Premeal almond load decreases postprandial glycaemia, adiposity and reversed prediabetes to normoglycemia: a randomized controlled trial.
Background: Asian Indians show rapid conversion from prediabetes to type 2 diabetes (T2D). Novel dietary strategies are needed to arrest this progression, by targeting postprandial hyperglycaemia (PPHG). Design: We conducted a free-living randomized controlled open-label parallel arm study to evaluate the effect of a premeal load of almonds (20 g) 30 min before major meals on anthropometric, glycaemic, and metabolic parameters over 3 months. Sixty-six participants with prediabetes in the age range of 18–60 yrs were recruited. The study was registered at clinicaltrials.gov (registration no. NCT04769726). Results: Thirty participants in each arm completed the study. As per ‘intention-to-treat’ analysis, overall additional mean reductions were statistically significant for body weight, BMI, waist circumference (WC), subscapular and suprailiac skinfolds, and improved handgrip strength (Kg) (p < 0·001 for all) in the treatment arm vs. the control arm (after multiple adjustments). In the blood parameters, the additional mean reduction in the treatment arm vs. control arm was statistically significant for fasting and post-75 g oral glucose-load blood glucose, postprandial insulin, HOMA-IR, HbA1c, proinsulin, total cholesterol, and very low-density lipoprotein cholesterol (p < 0·001 for all). Most importantly, we observed a reversal to normoglycemic state (fasting blood glucose and 2 h post-OGTT glucose levels) in 23.3% (7 out of 30) of participants in the treatment arm which is comparable to that seen with Acarbose treatment (25%). Conclusion: Incorporation of 20 g of almonds, 30 min before each major meal leads to significant improvement in body weight, WC, glycemia (particularly PPHG), and insulin resistance and shows potential for reversal of prediabetes to normal glucose regulation over 3 months. https://doi.org/10.1016/j.clnesp.2022.12.028
Nuts in the Prevention and Management of Type 2 Diabetes.
Diabetes is a continuously growing global concern affecting >10% of adults, which may be mitigated by modifiable lifestyle factors. Consumption of nuts and their inclusion in dietary patterns has been associated with a range of beneficial health outcomes. Diabetes guidelines recommend dietary patterns that incorporate nuts; however, specific recommendations related to nuts have been limited. This review considers the epidemiological and clinical evidence to date for the role of nut consumption as a dietary strategy for the prevention and management of type 2 diabetes (T2D) and related complications. Findings suggest nut consumption may have a potential role in the prevention and management of T2D, with mechanistic studies assessing nuts and individual nut-related nutritional constituents supporting this possibility. However, limited definitive evidence is available to date, and future studies are needed to elucidate better the impact of nuts on the prevention and management of T2D. https://doi.org/10.3390/nu15040878
Consumption of Nuts and Seeds and Health Outcomes Including Cardiovascular Disease, Diabetes and Metabolic Disease, Cancer, and Mortality: An Umbrella Review.
Consumption of nuts and seeds is associated with a range of health outcomes. Summarizing the best evidence on essential health outcomes from the consumption of nuts is essential to provide optimal recommendations. Our objective is to comprehensively assess health outcome associations related to the consumption of nuts and seeds, using a culinary definition including tree nuts and peanuts (registered in PROSPERO: CRD42021258300). Health outcomes of interest include cardiovascular disease, cancer, diabetes, obesity, respiratory disease, mortality, and their disease biomarkers. We present associations for high compared with low consumption, per serving, and dose-response relations. MEDLINE, Embase, Cochrane, and Epistemonikos were searched and screened for systematic reviews and meta-analyses. Evidence was extracted from 89 articles on the consumption of nuts and relevant health outcomes, including 23 articles with meta-analysis on disease and mortality, 66 articles on biomarkers for disease, and 9 articles on allergy/adverse outcomes. Intake of nuts was associated with reduced risk of cardiovascular diseases and related risk factors, with moderate quality of evidence. An intake of 28 g/d nuts compared with not eating nuts was associated with a 21% RR reduction of cardiovascular disease (including coronary heart disease incidence and mortality, atrial fibrillation, and stroke mortality), an 11% risk reduction of cancer deaths, and 22% reduction in all-cause mortality. Nut consumption was also inversely associated with mortality from respiratory diseases, infectious diseases, and diabetes; however, associations between nut consumption and diabetes incidence were mixed. Meta-analyses of trials on biomarkers for disease generally mirrored meta-analyses from observational studies on cardiovascular disease, cancers, and diabetes. Allergy and related adverse reactions to nuts were observed in 1-2% of adult populations, with substantial heterogeneity between studies. Overall, the current evidence supports dietary recommendations to consume a handful of nuts and seeds per day for people without allergies to these foods. https://doi.org/10.1093/advances/nmac077
Effect of Date Fruit Consumption on the Glycemic Control of Patients with Type 2 Diabetes: A Randomized Clinical Trial.
Objective: Date fruit has been reported to have benefits in type 2 diabetes (T2D), though there is a concern, given the high sugar content, about its effects on glycemic control. Design and setting: Prospective, interventional, randomized, parallel study. Participants: In total, 79 patients with T2D (39 male and 40 female). Intervention: Participants were randomly allocated to either 60 g date fruit or 60 g raisins daily of the equivalent glycemic index (amount split, given as midmorning and midafternoon snack) for 12 weeks. Main outcome measures: The primary outcome was to investigate the effect of date fruit on HbA1c and fasting blood glucose, and their variability, in patients with T2D in comparison to the same glycemic load of raisins. The secondary outcomes were to determine whether date fruit affected cardiovascular risk by measuring fasting lipids, C-reactive protein (CRP), blood pressure, and insulin resistance (IR) as measured by Homeostatic Model Assessment (HOMA-IR). Results: In total, 61 (27 female and 34 male) of 79 patients completed the study. There was no difference between or within groups for HbA1c or HbA1c variability, fasting glucose or glucose variability, insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S), beta cell function (HOMA-B), the disposition index, lipids, systolic (SBP) or diastolic blood pressure (DBP), or C-reactive protein (CRP) (p > 0.05). Conclusion: No improvement in glycemic indices was seen following supplementation of 60 g daily date fruit or raisins, though neither had a deleterious effect on glycemic control over a 12-week period, indicating their safety when consumed in T2D. Additionally, no beneficial therapeutic effects of date fruit on other cardiovascular indices in T2D were seen. https://doi.org/10.3390/nu14173491
Nuts as functional foods: Variation of nutritional and phytochemical profiles and their in vitro bioactive properties
The aim of the present study was to examine the nutritional (fat, fatty acids, minerals, sugars) and bioactive compounds (polyphenols, tocochromanols, triterpene) and their influence on in vitro anti-diabetic (pancreatic α-amylase and intestinal α-glucosidase), anti-obesity (pancreatic lipase) and anti-cholinergic (AChE and BuChE) inhibitory activity of 8 different popular nuts-pecan, pine, hazelnuts, pistachio, almonds, cashew, walnuts, and macadamia. The total content of phenolic compounds in nuts ranged from 432.9 (walnuts) to 5.9 (pistachio) mg/100 g. The dominant polyphenols are polymeric procyanidins (walnuts - 415.1 mg/100 g). Nuts are rich in tocochromanols (832.9-4377.5 μg/100 g), especially α- and γ-tocopherols. The highest content of α-tocopherol (vitamin E) was detected in hazelnuts and almonds (2551.0 and 2489.7 μg/100 g, respectively) while the lowest amounts were detected in macadamia, cashew and walnuts. The most abundant in nuts are oleanic and pomolic acids (35 and 22 % of total, respectively), while betulin, uvaol and erythrodiol are less characteristic triterpenes for nuts (<1%). Pine nuts are the nuts with the highest content of triterpene (690.3 mg/100 g). Pistachio and almonds are the richest in total fat (>45 %), but monounsaturated (17.5-79.3 %; hazelnuts, almonds, cashew, macadamia, pistachio and pecan) and polyunsaturated (7.5-69.3 %; pine, walnuts) are the dominant fatty acids. Moreover, nuts are low in Cu, Zn, Mn and Na content, but rich in K (464.5-1772.3 mg/100 g) and Mg (197.0-502.5 mg/100 g). Macadamia, walnuts and cashew are good sources of Se. Pistachio, almonds and cashew were characterized by the highest content of sugars, but the dominant sugar was saccharose (58.2-2399.3 mg/100 g). All nuts showed high activity in inhibiting intestinal α-glucosidase (>90 %), but lower ability to inhibit pancreatic α-amylase and pancreatic lipase activity. The activity in inhibiting acetyl- and butylcholinesterase was up to 30 %. As described above, all nuts contain various compounds that improve the nutritional value. Therefore they should be one of the important components of the daily human diet rich in functional. https://doi.org/10.1016/j.fochx.2022.100418
Phenolic Lipids Derived from Cashew Nut Shell Liquid to Treat Metabolic Diseases.
Metabolic diseases are increasing at staggering rates globally. The peroxisome proliferator-activated receptors (PPARα/γ/δ) are fatty acid sensors that help mitigate imbalances between energy uptake and utilization. Herein, we report compounds derived from phenolic lipids present in cashew nut shell liquid (CNSL), an abundant waste byproduct, in an effort to create effective, accessible, and sustainable drugs. Derivatives of anacardic acid and cardanol were tested for PPAR activity in HEK293 cell co-transfection assays, primary hepatocytes, and 3T3-L1 adipocytes. In vivo studies using PPAR-expressing zebrafish embryos identified CNSL derivatives with varying tissue-specific activities. LDT409 (23) is an analogue of cardanol with partial agonist activity for PPARα and PPARγ. Pharmacokinetic profiling showed that 23 is orally bioavailable with a half-life of 4 h in mice. CNSL derivatives represent a sustainable source of selective PPAR modulators with balanced intermediate affinities (EC50 ∼ 100 nM to 10 μM) that provide distinct and favorable gene activation profiles for the treatment of diabetes and obesity. https://doi.org/10.1021/acs.jmedchem.1c01542
The Effects of Peanuts and Tree Nuts on Lipid Profile in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized, Controlled-Feeding Clinical Studies
Background: Type 2 diabetes mellitus was found to be associated with metabolic disorders, particularly abnormal glucose and lipid metabolism. Dietary food choices may have profound effects on blood lipids. The primary objective of this study was to examine the effects of peanuts and tree nuts intake on lipid profile in patients with type 2 diabetes. Methods: According to preferred reporting items for systematic reviews and meta-analysis guidelines, we performed a systematic search of randomized controlled clinical trials and systematic reviews published in PubMed, Web of Science, Embase, Scopus, and Cochrane library, from inception through June 2021. Studies in populations with type 2 diabetes, which compare nuts or peanuts to a controlled-diet group were included. We used the mean difference with 95% CIs to present estimates for continuous outcomes from individual studies. In addition, we used the GRADEpro tool to evaluate the overall quality of evidence. Conclusion: Our findings suggest that consuming peanuts and tree nuts might be beneficial to lower TC concentration and TG concentration in type 2 diabetics subjects. Furthermore, peanuts and tree nuts supplementation could be considered as a part of a healthy lifestyle in the management of blood lipids in patients with type 2 diabetes. Given some limits observed in the current studies, more well-designed trials are still needed. https://doi.org/10.3389/fnut.2021.765571
Does a MediDiet with additional extra virgin olive oil (EVOO) and pistachios reduce the incidence of gestational diabetes?
Objective: The present study aimed to evaluate gestational diabetes mellitus (GDM) incidence in pregnant women following the Mediterranean diet with additional extra virgin olive oil (EVOO) and pistachios. Methods: 560 pregnant patients were enrolled in the present study. The Mediterranean diet (MedDiet) was introduced in both the interventional group (IG) and control group (CG). The females received 40 ml of extra virgin olive oil (EVOO) every day along with 25 - 30 gm of roasted pistachios in the interventional group. The incidence of Gestational Diabetes Mellitus (GDM) was recorded along with specific maternal and neonatal outcomes. Materials and methods: The nutritional and MEDAS scores were not statistically different among the groups at baseline, but the difference was statistically significant and higher in IG at 24-28 weeks (p = 0.001) and 36-38 weeks (p = 0.001). GDM was diagnosed in 51(20.4%) females in the Control group and 34 (13.6%) females in the Interventional group. The MedDiet significantly reduced the GDM incidence (p=0.02) after adjusting the confounding factors. Conclusion: The present study depicts that dietary intervention in pregnant women, including MedDiet and increased consumption of EVOO and pistachios, decreased the incidence of GDM. https://doi.org/10.1016/j.eprac.2021.08.010
The association between insulin resistance and the consumption of nut including peanut, pine nut and almonds in working-aged Korean population.
Objective: Studies have reported that nuts intake is potentially beneficial to cardiometabolic health. However, there have been heterogenous results regarding the association between nut intake/consumption and the risk of diabetes mellitus (DM). Insulin resistance (IR) is a major pathophysiology of DM. Thus, this study was to assess the association between nuts consumption and IR. Design: A Retrospective Cross-sectional Study. Setting: Multivariable adjusted odd ratio (OR) and 95% confidence interval (CI) for increased IR (adjusted OR [95% CI]) were calculated according to the frequency of consuming one serving dose (15g) of nuts including peanut, pine nut and almond (<1/month, 1/month-1/week, 1-3/week, 3-5/week, ≥ 5/week). Elevated IR was defined in HOMA-IR corresponding to the fourth quartile levels within each study group. Subgroup analysis was conducted for gender, glycemic status (normal, prediabetes and DM) and age (≥ and < 40 years). Participants: 379,310 Koreans who received health check-up. Results: Compared with nut consumption <1/month (reference), nuts consumption ≥ 1/month had the lower OR and 95% CI for elevated IR (1/month-1/week: 0.90 [0.89 - 0.92], 1-3/week: 0.90 [0.87 - 0.92], 3-5/week: 0.94 [0.89 - 0.98] and ≥ 5/week: 0.90 [0.86 - 0.94]). This association was more remarkable in women, normal glycemic group and young age group (< 40 years). However, men, prediabetes, DM and old age group didn't show the significant association. Conclusion: Nuts consumption ≥ 1/month was less associated with elevated IR. Increased nuts consumption may have a favorable effect on IR. https://doi.org/10.1017/S1368980021003803
Pecan-Enriched Diets Alter Cholesterol Profiles and Triglycerides in Adults at Risk for Cardiovascular Disease in a Randomized, Controlled Trial.
Background: Research indicates that tree nuts are cardioprotective, but studies on pecans are limited.
Objectives: We examined the impact of daily pecan consumption on blood lipids and glycemia in adults at-risk for cardiovascular disease (CVD). Methods: This was a randomized, controlled trial where 56 adults (BMI ≥28 kg/m2 or hypercholesterolemia) were randomly allocated into a control group (n = 18) or 1 of 2 pecan groups. The ADD group (n = 16) consumed pecans (68 g) as part of a free-living diet. The SUB group (n = 18) substituted the pecans (68 g) for isocaloric foods from their diet. At baseline and 8 wk, a high-fat meal was consumed with 4-h postprandial blood draws to determine changes in blood lipids and glycemia. Results: There was a significant reduction from baseline to 8 wk in fasting total cholesterol (TC) (204 ± 8.76 to 195 ± 8.12; 205 ± 8.06 to 195 ± 6.94 mg/dL), LDL cholesterol (143 ± 8.09 to 129 ± 7.71; 144 ± 6.60 to 135 ± 6.16 mg/dL), triglycerides (TGs) (139 ± 12.1 to 125 ± 14.6; 133 ± 10.7 to 120 ± 10.3 mg/dL), TC/HDL cholesterol ratio (3.92 ± 0.206 to 3.58 ± 0.175; 4.08 ± 0.167 to 3.79 ± 0.151), non-HDL cholesterol (151 ± 8.24 to 140 ± 7.95; 155 ± 6.87 to 143 ± 6.00 mg/dL), and apolipoprotein B (99.1 ± 5.96 to 93.0 ± 5.35; 104 ± 3.43 to 97.1 ± 3.11 mg/dL) in the ADD and SUB groups, respectively (P ≤ 0.05 for all), with no changes in control. There was a reduction in postprandial TGs (P ≤ 0.01) in ADD, and a reduction in postprandial glucose (P < 0.05) in SUB. Conclusions: Pecan consumption improves fasting and postprandial blood lipids in CVD at-risk adults. This trial was registered at clinicaltrials.gov as NCT04376632. https://doi.org/10.1093/jn/nxab248