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Research Nut: Cashews

Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children.

van der Valk, J.P.M., R. el Bouche, R. Gerth van Wijk1, H. de Groot, H.J. Wichers, A.E.J. Dubois, N.W. de Jong, 2017. Low percentage of clinically relevant pistachio nut and mango co-sensitisation in cashew nut sensitised children. Clin Transl Allergy. 7:8.

Background:  Cashew nut, pistachio nut and mango belong to the Anacardiaceae family and are botanically related. Therefore, cashew nut sensitised children are frequently advised to eliminate cashew nuts and pistachio nuts from their diet. The ‘Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572) study showed that cashew nut sensitised children were co-sensitised to pistachio nut in 98% of cases and to mango in 21% of cases. The aim of this follow-up study to IDEAL is to assess the clinical relevance of co-sensitisation to pistachio nut and mango in cashew nut sensitised children. Methods: Children were recruited from the study: ‘Improvement of Diagnostic mEthods for ALlergy assessment (IDEAL trial number NTR3572). Inclusion criterion for the IDEAL study was sensitization to cashew nut as demonstrated by either SPT or sIgE, and a clinical history of reactions to cashew nuts or no previous (known) exposure. Sensitized children who were tolerant to cashew nuts were excluded. Inclusion criterion for this IDEAL follow-up study was co-sensitization to pistachio nut, regardless the result of the DBPCFC with cashew nut. In this follow-up study a double-blind placebo-controlled food challenge with pistachio nut and an open food challenge with mango were performed. Results: Twenty-nine children (mean age of 11.6 years, 62% male) were included. Pistachio nut sensitisation was clinically relevant in only 34% of cashew-sensitised children and only 31% of cashew challenge positive children. None of the children was challenge positive to mango. Conclusion: Although co-sensitisation between cashew nut and pistachio nut was observed in 98%, pistachio nut sensitisation was only clinically relevant in 34% of the children. Therefore, a challenge test with pistachio nut is recommended in children with cashew nut and pistachio nut sensitisation.

Cashew consumption reduces total and LDL cholesterol: a randomized, crossover, controlled-feeding trial.

Mah, E., J.A. Schulz, V.N. Kaden, A.L. Lawless, J. Rotor, L.B. Mantilla, D.J. Liska, 2017.  Cashew consumption reduces total and LDL cholesterol: a randomized, crossover, controlled-feeding trial. Am J Clin. Nutr. 105(5):1070-1078.

Background: Cashews are the third most-consumed tree nut in the United States and are abundant with monounsaturated fatty acids and polyunsaturated fatty acids, which are associated with reduced cardiovascular disease risk. Although a qualified Food and Drug Administration health claim exists for nuts and heart health, cashews have been exempt from its use because cashews exceed the disqualifying amount of saturated fatty acids. Approximately one-third of the saturated fat in cashews is stearic acid, which is relatively neutral on blood lipids, thereby suggesting that cashews could have effects that are similar to those of other nuts. However, clinical data on cashews and blood lipids have been limited. Objective: We investigated the effect of reasonable intakes of cashews on serum lipids in adults with or at risk of high LDL cholesterol. Design: In a randomized, crossover, isocaloric, controlled-feeding study, 51 men and women (aged 21-73 y) with a median LDL-cholesterol concentration of 159 mg/dL (95% CI: 146, 165 mg/dL) at screening consumed typical American diets with cashews (28-64 g/d; 50% of kilocalories from carbohydrate, 18% of kilocalories from protein, and 32% of kilocalories from total fat) or potato chips (control; 54% of kilocalories from carbohydrate, 18% of kilocalories from protein, and 29% of kilocalories from total fat) for 28 d with a ≥2-wk washout period. Results: Consumption of the cashew diet resulted in a significantly greater median change from baseline (compared with the control, all P < 0.05) in total cholesterol [-3.9% (95% CI: -9.3%, 1.7%) compared with 0.8% (95% CI: -1.5%, 4.5%), respectively], LDL cholesterol [-4.8% (95% CI: -12.6%, 3.1%) compared with 1.2% (95% CI: -2.3%, 7.8%), respectively], non-HDL cholesterol [-5.3% (95% CI: -8.6%, 2.1%) compared with 1.7% (95% CI: -0.9%, 5.6%), respectively], and the total-cholesterol:HDL-cholesterol ratio [-0.0% (95% CI: -4.3%, 4.8%) compared with 3.4% (95% CI: 0.6%, 5.2%), respectively]. There were no significant differences between diets for HDL cholesterol and triglyceride. Conclusions: In comparison with a control diet, the incorporation of cashews into typical American diets decreases total cholesterol and LDL cholesterol. Results from this study provide support that the daily consumption of cashews, when substituted for a high-carbohydrate snack, may be a simple dietary strategy to help manage total cholesterol and LDL cholesterol. This study was registered at clinicaltrials.gov as NCT02769741.

Associations between nut consumption and health vary between omnivores, vegetarians, and vegans.

Brown, R.C., A.R. Gray, S.L. Tey, A. Chisholm, V. Burley, D.C. Greenwood, J. Cade, 2017. Associations between nut consumption and health vary between omnivores, vegetarians, and vegans. Nutrients. 7, 9, 1219; doi:10.3390/nu9111219.

Regular nut consumption is associated with reduced risk factors for chronic disease; however, most population-based studies lack consideration of effect modification by dietary pattern. The UK Women’s Cohort Study (UKWCS) provides an ideal opportunity to examine relationships between nut consumption and chronic disease risk factors in a large sample with diverse dietary patterns. Nut and nutrient intake from 34,831 women was estimated using a food frequency questionnaire among self-identified omnivores, vegetarians and vegans. In this cross-sectional analysis, higher nut consumption was associated with lower body weight (difference between highest and lowest consumption categories from adjusted model: 6.1kg; 95% CI: 4.7,7.6) body mass index (BMI, 2.4 units difference; 95% CI:1.9,2.9), and waist circumference (2.6cm difference; 95% CI:1.4,3.8) (all ρ for linear trend<0.001). Higher nut consumption was also associated with reduced prevalence of high cholesterol and high blood pressure; having a history of heart attack, diabetes and gallstones; and markers of diet quality (all adjusted ρ for linear trend ≤ 0.011). Higher nut consumption appeared over all to be associated with greater benefits amongst omnivores compared to vegetarians and vegans. Findings support existing literature around beneficial effects of nut consumption and suggest that benefits may be larger among omnivores. Nut promotion strategies may have the highest population impact by specifically targeting this group.

Longitudinal analysis of nut-inclusive diets and body mass index among overweight and obese African American women living in rural Alabama and Mississippi, 2011–2013.

Sterling, S.R., B. Bertrand, S. Judd, T.L. Carson, P. Chandler-Laney, M.L. Baskin, 2017. Longitudinal analysis of nut-inclusive diets and body mass index among overweight and obese African American women living in rural Alabama and Mississippi, 2011–2013. Prev Chronic Dis 2017;14:160595. DOI: https://doi.org/10.5888/pcd14.160595.

Introduction: Nuts, when eaten alongside other nutritionally rich foods, may decrease obesity and related chronic disease risks, which are high among African American women in the rural South. We monitored changes in nut intake, other obesity-related foods (fruits, vegetables, red or processed meats, added sugars), and body mass index (BMI) over a 2-year weight loss intervention among 383 overweight and obese African American women in rural Alabama and Mississippi. Methods: Two dietary recalls were administered at 4 points over 24 months. Mann–Whitney tests compared differences in median food group intake between nut consumers and non-nut consumers, and t tests identified BMI differences between groups. Mixed linear models tested the relationship between nut intake and intake of the select food groups, and between nut intake and BMI over time. Results: Overall nut consumers ate more fruits and vegetables and less red meat than non-nut consumers. Nut consumers had lower BMI values than non-nut consumers. Weight loss by the end of the intervention was significant for nut consumers but not for non-nut consumers, even after accounting for kilocalorie consumption and physical activity engagement. Conclusion: Nut consumption is associated with consumption of other nutritionally rich foods and lower BMI among African American women in rural Alabama and Mississippi. Future interventions should target increasing daily nut intake, decreasing added sugar intake, and identifying strategies to encourage positive dietary changes to continue after an intervention.

Prebiotic nut compounds and human microbiota.

Lamuel-Raventos, R.M., M.-P. St. Onge, 2017. Prebiotic nut compounds and human microbiota. Critical Reviews in Food Science and Nutrition. 57(14): 3154–3163.

Nut consumption is clearly related to human health outcomes. Its beneficial effects have been mainly attributed to nut fatty acid profiles and content of vegetable protein, fiber, vitamins, minerals, phytosterols and phenolics. However, in this review we focus on the prebiotics properties in humans of the nonbioaccessible material of nuts (polymerized polyphenols and polysaccharides), which provides substrates for the human gut microbiota and on the formation of new bioactive metabolites and the absorption of that may partly explain the health benefits of nut consumption.

Associations between nut consumption and inflammatory biomarkers

Yu, Z., V.S. Malik, N. Keum, F.B. Hu, E.L. Giovannucci, M.J. Stampfer, W.C. Willett, C.S. Fuchs, Y. Bao, 2016. Associations between nut consumption and inflammatory biomarkers. AJCN. First published ahead of print July 27, 2016 as doi: 10.3945/ajcn.116.134205.

Background: Increased nut consumption has been associated with reduced risk of cardiovascular disease and type 2 diabetes, as well as a healthy lipid profile. However, the associations between nut consumption and inflammatory biomarkers are unclear. Objective: We investigated habitual nut consumption in relation to inflammatory biomarkers in 2 large cohorts of US men and women. Design: We analyzed cross-sectional data from 5013 participants in the Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS) who were free of diabetes. Nut intake, defined as intake of peanuts and other nuts, was estimated from food frequency questionnaires, and cumulative averages from 1986 and 1990 in the NHS and from 1990 and 1994 in the HPFS were used. Plasma biomarkers were collected in 1989–1990 in the NHS and 1993–1995 in the HPFS. Multivariate linear regression was used to assess the associations of nut consumption with fasting plasma C-reactive protein (CRP, n = 4941), interleukin 6 (IL-6, n = 2859), and tumor necrosis factor receptor 2 (TNFR2, n = 2905). Results: A greater intake of nuts was associated with lower amounts of a subset of inflammatory biomarkers, after adjusting for demographic, medical, dietary, and lifestyle variables. The relative concentrations (ratios) and 95% CIs comparing subjects with nut intake of $5 times/wk and those in the categories of never or almost never were as follows: CRP: 0.80 (0.69, 0.90), P-trend = 0.0003; and IL-6: 0.86 (0.77, 0.97), P-trend = 0.006. These associations remained significant after further adjustment for body mass index. No significant association was observed with TNFR2. Substituting 3 servings of nuts/wk for 3 servings of red meat, processed meat, eggs, or refined grains/wk was associated with significantly lower CRP (all P , 0.0001) and IL-6 (P ranges from 0.001 to 0.017). Conclusion: Frequent nut consumption was associated with a healthy profile of inflammatory biomarkers.

Nut consumption and prostate cancer risk and mortality.

Wand, W., M. Yang, S.A. Kenfield, F.B. Hu, M.J. Stampfer, W.C. Willett, C.S. Fuchs, E.L. Giovannucci,  Y. Bao, 2016. Nut consumption and prostate cancer risk and mortality. British Journal of Cancer.doi:10.1038/bjc.2016.181

Background: Little is known of the association between nut consumption, and prostate cancer (PCa) incidence and survivorship. Methods: We conducted an incidence analysis and a case-only survival analysis in the Health Professionals Follow-up Study on the associations of nut consumption (updated every 4 years) with PCa diagnosis, and PCa-specific and overall mortality. Results: In 26 years, 6810 incident PCa cases were identified from 47 299 men. There was no association between nut consumption and being diagnosed with PCa or PCa-specific mortality. However, patients who consumed nuts five or more times per week after diagnosis had a significant 34% lower rate of overall mortality than those who consumed nuts less than once per month (HR=0.66, 95% CI: 0.52–0.83, P-trend=0.0005). Conclusions: There were no statistically significant associations between nut consumption, and PCa incidence or PCa-specific mortality. Frequent nut consumption after diagnosis was associated with significantly reduced overall mortality.

Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials.

Del Gobbo, L.C., M.C. Falk, R. Feldman, K. Lewis, D. Mozaffarian, 2015. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials. AJCN. First published ahead of print November 11, 2015 as doi: 10.3945/ajcn.115.110965.

Background: The effects of nuts on major cardiovascular disease (CVD) risk factors, including dose-responses and potential heterogeneity by nut type or phytosterol content, are not well established. Objectives: We examined the effects of tree nuts (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, and Brazil nuts) on blood lipids [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein, and triglycerides], lipoproteins [apolipoprotein A1, apolipoprotein B (ApoB), and apolipoprotein B100], blood pressure, and inflammation (C-reactive protein) in adults aged $18 y without prevalent CVD. Design: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two investigators screened 1301 potentially eligible PubMed articles in duplicate. We calculated mean differences between nut intervention and control arms, dose-standardized to one 1-oz (28.4 g) serving/d, by using inverse-variance fixed-effects meta-analysis. Dose-response for nut intake was examined by using linear regression and fractional polynomial modeling. Heterogeneity by age, sex, background diet, baseline risk factors, nut type, disease condition, duration, and quality score was assessed with meta-regression. Publication bias was evaluated by using funnel plots and Egger’s and Begg’s tests. Results: Sixty-one trials met eligibility criteria (n = 2582). Interventions ranged from 3 to 26 wk. Nut intake (per serving/d) lowered total cholesterol (24.7 mg/dL; 95% CI: 25.3, 24.0 mg/dL), LDL cholesterol (24.8 mg/dL; 95% CI: 25.5, 24.2 mg/dL), ApoB (23.7 mg/dL; 95% CI: 25.2, 22.3 mg/dL), and triglycerides (22.2 mg/dL; 95% CI: 23.8, 20.5 mg/dL) with no statistically significant effects on other outcomes. The dose-response between nut intake and total cholesterol and LDL cholesterol was nonlinear (P-nonlinearity , 0.001 each); stronger effects were observed for $60 g nuts/d. Significant heterogeneity was not observed by nut type or other factors. For ApoB, stronger effects were observed in populations with type 2 diabetes (211.5 mg/dL; 95% CI: 216.2, 26.8 mg/dL) than in healthy populations (22.5 mg/dL; 95% CI: 24.7, 20.3 mg/dL) (P-heterogeneity = 0.015). Little evidence of publication bias was found. Conclusions: Tree nut intake lowers total cholesterol, LDL cholesterol, ApoB, and triglycerides. The major determinant of cholesterol lowering appears to be nut dose rather than nut type. Our findings also highlight the need for investigation of possible stronger effects at high nut doses and among diabetic populations.

Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005–2010.

O’Neil, C.E., V.L. Fulgoni, T.A. Nicklas, 2015. Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005–2010. Nutrition Journal. 14:64. DOI 10.1186/s12937-015-0052-x

Introduction: Previous research has shown inconsistencies in the association of tree nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). Objective: To determine the association of tree nut consumption with risk factors for CVD and for MetS in adults. Methods: NHANES 2005–2010 data were used to examine the associations of tree nut consumption with health risks in adults 19+ years (n = 14,386; 51 % males). Tree nuts were: almonds, Brazil nuts, cashews, filberts [hazelnuts], macadamias, pecans, pine nuts, pistachios, and walnuts. Group definitions were non-consumers < ¼ ounce/day and consumers of ≥ ¼ ounce/day tree nuts using data from 24-h dietary recalls. Means and ANOVA (covariate adjusted) were determined using appropriate sample weights. Using logistic regression, odds ratios of being overweight (OW)/obese (OB) (body mass index [BMI] >25/<30 and ≥30, respectively) and having CVRF or MetS, were determined. Results: Tree nut consumption was associated with lower BMI (p = 0.004), waist circumference (WC) (p = 0.008), systolic blood pressure (BP) (p = 0.001), Homeostatic Model Assessment—Insulin Resistance (p = 0.043), and higher high density lipoprotein-cholesterol (p = 0.022), compared with no consumption, and a lower likelihood of OB (−25 %), OW/OB (−23 %), and elevated WC (−21 %). Conclusions: Tree nut consumption was associated with better weight status and some CVRF and MetS components.

Nut consumption and risk of colorectal cancer in women.

Yang, M., F.B. Hu, E.L. Giovannucci, M.J. Stampfer, W.C. Willett, C.S. Fuchs, K. Wu, Y. Bao, 2015. Nut consumption and risk of colorectal cancer in women. European Journal of Clinical Nutrition.  doi:10.1038/ejcn.2015.66.

Background/Objectives: Increasing nut consumption has been associated with reduced risk of obesity and type II diabetes, the risk factors for colorectal cancer. However, the association between nut consumption and colorectal cancer risk is unclear. We aimed to examine the association of long-term nut consumption with risk of colorectal cancer. Subjects/Methods: We prospectively followed 75 680 women who were free of cancer at baseline in the Nurses’ Health Study, and examined the association between nut consumption and colorectal cancer risk. Nut consumption was assessed at baseline and updated every 2–4 years. Relative risks (RRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazards models. Results: During 2 103 037 person-years of follow-up, we identified 1503 colorectal cancer cases. After adjustment for other known or suspected risk factors, women who consumed nuts 2 or more times per week (that is,  56 g per week) had a 13% lower risk of colorectal cancer compared with those who rarely consumed nuts, but the association was not statistically significant (RR: 0.87; 95%CI: 0.72–1.05; P-trend: 0.06). No association was observed for peanut butter. Conclusions: In this large prospective cohort of women, frequent nut consumption was not significantly associated with colorectal cancer risk after adjusting for other risk factors.