and dietary adjustments are the primary ways to manage obesity, they may not always be sufficient for long-term weight loss. In these cases, medication may be necessary. However, the options for drugs are limited due to their potential side effects. As a result, there is a need to identify safe and effective alternative treatments. Recently, dietary compounds, plants, and bioactive phytochemicals have been considered as promising sources for discovering new pharmacological agents to treat obesity and its related complications. These natural products can function independently or synergistically with other plants to augment their effects at various levels of the body. They can modulate appetite, lipase activity, thermogenesis and fat synthesis and degradation, satiation, adipogenesis, and adipocyte apoptosis. Additionally, targeting adipocyte growth and differentiation with diverse medicinal plants/diet is a significant strategy for devising new anti-obesity drugs that can intervene in preadipocytes, maturing preadipocytes, and mature adipocytes. Clinical trials have shown that the wild edible plants in the Mediterranean diet can reduce the risk of obesity and its related diseases. This review examines the effectiveness of the common components of the Mediterranean diet in managing obesity and its associated health issues. We conducted a comprehensive literature review using PubMed, Science Direct, Google Scholar, and Medline Plus to gather data on the therapeutic effects of the Mediterranean diet and phytochemicals in treating obesity and its associated diseases.

Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome-A Comprehensive Review

Atherosclerosis, chronic non-communicable diseases, and metabolic syndrome are highly interconnected and collectively contribute to global health concerns that reduce life expectancy and quality of life. These conditions arise from multiple risk factors, including inflammation, insulin resistance, impaired blood lipid profile, endothelial dysfunction, and increased cardiovascular risk. Adopting a plant-based diet has gained popularity as a viable alternative to promote health and mitigate the incidence of, and risk factors associated with, these three health conditions. Understanding the potential benefits of a plant-based diet for human health is crucial, particularly in the face of the rising prevalence of chronic diseases like diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Thus, this review focused on the plausible advantages of consuming a type of food pattern for the prevention and/or treatment of chronic diseases, emphasizing the dietary aspects that contribute to these conditions and the evidence supporting the benefits of a plant-based diet for human health. To facilitate a more in-depth analysis, we present separate evidence for each of these three concepts, acknowledging their intrinsic connection while providing a specific focus on each one. This review underscores the potential of a plant-based diet to target the underlying causes of these chronic diseases and enhance health outcomes for individuals and populations.

Effect of almond consumption on insulin sensitivity and serum lipids among Asian Indian adults with overweight and obesity- A randomized controlled trial

Background

Asian Indians have an increased susceptibility to type 2 diabetes and premature coronary artery disease. Nuts, like almonds, are rich in unsaturated fat and micronutrients with known health benefits.

Objectives

This study aimed to assess the efficacy of almonds for reduction of insulin resistance and improving lipid profile in overweight Asian Indian adults.

Methods

This parallel-arm, randomized, controlled trial was conducted in Chennai, India on 400 participants aged 25-65 years with a body mass index ≥ 23 kg/m². The intervention group received 43 g of almonds/day for 12 weeks, while the control group was advised to consume a customary diet but to avoid nuts. Anthropometric, clinical, and dietary data were assessed at periodic intervals. Glucose tolerance, serum insulin, glycated hemoglobin, C-peptide and lipid profile were assessed at baseline and end of the study. Insulin resistance (homeostasis assessment model-HOMA IR) and oral insulin disposition index (DIo) were calculated.

Results

A total of 352 participants completed the study. Significant improvement was seen in DIo [mean (95% CI) = + 0.7 mmol/L (0.1, 1.3); p = 0.03], HOMA IR (-0.4 (-0.7, -0.04; p = 0.03) and total cholesterol (-5.4 mg/dl (-10.2, -0.6); p = 0.03) in the intervention group compared to the control group. Incremental area under the curve (IAUC) and mean amplitude of glycemic excursion (MAGE) assessed using continuous glucose monitoring systems were also significantly lower in the intervention group. Dietary 24-h recalls showed a higher significant reduction in carbohydrate and increase in mono unsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake in the intervention group compared to the control group.

Conclusion

Daily consumption of almonds increased the intake of MUFA with decrease in carbohydrate calories and decreases insulin resistance, improves insulin sensitivity and lowers serum cholesterol in Asian Indians with overweight/obesity. These effects in the long run could aid in reducing the risk of diabetes and other cardiometabolic disease.

Ageing, Metabolic Dysfunction, and the Therapeutic Role of Antioxidants

The gradual ageing of the world population has been accompanied by a dramatic increase in the prevalence of obesity and metabolic diseases, especially type 2 diabetes. The adipose tissue dysfunction associated with ageing and obesity shares many common physiological features, including increased oxidative stress and inflammation. Understanding the mechanisms responsible for adipose tissue dysfunction in obesity may help elucidate the processes that contribute to the metabolic disturbances that occur with ageing. This, in turn, may help identify therapeutic targets for the treatment of obesity and age-related metabolic disorders. Because oxidative stress plays a critical role in these pathological processes, antioxidant dietary interventions could be of therapeutic value for the prevention and/or treatment of age-related diseases and obesity and their complications. In this chapter, we review the molecular and cellular mechanisms by which obesity predisposes individuals to accelerated ageing. Additionally, we critically review the potential of antioxidant dietary interventions to counteract obesity and ageing.

The effect of almond intake on cardiometabolic risk factors, inflammatory markers, and liver enzymes: A systematic review and meta-analysis

Almond intake may be correlated with improvements in several cardiometabolic parameters, but its effects are controversial in the published literature, and it needs to be comprehensively summarized. We conducted a systematic search in several international electronic databases, including MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until April 2021 to identify randomized controlled trials that examined the effects of almond consumption on cardiometabolic risk factors, inflammatory markers, and liver enzymes. Data were pooled using the random-effects model method and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Twenty-six eligible trials were analyzed (n = 1750 participants). Almond intake significantly decreased diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), non-high-density lipoprotein (HDL), and very LDL (p < 0.05). The effects of almond intake on systolic blood pressure, fasting blood glucose, insulin, hemoglobin A1c, homeostatic model assessment of insulin resistance, C-peptide, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, C-reactive protein (CRP), hs-CRP (high sensitivity C-reactive protein), interleukin 6, tumor necrosis factor-α, ICAM (Intercellular Adhesion Molecule), VCAM (Vascular Cell Adhesion Molecule), homocysteine, HDL, ox-LDL, ApoA1, ApoB, and lipoprotien-a were not statistically significant (p > .05). The current body of evidence supports the ingestion of almonds for their beneficial lipid-lowering and antihypertensive effects. However, the effects of almonds on antiinflammatory markers, glycemic control, and hepatic enzymes should be further evaluated via performing more extensive randomized trials.

Nuts as a Dietary Enrichment with Selected Minerals-Content Assessment Supported by Chemometric Analysis

Nuts used as a snack and meal accompaniment supply plant protein and fatty acids that are beneficial for human health; however, they can also provide minerals. The aim of this study was to determine the content of selected elements that are often deficient in the diet (calcium, potassium, magnesium, selenium, and zinc) in nuts and determine whether they can be used to supplement deficiencies in the diet. In this study, we analyzed 10 types of nuts (n = 120 samples) that are consumed and available for sale in Poland. The content of calcium, magnesium, selenium, and zinc was determined by the atomic absorption spectrometry method, and flame atomic emission spectrometry was used for determination of potassium contents. The highest median calcium content was found in almonds (2825.8 mg/kg), the highest potassium content in pistachio nuts (15,730.5 mg/kg), the highest magnesium and selenium contents in Brazil nuts (10,509.2 mg/kg and 4348.7 μg/kg, respectively), and the highest zinc content in pine nuts (72.4 mg/kg). All the tested nuts are a source of magnesium, eight types of tested nuts are a source of potassium, six nut types are a source of zinc, and four nut types are a source of selenium; however, among the tested nuts, only almonds can be considered a source of calcium. Moreover, we found that selected chemometric methods can be useful in the classification of nuts. The studied nuts are valuable products that can be used to supplement the diet with selected minerals and can therefore be labelled as functional products crucial for disease prevention.

Anti-Diabesity Middle Eastern Medicinal Plants and Their Action Mechanisms

Over the last four decades, the escalation in diabetes and obesity rates has become epidemic all over the world. Diabesity describes the strong link between T2D and obesity. It correlates deeper with the elevated risks of developing cardiovascular disease hypertension, stroke, and several malignancies. Therapeutic usage of medicinal plants and natural products in the treatment of diabetes and obesity has long been known to physicians of Greco-Arab and Islamic medicine. Improved versions of their abundant medicinal plant-based formulations are at present some of the most popular herbal treatments used. Preclinical and clinical data about medicinal plants along with their bioactive constituents are now available, justifying the traditionally known therapeutic uses of products derived from them for the prevention and cure of obesity-related T2D and other health problems. The aim of this review is to systematize published scientific data dealing with the efficiency of active ingredients or extracts from Middle Eastern medicinal plants and diet in the management of diabesity and its complications. Google Scholar, MEDLINE, and PubMed were searched for publications describing the medicinal plants and diet used in the management of T2D, obesity, and their complications. The used keywords were "medicinal plants" or "herbals" in combination with "obesity," "diabetes," "diabetes," or nephropathy. More than 130 medicinal plants were identified to target diabesity and its complications. The antidiabetic and anti-obesity effects and action mechanisms of these plants are discussed here. These include the regulation of appetite, thermogenesis, lipid absorption, and lipolysis; pancreatic lipase activity and adipogenesis; glucose absorption in the intestine, insulin secretion, glucose transporters, gluconeogenesis, and epigenetic mechanisms.

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.

Are fatty nuts a weighty concern? A systematic review and meta-analysis and dose-response meta-regression of prospective cohorts and randomized controlled trials

Nuts are recommended for cardiovascular health, yet concerns remain that nuts may contribute to weight gain due to their high energy density. A systematic review and meta-analysis of prospective cohorts and randomized controlled trials (RCTs) was conducted to update the evidence, provide a dose-response analysis, and assess differences in nut type, comparator and more in subgroup analyses. MEDLINE, EMBASE, and Cochrane were searched, along with manual searches. Data from eligible studies were pooled using meta-analysis methods. Interstudy heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Certainty of the evidence was assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Six prospective cohort studies (7 unique cohorts, n = 569,910) and 86 RCTs (114 comparisons, n = 5873) met eligibility criteria. Nuts were associated with lower incidence of overweight/obesity (RR 0.93 [95% CI 0.88 to 0.98] P < 0.001, "moderate" certainty of evidence) in prospective cohorts. RCTs presented no adverse effect of nuts on body weight (MD 0.09 kg, [95% CI -0.09 to 0.27 kg] P < 0.001, "high" certainty of evidence). Meta-regression showed that higher nut intake was associated with reductions in body weight and body fat. Current evidence demonstrates the concern that nut consumption contributes to increased adiposity appears unwarranted.

Pecan-Enriched Diets Alter Cholesterol Profiles and Triglycerides in Adults at Risk for Cardiovascular Disease in a Randomized, Controlled Trial

BACKGROUND

Research indicates that tree nuts are cardioprotective, but studies on pecans are limited.

OBJECTIVES

We examined the impact of daily pecan consumption on blood lipids and glycemia in adults at-risk for cardiovascular disease (CVD).

METHODS

This was a randomized, controlled trial where 56 adults (BMI ≥28 kg/m2 or hypercholesterolemia) were randomly allocated into a control group (n = 18) or 1 of 2 pecan groups. The ADD group (n = 16) consumed pecans (68 g) as part of a free-living diet. The SUB group (n = 18) substituted the pecans (68 g) for isocaloric foods from their diet. At baseline and 8 wk, a high-fat meal was consumed with 4-h postprandial blood draws to determine changes in blood lipids and glycemia.

RESULTS

There was a significant reduction from baseline to 8 wk in fasting total cholesterol (TC) (204 ± 8.76 to 195 ± 8.12; 205 ± 8.06 to 195 ± 6.94 mg/dL), LDL cholesterol (143 ± 8.09 to 129 ± 7.71; 144 ± 6.60 to 135 ± 6.16 mg/dL), triglycerides (TGs) (139 ± 12.1 to 125 ± 14.6; 133 ± 10.7 to 120 ± 10.3 mg/dL), TC/HDL cholesterol ratio (3.92 ± 0.206 to 3.58 ± 0.175; 4.08 ± 0.167 to 3.79 ± 0.151), non-HDL cholesterol (151 ± 8.24 to 140 ± 7.95; 155 ± 6.87 to 143 ± 6.00 mg/dL), and apolipoprotein B (99.1 ± 5.96 to 93.0 ± 5.35; 104 ± 3.43 to 97.1 ± 3.11 mg/dL) in the ADD and SUB groups, respectively (P ≤ 0.05 for all), with no changes in control. There was a reduction in postprandial TGs (P ≤ 0.01) in ADD, and a reduction in postprandial glucose (P < 0.05) in SUB.

CONCLUSIONS

Pecan consumption improves fasting and postprandial blood lipids in CVD at-risk adults. This trial was registered at clinicaltrials.gov as NCT04376632.

A calorie-restricted diet with nuts favourably raises plasma high-density lipoprotein-cholesterol in overweight and obese patients with stable coronary heart disease: A randomised controlled trial

BACKGROUND

Weight loss and consumption of nuts may both improve plasma lipids and lipoproteins. However, their effects in patients with coronary artery disease (CAD) who are under treatment with statins remain unclear. This study was conducted to determine plasma lipid and lipoprotein responses to a low-calorie (25% of energy deficit) nuts containing diet (NELCD) compared with a nut-free energy-restricted diet (NFLCD) in stable CAD patients who were overweight or obese (n = 67).

METHODS

Plasma lipids and lipoproteins and ATP-binding cassette (ABC) A1 and ABCG1 mRNA expressions in peripheral blood mononuclear cells (PBMCs) isolated from patients were assessed at baseline and after 8 weeks.

RESULTS

Plasma high-density lipoprotein (HDL) cholesterol and apoA1 increased significantly in the NELCD group at the end of Week 8 compared with those in NFLCD group (in NELCD group, mean change and 95% confidence interval (CI) were 1.17 [-1.31, 3.66] mg/dL, P = 0.012, and 2.55 [-2.10, 7.20] mg/dL, P = 0.011, for HDL cholesterol and apoA1, respectively). In both groups, the concentrations of total cholesterol, low-density lipoprotein cholesterol and triglyceride reduced significantly at Week 8 compared with those in baseline with no significant difference between the two groups. ABCA1 and ABCG1 mRNA expressions non-significantly decreased in both groups.

CONCLUSION

This study indicates that inclusion of nuts as part of a calorie-restricted diet improves the concentrations of HDL cholesterol and apoA-1 in patients with stable, established CHD receiving statins.

Effects of a Brazilian cardioprotective diet and nuts on cardiometabolic parameters after myocardial infarction: study protocol for a randomized controlled clinical trial

BACKGROUND

Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI).

METHODS

DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data.

DISCUSSION

It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.

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.

The Effect of Baru (Dypterix alata Vog.) Almond Oil on Markers of Bowel Habits in Hemodialysis Patients

Gastrointestinal symptoms are common in patients in hemodialysis treatment and were frequently associated with low intake of dietary fibers and liquids, oral iron supplementation, phosphate binders, and low level of physical activity. Thus, the aim of this study was to evaluate the effect of baru almond oil in comparison with mineral oil supplementation on bowel habits of hemodialysis patients. Thirty-five patients on hemodialysis (57% men, 49.9 ± 12.4 years) were enrolled in a 12-week single-blind clinical trial. Patients were allocated (1 : 2) by sex and age into (1) the mineral group: 10 capsules per day of mineral oil (500 mg each) or (2) the baru almond oil group: 10 capsules per day of baru almond oil (500 mg each). Bowel habits were assessed by the Rome IV criteria, Bristol scale, and self-perception of constipation. Food consumption, physical activity level, and time spent sitting were also evaluated at the baseline and at the end of the study. After 12 weeks of supplementation, the baru almond oil group showed reduced Rome IV score (6.1 ± 5.5 vs 2.8 ± 4.3, p=0.04) and the straining on the evacuation score (1.2 ± 1.4 vs 0.4 ± 0.7; p=0.04), while the mineral group did not show any change in the parameters. The frequency of self-perception of constipation was lower in the baru almond oil group after intervention (45.0% vs 15.0%, p=0.04). Baru almond oil improved bowel habit and the straining on evacuation in hemodialysis patients.

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.

The effect of almond intake on lipid profile: a systematic review and meta-analysis of randomized controlled trials

A number of clinical trials have examined the effect of almond intake on lipid profile in recent years; however, the results remain equivocal. Therefore, the present study aims to summarize and quantitatively examine the available evidence on the effectiveness of almond intake on lipid parameters by employing a systematic review and meta-analytic approach. Online databases including PubMed, Scopus, Embase, and Cochrane Library were searched up to September 2020 for randomized controlled trials that examined the effect of almond intake on lipid profile in adults. Treatment effects were expressed as weighted mean difference (WMD) and the corresponding standard error (SE) in the concentrations of serum lipids. To estimate the overall effect of almond intake, we employed the random-effect model. In total, 27 studies with 36 effect sizes were included in our analysis (1154 cases and 904 control subjects). The meta-analysis revealed that almond intake significantly changed the concentrations of triglycerides (WMD = -6.68 mg dL-1; 95% CI: -11.62, -1.75, p = 0.008), total cholesterol (WMD = -4.92 mg dL-1; 95% CI: -7.81, -2.03, p = 0.001), and low-density lipoproteins (WMD = -5.65 mg dL-1; 95% CI: -8.75, -2.55, p < 0.001); however it did not have a significant effect on high-density lipoprotein (WMD = -0.21 mg dL-1; 95% CI: -1.26, 0.84, p = 0.697) levels. Meta-regression analysis indicated a linear relationship between the dose of almond and change in TG (P = 0.021). This meta-analysis concludes that almond intake can significantly reduce lipid parameters. To draw straightforward conclusions regarding generalized recommendations for almond intake for improving lipid profile, there is a need for more well-controlled trials exclusively targeting patients with dyslipidaemia.

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.

Effects of baru almond oil (Dipteryx alata Vog.) supplementation on body composition, inflammation, oxidative stress, lipid profile, and plasma fatty acids of hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

The consumption of nuts and edible seeds is associated with the improvement of the metabolic profile and reduction of cardiovascular diseases. However, the effects of its subproducts, such as oil, are still poorly studied. This study aimed to evaluate the effect of the baru almond oil supplementation on inflammation, oxidative stress, body composition, lipid profile, and plasma fatty acids of hemodialysis patients.

METHODS

In a randomized, double-blind, 12-week placebo-controlled clinical study, hemodialysis patients were supplemented with 5 g of baru oil (BG, n = 17) or 5 g of mineral oil (placebo, BP, n = 12). Body composition, renal function, ultra-sensitive C-reactive protein (us-CRP), oxidative stress, plasma fatty acids, and lipid profile were analysed before and after the intervention.

RESULTS

Patients were aged 50.5 ± 2.2 years and the average time of dialyses was 52,1 ± 42,6 months. The BG decreased us-CRP concentration compared to PG (-1.2 ± 0.2 vs. + 0.8 ± 0.2 mg / L,d = 0.88; p =  0.01). Baru almond oil supplementation was not effective in improving body composition, lipid profile, and oxidative stress.

CONCLUSION

Baru almond oil supplementation decreased us-CRP concentration in patients with chronic kidney disease under hemodialysis treatment.

Edible Nuts for Memory

Nuts hold prime significance throughout the world as they offer multiple health benefits owing to their highly nutritious profile. A number of scientific studies have demonstrated their actions against inflammation, oxidative damage, the aging process, as well as dementia or memory loss. However, only walnuts, followed by almonds, hazelnuts and pistachios, have shown promising results in empirical studies for memory improvements. So, the current review focuses on presenting hypotheses regarding anti-dementia property of nine different nuts: almond, walnut, pistachio, Brazil nut, peanut, pecans, cashew, hazelnut, and chestnut. The nutritious profile of nuts contains essential fats (mostly mono- and poly-unsaturated fatty acids), proteins (source for arginine, lysine and tryptophan), vitamins (riboflavin, folate, and various tocopherols), fibers, minerals (calcium, sodium, magnesium, phosphorus and potassium) and trace elements (copper, zinc, and selenium). Interestingly, the constituents of natural products, nuts being an excellent example, work synergistically and/or in a side-effect neutralizing manner. These latter properties can make nuts an alternate therapy for humankind to fight against memory loss.

The effect of almond intake on blood pressure: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The present systematic review and meta-analysis aimed determine the efficacy of almond intake on blood pressure (BP).

METHODS

PubMed, Scopus, ISI Web of Science, Cochrane library and Google Scholar were comprehensively searched to infinity until December 2019. Randomized clinical trials (RCTs) reporting effects of almond intake on aortic and brachial BP were included. Weighted mean differences (WMDs) were pooled using a random-effects model. Standard methods were used for assessment of heterogeneity, sensitivity analysis, and publication bias.

RESULTS

A total of 16 RCTs (1128 participants) were included in the meta-analysis. Pooled analysis suggested that almond intake can reduced diastolic BP (DBP) (WMD = -1.30 mmHg; 95 % CI: -2.31,-0.30, p = 0.01, I² = 0.0 %). However, there was not any impact of almond intake on systolic BP (SBP) (WMD = -0.83 mmHg; 95 % CI: -2.55, 0.89, p = 0.34, I² = 58.9 %). Subgroup analysis revealed a significant reduction in SBP levels in subjects with lower SBP and lower dose of almonds.

CONCLUSION

We found that almonds might have a considerable favorite effect in BP and especially in DBP, and it could be encouraged as part of a healthy diet; however due to the high calorie content, the intake should be part of healthy diet.

Adipokines and Adipose Tissue-Related Metabolites, Nuts and Cardiovascular Disease

Adipose tissue is a complex structure responsible for fat storage and releasing polypeptides (adipokines) and metabolites, with systemic actions including body weight balance, appetite regulation, glucose homeostasis, and blood pressure control. Signals sent from different tissues are generated and integrated in adipose tissue; thus, there is a close connection between this endocrine organ and different organs and systems such as the gut and the cardiovascular system. It is known that functional foods, especially different nuts, may be related to a net of molecular mechanisms contributing to cardiometabolic health. Despite being energy-dense foods, nut consumption has been associated with no weight gain, weight loss, and lower risk of becoming overweight or obese. Several studies have reported beneficial effects after nut consumption on glucose control, appetite suppression, metabolites related to adipose tissue and gut microbiota, and on adipokines due to their fatty acid profile, vegetable proteins, l-arginine, dietary fibers, vitamins, minerals, and phytosterols. The aim of this review is to briefly describe possible mechanisms implicated in weight homeostasis related to different nuts, as well as studies that have evaluated the effects of nut consumption on adipokines and metabolites related to adipose tissue and gut microbiota in animal models, healthy individuals, and primary and secondary cardiovascular prevention.

Effects of a healthy diet enriched or not with pecan nuts or extra-virgin olive oil on the lipid profile of patients with stable coronary artery disease: a randomised clinical trial

BACKGROUND

The present study aimed to assess the effect of a healthy diet, enriched or not with pecan nuts or extra-virgin olive oil, on the lipid profile of patients with stable coronary artery disease (CAD).

METHODS

This was a randomised clinical trial conducted for 12 weeks with patients aged between 40 and 80 years with stable CAD for more than 60 days. Individuals were randomised into groups [control group (CG) with 67 patients, pecan nut group (PNG) with 68 patients and olive oil group (OOG) with 69 patients]. The CG was prescribed a healthy diet according to the nutritional guidelines; the PNG was prescribed the same healthy diet plus 30 g day^-1 of pecan nuts; and the OOG was prescribed a healthy diet plus 30 mL day^-1 of extra-virgin olive oil.

RESULTS

In total, 204 subjects were submitted to an intention-to-treat analysis. After adjustment for baseline values and type of statin used, there was no difference regarding low-density lipoprotein (LDL)-cholesterol (primary outcome), high-density lipoprotein (HDL)-cholesterol, LDL-cholesterol/HDL-cholesterol ratio and HDL-cholesterol/triglycerides ratio according to groups. However, the PNG exhibited a significant reduction in non-HDL-cholesterol levels [PNG: 114.9 (31) mg dL^-1 ; CG: 127 (33.6) mg dL^-1 ; OOG: 126.6 (37.4) mg dL^-1 ; P = 0.033] and in the total cholesterol/HDL-cholesterol ratio [PNG: 3.7 (0.7); CG: 4.0 (0.8); OOG: 4.0 (0.8); P = 0.044] compared to the CG and OOG.

CONCLUSIONS

Supplementing a healthy diet with 30 g day^-1 of pecan nuts for 12 weeks did not improve LDL-cholesterol levels but may improve other lipid profile markers in patients with stable CAD.

Prospective randomized controlled pilot study on the effects of almond consumption on skin lipids and wrinkles

OBJECTIVE

Almonds are a rich source of fatty acids and antioxidants, and their supplementation is known to significantly modulate serum lipids. The effects of almond on the skin's lipid barrier and the appearance of wrinkles have not yet been elucidated. The aim of this study was to investigate the effects of almond consumption on facial sebum production and wrinkles.

METHODS

This was a prospective, investigator-blinded, randomized controlled trial in which subjects consumed 20% of their daily energy consumption in either almonds or a calorie-matched snack for 16 weeks. This study was completed at the UC Davis Dermatology clinic. Participants were a volunteer sample of generally healthy postmenopausal females with Fitzpatrick skin types 1 and 2. A facial photograph and image analysis system was used to obtain standardized photographs and information on wrinkle width and severity at 0, 8, and 16 weeks. Measurements of transepidermal water loss and sebum production were also completed at 0, 8, and 16 weeks.

RESULTS

Fifty healthy postmenopausal females were recruited, 31 participants were enrolled, and 28 completed the study. Under photographic analysis, the almond group had significantly decreased wrinkle severity and width compared with the control group at 16 weeks (p < .02). Changes in skin barrier function were nonsignificant, measured by the transepidermal water loss (p = .65) between the almond and control groups relative to baseline after 16 weeks. No adverse effects were reported.

CONCLUSION

Our study demonstrates that daily almond consumption may reduce wrinkle severity in postmenopausal females to potentially have natural antiaging benefits.

Long-term association of nut consumption and cardiometabolic risk factors

BACKGROUND AND AIMS

Long-term associations between nut consumption and cardiometabolic risk factors are not well known. We investigated the relationship between nut consumption and cardiometabolic risk factors including dyslipidemia, hypertension, diabetes mellitus (DM), and obesity in a cohort of Iranian adults.

METHODS AND RESULTS

The study was conducted within the framework of the Isfahan Cohort Study on 1387 healthy participants. The participants were followed up for 12 years. A validated food frequency questionnaire was completed, and anthropometric measurements, blood pressure, and fasting serum lipids and blood sugar were evaluated in three phases. Mixed-effects binary logistic regression was applied to examine the associations between nut consumption and cardiometabolic risk factors. The participants were classified according to the tertiles of nut consumption as cut-points, and associations were evaluated between the thirds of nut intake. Subjects in the last third were less likely to have hypercholesterolemia [OR (95% CI): 0.76 (0.60-0.97)], hypertriglyceridemia [OR (95% CI): 0.74 (0.58-0.93)], and obesity [OR (95% CI): 0.79 (0.50-0.98)] but more likely to have DM [OR (95% CI): 1.85 (1.27-2.68)] than those in the first third. However, after adjustment for various potential confounders, the associations remained significant only for obesity [OR (95% CI): 0.67 (0.48-0.94)] and DM [OR (95% CI): 2.23 (1.37-3.64)].

CONCLUSION

After adjustment for potential confounders, we observed an inverse association for nut consumption and obesity but positive association for DM and nut intake. On the basis of our findings, it is suggested that incorporation of nuts into people's usual diet may have beneficial effects for individuals with lower risk such as subjects without DM.

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.

Abdominal Fat in Individuals with Overweight Reduced by Consumption of a 1975 Japanese Diet: A Randomized Controlled Trial

OBJECTIVE

This study aimed to investigate whether the intake of the 1975 Japanese diet (JD) could reduce the amount of abdominal fat in people with overweight.

METHODS

Using a single-blind randomized controlled trial, the modern diet (MD) was compared with the 1975-type JD, which is based on the MD but includes five characteristics of the 1975 JD in an enhanced form. Overweight people were randomly assigned to an MD group (n = 30) and a JD group (n = 30). The participants consumed test diets that were provided three times a day for 28 days. Body composition measurements and blood biochemical examinations were performed before and after the test diet intake, and the proportions of change were compared.

RESULTS

Those in the JD group had significantly decreased BMI, fat mass, and levels of low-density lipoprotein cholesterol, glycated hemoglobin, and C-reactive protein (P = 0.002, 0.015, 0.014, 0.012, and 0.039, respectively) and significantly increased high-density lipoprotein cholesterol levels compared with those in the MD group (P = 0.020).

CONCLUSIONS

The intake of a diet with the characteristics of the 1975 JD may have beneficial effects on lipid metabolism in people with overweight and reduce the onset risk of metabolism-related disorders, such as obesity and diabetes.

The Type of Dietary Fat in an Isocaloric Breakfast Meal Does Not Modify Postprandial Metabolism in Overweight/Obese Pregnant Women

Almonds provide a satiating, healthy source of fat and fiber. The postprandial metabolic and satiety response to 2 ounces of nuts or dairy was assessed in 18 overweight/obese women during late pregnancy. Serum glucose, triglycerides, insulin, c-peptide, leptin, ghrelin, and lipoprotein particles were measured prior to and during a 5-h postprandial period following the consumption of an isocaloric breakfast meal with equivalent amounts of fat from either nuts or dairy on two separate mornings. Satiety was assessed by visual analogue scale (VAS) questionnaires and ad libitum food intake at the end of the study. At 33 weeks gestation, the women had gained an average of 7.0 ± 4.4 kg during gestation. Body fat averaged 41.9 ± 5.5% and hemoglobin A1c levels were elevated, (7.2 ± 0.6%). Fasting glucose levels were normal, but hyperinsulinemia was evident. The two test meals did not affect the postprandial metabolic response, but glucose, triglyceride, and ghrelin concentrations changed with time during the postprandial period (p < 0.001, p = 0.0008, p = 0.006). Satiety measures did not differ between the two test meals. Consuming an isocaloric breakfast meal with equivalent amounts of fat from nuts or dairy did not alter postprandial levels of blood lipids, glucose, hormones, or measures of satiety in overweight/obese, pregnant women.

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).

Nuts and Cardiovascular Disease Prevention

PURPOSE OF REVIEW

We review recent epidemiological and clinical studies investigating the consumption of tree nuts and peanuts and cardiovascular disease (CVD) mortality as well as CVD risk factors.

RECENT FINDINGS

A greater consumption of tree nuts and peanuts is associated with a reduced risk of CVD mortality, as well as lower CVD events. Furthermore, risk factors associated with the development of CVD such as dyslipidemia, impaired vascular function, and hypertension are improved with regular tree nut and peanut consumption through a range of mechanism associated with their nutrient-rich profiles. There is weak inconsistent evidence for an effect of nut consumption on inflammation. There is emerging evidence that consuming tree nuts reduces the incidence of non-alcoholic fatty liver disease (NAFLD) and promotes diversity of gut microbiota, which in turn may improve CVD outcomes. Evidence for CVD prevention is strong for some varieties of tree nuts, particularly walnuts, and length of supplementation and dose are important factors for consideration with recommendations.

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

Background

Nut consumption has been shown to reduce the risk of cardiovascular disease. However, its role in the prevention of metabolic disorders, such as metabolic syndrome (Mets) and overweight/obesity, remains controversial. We therefore conducted a meta-analysis to determine the association of nut consumption with Mets and overweight/obesity.

Methods

Eligible studies were identified by searching the PubMed and Embase databases and by reviewing the references of relevant literatures. We used random effect models to pool the studies-specific risk ratio (RR) and weighted mean difference (WMD).

Results

This meta-analysis included six prospective cohort studies with 420,890 subjects and 62 randomized feeding trials with 7184 participants. Among the cohort studies, the summary RR for every 1-serving/week increase in nut intake was 0.96 (95% confidence interval [CI]: 0.92 to 0.99; n = 3) for Mets, 0.97 (95% CI: 0.95 to 0.98; n = 2) for overweight/obesity, and 0.95 (95% CI: 0.89 to 1.02; n = 2) for obesity. Pooling of randomized trials indicated that nut consumption was related to a significant reduction in body weight (WMD: - 0.22 Kg, 95% CI: -0.40 to - 0.04), body mass index (WMD: - 0.16 Kg/m², 95% CI: -0.31 to - 0.01), and waist circumference (WMD: - 0.51 cm, 95% CI: -0.95 to - 0.07). These findings remained stable in the sensitivity analysis, and no publication bias was detected.

Conclusion

Nut consumption may be beneficial in the prevention of Mets and overweight/obesity. Additional prospective studies are needed to enhance these findings and to explore the metabolic benefits for specific subclasses of nut.

Almonds and Cardiovascular Health: A Review

Several preventive strategies to reduce dyslipidemia have been suggested, of which dietary modification features as an important one. Dyslipidemia is a major risk factor for coronary heart disease and strategies to manage dyslipidemia have been shown to reduce the incidence of cardiovascular disease (CVD). Although there are proven pharmacological therapies to help manage this condition, nutritional interventions are a safer option to help prevent and manage dyslipidemia. Addition of almonds in the daily diet has been proposed to beneficially impact the lipid profile. This review critically examines the available evidence assessing the effect of almonds on dyslipidemia in the South Asian (particularly Indian) context. An extensive review comprised of epidemiological studies, clinical trials, meta-analyses, and systematic reviews was conducted from published literature from across the world. Studies examining the effect of almonds on different aspects of dyslipidemia viz. high low-density lipoprotein-cholesterol (LDL-C), low high-density lipoprotein-cholesterol (HDL-C), triglyceridaemia, and high total cholesterol levels have been included. In several studies, almonds have been shown to reduce LDL-C-which is a known risk factor for CHD-and the effect of almonds has been well documented in systematic reviews and meta-analysis of clinical trials. Addition of almonds in the diet has been shown to not only to reduce LDL-C levels, but also to maintain HDL-C levels. This review provides information about the use of this simple nutritional strategy which may help manage known major risk factors for heart disease, such as high LDL-C and low HDL-C levels especially in the context of South Asians.

Time and Intervention Effects of Daily Almond Intake on the Changes of Lipid Profile and Body Composition Among Free-Living Healthy Adults

Favorable health benefits of almond have been shown in several previous studies. However, repeated measures, randomized, controlled trials to investigate the changes due to almond intake based on the time effects have not yet been reported. The current study was conducted to evaluate the effects of daily almond intake on changes in body composition and lipid profiles for 20 weeks with four measurements among healthy adults. Participants in the almond group showed favorable changes on blood lipid profiles, including levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein (non-HDL-C) after consuming 56 g of almond per day for 20 weeks compared with those at baseline. At week 20, subjects in the almond group showed significantly decreased TC, LDL-C, non-HDL-C, TG, body fat mass, and waist–hip ratio compared with those of the control group who consumed isocaloric control food. The mixed model also confirmed that there were significant time effects in several bioimpedance indicators (i.e., total body protein, fat-free mass, etc.) and all of the lipid profile parameters in the almond group. These results confirm the effects of lipid-lowering and modifying body composition of almond consumption. In addition, our results suggest that the measuring time points would be critical to capture the effects of dietary intervention.

Nuts and Human Health Outcomes: A Systematic Review

There has been increasing interest in nuts and their outcome regarding human health. The consumption of nuts is frequently associated with reduction in risk factors for chronic diseases. Although nuts are high calorie foods, several studies have reported beneficial effects after nut consumption, due to fatty acid profiles, vegetable proteins, fibers, vitamins, minerals, carotenoids, and phytosterols with potential antioxidant action. However, the current findings about the benefits of nut consumption on human health have not yet been clearly discussed. This review highlights the effects of nut consumption on the context of human health.

Lifestyle Medicine and the Management of Cardiovascular Disease

PURPOSE OF REVIEW

Evidence has clearly demonstrated the importance of lifestyle factors (e.g., diet, physical activity, smoking) in the development of cardiovascular disease (CVD). Interventions targeting these behaviors may improve outcomes for CVD patients. The aim of this review is to summarize the effects of lifestyle interventions in individuals with established CVD.

RECENT FINDINGS

Most recent trials focused on diet, physical activity, stress reduction, or a combination of these. Findings were mixed, but most interventions improved at least some markers of cardiovascular risk. Few studies measured long-term clinical outcomes, but some suggested a possible benefit of stress reduction and multifaceted interventions on cardiovascular events. The benefits of lifestyle change for CVD patients have been established by decades of evidence. However, further research is needed to determine the optimal intensity, duration, and mode of delivery for interventions. Additional studies with long-term follow-up and measurement of clinical outcomes are also needed.

Vascular Disease in Young Indians (20-40 years): Role of Dyslipidemia

Dyslipidemia is an established risk factor for cardiovascular disease (CVD). Atherosclerosis begins early in life as suggested by "fatty streaks" observed in coronaries of healthy organ donors aged 20-29 years. Premature occurrence of coronary heart disease (CHD) in Indians, increases the risk for young individuals. Management of Dyslipidemia in the young Indian poses several challenges. In this article we provide in-depth review of prevalence, guidelines' perspective and expert comments on management of Dyslipidemia in the young (20-40 years) Indian.

Almond supplementation reduces serum uric acid in coronary artery disease patients: a randomized controlled trial

OBJECTIVE

Elevated serum uric acid (UA), a biomarker of renal insufficiency, is also an independent prognostic marker for morbidity in coronary artery disease (CAD) and poses serious health risks. This study reports the effect of almond consumption on UA in CAD patients.

STUDY DESIGN

A randomized controlled clinical trial was conducted with three groups: no-intervention (NI), Pakistani almonds (PA) or American almonds (AA). Patients were recruited from the Cardiology Clinics, Aga Khan University Hospital. Two follow-ups were scheduled at week-6 and week-12. 150 patients were randomly divided in three groups (50 per group). NI was not given almonds, whereas the PA and AA were given Pakistani and American almond varieties (10 g/day), respectively; with instruction to soak overnight and eat before breakfast.

RESULTS

Almonds supplementation significantly reduced (p < 0.05) serum UA among groups, and over time. At week-6, UA concentrations were -13 to -16 % less in PA and AA; at week-12 the concentrations were -14 to -18 % less, compared to NI. Systolic and diastolic blood pressure and body weights of the participants remained fairly constant among all the groups.

CONCLUSION

Almonds (10 g/day), eaten before breakfast, reduces serum UA in CAD patients. Prevention of hyperuricemia can confer protection from kidney and vascular damage and if extrapolated for general population, dietary almonds can offer grander health benefit. Trial is registered at Australian New Zealand Clinical trial registry as ACTRN12614000036617.