Brennan A.M., L.L. Sweeney, X. Liu, C.S. Mantzoros, 2009. Walnut consumption increases satiation but has no effect on insulin resistance or the metabolic profile over a 4-day period. Obesity. doi:10.1038/oby.2009.409
Obesity and diabetes have been associated with increased consumption of highly processed foods, and reduced consumption of whole grains and nuts. It has been proposed, mainly on the basis of observational studies, that nuts may provide superior satiation, may lead to reduced calorie consumption, and may decrease the risk of type 2 diabetes; but evidence from randomized, interventional studies is lacking. A total of 20 men and women with the metabolic syndrome participated in a randomized, double-blind, crossover study of walnut consumption. Subjects had two 4-day admissions to the clinical research center where they were fed an isocaloric diet. In addition, they consumed shakes for breakfast containing either walnuts or placebo (shakes were standardized for calories, carbohydrate, and fat content). Appetite, insulin resistance, and metabolic parameters were measured. We found an increased level of satiety (overall P value = 0.0079) and sense of fullness (P = 0.05) in pre-lunch questionnaires following the walnut breakfast as compared to the placebo breakfast, with the walnut effect achieving significance on day 3 and 4 (P = 0.02 and P = 0.03). We did not find any change in resting energy expenditure, hormones known to mediate satiety, or insulin resistance when comparing the walnut vs. placebo diet. Walnut consumption over 4 days increased satiety by day 3. Long-term studies are needed to confirm the physiologic role of walnuts, the duration of time needed for these effects to occur, and to elucidate the underlying mechanisms.
Banel, D.K., F.B. Hu, 2009. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr 90:1-8.
Background: Consumption of nuts has been associated with a decreased risk of cardiovascular disease events and death. Walnuts in particular have a unique profile: they are rich in polyunsaturated fatty acids, which may improve blood lipids and other cardiovascular disease risk factors. Objectives: We aimed to conduct a literature review and a meta-analysis to combine the results from several trials and to estimate the effect of walnuts on blood lipids. Design: Literature databases were searched for published trials that compared a specifically walnut-enhanced diet with a control diet. We conducted a random-effects meta-analysis of weighted mean differences (WMDs) of lipid outcomes. Results: Thirteen studies representing 365 participants were included in the analysis. Diets lasted 4–24 wk with walnuts providing 10–24% of total calories. When compared with control diets, diets supplemented with walnuts resulted in a significantly greater decrease in total cholesterol and in LDL-cholesterol concentrations (total cholesterol: WMD = 210.3 mg/dL, P < 0.001; LDL cholesterol: WMD = 29.2 mg/dL, P < 0.001). High-density lipoprotein (HDL) cholesterol and triglycerides were not significantly affected by walnut diets more than with control diets (HDL cholesterol: WMD = 20.2, P = 0.8; triglycerides: WMD = 23.9, P = 0.3). Other results reported in the trials indicated that walnuts provided significant benefits for certain antioxidant capacity and inflammatory markers and had no adverse effects on body weight [body mass index (kg/m2): WMD = 20.4, P = 0.5; weight (kg): WMD = 20.05, P = 0.97]. Conclusions: Overall, high-walnut-enriched diets significantly decreased total and LDL cholesterol for the duration of the short-term trials. Larger and longer-term trials are needed to address the effects of walnut consumption on cardiovascular risk and body weight.
Ros, E., 2009. Nuts and novel biomarkers of cardiovascular disease. Am J Clin Nutr. 89(suppl):1649S-56S.
Nuts are energy-dense foods, rich in total fat and unsaturated fatty acids. The favorable fatty acid profile probably contributes to the beneficial effects of nut consumption observed in epidemiologic studies (prevention of coronary heart disease and diabetes) and feeding trials (cholesterol lowering). Besides fat, the complex matrices of nuts contain many bioactive compounds: vegetable protein, fiber, minerals, tocopherols, and phenolic compounds. By virtue of their unique composition, nuts are likely to benefit newer cardiovascular risk biomarkers, such as LDL oxidizability, soluble inflammatory molecules, and endothelial dysfunction. Protection of LDL oxidation by nut intake has been documented in some, but not all, clinical studies. In one study, feeding one daily serving of mixed nuts was associated with lower oxidized LDL concentrations. Regarding inflammation, cross-sectional studies have shown that nut consumption is associated with lower concentrations of circulating inflammatory molecules and higher plasma adiponectin, a potent anti-inflammatory adipokine. Clinical studies with nuts have documented reduced inflammatory cytokine concentrations but no consistent changes of C-reactive protein. Only walnuts have been formally tested for effects on endothelial function. After both walnut diets and single walnut meals, favorable vasoreactivity changes have been observed. Walnut consumption also reduced expression of endothelin 1, a potent endothelial activator, in an animal model of accelerated atherosclerosis. Beneficial effects on vascular reactivity may be ascribed to several constituents of walnuts: L-arginine, the precursor of nitricoxide, a-linolenic acid, and phenolic antioxidants. Although more studies are warranted, the emerging picture is that nut consumption beneficially influences cardiovascular risk beyond cholesterol lowering.
Lopez-Uriarte. P., M. Bullo, P. Casas-Agustench, N. Babio, J. Salas-Salvado, 2009. Nuts and oxidation: a systematic review. Nutrition Reviews. 67(9):497-508.
In recent years, nuts have received special attention because of their potential role in preventing cardiovascular disease. Because nuts are very rich in total fat that can potentially be oxidized and their skins contain several antioxidants, studies have been conducted to evaluate the potential effect of nut consumption on oxidative stress. This review evaluates the in vitro and in vivo studies conducted in animals or humans to analyze the effect of nuts on oxidation.
Torabian, S., E. Haddad, S. Rajaram, J. Banta, J. Sabate’, 2009. Acute effect of nut consumption on plasma total polyphenols, antioxidant capacity and lipid peroxidation. J Hum Nutr Diet. 22:64-71.
Background: Nuts have been shown to have beneficial effects on human health due to the healthy fat content; however, the effect of antioxidants (i.e. polyphenols) in nuts have not been fully investigated. The present study aimed to assess the immediate effect of a polyphenol-rich meal (75% of energy from nuts: walnuts or almonds) and a polyphenol-free meal on plasma polyphenol content, antioxidant capacity and lipid peroxidation in healthy volunteers. Methods: Thirteen subjects participated in a randomized, crossover, intervention study. After an overnight fast, walnuts, almonds or a control meal in the form of smoothies were consumed by study subjects. Each subject participated on three occasions, 1 week apart, consuming one of the smoothies each time. Blood samples were obtained at fasting and then at intervals up to 3.5 h after consumption of the smoothies. Results: There was a significant increase in plasma polyphenol concentration following both nut meals, with peak concentrations being achieved at 90 min, and with a walnut meal having a more sustained higher concentration than an almond meal. The plasma total antioxidant capacity reached its highest point at 150 min postconsumption of the nut meals, and was higher after the almond compared to walnut meal. A gradual significant (P < 0.05) reduction in the susceptibility of plasma to lipid peroxidation was observed 90 min after ingestion of the nut meals. No changes were observed following consumption of control meal. Conclusions: Consumption of both nuts increased plasma polyphenol concentrations, increased the total antioxidant capacity and reduced plasma lipid peroxidation.
Papoutsi, Z., E. Kassi, I. Chinou, M. Halabalaki, L.A. Skaltsounis, P. Moutsatsou, 2008. Walnut extract (Juglans regia L.) and its component ellagic acid exhibit anti-inflammatory activity in human aorta endothelial cells and osteoblastic activity in the cell line KS483. British Journal of Nutrition. 99(4):715-22.
Epidemiological studies suggest that the incidence of CVD and postmenopausal osteoporosis is low in the Mediterranean area, where herbs and nuts, among others, play an important role in nutrition. In the present study, we sought a role of walnuts (Juglans regia L.) in endothelial and bone-cell function. As the endothelial cell expression of adhesion molecules has been recognised as an early step in inflammation and atherogenesis, we examined the effect of walnut methanolic extract and ellagic acid, one of its major polyphenolic components (as shown by HPLC analysis), on the expression of vascular cell adhesion molecule (VCAM)-1 and intracellular adhesion molecule (ICAM)-1 in human aortic endothelial cells. After incubating the cells with TNF-α (1 ng/ml) in the absence and in the presence of walnut extract (10–200 µg/ml) or ellagic acid (10-7–10-5 M), the VCAM-1 and ICAM-1 expression was quantified by cell-ELISA. We further evaluated the effect of walnut extract (10–50 mg/ml), in comparison with ellagic acid (10-9–10-6 M), on nodule formation in the osteoblastic cell line KS483.Walnut extract and ellagic acid decreased significantly the TNF-a-induced endothelial expression of both VCAM-1 and ICAM-1 (P < 0.01; P < 0.001). Both walnut extract (at 10–25µg/ml) and ellagic acid (at 10-9–10-8 M) induced nodule formation in KS483 osteoblasts. The present results suggest that the walnut extract has a high anti-atherogenic potential and a remarkable osteoblastic activity, an effect mediated, at least in part, by its major component ellagic acid. Such findings implicate the beneficial effect of a walnut-enriched diet on cardioprotection and bone loss.
Hardman, W.E., G. Ion, 2008. Suppression of implanted MDA-MB 231 human breast cancer growth in nude mice by dietary walnut. Nutrition and Cancer. 60:5,666-674.
Walnuts contain components that may slow cancer growth including omega 3 fatty acids, phytosterols, polyphenols, carotenoids, and melatonin. A pilot study was performed to determine whether consumption of walnuts could affect growth of MDA-MB 231 human breast cancers implanted into nude mice. Tumor cells were injected into nude mice that were consuming an AIN-76A diet slightly modified to contain 10% corn oil. After the tumors reached 3 to 5 mm diameter, the diet of one group of mice was changed to include ground walnuts, equivalent to 56 g (2 oz) per day in humans. The tumor growth rate from Day 10, when tumor sizes began to diverge, until the end of the study of the group that consumed walnuts (2.9 ± 1.1 mm3/day; mean ± standard error of the mean) was significantly less (P < 0.05, t-test of the growth rates) than that of the group that did not consume walnuts (14.6 ± 1.3 mm3/day). The eicosapentaenoic and docosahexaenoic acid fractions of the livers of the group that consumed walnuts were significantly higher than that of the group that did not consume walnuts. Tumor cell proliferation was decreased, but apoptosis was not altered due to walnut consumption. Further work is merited to investigate applications to cancer in humans.
Zazpe, I.A. Sanchez-Tainta, R. Estruch, R.M. Lamuela-Raventos, H. Schröder, J. Salas-Salvado, D. Corella, M. Fiol, E. Gomez-Gracia, F. Aros, E. Ros, V. Ruíz-Gutierrez, P. Iglesias, M. Conde-Herrera, M.A. Martinez-Gonzalez, 2008. A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study. J Am Diet Assoc. 108:7 1134-1143.
Objective: To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet. Design: A 12-month assessment of a randomized primary prevention trial. Subjects/settings: One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or ≥3 cardiovascular risk factors. Intervention: Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines. Main outcome measures: Changes in food and nutrient intake after 12 months. Statistical analyses: Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted. Results: Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits (P<0.05 for all within- and between-group differences). Participants in all three groups decreased their intake of meat and pastries, cakes, and sweets (P<0.05 for all). Fiber, monounsaturated fatty acid, and polyunsaturated fatty acid intake increased in the Mediterranean diet groups (P<0.005 for all). Favorable, although nonsignificant, changes in intake of other nutrients occurred only in the Mediterranean diet groups. Conclusions: A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual’s overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.
Salas-Salvadó, J., A. Garcia-Arellano , R. Estruch, F. Marquez-Sandoval , D. Corella, M. Fiol , E. Gómez-Gracia, E. Viñoles , F. Arós, C. Herrera, C. Lahoz, J. Lapetra, J.S. Perona, D. Muñoz-Aguado, M.A. Martínez-González, E. Ros; for the PREDIMED Investigators, 2008. Components of the Mediterranean-type food pattern and serum inflammatory markers among patients at high risk for cardiovascular disease. European Journal of Clinical Nutrition. 62, 651-659.
Objective: To evaluate associations between components of the Mediterranean diet and circulating markers of inflammation in a large cohort of asymptomatic subjects at high risk for cardiovascular disease. Subjects/Methods: A total of 339 men and 433 women aged between 55 and 80 years at high cardiovascular risk because of presence of diabetes or at least three classical cardiovascular risk factors, food consumption was determined by a semi-quantitative food frequency questionnaire. Serum concentrations of high-sensitivity C-reactive protein (CRP) were measured by immunonephelometry and those of interleukin-6 (IL-6), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) by enzyme-linked immunosorbent assay. Results: After adjusting for age, gender, body mass index, diabetes, smoking, use of statins, non-steroidal anti-inflammatory drugs and aspirin, a higher consumption of fruits and cereals was associated with lower concentrations of IL-6 (P for trend 0.005;both). Subjects with the highest consumption of nuts and virgin olive oil showed the lowest concentrations of VCAM-1, ICAM-1, IL-6 and CRP; albeit only for ICAM-1 was this difference statistically significant in the case of nuts (for trend 0.003) and for VCAM-1 in the case of virgin olive oil (P for trend 0.02). Participants with higher adherence to the Mediterranean-type diet did not show significantly lower concentrations of inflammatory markers (P<0.1 for VCAM-1 and ICAM-1).
Mattes, R.D., P.M. Kris-Etherton, G.D. Foster, 2008. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J. Nutr. 138: 1741S-1745S.
Nuts (ground and tree) are rich sources of multiple nutrients and their consumption is associated with health benefits, including reduced cardiovascular disease risk. This has prompted recommendations to increase their consumption. However, they are also high in fat (albeit largely unsaturated) and are energy dense. The associations between these properties, positive energy balance, and body weight raise questions about such recommendations. This issue is addressed through a review of the literature pertaining to the association between nut consumption and energy balance. Epidemiological studies document an inverse association between the frequency of nut consumption and BMI. Clinical trials reveal little or no weight change with inclusion of various types of nuts in the diet over 1-6 mo. Mechanistic studies indicate this is largely attributable to the high satiety property of nuts, leading to compensatory responses that account for 65-75% of the energy they provide. Limited data suggest chronic consumption is associated with elevated resting energy expenditure resulting in dissipation of another portion of the energy they provide. Additionally, due to poor bioaccessibility, there is limited efficiency of energy absorption from nuts. Collectively, these mechanisms offset much of the energy provided by nuts. The few trials contrasting weight loss through regimens that include or exclude nuts indicate improved compliance and greater weight loss when nuts are permitted. This consistent literature suggests nuts may be included in the diet, in moderation, to enhance palatability and nutrient quality without posing a threat for weight gain.
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