Archive

Research Area: Cardiovascular Health

Effect of premeal pistachio supplementation on cardiometabolic risk factors among Asian Indian adults with prediabetes: A randomized controlled trial.

Ashwini, K., K. Abirami, R. Gayathri, S. Sasikala, V. Sudha, S. Shobana, R.G. Jeevan, K. Krishnaswamy, V. Deepika, M. Rajalakshmi, R.M.R. Bai, K. Parkavi, S. Padmavathi, R.M. Anjana, R. Unnikrishnan, F.B. Hu, W.C. Willett, J. Salas-Salvadó, S.N. Bhupathiraju, V. Mohan, 2025. Effect of premeal pistachio supplementation on cardiometabolic risk factors among Asian Indian adults with prediabetes: A randomized controlled trial. J Nutr. 155(3):899-909. https://doi.org/10.1016/j.tjnut.2024.12.005

Background: Asian Indians are susceptible to developing type 2 diabetes at a lower age and often consume diets that are high in glycemic load and low in healthy fats. Objectives: This study aimed to evaluate the effect of 30g prebreakfast and 30g predinner supplementation of pistachios for 12 wk on glycated hemoglobin (HbA1c), other glycemic markers, anthropometry, and lipid profile of Asian Indians with prediabetes. Methods: In a 12-wk parallel arm, randomized controlled trial, we recruited 120 participants with prediabetes based on American Diabetes Association criteria. The intervention group (n = 60) consumed 60g pistachios (30g prebreakfast and predinner) whereas the control group (n = 60) followed a routine diet that excluded nuts. At baseline and 12 wk, we collected blood samples for biochemical analysis, anthropometrics, and 24-h recalls. Participants wore a continuous glucose monitoring (CGM) sensor during the trial’s first and last 2 wk. Urinary N-methyl-trans-4-hydroxy-l-proline (MHP) was measured as a marker of pistachio consumption. Results: A total of 109 participants completed the study (follow-up rate = 90.8%). Compared with participants in the control group, those in the intervention group had significant reductions in HbA1c (mean between-group difference: −0.2; 95% confidence interval: −0.3, −0.1; P < 0.001] with no significant changes in fasting or 2-h post glucose load plasma glucose. Compared with the control group, the intervention group had significant reductions in serum triglyceride, waist circumference, lipid accumulation product, visceral adiposity index, and atherogenic index. Urinary MHP (mg/g creatinine) showed a 62% increase in the intervention compared with the control group (P < 0.05). CGM data revealed significant decreases in the incremental area under the curve, 2-h after breakfast (28%, p=0.01) and after dinner (17%, P = 0.002) in the intervention group compared to the control group. Conclusions: A 12-wk, premeal load of 60g pistachios lowers HbA1c and improves cardiometabolic profile among Asian Indians with prediabetes. This is among the first studies to investigate these effects in this ethnic group.

Consumption of tree nuts as snacks stimulates changes in plasma fatty acid profiles and adipose tissue gene expression in young adults at risk for metabolic syndrome

Widmer, A., K. Lillegard, K. Wood, M. Robles, R. Fan, F. Ye, J.R. Koethe, H.J. Silver, 2025. Consumption of tree nuts as snacks stimulates changes in plasma fatty acid profiles and adipose tissue gene expression in young adults at risk for metabolic syndrome. Clinical Nutrition. (48)25 – 34. https://doi.org/10.1016/j.clnu.2025.03.002.

Background and aims: The prevalence of metabolic syndrome has been increasing in young adults, concomitant with the occurrence of increased abdominal adiposity. We previously reported that consuming tree nuts, as replacement for typical high-carbohydrate snacks, reduces visceral fat and waist circumference in young adults who have one or more metabolic syndrome risk factors. We aimed to investigate the effects of tree nuts snack consumption on plasma and adipose tissue fatty acid profiles along with changes in the expression of adipose tissue genes involved in thermogenesis, glycemia, adipocyte signaling, lipolysis, and immunity. Methods: A randomized parallel-arm 16-week intervention trial was conducted in 84 adults aged 22-36 years. Participants in both groups were provided with caloric goals for weight maintenance, daily menus, and pre-portioned snacks at every other week visits with study registered dietitians. Changes in dietary fatty acid intakes, plasma and abdominal subcutaneous adipose tissue (SAT) triglycerides fatty acid profiles using gas-liquid chromatography, and the expression of 241 genes in abdominal SAT were evaluated. Results: Consuming tree nuts snacks increased mono- and polyunsaturated fatty acid intakes yielding a 9-fold greater dietary unsaturated to saturated fat ratio. The tree nuts snack group also had significantly greater improvements in plasma 16:1/16:0 ratio; plasma phospholipids oleic and gamma linolenic acid content; plasma diglycerides, triglycerides, and cholesterol esters oleic acid content; and total plasma monounsaturated fatty acids. While abdominal SAT only showed trends for increased oleic acid content and unsaturated to saturated fat ratio, the tree nuts snacks participants had altered expression of 13 genes in abdominal SAT that have roles in nutrient sensing, energy homeostasis, and vulnerability to obesity. Conclusions: Replacing typical high-carbohydrate snacks with tree nuts results in more favorable dietary, plasma, and adipose tissue fatty acid profiles that could aid in preventing the development of excess adiposity and cardiometabolic disease states including metabolic syndrome.

Consuming pecans as a snack improves lipids/lipoproteins and diet quality compared with usual diet in adults at increased risk of cardiometabolic diseases: a randomized controlled trial.

Hart, T.L., P.M. Kris-Etherton, K.S. Petersen, 2025. Consuming pecans as a snack improves lipids/lipoproteins and diet quality compared with usual diet in adults at increased risk of cardiometabolic diseases: a randomized controlled trial. Amer J Clin Nutr. ISSN 0002-9165,doi.org/10.1016/j.ajcnut.2025.01.024.

Background: The vascular and cardiometabolic effects of pecans are relatively understudied. Objectives: The aim was to examine how substitution of usual snack foods with 57g/d of pecans affects vascular health, risk factors for cardiometabolic diseases, and diet quality, compared with continuing usual intake in individuals at risk of cardiometabolic diseases. Methods: A 12-wk single-blinded, parallel, randomized controlled trial was conducted. Adults with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease and type 2 diabetes were included. Participants were provided with 57g/d of pecans and instructed to replace the snacks usually consumed with the provided pecans. The control group was instructed to continue consuming their usual diet. Flow-mediated dilation (FMD),primary outcome, along with blood pressure, carotid-femoral pulse wave velocity (cf-PWV), lipids/lipoproteins, and glycemic control were measured at baseline and following the intervention. Participants completed 3 24-h recalls at 3 time points (baseline, week 6, and week 12) during the study (9 recalls in total). The Healthy Eating Index-2020 (HEI-2020) was calculated to assess diet quality. Results: In total, 138 participants (mean ± SD; 46 ± 13 y, 29.8 ± 3.7 kg/m2) were randomly assigned (69 per group). No between-group differences in FMD, cf-PWV, or blood pressure were observed. Compared with the usual diet group, pecan intake reduced total cholesterol (− 8.1 mg/dL; 95% confidence interval [CI]: −14.5, −1.7), LDL cholesterol ( −7.2 mg/dL; 95% CI −12.3, −2.1), non-HDL-cholesterol (− 9.5 mg/dL; 95% CI −15.3, −3.7), and triglycerides concentrations ( −16.4 mg/dL; 95% CI −30.0, −2.9). Weight tended to increase in the pecan group compared with the usual diet group (0.7 kg; 95% CI −0.1, 1.4). The HEI-2020 increased by 9.4 points (95% CI 5.0, 13.7) in the pecan group compared with the usual diet group. Conclusions: Replacing usual snacks with 57 g/d of pecans for 12-wk improves lipids/lipoproteins and diet quality but does not affect vascular health in adults at risk of cardiometabolic disease.

Cashew nut (Anacardium occidentale L.) and cashew nut oil reduce cardiovascular risk factors in adults on weight-loss treatment: a randomized controlled three-arm trial (Brazilian Nuts Study).

Meneguelli, T.S., A.C.P. Kravchychyn, A.L. Wendling, A.P. Dionísio, J. Bressan, H.S.D. Martino, E. Tako, H.H.M. Hermsdorff, 2024. Cashew nut (Anacardium occidentale L.) and cashew nut oil reduce cardiovascular risk factors in adults on weight-loss treatment: a randomized controlled three-arm trial (Brazilian Nuts Study). Front Nutr. 11:1407028. https://doi.org/10.3389/fnut.2024.1407028

Introduction: Cashew nut contains bioactive compounds that modulate satiety and food intake, but its effects on body fat during energy restriction remains unknown. This study aimed to assess the effects of cashew nut and cashew nut oil on body fat (primary outcome) as well as adiposity, cardiometabolic and liver function markers (secondary outcomes). Materials and methods: An eight-week (8-wk) randomized controlled-feeding study involved 68 adults with overweight/obesity (40 women, BMI: 33 ± 4 kg/m2). Participants were randomly assigned to one of the energy-restricted (−500 kcal/d) groups: control (CT, free-nuts), cashew nut (CN, 30 g/d), or cashew nut oil (OL, 30 mL/d). Body weight, body composition, and blood collection were assessed at the baseline and endpoint of the study. Results: After 8-wk, all groups reduced significantly body fat (CT: −3.1 ± 2.8 kg; CN: −3.3 ± 2.7 kg; OL: −1.8 ± 2.6 kg), body weight (CT: −4.2 ± 3.8 kg; CN: −3.9 ± 3.1 kg; OL: −3.4 ± 2.4 kg), waist (CT: −5.1 ± 4.6 cm; CN: −3.9 ± 3.9 cm; OL: −3.7 ± 5.3 cm) and hip circumferences (CT: −2.9 ± 3.0 cm; CN:−2.7 ± 3.1 cm; OL: −2.9 ± 2.3 cm). CN group reduced liver enzymes (AST: −3.1 ± 5.3 U/L; ALT:−6.0 ± 9.9 U/L), while the OL-group reduced LDL-c (−11.5 ± 21.8 mg/dL) and atherogenic index (−0.2 ± 0.5). Both intervention groups decreased neck circumference (CN: −1.0 ± 1.2 cm; OL: −0.5 ± 1.2 cm) and apo B (CN: −6.6 ± 10.7 mg/dL; OL: −7.0 ± 15.3 mg/dL). Conclusion: After an 8-wk energy-restricted intervention, all groups reduced body fat (kg), weight, and some others adiposity indicators, with no different effect of cashew nut or cashew nut oil. However, participants in the intervention groups experienced additional reductions in atherogenic marker, liver function biomarkers, and cardiovascular risk factors (neck circumference and apo B levels), with these effects observed across the OL group, CN group, and both intervention groups, respectively.

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

Nishi, S.K., I. Paz-Graniel, J. Ni, C. Valle-Hita, N. Khoury, J.F. Garcia-Gavilán, N. Babio, J. Salas-Salvadó, 2024. Effect of nut consumption on blood lipids: An updated systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis. https://doi.org/10.1016/j.numecd.2024.10.009

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.

Association between nut consumption and mortality risk: a 20-year cohort study in Korea with a stratified analysis by health-related variables. 

Shin, H.R., J. Kim, S. Song, 2024. Association between nut consumption and mortality risk: a 20-year cohort study in Korea with a stratified analysis by health-related variables. Nutr J. 23,113. https://doi.org/10.1186/s12937-024-01019-y

Background: Although nuts are a well-known healthy food group, the relationship between nut consumption and mortality remains unclear, particularly among Asians. This prospective cohort study examined the association between nut consumption and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in Korean adults. Methods: Data from two cohorts (the Ansan-Ansung and Health-Examinees) from the Korean Genome and Epidemiology Study were used. A total of 114,140 individuals aged 40–79 years were included in the data analyses. Nut consumption was assessed using a validated semi-quantitative food frequency questionnaire and categorized into four groups: non-consumers, less than 1 serving/week, 1–2 servings/week, and 2 or more servings/week (one serving was 15g of nuts). Mortality outcomes were determined based on the 2001–2021 death records from Statistics Korea. Cox proportional hazard regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality across nut consumption categories. A stratified subgroup analysis by health-related variables was also performed. Results: During a mean follow-up of 12.3 years, 4,559 deaths were recorded. After adjusting for covariates, the HR for all-cause mortality was 0.877 (95% CI = 0.772–0.996, p for trend = 0.006) in individuals with a nut consumption of 2 or more servings/week compared with that in non-consumers. Multivariable HRs for CVD mortality were 0.800 (95% CI = 0.681–0.939) in individuals consuming less than 1 serving/week, 0.656 (95% CI = 0.469–0.918) in those consuming 1–2 servings/week, and 1.009 (95% CI = 0.756–1.347) in those consuming 2 or more servings/week compared with that in non-consumers (p for trend = 0.080). No association was observed between nut consumption and cancer mortality. Stratified analysis identified significant interactions in the association between nut consumption and all-cause mortality by age, body mass index, and physical activity. Conclusions: Nut consumption was linearly associated with the reduced risk of all-cause mortality and showed a non-linear dose-response relationship with CVD mortality in Koreans, but had no association with cancer mortality.

Mixed nut consumption improves brain insulin sensitivity: a randomized, single-blinded, controlled, crossover trial in older adults with overweight or obesity.

 Nijssen, K.M., R.P. Mensink, J. Plat, D. Ivanov, H. Preissl, P.J. Joris, 2024. Mixed nut consumption improves brain insulin sensitivity: a randomized, single-blinded, controlled, crossover trial in older adults with overweight or obesity. Am J Clin Nutr. 119(2):314-323. https://doi.org/10.1016/j.ajcnut.2023.12.010

Background: Improving brain insulin sensitivity, which can be assessed by measuring regional cerebral blood flow (CBF) responses to intranasal insulin, may prevent age-related metabolic and cognitive diseases. Objectives: This study aimed to investigate longer-term effects of mixed nuts on brain insulin sensitivity in older individuals with overweight/obesity. Methods: In a randomized, single-blinded, controlled, crossover trial, 28 healthy adults (mean ± standard deviation: 65 ± 3 years; body mass index: 27.9 ± 2.3 kg/m2) received either daily 60-g mixed nuts (15 g of walnuts, pistachio, cashew, and hazelnuts) or no nuts (control) for 16 weeks, separated by an 8-week washout period. Throughout the study, participants were instructed to adhere to the Dutch food-based dietary guidelines. During follow-up, brain insulin action was assessed by quantifying acute effects of intranasal insulin on regional CBF using arterial spin labeling magnetic resonance imaging. Furthermore, effects on peripheral insulin sensitivity (oral glucose tolerance test), intrahepatic lipids, and cardiometabolic risk markers were assessed. Results: Body weight and composition did not change. Compared with control, mixed nut consumption improved regional brain insulin action in 5 clusters located in the left (difference in CBF responses to intranasal insulin: -4.5 ± 4.7 mL/100 g/min; P < 0.001; -4.6 ± 4.8 mL/100 g/min; P < 0.001; and -4.3 ± 3.6 mL/100 g/min; P = 0.007) and right occipital lobes (-4.3 ± 5.6 mL/100 g/min; and -3.9 ± 4.9 mL/100 g/min; P = 0.028). A fifth cluster was part of the left frontal lobe (-5.0 ± 4.6 mL/100 g/min; P < 0.001). Peripheral insulin sensitivity was not affected. Intrahepatic lipid content (-0.7%-point; 95% CI: -1.3%-point to -0.1%-point; P = 0.027), serum low-density lipoprotein cholesterol concentration (-0.24 mmol/L; 95% CI: -0.44 to -0.04 mmol/L; P = 0.019), and systolic blood pressure (-5 mm Hg; 95% CI: -8 to -1 mm Hg; P = 0.006) were lower after the mixed nut intervention. Conclusions: Longer-term mixed nut consumption affected insulin action in brain regions involved in the modulation of metabolic and cognitive processes in older adults with overweight/obesity. Intrahepatic lipid content and different cardiometabolic risk markers also improved, but peripheral insulin sensitivity was not affected.

Effects of longer-term mixed nut consumption on lipoprotein particle concentrations in older adults with overweight or obesity.

Nijssen, K.M.R., M.A. Chavez-Alfaro, P.J. Joris, J. Plat, R.P. Mensink, 2024. Effects of longer-term mixed nut consumption on lipoprotein particle concentrations in older adults with overweight or obesity. Nutrients. 17(1):8. https://doi.org/10.3390/nu17010008

Background: Recently, we reported that longer-term mixed nut intake significantly reduced serum total and low-density lipoprotein (LDL)-cholesterol, but these markers may not fully capture lipoprotein-related cardiovascular disease (CVD) risk. Objectives: This randomized, controlled, single-blinded, crossover trial in older adults with overweight or obesity examined the effects of longer-term mixed nut consumption on lipoprotein particle size, number, and lipid distribution. Methods: Twenty-eight participants (aged 65 ±3years; BMI 27.9 ± 2.3 kg/m2) completed two 16-week periods (control [no nuts] vs. mixed nuts (60 g/day: 15g of walnuts, pistachios, cashews, and hazelnuts), separated by an 8-week washout. Plasma lipoprotein particle numbers, sizes, and lipid distributions across subclasses were analyzed using high-throughput nuclear magnetic resonance (NMR) spectroscopy. Results: Mixed nut consumption significantly reduced Apolipoprotein B (ApoB) concentrations (−0.07 g/L; p = 0.009), total cholesterol (−0.27 mmol/L; p = 0.047), non-HDL cholesterol (−0.28 mmol/L; p = 0.022), and total triacylglycerol (TAG) (−0.27 mmol/L; p = 0.008). Total very large-density lipoprotein (VLDL) particle numbers decreased by 24 nmol/L (p < 0.001), with reductions observed across all VLDL subclasses. Total LDL particle numbers (p = 0.044), specifically intermediate-density lipoprotein (IDL) (p = 0.002) and large LDL particles (p = 0.015), were also reduced, while HDL particle numbers and sizes were unaffected. The mixed nut intervention significantly reduced cholesterol concentrations across all VLDL subclasses and IDL (all p < 0.01), with no changes in LDL or HDL subclasses. TAG concentrations showed reductions across all lipoprotein subclasses (all p < 0.05). Conclusions: Longer-term mixed nut consumption may lower CVD risk in older adults and favorable shifts in ApoB-containing lipoprotein subclasses towards a less atherogenic profile.

Perspective: current scientific evidence and research strategies in the role of almonds in cardiometabolic health.

Trumbo, P.R., J. Ard, F. Bellisle, A. Drewnowski, J.A. Gilbert, R. Kleinman, A. Misra, J. Sievenpiper, M. Tahiri, K.E. Watson, J. Hill, 2024. Perspective: current scientific evidence and research strategies in the role of almonds in cardiometabolic health. Curr Dev Nutr. 9(1):104516. https://doi.org/10.1016/j.cdnut.2024.104516.

 Almonds are consumed by individuals around the world. Because almonds are rich in protein, unsaturated fatty acids, and fiber, a significant amount of research has been conducted on their role in affecting various cardiometabolic endpoints (body weight, blood pressure, blood cholesterol levels, and glycemic response). The most current meta-analyses on almond consumption and various health-related endpoints suggest that almond consumption does not result in weight gain and results in small reductions in LDL cholesterol and diastolic blood pressure, as well as improved glycemic responses in certain populations (i.e. Asian Indians). A number of research gaps on almond consumption and cardiometabolic health were identified that should be addressed to further understand their role in the various cardiometabolic endpoints, including the mechanisms of action interactions with the microbiome with regular consumption and their role as part of a healthy dietary pattern for both individuals and the general population.

The effects of almond consumption on cardiovascular health and gut microbiome: A comprehensive review.

Singar, S., S. Kadyan, C. Patoine, G. Park, B. Arjmandi, R. Nagpal, 2024. The effects of almond consumption on cardiovascular health and gut microbiome: A comprehensive review.  Nutrients. 4, 16, 1964. https://doi.org/10.3390/nu16121964

The consumption of almonds has been associated with several health benefits, particularly concerning cardiovascular and intestinal health. In this comprehensive review, we compile and deliberate studies investigating the effects of almond consumption on cardiovascular disease (CVD) risk factors and gut health. Almonds are rich in monounsaturated fats, fiber, vitamins, minerals, and polyphenols, which contribute to their health-promoting properties. Regular intake of almonds has been shown to improve lipid profiles by reducing LDL cholesterol and enhancing HDL functionality. Additionally, almonds aid in glycemic control, blood pressure reduction, and chronic inflammation amelioration, which are critical for cardiovascular health. The antioxidant properties of almonds, primarily due to their high vitamin E content, help in reducing oxidative stress markers. Furthermore, almonds positively influence body composition by reducing body fat percentage and central adiposity and enhancing satiety, thus aiding in weight management. Herein, we also contemplate the emerging concept of the gut–heart axis, where almond consumption appears to modulate the gut microbiome, promoting the growth of beneficial bacteria and increasing short-chain fatty acid production, particularly butyrate. These effects collectively contribute to the anti-inflammatory and cardioprotective benefits of almonds. By encompassing these diverse aspects, we eventually provide a systematic and updated perspective on the multifaceted benefits of almond consumption for cardiovascular health and gut microbiome, corroborating their broader consideration in dietary guidelines and public health recommendations for CVD risk reduction.