Nut consumption and lipid levels

  • Sabate J
  • Oda K
  • Ros E
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Background: Epidemiological studies have consis- tently associated nut consumption with reduced risk for coronary heart disease. Subsequently, many dietary in- tervention trials investigated the effects of nut consump- tion on blood lipid levels. The objectives of this study were to estimate the effects of nut consumption on blood lipid levels and to examine whether different factors modify the effects. Methods: We pooled individual primary data from 25 nut consumption trials conducted in 7 countries among 583 men and women with normolipidemia and hyper- cholesterolemiawhowere not taking lipid-lowering medi- cations. In a pooled analysis, we used mixed linear mod- els to assess the effects of nut consumption and the potential interactions. Results: With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: total cholesterol concentration (10.9 mg/dL [5.1% change]), low-density lipoprotein cholesterol concen- tration (LDL-C) (10.2 mg/dL [7.4% change]), ratio of LDL-C to high-density lipoprotein cholesterol concen- tration (HDL-C) (0.22 [8.3% change]), and ratio of total cholesterol concentration toHDL-C(0.24 [5.6% change]) (P?.001 for all) (to convert all cholesterol concentra- tions to millimoles per liter, multiply by 0.0259). Tri- glyceride levels were reduced by 20.6 mg/dL (10.2%) in subjects with blood triglyceride levels of at least 150mg/dL (P?.05) but not in those with lower levels (to convert triglyceride level to millimoles per liter, multiply by 0.0113). The effects of nut consumption were dose re- lated, and different types of nuts had similar effects on blood lipid levels. The effects of nut consumption were significantly modified by LDL-C, body mass index, and diet type: the lipid-lowering effects of nut consumption were greatest among subjects with high baseline LDL-C and with low body mass index and among those con- suming Western diets. Conclusion: Nut consumption improves blood lipid lev- els in a dose-related manner, particularly among sub- jects with higher LDL-C or with lower BMI. Arch Intern Med. 2010;170(9):821-827 Author Affiliations: Departments of Nutrition (Dr Sabate´) and Epidemiology and Biostatistics (Dr Sabate´ and Mr Oda), Loma Linda University, Loma Linda, California; and Unitat de Lı´pids, Servei d’Endocrinologia i Nutricio´ , Institut d’Investigacions Biomèdiques August Pi Sunyer, Hospital Clı´nic de Barcelona, and Centro de Investigacio´n Biome´dica en Red Fisiopatologı´a de la Obesidad y Nutricio´n, Instituto de Salud Carlos III, Barcelona, Spain (Dr Ros). IETARY INTERVENTIONS TO lower blood cholesterol concentrations and to modify blood lipopro- tein levels are the corner- stone of prevention and treatment plans D for coronary heart disease (CHD).1 Re- cently, consumption of nuts has been the focus of intense research because of their potential to reduceCHDrisk and to lower blood lipid levels based on their unique nutritional attributes.2,3 Nuts are a nutrient- dense food rich in plant protein (10%- 25%) and fat (50%-75%), mostly unsat- urated fatty acids.2-4 They are a rich source of additional nutrients, dietary fiber, min- erals (eg, copper, magnesium, and potas- sium), vitamins (eg, folic acid, niacin, vi- tamin E, and vitamin B6 ), and other bioactive constituents such as phenolic an- tioxidants and phytosterols.2-4 Epidemiological investigationshavecon- sistentlyshownthat frequent nutconsump- tion reduces CHD risk.5 In a summary es- timate of4major epidemiological studies,6-9 the meanCHDrisk was 37% lower among subjects who consumed 4 or more serv- ings of nuts a week compared with those whoseldom or never ate nuts, with a mean reduction of8.3%for each incremental serv- ing per week of nuts consumed.5 Based on scientific data documenting the benefits of nut consumption, the US Food and Drug Administration10 issued a qualified health claim in 2003 stating that eating 43 g/d (1.5 oz/d) of specific nuts (almonds, hazel- nuts, pecans, pistachios, walnuts, and pea- nuts) may reduce CHD risk. While many mechanisms by which nuts exert thisCHD protective effect have been postulated,11,12 their lipid-lowering properties have been studied extensively. (REPRINTED)

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  • Joan Sabate

  • Keiji Oda

  • Emilio Ros

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