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Research Nut: Walnuts

Effects of long-term walnut supplementation on body weight in free-living elderly: results of a randomized controlled trial.

Bitok, E., S. Rajaram, K. Jaceldo-Siegl, K. Oda, A. Sala-Vila, M. Serra-Mir, E. Ros, J. Sabaté, 2018. Effects of long-term walnut supplementation on body weight in free-living elderly: results of a randomized controlled trial. Nutrients. 10(9). pii: E1317. doi: 10.3390/nu10091317.

Abstract: Objective: To assess the effects of chronic walnut consumption on body weight and adiposity in elderly individuals. Methods: The Walnuts and Healthy Aging study is a dual-center (Barcelona, Spain and Loma Linda University (LLU)), 2-year randomized parallel trial. This report concerns only the LLU cohort. Healthy elders (mean age 69 year, 67% women) were randomly assigned to walnut (n = 183) or control diets (n = 173). Subjects in the walnut group received packaged walnuts (28–56 g/day), equivalent to ≈15% of daily energy requirements, to incorporate into their habitual diet, while those in the control group abstained from walnuts. Adiposity was measured periodically, and data were adjusted for in-trial changes in self-reported physical activity. Results: After 2 years, body weight significantly decreased (p = 0.031), while body fat significantly increased (p = 0.0001). However, no significant differences were observed between the control and walnut groups regarding body weight (−0.6 kg and −0.4 kg, respectively, p = 0.67) or body fat (+0.9% and +1.3%, respectively, p = 0.53). Lean body mass, waist circumference, and waist-to-hip ratio remained essentially unchanged. Sensitivity analyses were consistent with the findings of primary analysis. Conclusion: Our findings indicate that walnuts can be incorporated into the daily diet of healthy elders without concern for adverse effects on body weight or body composition.

A walnut-enriched diet affects gut microbiome in healthy Caucasian subjects: A randomized, controlled trial.

Bamberger, C., A. Rossmeier, K. Lechner, L. Wu, E. Waldmann, S. Fischer, R.G. Stark, J. Altenhofer, K. Henze, K.G. Parhofer, 2018. A walnut-enriched diet affects gut microbiome in healthy Caucasian subjects: A randomized, controlled trial. Nutrients. 10(2). pii: E244. doi: 10.3390/nu10020244.

Regular walnut consumption is associated with better health. We have previously shown that eight weeks of walnut consumption (43 g/day) significantly improves lipids in healthy subjects. In the same study, gut microbiome was evaluated. We included 194 healthy subjects (134 females, 63 ± 7 years, BMI 25.1 ± 4.0 kg/m²) in a randomized, controlled, prospective, cross-over study. Following a nut-free run-in period, subjects were randomized to two diet phases (eight weeks each); 96 subjects first followed a walnut-enriched diet (43 g/day) and then switched to a nut-free diet, while 98 subjects followed the diets in reverse order. While consuming the walnut-enriched diet, subjects were advised to either reduce fat or carbohydrates or both to account for the additional calories. Fecal samples were collected from 135 subjects at the end of the walnut-diet and the control-diet period for microbiome analyses. The 16S rRNA gene sequencing data was clustered with a 97% similarity into Operational Taxonomic Units (OTUs). UniFrac distances were used to determine diversity between groups. Differential abundance was evaluated using the Kruskal-Wallis rank sum test. All analyses were performed using Rhea. Generalized UniFrac distance shows that walnut consumption significantly affects microbiome composition and diversity. Multidimensional scaling (metric and non-metric) indicates dissimilarities of approximately 5% between walnut and control (p = 0.02). The abundance of Ruminococcaceae and Bifidobacteria increased significantly (p < 0.02) while Clostridium sp. cluster XIVa species (Blautia; Anaerostipes) decreased significantly (p < 0.05) during walnut consumption. The effect of walnut consumption on the microbiome only marginally depended on whether subjects replaced fat, carbohydrates or both while on walnuts. Daily intake of 43 g walnuts over eight weeks significantly affects the gut microbiome by enhancing probiotic- and butyric acid-producing species in healthy individuals. Further evaluation is required to establish whether these changes are preserved during longer walnut consumption and how these are linked to the observed changes in lipid metabolism.

Insulin resistance improves more in women than in men in association with a weight loss intervention.

Badri, N.W., S.W. Flatt, H.S. Barkai, B. Pakiz, D.D. Heath, C.L. Rock, 2018. Insulin resistance improves more in women than in men in association with a weight loss intervention. J Obes Weight Loss Ther. 8(1). pii: 365. doi: 10.4172/2165-7904.1000365.

Background: Fasting glucose and homeostatic model assessment-insulin resistance (HOMA-IR) are important measures of the risk for metabolic syndrome and diabetes. Weight loss interventions are considered part of the first line of therapy for those who develop disease states associated with insulin resistance, such as pre-diabetes, diabetes, or metabolic syndrome. Sex differences in insulin resistance have been extensively reported, but sex differences in the ability to improve insulin sensitivity are not well-established. This study sought to identify factors that predict change in HOMA-IR in response to weight loss. Methods: Non-diabetic subjects who were overweight/obese (n=100) were randomly assigned to a walnut-enriched reduced-energy diet or a standard reduced-energy-density diet in a 6-month weight loss intervention. There were no significant differences in weight change, glucose, insulin, or HOMA-IR between the two diet groups. These subjects were combined into a single cohort and analyzed with multivariate analysis. Results: The combined groups lost an average of 8.7 kg (p<0.0001), decreased serum glucose by an average 0.2 mmol/L (p<0.001), and decreased HOMA-IR by an average of 1.4 (p<0.0001). Change in HOMA-IR (R2=0.69) was positively associated with weight change (p<0.0001) and male sex (p<0.01), and negatively associated with baseline HOMA-IR (p<0.0001). Conclusion: Findings from this study suggest that men may have a more difficult time improving insulin sensitivity as compared with women with an equivalent weight loss and baseline HOMA-IR. One hypothesis to explain the differences across sexes may be due to sex differences in visceral adipose fat (VAT). This may mean that insulin resistant men require more aggressive intervention than women to prevent progression to metabolic syndrome or diabetes.

Association between walnut consumption and diabetes risk in NHANES.

Arab, L., S.K. Dhaliwal, C.J. Martin, A.D. Larios, N.J. Jackson, D. Elashoff , 2018. Association between walnut consumption and diabetes risk in NHANES. Diabetes Metab Res Rev. Oct; 34(7):e3031. doi: 10.1002/dmrr.3031. Epub 2018 Jul 11.

BACKGROUND: Dietary interventions and cohort studies relating tree nut consumption to blood glucose levels suggest a possible effect of walnuts. OBJECTIVE: To examine the associations between walnut consumption and diabetes risk using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: NHANES survey data on adults conducting 24-hour dietary recall was pooled across the years 1999 through 2014. Diabetes status or risk was based on self-report, medication use, fasting plasma (FPG) glucose levels and hemoglobin A1c (HbA1c) levels. Individuals were characterized based on reported consumption of walnuts, mixed-nuts, or no nuts. RESULTS: After adjustment for covariates, walnut consumers showed lower risk for diabetes compared to non-nut consumers based on self-report (odds ratio of 0.47 95% confidence interval 0.31-0.72) as well as fasting blood glucose (RRR 0.32 CI 0.17-0.58) and HbA1c (RRR 0.51 CI 0.27-0.99). For each standard deviation of increase in walnut intake, prevalence of diabetes dropped 47%. The gender by walnut interaction suggests the effect may be more potent among women than men (dose response p=0.061). CONCLUSIONS: Both among individuals with known diabetes and those diagnosed based on elevated diabetes blood markers, the prevalence of individuals with diabetes was significantly lower among the walnut consumers. A possible gender specific effect invites further attention.

Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts.

Estruch, R., E. Ros, J. Salas-Salvadó, M.-I. Covas, D. Corella, F. Arós, E. Gómez-Gracia, V. Ruiz-Gutiérrez, M. Fiol, J. Lapetra, R.M. Lamuela-Raventos, L. Serra-Majem, X. Pintó, J. Basora, M.A. Muñoz, J.V. Sorlí, J.A. Martínez, M. Fitó, A. Gea, M.A. Hernán, M.A. Martínez-González, PREDIMED Study Investigators, 2018. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med.  378(25):e34. doi: 10.1056/NEJMoa1800389. Epub 2018 Jun 13.

Background: Observational cohort studies and a secondary prevention trial have shown inverse associations between adherence to the Mediterranean diet and cardiovascular risk. Methods: In a multicenter trial in Spain, we assigned 7447 participants (55 to 80 years of age, 57% women) who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was a major cardiovascular event (myocardial infarction, stroke, or death from cardiovascular causes). After a median follow-up of 4.8 years, the trial was stopped on the basis of a prespecified interim analysis. In 2013, we reported the results for the primary end point in the Journal. We subsequently identified protocol deviations, including enrollment of household members without randomization, assignment to a study group without randomization of some participants at 1 of 11 study sites, and apparent inconsistent use of randomization tables at another site. We have withdrawn our previously published report and now report revised effect estimates based on analyses that do not rely exclusively on the assumption that all the participants were randomly assigned. Results: A primary end-point event occurred in 288 participants; there were 96 events in the group assigned to a Mediterranean diet with extra-virgin olive oil (3.8%), 83 in the group assigned to a Mediterranean diet with nuts (3.4%), and 109 in the control group (4.4%). In the intention-to-treat analysis including all the participants and adjusting for baseline characteristics and propensity scores, the hazard ratio was 0.69 (95% confidence interval [CI], 0.53 to 0.91) for a Mediterranean diet with extra-virgin olive oil and 0.72 (95% CI, 0.54 to 0.95) for a Mediterranean diet with nuts, as compared with the control diet. Results were similar after the omission of 1588 participants whose study-group assignments were known or suspected to have departed from the protocol. Conclusions: In this study involving persons at high cardiovascular risk, the incidence of major cardiovascular events was lower among those assigned to a Mediterranean diet supplemented with extra-virgin olive oil or nuts than among those assigned to a reduced-fat diet. (Funded by Instituto de Salud Carlos III, Spanish Ministry of Health, and others; Current Controlled Trials number, ISRCTN35739639 .).

Effect of nut consumption on vascular endothelial function: A systematic review and meta-analysis of randomized controlled trials.

Xiao, Y., W. Huang, C. Peng, J. Zhang, C. Wong, J.H. Kim, E.-K. Yeoh, 2017. Effect of nut consumption on vascular endothelial function: A systematic review and meta-analysis of randomized controlled trials. Clinical Nutrition. http://dx.doi.org/10.1016/j.clnu.2017.04.011

Objective: Nut consumption has consistently been found to be associated with a reduced risk of cardiovascular diseases (CVD) and mortality in prospective studies. However, its effect on endothelial function, a prognostic marker of CVD, is still controversial in clinical trials. This meta-analysis of randomized controlled trials (RCTs) aimed to quantitatively assess the effect of nuts on vascular endothelial function. Methods: Major electronic databases were searched for published RCTs that reported the effect of nuts on flow mediated dilation (FMD) as a measurement of endothelial function in the adult population (age eighteen years or over). We calculated the pooled estimates of weighted mean differences (WMDs) and their 95% confidence intervals (CIs) by using random-effects models. Results: A total of nine papers (10 trials) involving 374 participants were included. The pooled estimates found that nut consumption significantly improved FMD (WMD: 0.41%; 95% CI: 0.18%, 0.63%; P = 0.001). Moderate and marginally significant heterogeneity was observed among the studies (I2 = 39.5%, P = 0.094). Subgroup analyses indicated that walnuts significantly improved FMD (WMD: 0.39%; 95% CI: 0.16%, 0.63%; P = 0.001). In addition, nut consumption had a significant effect on FMD in the trials with study duration <18 weeks, nut dose <67 g/d, or subjects with baseline FMD ≥8.6%. Conclusions: Nut consumption significantly improved endothelial function. However, the beneficial effect was limited to walnuts. More studies examining the effect of other nuts on endothelial function are needed in the future.

Replacing American snacks with tree nuts increases consumption of key nutrients among US children and adults: results of an NHANES modeling study.

Rehm, C.D., A. Drewnowski. 2017. Replacing American snacks with tree nuts increases consumption of key nutrients among US children and adults: results of an NHANES modeling study. Nutr. J. doi:10.1186/s12937017-0238-5.

Background: Replacing typical American snacks with tree nuts may be an effective way to improve diet quality and compliance with the 2015–2020 Dietary Guidelines for Americans (DGAs). Objective: To assess and quantify the impact of replacing typical snacks with composite tree nuts or almonds on diet metrics, including empty calories (i.e., added sugars and solid fats), individual fatty acids, macronutrients, nutrients of public health concern, including sodium, fiber and potassium, and summary measures of diet quality. Methods: Food pattern modeling was implemented in the nationally representative 2009–2012 National Health and Examination Survey (NHANES) in a population of 17,444 children and adults. All between-meal snacks, excluding beverages, were replaced on a per calorie basis with a weighted tree nut composite, reflecting consumption patterns in the population. Model 1 replaced all snacks with tree nuts, while Model 2 exempted whole fruits, non-starchy vegetables, and whole grains (>50% of total grain content). Additional analyses were conducted using almonds only. Outcomes of interest were empty calories (i.e., solid fats and added sugars), saturated and mono- and polyunsaturated fatty acids, fiber, protein, sodium, potassium and magnesium. The Healthy Eating Index-2010, which measures adherence to the 2010 Dietary Guidelines for Americans, was used as a summary measure of diet quality. Results: Compared to observed diets, modeled food patterns were significantly lower in empty calories (−20.1% and −18.7% in Model 1 and Model 2, respectively), added sugars (−17.8% and −16.9%), solid fats (−21.0% and −19.3%), saturated fat (−6.6% and −7.1%)., and sodium (−12.3% and −11.2%). Modeled patterns were higher in oils (65.3% and 55.2%), monounsaturated (35.4% and 26.9%) and polyunsaturated fats (42.0% and 35.7%), plant omega 3 s (53.1% and 44.7%), dietary fiber (11.1% and 14.8%), and magnesium (29.9% and 27.0%), and were modestly higher in potassium (1.5% and 2.9%). HEI-2010 scores were significantly higher in Model 1 (67.8) and in Model 2 (69.7) compared to observed diets (58.5). Replacing snacks with almonds only produced similar results; the decrease in sodium was more modest and no increase in plant omega-3 fats was observed. Conclusion: Replacing between-meal snacks with tree nuts or almonds led to more nutrient-rich diets that were lower in empty calories and sodium and had more favorable fatty acid profiles. Food pattern modeling using NHANES data can be used to assess the likely nutritional impact of dietary guidance.

 

Determination of myo-inositol phosphates in tree nuts and grain fractions by HPLC–ESI–MS.

Duong, Q.H., K.D. Clark, K.G. Lapsley, R.B. Pegg. 2017. Determination of myo-inositol phosphates in tree nuts and grain fractions by HPLC–ESI–MS. J. Food Comp. Anal. 59:74-82.

High-performance liquid chromatography coupled with electrospray ionization mass spectrometry (HPLC–ESI–MS) was utilized for the rapid, on-line detection of all six forms of inositol phosphate (InsP) in seven major tree nuts (i.e., cashews, Brazil nuts, macadamias, walnuts, pecans, pistachios, hazelnuts) and three grain components that are allegedly rich in phosphorus (wheat aleurone, rice bran, corn germ). The total InsP levels ranged from 3 to 20 μmol/g in the tree nuts and from 10 to 97 μmol/g in the grain components. While inositol hexakisphosphate was the predominant form in all samples, at least 20% of the InsP molar concentration comprised lower forms of InsPs. In tree nuts, InsPs accounted for 18–59% of the organic phosphorus content and 12–46% of the total phosphorus content. For grain samples, these values ranged from 66–97% and 58–80%, respectively. Significant differences in InsP levels among tree nuts underline the need for further investigation of InsPs in this food group, particularly with regard to different cultivars, growing conditions, and processing conditions. HPLC–ESI–MS offered a sensitive and time-efficient detection approach for InsPs in various complex nut and grain matrices, highlighting its potential application for many other sample types.

 

A PUFA-rich diet improves fat oxidation following saturated fat-rich meal.

Stevenson, J.L., M.K. Miller, H.E. Skillman, C.M. Paton, J.A. Cooper, 2017. A PUFA-rich diet improves fat oxidation following saturated fat-rich meal. Eur J Nutr. 56(5):1845–1857.

Purpose: To determine substrate oxidation responses to saturated fatty acid (SFA)-rich meals before and after a 7-day polyunsaturated fatty acid (PUFA)-rich diet versus control diet. Methods: Twenty-six, normal-weight, adults were randomly assigned to either PUFA or control diet. Following a 3-day lead-in diet, participants completed the pre-diet visit where anthropometrics and resting metabolic rate (RMR) were measured, and two SFA-rich HF meals (breakfast and lunch) were consumed. Indirect calorimetry was used to determine fat oxidation (Fox) and energy expenditure (EE) for 4 h after each meal. Participants then consumed a PUFA-rich diet (50% carbohydrate, 15% protein, 35% fat, of which 21% of total energy was PUFA) or control diet (50% carbohydrate, 15% protein, 35% fat, of which 7% of total energy was PUFA) for the next 7 days. Following the 7-day diet, participants completed the post-diet visit. Results: From pre- to post-PUFA-rich diet, there was no change in RMR (16.3 ± 0.8 vs. 16.4 ± 0.8 kcal/20 min) or in incremental area under the curve for EE (118.9 ± 20.6-126.9 ± 14.1 kcal/8h, ns). Fasting respiratory exchange ratio increased from pre- to post-PUFA-rich diet only (0.83 ± 0.1-0.86 ± 0.1, p < 0.05). The postprandial change in Fox increased from pre- to post-visit in PUFA-rich diet (0.03 ± 0.1-0.23 ± 0.1 g/15 min for cumulative Fox; p < 0.05), whereas controls showed no change. Conclusions: Adopting a PUFA-rich diet initiates greater fat oxidation after eating occasional high SFA meals compared to a control diet, an effect achieved in 7 days.

Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial.

Zelicha, H., D. Schwarzfuchs, I. Shelef, Y. Gepner, G. Tsaban, L. Ten, A.Y. Meir, A. Bilitzky, O. Komy, N. Cohen, N. Bril, M. Rein, D. Serfaty, S. Kenigsbuch, Y. Chassidim, B. Sarusi, J. Thiery, U. Ceglarek, M. Stumvoll, M. Blüher, Y.S. Haviv, M.J. Stampfer, A. Rudich, I. Shai, 2017. Changes of renal sinus fat and renal parenchymal fat during an 18-month randomized weight loss trial. Clin Nutr. http://dx.doi.org/10.1016/j.clnu.2017.04.007.

Background & Aims: Data regarding the role of kidney adiposity, its clinical implications, and its dynamics during weight-loss are sparse. We investigated the effect of long-term weight-loss induced intervention diets on dynamics of renal-sinus-fat, an ectopic fat depot, and %renal-parenchymal-fat, lipid accumulation within the renal parenchyma. Methods: We randomized 278 participants with abdominal obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets, with or without exercise. We quantified renal-sinus-fat and %renal-parenchymal-fat by whole body magnetic-resonance-imaging. Results: Participants (age = 48 years; 89% men; body-mass-index = 31 kg/m2) had 86% retention to the trial after 18 months. Both increased renal-sinus-fat and %renal-parenchymal-fat were directly associated with hypertension, and with higher abdominal deep-subcutaneous-adipose-tissue and visceral-adipose-tissue (p of trend < 0.05 for all) after adjustment for body weight. Higher renal-sinus-fat was associated with lower estimated-glomerular-filtration-rate and with higher microalbuminuria and %HbA1C beyond body weight. After 18 months of intervention, overall renal-sinus-fat (-9%; p < 0.05 vs. baseline) but not %renal-parenchymal-fat (-1.7%; p = 0.13 vs. baseline) significantly decreased, and similarly across the intervention groups. Renal-sinus-fat and %renal-parenchymal-fat changes were correlated with weight-loss per-se (p < 0.05). In a model adjusted for age, sex, and visceral-adipose-tissue changes, 18 months reduction in renal-sinus-fat associated with decreased pancreatic, hepatic and cardiac fats (p < 0.05 for all) and with decreased cholesterol/high-density lipoprotein-cholesterol (HDL-c) (β = 0.13; p = 0.05), triglycerides/HDL-c (β = 0.13; p = 0.05), insulin (β = 0.12; p = 0.05) and gamma glutamyl transpeptidase (β = 0.24; p = 0.001), but not with improved renal function parameters or blood pressure. Decreased intake of sodium was associated with a reduction in %renal-parenchymal-fat, after adjustment for 18 months weight-loss (β = 0.15; p = 0.026) and hypertension (β = 0.14; p = 0.04). Conclusions: Renal-sinus-fat and renal-parenchymal-fat are fairly related to weight-loss. Decreased renal-sinus-fat is associated with improved hepatic parameters, independent of changes in weight or hepatic fat, rather than with improved renal function or blood pressure parameters.