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Research Nut: Mixed Nuts

Multicenter study of emergency department visits for food allergies.

Clark, S., S. Allan Bock, T.J. Gaeta, B.E. Brenner, R.K. Cydulka, C.A. Camargo, on behalf of the Multicenter Airway Research Collaboration–8 Investigators, 2004. Multicenter study of emergency department visits for food allergies. J Allergy Clin Immunol. 113:347-352.

Background: Relatively little is known about the characteristics of patients who visit the emergency department (ED) for an acute allergic reaction. Although anaphylaxis guidelines suggest treatment with epinephrine, teaching about self-injectable epinephrine, and referral to an allergist, current ED management remains uncertain. Objective: The objective of this study was to describe the management of food-related acute allergic reactions. Methods: The Multicenter Airway Research Collaboration performed a chart review study in 21 North American EDs. Investigators reviewed a random sample of 678 charts of patients who presented with food allergy (International Classification of Diseases–ninth revision codes 693.1, 995.0, 995.3, and 995.60-995.69). Results: Patients had an average age of 29 years; the cohort was 57% female and 40% white. A variety of foods provoked the allergic reaction, including nuts (21%), crustaceans (19%), fruit (12%), and fish (10%). Although exposure to these foods can be life threatening, only 18% of patients came to the ED by ambulance. In the ED, 72% of patients received antihistamines, 48% received systemic corticosteroids, and 16% received epinephrine; 33% received respiratory treatments such as inhaled albuterol. Among patients with severe reactions (55% of total), 24% received epinephrine. Overall, 97% of patients were discharged to home. At ED discharge, 16% of patients were prescribed self-injectable epinephrine, and 12% were referred to an allergist. Conclusions: Although guidelines suggest specific approaches for the management of acute allergic reactions, ED concordance for food allergy appears low. These findings support a new collaboration between professional organizations in allergy and emergency medicine and the development of educational programs and materials for ED patients and staff.

Update on food allergy

Sampson, H.A., 2004. Update on Food Allergy. J. Allergy Clin Immunol. 113:805-819.

Tremendous progress has been made in our understanding of food-based allergic disorders over the past 5 years. Recent epidemiologic studies suggest that nearly 4% of Americans are afflicted with food allergies, a prevalence much higher than appreciated in the past. In addition, the prevalence of peanut allergy was found to have doubled in American children less than 5 years of age in the past 5 years. Many food allergens have been characterized at the molecular level, which has contributed to our increased understanding of the immunopathogenesis of many allergic disorders and might soon lead to novel diagnostic and immunotherapeutic approaches. The management of food allergies continues to consist of educating patients on how to avoid relevant allergens, to recognize early symptoms of an allergic reaction in case of an accidental ingestion, and to initiate the appropriate emergency therapy. However, the recent successful clinical trial of anti-IgE therapy in patients with peanut allergy and the number of  immunomodulatory therapies in the pipeline provide real hope that we will soon be able to treat patients with food allergy.

Lipophilic and hydrophilic antioxidant capacities of common foods in the United States

Wu, X., Beecher, G.R., Holden, J.M., Haytowitz, D.B., Gebhardt, S.E., R.L. Prior, 2004.  Lipophilic and hydrophilic antioxidant capacities of common foods in the United States. J Agric Food Chem. 52:4026-37.

Both lipophilic and hydrophilic antioxidant capacities were determined using the oxygen radical absorbance capacity (ORACFL) assay with fluorescein as the fluorescent probe and 2,2´-azobis(2-amidinopropane) dihydrochloride as a peroxyl radical generator on over 100 different kinds of foods, including fruits, vegetables, nuts, dried fruits, spices, cereals, infant, and other foods. Most of the foods were collected from four different regions and during two different seasons in U.S. markets. Total phenolics of each sample were also measured using the Folin-Ciocalteu reagent. Hydrophilic ORACFL values (H-ORACFL) ranged from 0.87 to 2641 μmol of Trolox equivalents (TE)/g among all of the foods, whereas lipophilic ORACFL values (L-ORACFL) ranged from 0.07 to 1611 μmol of TE/g. Generally, L-ORACFL values were <10% of the H-ORACFL values except for a very few samples. Total antioxidant capacity was calculated by combining L-ORACFL and H-ORACFL. Differences of ORACFL values in fruits and vegetables from different seasons and regions were relatively large for some foods but could not be analyzed in detail because of the sampling scheme. Two different processing methods, cooking and peeling, were used on selected foods to evaluate the impact of processing on ORACFL. The data demonstrated that processing can have significant effects on ORACFL. Considering all of the foods analyzed, the relationship between TP and H-ORACFL showed a very weak correlation. Total hydrophilic and lipophilic antioxidant capacity intakes were calculated to be 5558 and 166 μmol of TE/day, respectively, on the basis of data from the USDA Continuing Survey of Food Intakes by Individuals (1994-1996).

Mediterranean diet, lifestyle factors, and 10-year mortality in elderly men and women

Knoops, K.T.B., L.C.P.G.M. de Groot, D. Kromhout, A-E. Perrin, O. Moreiras-Varela, A. Menotti, W.A. van Staveren, 2004.  Mediterranean diet, lifestyle factors, and 10-year mortality in elderly men and women. JAMA. 292:1433-39.

Context: Dietary patterns and lifestyle factors are associated with mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer, but few studies have investigated these factors in combination. Objective: To investigate the single and combined effect of Mediterranean diet, being physically active, moderate alcohol use, and nonsmoking on all-cause and cause specific mortality in European elderly individuals. Design, Setting, and Participants The Healthy Ageing: a Longitudinal study in Europe (HALE) population, comprising individuals enrolled in the Survey in Europe on Nutrition and the Elderly: a Concerned Action (SENECA) and the Finland, Italy, the Netherlands, Elderly (FINE) studies, includes 1507 apparently healthy men and 832 women, aged 70 to 90 years in 11 European countries. This cohort study was conducted between 1988 and 2000. Main Outcome Measures: Ten-year mortality from all causes, coronary heart disease, cardiovascular diseases, and cancer. Results During follow-up, 935 participants died: 371 from cardiovascular diseases, 233 from cancer, and 145 from other causes; for 186, the cause of death was unknown. Adhering to a Mediterranean diet (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.68-0.88), moderate alcohol use (HR, 0.78; 95% CI, 0.67-0.91), physical activity (HR, 0.63; 95% CI, 0.55-0.72), and nonsmoking (HR, 0.65; 95% CI, 0.57- 0.75) were associated with a lower risk of all-cause mortality (HRs controlled for age, sex, years of education, body mass index, study, and other factors). Similar results were observed for mortality from coronary heart disease, cardiovascular diseases, and cancer. The combination of 4 low risk factors lowered the all-cause mortality rate to 0.35 (95% CI, 0.28-0.44). In total, lack of adherence to this low-risk pattern was associated with a population attributable risk of 60% of all deaths, 64% of deaths from coronary heart disease, 61% from cardiovascular diseases, and 60% from cancer. Conclusion: Among individuals aged 70 to 90 years, adherence to a Mediterranean diet and healthful lifestyle is associated with a more than 50% lower rate of all-causes and cause-specific mortality.

Frequent nut consumption and decreased risk of cholecystectomy in women

Tsai, C-J., M.F. Leitzmann, F.B. Hu, W.C. Willett, E.L. Giovannucci, 2004.  Frequent nut consumption and decreased risk of cholecystectomy in women. Am J Clin Nutr. 80:76-81.

Background: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. Objective: The association between nut intake and cholecystectomy was examined in a large cohort of women. Design: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy in a cohort of 80 718 women from the Nurses’ Health Study who were 30–55 y old in 1980 and had no history of gallstone disease. As part of the Nurses’ Health Study, the women reported on questionnaires mailed to them every 2 y both their consumption of nuts and whether they had undergone cholecystectomy. The women were followed through 2000. Results: During 1 393 256 person-years of follow-up from 1980 to 2000, we documented 7831 cholecystectomies. After adjustment for age and other known or suspected risk factors, women who consumed ≥5 units of nuts (1 unit = 1 oz or 28.6 g nuts)/wk (frequent consumption) had a significantly lower risk of cholecystectomy (relative risk: 0.75; 95% CI: 0.66, 0.85; P for trend < 0.0001) than did women who never ate nuts or who ate <1 unit/mo (rare consumption). Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were associated with a lower risk of cholecystectomy. Conclusion: In women, frequent nut consumption is associated with a reduced risk of cholecystectomy.

Magnesium intake and risk of type 2 diabetes in men and women

Lopez-Ridaura, R., W.C. Willett, E.B. Rimm, S. Liu, M.J. Stampfer, J.E. Manson, F.B. Hu, 2004.  Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care. 27(1): 134-40.

Objective: To examine the association between magnesium intake and risk of type 2 diabetes. Research Design and Methods: We followed 85,060 women and 42,872 men who had no history of diabetes, cardiovascular disease, or cancer at baseline. Magnesium intake was evaluated using a validated food frequency questionnaire every 2–4 years. After 18 years of follow-up in women and 12 years in men, we documented 4,085 and 1,333 incident cases of type 2 diabetes, respectively. Results:After adjusting for age, BMI, physical activity, family history of diabetes, smoking, alcohol consumption, and history of hypertension and hypercholesterolemia at baseline, the relative risk (RR) of type 2 diabetes was 0.66 (95% CI 0.60–0.73; P for trend<0.001) in women and 0.67 (0.56–0.80; P for trend <0.001) in men, comparing the highest with the lowest quintile of total magnesium intake. The RRs remained significant after additional adjustment for dietary variables, including glycemic load, polyunsaturated fat, trans fat, cereal fiber, and processed meat in the multivariate models. The inverse association persisted in subgroup analyses according to BMI, physical activity, and family history of diabetes. Conclusions: Our findings suggest a significant inverse association between magnesium intake and diabetes risk. This study supports the dietary recommendation to increase consumption of major food sources of magnesium, such as whole grains, nuts, and green leafy vegetables.

Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome

Esposito, K., R. Marfella, M. Ciotola, C. Di Palo, F. Giugliano, G. Giugliano, M. D’Armiento, F. D’Andrea, D. Giugliano, 2004.  Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA. 292:1440-6.

Context The metabolic syndrome has been identified as a target for dietary therapies to reduce risk of cardiovascular disease; however, the role of diet in the etiology of the metabolic syndrome is poorly understood. Objective To assess the effect of a Mediterranean-style diet on endothelial function and vascular inflammatory markers in patients with the metabolic syndrome. Design, Setting, and Patients Randomized, single-blind trial conducted from June 2001 to January 2004 at a university hospital in Italy among 180 patients (99 men and 81 women) with the metabolic syndrome, as defined by the Adult Treatment Panel III. Interventions Patients in the intervention group (n=90) were instructed to follow a Mediterranean-style diet and received detailed advice about how to increase daily consumption of whole grains, fruits, vegetables, nuts, and olive oil; patients in the control group (n=90) followed a prudent diet (carbohydrates, 50%-60%; proteins, 15%-20%; total fat, <30%). Main Outcome Measures Nutrient intake; endothelial function score as a measure of blood pressure and platelet aggregation response to L-arginine; lipid and glucose parameters; insulin sensitivity; and circulating levels of high-sensitivity C-reactive protein (hs-CRP) and interleukins 6 (IL-6), 7 (IL-7), and 18 (IL-18). Results After 2 years, patients following the Mediterranean-style diet consumed more foods rich in monounsaturated fat, polyunsaturated fat, and fiber and had a lower ratio of omega-6 to omega-3 fatty acids. Total fruit, vegetable, and nuts intake (274 g/d), whole grain intake (103 g/d), and olive oil consumption (8 g/d) were also significantly higher in the intervention group (P<.001). The level of physical activity increased in both groups by approximately 60%, without difference between groups (P=.22). Mean (SD) body weight decreased more in patients in the intervention group (−4.0 [1.1] kg) than in those in the control group (−1.2 [0.6] kg) (P<.001). Compared with patients consuming the control diet, patients consuming the intervention diet had significantly reduced serum concentrations of hs-CRP (P=.01), IL-6 (P=.04), IL-7 (P=0.4), and IL-18 (P=0.3), as well as decreased insulin resistance (P<.001). Endothelial function score improved in the intervention group (mean [SD] change, +1.9 [0.6]; P<.001) but remained stable in the control group (+0.2 [0.2]; P=.33). At 2 years of follow-up, 40 patients in the intervention group still had features of the metabolic syndrome, compared with 78 patients in the control group (P<.001). Conclusion A Mediterranean-style diet might be effective in reducing the prevalence of the metabolic syndrome and its associated cardiovascular risk.

Association of nut and seed intake with colorectal cancer risk in the European prospective investigation into cancer and nutrition.

Jenab, M., et al., 2004.  Association of nut and seed intake with colorectal cancer risk in the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev. 13(10):1595-603.

A link between unsaturated fatty acids or phytonutrients and reduced risk of colorectal cancer has been suggested. However, the effects of higher intake of dietary sources of these nutrients, such as the nuts and seeds food group, are less clear. The objective of this study was to determine the effects of nut and seed intake on colorectal cancer risk within the European Prospective Investigation into Cancer and Nutrition study, a large prospective cohort study involving 10European countries. Total nut and seed intake was determined from country-specific dietary questionnaires. The data set included 478,040 subjects (141,988 men, 336,052 women) with a total of 855 (327 men, 528 women) colon and 474 (215 men, 259 women) rectal cancer cases. A multivariate Cox proportional hazards model, stratified by center and controlled for fruit intake, dietary fiber, energy, height, weight, sex, age, physical activity, and smoking, was used. The data show no association between higher intake of nuts and seeds and risk of colorectal, colon, and rectal cancers in men and women combined, but a significant inverse association was observed in subgroup analyses for colon cancer in women at the highest (>6.2 g/d) versus the lowest (nonconsumers; hazard ratio, 0.69; 95% confidence interval, 0.50-0.95) category of intake and for the linear effect of log-transformed intake (hazard ratio, 0.89; 95% confidence interval, 0.80-0.98), with no associations in men. It is not evident from this data why there may be a stronger association in women or why it may be limited to the colon, suggesting that much further research is necessary.

Vitamin K content of nuts and fruits in the US diet.

Dismore, M.L.,  D.B. Haytowitz, S.E. Gebhardt, J.W. Peterson, S.L. Booth, 2003. Vitamin K content of nuts and fruits in the US diet. J Am Diet Assoc. 103:1650-1652.

Assessment of vitamin K dietary intakes has been limited by incomplete vitamin K food composition data for the US food supply. The phylloquinone (vitamin K1) concentrations of nuts (n=76) and fruits (n=215) were determined by high-performance liquid chromatography. Each sample represented a composite of units obtained from 12 to 24 outlets, which provided geographic representation of the US food supply. With the exception of pine nuts and cashews, which contain 53.9 and 34.8 µg of phylloquinone per 100 g of nut, respectively, nuts are not important dietary sources of vitamin K. Similarly, most fruits are not important sources of vitamin K, with the exception of some berries, green fruits, and prunes. Menu planning for patients on warfarin can include a healthy diet including fruits and nuts without compromising the stability of their oral anticoagulation therapy.