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The impact of pistachio intake alone or in combination with high-carbohydrate foods on post-prandial glycemia

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Abstract

Dietary strategies that reduce post-prandial glycemia are important in the prevention and treatment of diabetes and coronary heart disease (CHD). This may be achieved by addition of high-quality protein and fat contained in pistachio nuts, to carbohydrate-containing foods or meals. A total of 10 healthy volunteers (3 males, 7 females); aged 48.3±6.4 years; Body mass index (BMI) 28.0±4.8 kg/m(2) participated in two studies. Study 1 assessed the dose-response effect of 28, 56 and 84 g pistachios consumed alone or co-ingested with white bread (50 g available carbohydrate); Study 2 assessed the effective dose (56 g) of pistachios on post-prandial glycemia consumed with different commonly consumed carbohydrate foods (50 g available carbohydrate). Relative glycemic responses (RGRs) of study meals compared with white bread, were assessed over the 2 h post-prandial period. The RGRs of pistachios consumed alone expressed as a percentage of white bread (100%) were: 28 g (5.7±1.8%); 56 g (3.8±1.8%); 84 g (9.3±3.2%), P<0.001. Adding pistachios to white bread resulted in a dose-dependent reduction in the RGR of the composite meal; 28 g (89.1±6.0, P=0.100); 56 g (67.3±9.8, P=0.009); 84 g (51.5±7.5, P<0.001). Addition of 56 g pistachios to carbohydrate foods significantly reduced the RGR: parboiled rice (72.5±6.0) versus rice and pistachios (58.7±5.1) (P=0.031); pasta (94.8±11.4) versus pasta and pistachios (56.4±5.0) (P=0.025); whereas for mashed potatoes (109.0±6.6) versus potatoes and pistachios, (87.4±8.0) (P=0.063) the results approached significance. Pistachios consumed alone had a minimal effect on post-prandial glycemia and when taken with a carbohydrate meal attenuated the RGR. The beneficial effects of pistachios on post-prandial glycemia could, therefore, be part of the mechanism by which nuts reduce the risk of diabetes and CHD.

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... Based on the knowledge presented above, a literature review was conducted to identify foods that were shown to positively influence postprandial glycemia and insulinemia, GLP-1 secretion, and subjective appetite sensations. Fourteen original articles were identified, and foods included almonds, pistachios, avocados, oatmeal, and eggs [267][268][269][270][271][272][273][274][275][276][277][278][279]281]. The first part of the study was conducted in a sample of middle-aged adults with or without prediabetes and aimed to assess the influences of gender/sex and health status on 1) the relative ranking of the importance of common determinants of food choices and 2) the consumption and sensory evaluation of almonds, pistachios, avocados, oatmeal, and eggs. ...
... The addition of foods with a high protein, MUFAs and fiber content, such as almonds (30.0 to 90.0 g) or pistachios (28.0 to 85.0 g) to a high-carbohydrate meal has also been shown to improve postprandial glycemic responses in a dose-dependent manner [272][273][274][275][276][277][278]. colleagues (2006, 2008) also found a decrease in insulin secretion in healthy adults and adults with hyperlipidemia following acute and prolonged almond consumption [272,274]. ...
... The main limitation of studies assessing the metabolic effects of almonds, pistachios, avocados, oatmeal, and eggs, is that it is impossible to distinguish the specific impact of macronutrient subtypes (e.g., MUFAs vs. PUFAs vs. SFAs) from the impact of the amount of their intake per se because the experimental meals were not matched for macronutrient content [270,271,[273][274][275][276][278][279][280][281][282][283]. Furthermore, several studies [273,277,279] did not use isocaloric test and control meals. ...
... Minerals (Cu, Mg, Mn, K, and Ca) and vitamins (A, B, and C) in pistachio are suitable for the health of many parts of the body such as the heart, blood vessels, immune system, and eyes (10). In addition, Kendall et al. noted that consumption of pistachios alone had little effect on postprandial blood sugar, but when consumed with carbohydrates it caused a reduction in relative glycemic response (RGR) (11). In other words, nuts due to their desirable fat and protein can lower postprandial blood sugar, and thus, reduce the risk of heart disease and diabetes (11). ...
... In addition, Kendall et al. noted that consumption of pistachios alone had little effect on postprandial blood sugar, but when consumed with carbohydrates it caused a reduction in relative glycemic response (RGR) (11). In other words, nuts due to their desirable fat and protein can lower postprandial blood sugar, and thus, reduce the risk of heart disease and diabetes (11). In another study, the role of pistachios in glucose level was compared to that of the Mediterranean diet (vegetables, fish and red meat, fat, and eggs) (12). ...
... Therefore, nutrients in pistachios can help individuals with pre-diabetes in reducing blood sugar and insulin. Moreover, research showed that consumption of pistachios had a positive effect on patients with diabetes (3,11,27). Diabetes is a disease characterized mainly by hyperglycemia, and carbohydrate, fat, and protein dysfunction. This disease is caused by defects in insulin secretion or insulin action, or both. ...
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using the keyword pistachio in combination with cholesterol, cardiovascular, health, consumption, diabetes, serum lipid levels, glucose, and metabolic syndrome. Results: Of the total of 194 articles searched, 19 articles were included in the study. The consumption of pistachio, due to its minerals, vitamins, proteins, and antioxidants, improved health and had a positive impact on health outcomes, such as fat, blood sugar, and weight control. It also helped in the promotion of a healthy heart and recovery of high blood pressure, diabetes, coronary heart disease (CHD), metabolic syndrome, and pre-diabetes. Conclusions: Pistachio, due to its nutrients, has positive impact on human body health, including the cardiovascular system, blood lipids, and blood pressure. Moreover, because of its unsaturated fats, it also affects the lipoproteins and reduces cardiovascular disease (CVD) and diabetes, and helps in the management of weight and metabolic syndrome. It can also help in the recovery of patients with pre-diabetes through changes in their harmful metabolism. Pistachios are recommended as part of a healthy diet for the human health and prevention of chronic non-infectious diseases.
... In overweight (Ow) healthy subjects, pistachio consumption was reported to have a minimal effect on postprandial glycaemia. When pistachios were included in a carbohydrate meal, the relative glycaemic response (RGR) was attenuated [74]. In a crossover trial with 20 subjects with MetS, postprandial glycaemia decreased after the consumption of pistachios (85 g) compared to white bread. ...
... In this study conducted in 10 diabetic and 14 non-diabetic subjects, nut consumption decreased the RGR compared to white bread. Importantly, this study also reported that nut consumption improved short-term glycaemic control in patients with T2D [74]. ...
... Overall fiber contained in nuts and DFs is also able to decrease postprandial glycaemic levels and this could be a strategy for increasing insulin sensitivity which improves T2D and several other CV risk factors for chronic diseases [74,127]. ...
Article
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Nuts and dried fruit are essential foods in the Mediterranean diet. Their frequent consumption has been associated with the prevention and/or the management of such metabolic conditions as type 2 diabetes (T2D), metabolic syndrome and cardiovascular diseases. Several previous reviews of epidemiological studies and clinical trials have evaluated the associations of nuts and/or dried fruit with various metabolic disorders. However, no reviews have focused on the mechanisms underlying the role of nuts and/or dried fruit in insulin resistance and T2D. This review aims to report nut and dried-fruit nutritional interventions in animals and humans, and to focus on mechanisms that could play a significant role in the prevention and treatment of insulin resistance and T2D. View Full-Text
... Compared with other edible nuts, pistachios have higher MUFA content (67%), lower ratio of polyunsaturated to saturated fat and a lower glycemic index, which provides incremental health benefits [15][16][17][18]. Consistent with these observations, numerous studies have documented lipid-lowering and antioxidant properties of pistachios [16][17][18][19][20][21][22][23][24]. However, only limited data is available to assess whether these beneficial properties of regular consumption of pistachios actually translate into improved vascular health [25,26]. ...
... Several previous studies have documented beneficial effects of regular consumption of pistachios on metabolic parameters, body weight, antioxidant levels, and anti-inflammatory markers [16][17][18][19][20][21][22][23][24]. In one study 44 healthy individuals were randomized to a regular diet versus a diet substituting pistachio nuts for 20% of daily caloric intake [17]. ...
... Apart from these effects, pistachios have numerous other beneficial properties. They have low glycemic index, which prevents postprandial hyperglycemia, while at the same time, their tendency to induce early satiety helps in weight management [19,38]. Additionally, pistachios are a good source of proteins (w20% weight by weight) with particularly high content of arginine (2 g/100 g) [37]. ...
Article
Previous studies have demonstrated beneficial effects of regular consumption of pistachio nuts on glycemic, lipid, and oxidative stress parameters. The aim of this study was to determine its effect on vascular health, which has not been adequately studied so far. In this open label, randomized parallel-group study, 60 adults with mild dyslipidemia were randomized to lifestyle modification (LSM) alone or LSM with consumption of 80 g (in-shell) pistachios (equivalent to 40 g or 1.5 oz shelled pistachios) daily for 3 mo. Biochemical parameters, brachial artery flow-mediated vasodilation (BAFMD), and carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV, respectively) were measured before and after the intervention. At 3 mo, there was no change in any of the clinical or biochemical parameters in the LSM group. However, the patients in the pistachio group had a significant increase in high-density lipoprotein cholesterol (HDL-C; 35.7 ± 8.8 mg/dL versus 37.8 ± 10.1 mg/dL; P = 0.04) and a reduction in low-density lipoprotein cholesterol (137.2 ± 32.6 mg/dL versus 127.6 ± 34.0 mg/dL; P = 0.02), total cholesterol (TC)-to-HDL-C ratio (5.8 ± 1.3 mg/dL versus 5.3 ± 1.1 mg/dL; P = 0.001), and fasting blood sugar (88.8 ± 7.1 mg/dL versus 86.6 ± 6.3 mg/dL; P = 0.05). Additionally, whereas LSM alone was associated with no improvement in BAFMD or PWV, individuals in the pistachio group had significant reduction in left baPWV (1261.7 ± 187.5 cm/sec versus 1192.4 ± 152.5 cm/sec; P = 0.02) and statistically nonsignificant improvement in most other parameters, including BAFMD. As a result, at 3 mo the patients in the pistachio group had lower cfPWV (770.9 ± 96.5 cm/sec versus 846.4 ± 162.0 cm/sec; P = 0.08), lower left baPWV (1192.4 ± 152.5 cm/sec versus 1326.3 ± 253.7 cm/sec; P = 0.05), and lower average baPWV (1208.2 ± 118.4 cm/sec versus 1295.8 ± 194.1 cm/sec; P = 0.08) compared with the LSM group. Two-way analysis of variance revealed significant treatment effect of pistachio consumption on cfPWV, left baPWV, average baPWV, and BAFMD (P = 0.037, 0.01, 0.07, and 0.046, respectively). The present study demonstrates that regular consumption of pistachio nuts not only improves glycemic and lipid parameters, but also results in improvements in vascular stiffness and endothelial function. Importantly, these improvements were seen in apparently healthy individuals and with a diet (including pistachios) and exercise regimen that every adult individual is expected to follow. Copyright © 2015 Elsevier Inc. All rights reserved.
... The reduction of lipid peroxidation [35] and the improvement of endothelial function [24,28] are associated with high concentration of antioxidants present in walnuts [23,35], such as α-linolenic acid and alpha-tocopherol [3,26]. Table 3 summarizes the randomized studies regarding pistachio consumption [36][37][38][39][40][41][42][43][44]. Pistachio consumption has been associated with improvement of glucose metabolism [36,37], lipid profile [39,40], and vascular function [41,42]. ...
... Evaluation of the dose-response effect of pistachio intake (28, 56, and 84 g/day) alone or in combination with high-carbohydrate bread (50 g available carbohydrate) showed a reduction in post-prandial glycemia, highlighting a progressive reduction in bread glycemic response with the highest doses of pistachios [43]. Replacing 20% of the total energy from pistachios for four weeks modified systemic hemodynamics, increased heart rate variability, and reduced 24-h systolic blood pressure in adults with well-controlled type 2 diabetes [42]. ...
... Thus, clear evidence exists that pistachio consumption (range 25-84 g/day) may be beneficial to ameliorate the lipid profile [38][39][40][41] and attenuate the inflammatory markers [35,38] and blood pressure in individuals with overweight-associated risk factors [35,36]. Moreover, studies also show improvement in glucose metabolism [36,37,41,43] and improvement of vascular function and systemic hemodynamics [41,42]. ...
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There has been increasing interest in nuts and their outcome regarding human health. The consumption of nuts is frequently associated with reduction in risk factors for chronic diseases. Although nuts are high calorie foods, several studies have reported beneficial effects after nut consumption, due to fatty acid profiles, vegetable proteins, fibers, vitamins, minerals, carotenoids, and phytosterols with potential antioxidant action. However, the current findings about the benefits of nut consumption on human health have not yet been clearly discussed. This review highlights the effects of nut consumption on the context of human health.
... Several lines of evidence have suggested that frequent nut consumption is associated with a decreased risk of T2DM, mostly related to the high content of antioxidants, anti-inflammatory compounds, fiber, and healthy fats [14,20e23]. Amongst all nuts, pistachio nuts with a very low glycemic index are a potential candidate for decreasing the risk of T2DM, by possible impacts on reducing fasting and postprandial glucose or insulin [24]. Moreover, pistachio nuts are rich in many antioxidant compounds, including beta-carotene, lutein, proanthocyanidins, and vitamin E [15] as well as monounsaturated fatty acids [25,26]. ...
... Although, it has been shown that pistachio nuts had no beneficial effect on oral glucose tolerance test (OGTT) [31], pistachio nuts consumption in high amount (70 g/day) mitigated impaired OGTT [30]. However, pistachio nuts consumption alone exerted a minimal impact on postprandial blood glucose, the consumption of pistachio nuts with high-glycemic-index foods (white bread, pasta, mashed potatoes, and parboiled rice) reduced postprandial glucose by 20e30%, in healthy subjects [24] and patients with MS [28]. It seems consumption of pistachio nuts in higher daily doses (>50 g/day) and in a longer period of time (>12 weeks) is closely associated with the reduction of patients' FBG. ...
... However, in one of the included RCTs, intervention with a high amount of pistachio nuts (57 g/day) for a relatively long-term period (16 weeks) demonstrated a significant reduction of FPI in patients with PD [27]. A positive impact of pistachio nuts on a very high daily dose (85 g/day) on postprandial insulin has also been reported, particularly when consumed with a high-carbohydrate diet [24,28]. Moreover, the consumption of high daily doses of these nuts (>57 g/ day) has an upregulatory effect on glucagon-like peptide-1 (GLP-1) secretion [27,28]. ...
Article
Background and aims Pistachio nuts have been considered to improve dysglycemia. However, there are controversial results. This systematic review and meta-analysis carried out to evaluate the effects of pistachio nuts on glycemic control and insulin sensitivity in patients with type 2 diabetes mellitus (T2DM), prediabetes, and metabolic syndrome. Methods Medline/PubMed, ProQuest, Web of Knowledge, Scopus, Cochrane library, and ScienceDirect were systematically searched to find randomized controlled trials (RCTs). Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist was used to conduct the study. Results Six RCTs were included in the review. Treatment with pistachio nuts exerted a significant reduction in fasting blood glucose (FBG) level (OR = 1.7, 95% CI; 1.2–2.4, P = 0.002, I² = 0.0%, P = 0.731) and homeostasis model of insulin resistance (HOMA-IR) index (OR = 1.5, 95% CI; 1.0–2.4, P = 0.043, I² = 0.0%, P = 0.617), but no significant improvement was observed in regard to glycated hemoglobin (HbA1c) level (OR = 1.4, 95% CI; 0.9–2.1 P = 0.089, I² = 0.0%, P = 0.957) and fasting plasma insulin (FPI) level (OR = 1.3, 95% CI; 0.9–1.9, P = 0.133, I² = 0.0%, P = 0.776). Conclusions Pistachio nuts could cause a significant reduction in FBG and HOMA-IR, although HbA1c and FPI could not significantly improve in patients suffering from or at risk of T2DM.
... Several acute studies have shown the consumption of nuts over a wide range of doses (i.e. 28-90 g) with carbohydrate-rich foods resulted in significant reductions in the postprandial glucose of the meal in a dose-response manner compared to the control meals in healthy individuals [16][17][18] and people with type 2 diabetes [19] or the metabolic syndrome [20]. It is important to emphasise that participants in these studies were asked to consume white bread in combination with nuts. ...
... An important finding of this study was that when hazelnuts, in three different forms, were added to a staple such as bread, there is a significant reduction in postprandial glycaemic response. Previous studies have shown that the consumption of nuts blunts blood glucose response when eaten alone or co-ingested with carbohydrate-rich foods [16][17][18][19][20]. However, to the best of our knowledge, no study has incorporated nuts into the bread itself. ...
... However, to the best of our knowledge, no study has incorporated nuts into the bread itself. It is reassuring that enriching bread with nuts results in a similar reduction in glycaemic response as reported in other studies [16][17][18][19][20]. This is particularly important considering that postprandial glucose concentrations have been shown to be an independent risk factor for CVD [7][8][9]. ...
Article
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Purpose: Consuming 30 g of nuts/day is recommended to reduce chronic disease. However, nut consumption appears far from ideal among several populations. A potential strategy to increase consumption is to add nuts to a staple, for example, bread. Whether the health benefits and acceptability of nuts persist in this form is currently unknown. Thus, we examined the effects of consuming three nut-enriched breads on postprandial glycaemia, satiety, gastrointestinal tolerance, dietary intakes, and acceptance. Methods: In this controlled, crossover study, 32 participants were randomly allocated to receive one of four breads for 8 days each. Three breads contained either 30 g of finely sliced hazelnuts, 30 g semi-defatted hazelnut flour, or 15 g of each (amounts per 120 g bread) and were compared with a control nut-free bread. Blood glucose response was measured over 120 min, along with ratings of gastrointestinal discomfort. Appetite ratings and diet diaries were completed during each treatment period. Results: Area under the blood glucose curve was significantly lower for the nut breads compared to the control bread (all P < 0.001), with no significant differences between the nut breads (all P ≥ 0.130). There were no significant differences in satiety (all P ≥ 0.135) or gastrointestinal symptoms (all P ≥ 0.102) between the breads. Acceptance was highest for the finely sliced hazelnut bread. Furthermore, consuming hazelnut-enriched bread improved diet quality, increasing monounsaturated fat, vitamin E, and dietary fibre intakes. Conclusion: Bread appears to be an effective and acceptable vehicle for increasing nut consumption, resulting in improved postprandial glycaemia and diet profiles. Long-term studies are now required.
... Due to their low GI, pistachios may have a possible effect on reducing postprandial glycaemia and insulinaemia, especially when substituting carbohydrates, thereby potentially decreasing the risk of T2D and/or other metabolic conditions. The effect of pistachios, consumed alone or combined with meals, on postprandial glycaemia has been also evaluated in two acute clinical trials (Kendall et al., 2011. Thus, whereas pistachios consumed alone had a minimal effect on postprandial glycaemia, the addition of pistachios (56 g) to foods with a high GI (pasta, parboiled rice and instant mashed potatoes) reduced, in a dose-dependent manner, the total postprandial glycaemic response by 20-30% (Kendall et al., 2011). ...
... The effect of pistachios, consumed alone or combined with meals, on postprandial glycaemia has been also evaluated in two acute clinical trials (Kendall et al., 2011. Thus, whereas pistachios consumed alone had a minimal effect on postprandial glycaemia, the addition of pistachios (56 g) to foods with a high GI (pasta, parboiled rice and instant mashed potatoes) reduced, in a dose-dependent manner, the total postprandial glycaemic response by 20-30% (Kendall et al., 2011). In another acute crossover study conducted on 20 subjects with metabolic syndrome (MetS), 85.04 g of pistachios consumed with bread significantly reduced postprandial glycaemia and increased GLP-1 levels compared with bread alone, implying not only a benefit in postprandial levels of glucose but also for satiety status . ...
... Some experimental studies conducted with healthy individuals have examined the effects of several specific foods on glycemic response, subjective appetite sensations as well as energy intake at a subsequent meal [151][152][153][154][155][156][157][158][159][160][161][162][163][164][165][166][167][168]. The main findings of these studies are summarized in Table 3. ...
... The fact that the authors found an increase in breath hydrogen and SCFAs blood concentrations, suggests that the positive effects of the barley kernelbased bread were mediated by an increased SCFAs production triggered by the colonic of dietary fiber [166]. The addition of foods with a high protein, MUFAs and fiber content, such as almonds (30.0 to 90.0 g) or pistachios (28.0 to 85.0 g) to a high-carbohydrate meal has also been shown to improve postprandial glycemic responses in a dose-dependent manner [153][154][155][156][157][158][159]167]. Jenkins and colleagues [156] also found a decrease in insulin secretion in healthy adults and in adults with hyperlipidemia following acute and prolonged almond consumption. ...
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Background The positive influences of glucagon-like peptide-1 (GLP-1) on blood glucose homeostasis, appetite sensations, and food intake provide a strong rationale for its therapeutic potential in the nutritional management of obesity and type 2 diabetes. AimTo summarize GLP-1 physiology and the nutritional modulation of its secretion in the context of obesity and type 2 diabetes management. FindingsGLP-1 is mainly synthesized and secreted by enteroendocrine L-cells of the gastrointestinal tract. Its secretion is partly mediated by the direct nutrient sensing by G-protein coupled receptors which specifically bind to monosaccharides, peptides and amino-acids, monounsaturated and polyunsaturated fatty acids as well as to short chain fatty acids. Foods rich in these nutrients, such as high-fiber grain products, nuts, avocados and eggs also seem to influence GLP-1 secretion and may thus promote associated beneficial outcomes in healthy individuals as well as individuals with type 2 diabetes or with other metabolic disturbances. Conclusion The stimulation of endogenous GLP-1 secretion by manipulating the composition of the diet may be a relevant strategy for obesity and type 2 diabetes management. A better understanding of the dose-dependent effects as well as the synergistic effects of nutrients and whole foods is needed in order to develop recommendations to appropriately modify the diet to enhance GLP-1 beneficial effects.
... Because of their fat content, adding nuts to a dried fruit snack would be expected to lower the glycemic response. Pistachios consumed with a carbohydrate containing food (pasta, parboiled rice, mashed potatoes) reduced in a dose-dependent manner the total postprandial response by 20 -30 % [41]. ...
... The majority of short-term clinical trials, conducted in otherwise healthy adults with type 2 diabetes or metabolic syndrome, are in agreement that an improvement in glucose and insulin metabolism occurs in the postprandial state with the consumption of 28-90 g of almond, pistachios or mixed nuts [41,[69][70][71][72]. ...
Article
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Certain dietary patterns, in which fruits and nuts are featured prominently, reduce risk of diabetes and cardiovascular disease. However, estimated fruit consumption historically in the U.S. has been lower than recommendations. Dried fruit intake is even lower with only about 6.9 % of the adult population reporting any consumption. The 2015 Dietary Guidelines Advisory Committee identified a gap between recommended fruit and vegetable intakes and the amount the population consumes. Even fewer Americans consume tree nuts, which are a nutrient-dense food, rich in bioactive compounds and healthy fatty acids. Consumption of fruits and nuts has been associated with reduced risk of cardiometabolic disease. An estimated 5.5 to 8.4 % of U.S. adults consume tree nuts and/or tree nut butter. This review examines the potential of pairing nuts and dried fruit to reduce cardiometabolic risk factors and focuses on emerging data on raisins and pistachios as representative of each food category. Evidence suggests that increasing consumption of both could help improve Americans' nutritional status and reduce the risk of chronic diseases.
... This is due to the presence of unsaturated fatty acids, both MUFA (monounsaturated fatty acids) and PUFA (polyunsaturated fatty acids) in nuts. In another study, Kendall et al. checked the impact of pistachios on the postprandial glycaemia[15], which was administered in three portions: 28, 56 and 84 g as a separate meal or in combination with wheat bread. Then the blood glucose level was measured after 30, 45, 60 and 90 minutes after their consumption. ...
... The evidence submitted above confirmed, that nuts reveal positive impact on the glycaemic index and the tissue resistance[13][14][15][16][17][18][19]. However, in the process of disease progress monitoring there is an additional index applied — HbA 1c , which enables to reflect the glycaemic state up to three months back, which is linked to the period of the erythrocyte life cycle (8–12 weeks)[4,27]. ...
Article
Type 2 diabetes (DMT2) constitutes approximately 90% of all diabetes cases worldwide and its main feature is chronic hyperglycaemia, which may lead to endothelium dysfunction, atherosclerosis, hypertension, microangiopathy, nephropathy, retinopathy and strokes. Therapy of patients with type 2 diabetes, despite the control of glycaemia, should encompass surveillance of lipid profile, blood pressure and body mass as factors increasing the risk of cardiovascular diseases. The aim of this study was to indicate the association of the consumption of nuts with lower risk of DMT2 and its complication prevention. It was established that the nuts have a positive impact on postprandial glycaemia decrease, insulin sensitivity improvement, ideal body mass maintenance (or its reduction among overweight people) and blood pressure control. As has been shown, implementation of nuts into DMT2 patients' diet may reinforce the efficacy of the treatment outcomes.
... Compared to other nuts, pistachios have lower fat (mostly from poly-and monounsaturated fatty acids) and energy content, and higher levels of fiber (both soluble and insoluble), potassium, phytosterols, γ-tocopherol, xanthophyll and carotenoids. Because pistachios are low in carbohydrate and sugars (27.5g /100g and 7.6g /100g respectively) they have a very low glycemic index that is in the range of 3.8 to 9.3 [12] giving pistachios utility for improved postprandial blood glucose and lipids. ...
... It is worth noting that none of these prior studies administered the phytosterol-rich pistachios at bedtime, when the nuts might have the greatest potential impact on the metabolic pathways that lead to obesity, dyslipidemia, and type 2 diabetes. On the other hand, whereas pistachios consumed alone have been shown to have a minimal effect on postprandial glycemia, the addition of pistachios (28g, 56g or 84g) to foods with a high glycemic index (pasta, parboiled rice and mashed potatoes) reduce, in an acute dose-dependent manner, the total postprandial glycemic response by 20 to 30% [12] . The beneficial impact of pistachio intake alone or in combination with high-carbohydrate foods on post-prandial glycemia has also been demonstrated (Eur J Clin Nutr65, 696-702). ...
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Overweight persons trend for dyslipidemia and diabetes risk, while mono- and polyunsaturated fats in pistachios (PI) may improve lipoprotein and glycemic status. This study determined if a small amount of PI consumed by obese persons at bedtime promotes beneficial changes in metabolic status. Obese subjects were randomized to 35.4 g PI self-administered at bedtime or control (CO; no PI) for 6 weeks. There was no difference in activity level,body weight, or BMI between PI and CO at weeks 0, 1, 2, 4 or 6. Plasma glucose at wk 0 and 6 in PI was 104.6 ± 13.1 and 99.6 ± 12.2 mg/dL, and CO was 102.0 ± 12.8 and 101.1 ± 12.2 mg/dL; from wk 0 to wk 6 PI had improved slightly (P= 0.09). In conclusion 35.4 grams pistachios/day for 6 wks is probably near the lower end of what is needed to promote beneficial metabolic changes. This study suggests that 35g of pistachios per day at bedtime may be the minimum daily amount to observe beneficial effects in an obese population. Future studies may wish to examine pistachio consumption in populations with specific metabolic disorders such as type 2 diabetes.
... In summary, given the results from the meta-analysis of 12 RCTs [20] and chronic studies [21-26] that were not included in the meta-analysis [20], nut consumption benefits glycemic control regardless of the type of nut but the effect is small and the amount of nuts required is large. Moreover, nut consumption reduces postprandial glycemia responses as shown in all nine studies [27][28][29][30][31][32][33][34][35]. ...
... A favourable effect of pistachios on postprandial glycemia was seen in 10 healthy adults [27] and 20 subjects with metabolic syndrome [28]. Two acute meal studies [29,30] examined the glucose-lowering effect of peanuts. ...
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Epidemiological and clinical studies have indicated that nut consumption could be a healthy dietary strategy to prevent and treat type 2 diabetes (T2DM) and related cardiovascular disease (CVD). The objective of this review is to examine the potential mechanisms of action of nuts addressing effects on glycemic control, weight management, energy balance, appetite, gut microbiota modification, lipid metabolism, oxidative stress, inflammation, endothelial function and blood pressure with a focus on data from both animal and human studies. The favourable effects of nuts could be explained by the unique nutrient composition and bioactive compounds in nuts. Unsaturated fatty acids (monounsaturated fatty acids and polyunsaturated fatty acids) present in nuts may play a role in glucose control and appetite suppression. Fiber and polyphenols in nuts may also have an anti-diabetic effect by altering gut microbiota. Nuts lower serum cholesterol by reduced cholesterol absorption, inhibition of HMG-CoA reductase and increased bile acid production by stimulation of 7-α hydroxylase. Arginine and magnesium improve inflammation, oxidative stress, endothelial function and blood pressure. In conclusion, nuts contain compounds that favourably influence glucose homeostasis, weight control and vascular health. Further investigations are required to identify the most important mechanisms by which nuts decrease the risk of T2DM and CVD.
... Kendall ve ark. [76], yemek sonrası glukoz seviyelerini incelediği çalışmasında glisemik indeksi yüksek pirinç ve makarna gibi yaygın karbonhidrat içeren gıdalara antepfıstığını eklemiş ve tüketen kişilerin kan glukoz seviyesinin önemli bir oranda azaldığını tespit etmişlerdir. Ayrıca, antepfıstığı daha uzun süre tokluk hissinin sürdürülmesine ve yemek sonrası kan glikoz konsantrasyonlarının düşürülmesine katkı sağlayan düşük glisemik indekse sahip bir besin maddesidir [77,78]. ...
... Ayrıca, antepfıstığı daha uzun süre tokluk hissinin sürdürülmesine ve yemek sonrası kan glikoz konsantrasyonlarının düşürülmesine katkı sağlayan düşük glisemik indekse sahip bir besin maddesidir [77,78]. Düşük glisemik indekse sahip olan antepfıstığı potansiyel olarak diyabet riskini azaltmaktadır [76,77]. Tip 2 diyabete sahip yetişkinlerin diyetinde günlük enerjinin %20'sini antepfıstığından sağlayan grupla diyetinde antepfıstığı bulunmayan (kontrol) grup karşılaştırıldığında daha düşük toplam kolesterol, trigliserid ve fruktozamin tespit edilmiştir. ...
... Current research suggests that combining dried fruits with high GI foods by displacing available carbohydrate may benefit postprandial glycemia in comparison to high GI foods alone. This is supported by acute studies showing that nuts and/or dried fruits combined with high GI foods can attenuate relative glycemic responses in healthy participants when compared to high GI foods alone 7,12,13 . Dried fruits may also benefit postprandial glycemia by providing small or 'catalytic' doses of fructose (≤10 g/meal). ...
... In terms of our findings regarding a displacement effect of dried fruit, we expect this would also be observed with other high GI carbohydrate foods. The addition of pistachios to a number of commonly consumed high GI carbohydrate foods (bread, pasta, rice, potato) was found to attenuate the glycemic response in healthy individuals (n = 10), all of which were statistically significant except for potato 12 . To our knowledge, only one randomized trial has been conducted where 4 different dried fruits (raisins, apples, jujubes, and apricots) were used to displace half the available carbohydrate of white rice in healthy individuals (n = 11) 7 . ...
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Background/Objectives To investigate the effect of dried fruit in modifying postprandial glycemia, we assessed the ability of 4 dried fruits (dates, apricots, raisins, sultanas) to decrease postprandial glycemia through three mechanisms: a glycemic index (GI) effect, displacement effect, or ‘catalytic’ fructose effect. Subjects/Methods We conducted an acute randomized, multiple-crossover trial in an outpatient setting in 10 healthy adults. Participants received 3 white bread control meals and 12 dried fruit test meals in random order. The test meals included each of 4 dried fruits (dates, apricots, raisins, sultanas) alone (GI effect), 4 of the dried fruits displacing half the available carbohydrate in white bread (displacement effect), or 4 of the dried fruits providing a small ‘catalytic’ dose (7.5 g) of fructose added to white bread (‘catalytic’ fructose effect). The protocol followed the ISO method for the determination of GI (ISO 26642:2010). The primary outcome was mean ± SEM GI (glucose scale) for ease of comparison across the three mechanisms. Results Ten healthy participants (7 men, 3 women; mean ± SD age and BMI: 39 ± 12 years and 25 ± 2 kg/m²) were recruited and completed the trial. All dried fruit had a GI below that of white bread (GI = 71); however, only dried apricots (GI = 42 ± 5), raisins (GI = 55 ± 5), and sultanas (51 ± 4) showed a significant GI effect (P < 0.05). When displacing half the available carbohydrate in white bread, all dried fruit lowered the GI; however, only dried apricots (GI = 57 ± 5) showed a significant displacement effect (P = 0.025). None of the dried fruits showed a beneficial ‘catalytic’ fructose effect. Conclusions In conclusion, dried fruits have a lower GI and reduce the glycemic response of white bread through displacement of half of the available carbohydrate. Longer-term randomized trials are needed to confirm whether dried fruit can contribute to sustainable improvements in glycemic control. Trial registration ClinicalTrials.gov identifier, NCT02960373
... Thus, whereas acute feeding studies reported reduced postprandial glucose and insulin excursions after nut consumption in healthy or T2DM subjects (19,20), medium-and long-term changes in fasting glucose or insulin sensitivity in response to nut diets are still controversial (21)(22)(23). Recently, it has been reported that acute consumption of pistachios can attenuate postprandial glucose levels when they are consumed with carbohydrates (24,25). It has also been demonstrated that chronic consumption of pistachios can improve blood glucose levels, LDL-c, and some inflammatory markers, but not fasting insulin, in healthy subjects and subjects with metabolic syndrome (14,26,27). ...
... The results of this crossover, randomized, controlled clinical trial provide evidence that chronic consumption of pistachio decreases glucose and insulin levels, thus improving insulin resistance and other inflammatory and metabolic risk markers. A beneficial dose-response effect of pistachios has been observed on postprandial glycemia and insulinemia when pistachios are consumed with carbohydrate foods (24,25). Likewise, significant improvements have been reported in fasting blood glucose after healthy young men consumed 20% of their daily energy intake as pistachios for 4 weeks (14). ...
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Objective: To examine whether a pistachio-rich diet reduces the prediabetes stage and improves its metabolic risk profile. Research design and methods: Prediabetic subjects were recruited to participate in this Spanish randomized clinical trial between 20 September 2011 and 4 February 2013. In a crossover manner, 54 subjects consumed two diets, each for 4 months: a pistachio-supplemented diet (PD) and a control diet (CD). A 2-week washout period separated study periods. Diets were isocaloric and matched for protein, fiber, and saturated fatty acids. A total of 55% of the CD calories came from carbohydrates and 30% from fat, whereas for the PD, these percentages were 50 and 35%, respectively (including 57 g/day of pistachios). Results: Fasting glucose, insulin, and HOMA of insulin resistance decreased significantly after the PD compared with the CD. Other cardiometabolic risk markers such as fibrinogen, oxidized LDL, and platelet factor 4 significantly decreased under the PD compared with the CD (P < 0.05), whereas glucagon-like peptide-1 increased. Interleukin-6 mRNA and resistin gene expression decreased by 9 and 6%, respectively, in lymphocytes after the pistachio intervention (P < 0.05, for PD vs. CD). SLC2A4 expression increased by 69% in CD (P = 0.03, for PD vs. CD). Cellular glucose uptake by lymphocytes decreased by 78.78% during the PD (P = 0.01, PD vs. CD). Conclusions: Chronic pistachio consumption is emerging as a useful nutritional strategy for the prediabetic state. Data suggest that pistachios have a glucose- and insulin-lowering effect, promote a healthier metabolic profile, and reverse certain metabolic deleterious consequences of prediabetes.
... In addition, among all nuts, pistachios have a low glycaemic index, suggesting a possible effect on reducing postprandial glycaemia and insulinaemia, thereby potentially decreasing the risk of diabetes. The effect of pistachios, consumed alone or combined with meals, on postprandial glycaemia has been evaluated (30,105) (Table 5). Thus, whereas pistachios consumed alone had a minimal effect on postprandial glycaemia, the addition of pistachios (56 g) to foods with a high glycaemic index (pasta, parboiled rice and instant mashed potatoes) reduced, in a dose-dependent manner, the total postprandial glycaemic response by 20 -30 % (105) . ...
... The effect of pistachios, consumed alone or combined with meals, on postprandial glycaemia has been evaluated (30,105) (Table 5). Thus, whereas pistachios consumed alone had a minimal effect on postprandial glycaemia, the addition of pistachios (56 g) to foods with a high glycaemic index (pasta, parboiled rice and instant mashed potatoes) reduced, in a dose-dependent manner, the total postprandial glycaemic response by 20 -30 % (105) . In a recent randomised, cross-over study conducted on twenty subjects with the metabolic syndrome, 85·04 g of pistachios consumed with bread reduced postprandial glycaemia levels and increased glucagon-like peptide levels compared with bread alone (30) . ...
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Epidemiological and/or clinical trials have suggested that nut consumption has a beneficial impact on health outcomes such as hypertension, diabetes, CVD, cancer, other inflammatory conditions and total mortality. Nuts are nutrient-dense foods with a healthy fatty acid profile, as well as provide other bioactive compounds with recognised health benefits. Among nuts, pistachios have a lower fat and energy content and the highest levels of K, γ-tocopherol, vitamin K, phytosterols, xanthophyll carotenoids, certain minerals (Cu, Fe and Mg), vitamin B 6 and thiamin. Pistachios have a high antioxidant and anti-inflammatory potential. The aforementioned characteristics and nutrient mix probably contribute to the growing body of evidence that consumption of pistachios improves health. The present review examines the potential health effects of nutrients and phytochemicals in pistachios, as well as epidemiological and clinical evidence supporting these health benefits.
... Pistachios are also known for their high antioxidant potential (10). Recently, the acute effects of adding pistachios to high carbohydrate foods has been reported and attenuation of postprandial glucose levels in healthy subjects and subjects with metabolic diseases was observed (11,12). In addition, chronic consumption of pistachios lowered blood glucose levels, LDL-c, and some inflammatory markers in healthy subjects and subjects with metabolic syndrome (13)(14)(15). ...
... In both healthy subjects and subjects with metabolic syndromes, significantly improved postprandial glycemia has been reported when white bread was consumed with pistachios compared to white bread alone (11,12). Hernández-Alonso et al. has found that long-term incorporation of pistachios into regular diets improved the glycemic control and other metabolic markers in prediabetic patients (18). ...
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Long-term consumption of pistachios could potentially improves glucose homeostasis. Impaired postprandial glucose, insulin, and glucagon-like peptide-1 (GLP-1) responses have been reported in gestational diabetes mellitus (GDM) patients. The objective of this study was to evaluate the acute effects of two isocaloric test meals, 42 g pistachios and 100 g whole-wheat bread (WWB) on postprandial glucose, insulin, and gut derived incretin levels in Chinese women with gestational impaired glucose tolerance (GIGT) or GDM. Expected glucose and insulin responses were observed after WWB consumption. Isocaloric pistachio intake had minimal effect on blood glucose or insulin. In both GIGT and GDM patients, significant higher GLP-1 levels were observed at 90 and 120 min after pistachio compared to WWB intake. Significant lower gastric inhibitory polypeptide (GIP) levels were observed at 30 and 60 min in GDM patients or 120 min in GIGT patients after pistachio compared to WWB intake. In summary, isocaloric pistachio intake induced significantly lower postprandial glucose, insulin and GIP but higher GLP-1 levels compared to WWB. Our data suggest pistachios are effective alternative to a low-fat, high-carbohydrate food to improve postprandial glucose, insulin, and GLP-1 response in women with GDM and GIGT.
... Compared to other nuts, pistachios have lower fat (mostly from poly-and monounsaturated fatty acids) and energy content, and higher levels of fiber (both soluble and insoluble), potassium, phytosterols, γ-tocopherol, xanthophyll and carotenoids. Because pistachios are low in carbohydrate and sugars (27.5g /100g and 7.6g /100g respectively) they have a very low glycemic index that is in the range of 3.8 to 9.3 [12] giving pistachios utility for improved postprandial blood glucose and lipids. ...
... It is worth noting that none of these prior studies administered the phytosterol-rich pistachios at bedtime, when the nuts might have the greatest potential impact on the metabolic pathways that lead to obesity, dyslipidemia, and type 2 diabetes. On the other hand, whereas pistachios consumed alone have been shown to have a minimal effect on postprandial glycemia, the addition of pistachios (28g, 56g or 84g) to foods with a high glycemic index (pasta, parboiled rice and mashed potatoes) reduce, in an acute dose-dependent manner, the total postprandial glycemic response by 20 to 30% [12] . The beneficial impact of pistachio intake alone or in combination with high-carbohydrate foods on post-prandial glycemia has also been demonstrated (Eur J Clin Nutr65, 696-702). ...
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Overweight persons trend for dyslipidemia and diabetes risk, while mono-and polyunsaturated fats in pistachios (PI) may improve lipoprotein and glycemic status. This study determined if a small amount of PI consumed by obese persons at bedtime promotes beneficial changes in metabolic status. Obese subjects were randomized to 35.4 g PI self-administered at bedtime or control (CO; no PI) for 6 weeks. There was no difference in activity level or body weight between PI and CO at weeks 0, 1, 2, 4 or 6. HDL cholesterol at wk 0 and 6 in PI was 49.2 ± 3.5 and50.3 ± 3.0, and CO was 60.8 ± 3.8 and 58.0 ± 2.7 mg/dL, at week 6 PI had improved slightly relative to CO (P= 0.12). Plasma glucose at wk 0 and 6 in PI was 104.6 ± 2.8 and 99.6 ± 2.6 mg/dL, and CO was 102.0 ± 2.8 and 101.1 ± 2.6 mg/dL, at wk 6 PI had improved slightly relative to CO (P= 0.16). Plasma Insulin at wk 0 and 6 in PI was 8.5 ± 1.0 and 8.4 ± 0.9, and CO was 7.2 ± 0.7 to 8.8 ± 0.7 μU/mL, at wk 6 PI had improved slightly relative to CO (P = 0.21). In conclusion 35.4 grams pistachios/day for 6 wks is probably near the lower end of what is needed to promote beneficial metabolic changes. Future studies may wish to look at pistachio consumption in populations with specific metabolic disorders such as type 2 diabetes.
... Nuts are a good source of high-quality plant protein, and mono-(MUFA) and polyunsaturated fatty acids (PUFA) (18) , all of which are proposed to improve blood lipid profile, decrease insulin resistance (IR), decrease inflammation and oxidative stress and modulate endothelial function (10) , as well as potentially promoting satiety (17,19) . Of particular interest are prior studies that have shown that tree nuts, including almonds, consumed at different doses can suppress postprandial glycaemia induced by high carbohydrate (CHO) foods (20,21) . An acute study reported that the addition of pistachios to a white bread (WB) meal resulted in a dosedependent decrease in the postprandial glycaemic response in ten healthy participants (20) . ...
... Of particular interest are prior studies that have shown that tree nuts, including almonds, consumed at different doses can suppress postprandial glycaemia induced by high carbohydrate (CHO) foods (20,21) . An acute study reported that the addition of pistachios to a white bread (WB) meal resulted in a dosedependent decrease in the postprandial glycaemic response in ten healthy participants (20) . Another dose-response study in healthy participants also confirmed that the consumption of almonds with WB resulted in a decrease in postprandial glycaemia, with approximately 1⋅0 mM reduction in peak circulating glucose, despite the increase in total available CHO content (21) . ...
Article
Nut-based products may aid low-glycaemic dietary strategies that are important for diabetes prevention in populations at increased risk of dysglycaemia, such as Asian Chinese. This randomised cross-over trial assessed the postprandial glycaemic response (0-120 min) of a higher-protein nut-based (HP-NB) snack formulation, in bar format (1009 kJ, Nutrient Profiling Score, NPS, -2), when compared with an iso-energetic higher-carbohydrate (CHO) cereal-based bar (HC-CB, 985 kJ, NPS +3). It also assessed the ability to suppress glucose response to a typical CHO-rich food (white bread, WB), when co-ingested. Ten overweight prediabetic Chinese adults (mean, sd: age 47⋅9, 15⋅7 years; BMI 25⋅5, 1⋅6 kg/m2), with total body fat plus ectopic pancreas and liver fat quantified using dual-energy X-ray absorptiometry and magnetic resonance imaging and spectroscopy, received the five meal treatments in random order: HP-NB, HC-CB, HP-NB + WB (50 g available CHO), HC-CB + WB and WB only. Compared with HC-CB, HP-NB induced a significantly lower 30-120 min glucose response (P < 0⋅05), with an approximately 10-fold lower incremental area under the glucose curve (iAUC0-120; P < 0⋅001). HP-NB also attenuated glucose response by approximately 25 % when co-ingested with WB (P < 0⋅05). Half of the cohort had elevated pancreas and/or liver fat, with 13-21 % greater suppression of iAUC0-120 glucose in the low v. high organ fat subgroups across all five treatments. A nut-based snack product may be a healthier alternative to an energy equivalent cereal-based product with evidence of both a lower postprandial glycaemic response and modulation of CHO-induced hyperglycaemia even in high-risk, overweight, pre-diabetic adults.
... Three experimental scenarios have demonstrated beneficial effects for pistachios on glycaemic control. When consumed alone, they have minimal effects on blood glucose (70) ; when added to high-carbohydrate foods, pistachios attenuate postprandial glucose levels in healthy participants and participants with metabolic diseases (70) ; in persons with metabolic syndrome, daily consumption of pistachios attenuates postprandial glycaemia, increases glucagon-like peptide levels and may have insulin-sparing properties (reducing the amount of insulin required to achieve a given level of glycaemic control) (71,72) . Pistachios' composition includes several candidates that can explain these findings, aside from their low carbohydrate content, including their fatty acid profile, fibre, antiinflammatory compounds and antioxidants content (73) . ...
... Three experimental scenarios have demonstrated beneficial effects for pistachios on glycaemic control. When consumed alone, they have minimal effects on blood glucose (70) ; when added to high-carbohydrate foods, pistachios attenuate postprandial glucose levels in healthy participants and participants with metabolic diseases (70) ; in persons with metabolic syndrome, daily consumption of pistachios attenuates postprandial glycaemia, increases glucagon-like peptide levels and may have insulin-sparing properties (reducing the amount of insulin required to achieve a given level of glycaemic control) (71,72) . Pistachios' composition includes several candidates that can explain these findings, aside from their low carbohydrate content, including their fatty acid profile, fibre, antiinflammatory compounds and antioxidants content (73) . ...
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Pistachio nuts are a nutrient-dense source of good quality plant protein, commonly consumed as a minimally processed snack food or ingredient. The present paper is based on a symposium held during the 13th FENS (Federation of European Nutrition Societies) 2019 conference in Dublin that explored recent research and practical applications of pistachios as a plant-based snack, in particular, for appetite control and healthy weight management; and for glycaemic control during pregnancy. Individual nut types, whilst similar in nutritional composition, have unique characteristics which may have a significant impact on potential health effects. Recognising this, the further purpose here is to explore future research needs for pistachios, based on work completed to date and the discussion that ensued among researchers at this event, in order to advance the full scope of health benefits from pistachios, in particular, taking into account of both sustainability and nutritional health.
... Studies that have examined the acute appetite and/or glycaemic responses to nuts have had relatively small samples [34,35], only included females [36,37], or not directly compared outcomes to an isocaloric control snack food [26]. Adequately powered and wellconducted studies with an appropriate comparison group are important for formulating evidence-informed guidelines regarding nut consumption. ...
... Other studies have shown improved acute glycaemic control when nuts are consumed as snacks compared to other snack foods such as savoury crackers [35,36]. In addition, when nuts have been added to high-carbohydrate foods such as bread or muffins, post-prandial glycaemia has decreased [34,[50][51][52]. Interestingly, in our study, the lower post-prandial response elicited by almonds compared to biscuits was not reflected in changes in appetite ratings. ...
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Consuming nuts may have advantages over other snack foods for health and body-weight regulation. Suggested mechanisms include increased satiety and lower glycaemia. We used an acute randomised crossover trial to assess glycaemic and appetite responses to consuming two isocaloric snacks (providing 10% of participants' total energy requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever provided greater energy): raw almonds and sweet biscuits among 100 participants with available data (25 males and 75 females) following 106 being randomised. Two hours after consuming a standardised breakfast, participants consumed the snack food. Finger-prick blood samples measuring blood glucose and subjective appetite ratings using visual analogue scales were taken at baseline and at 15 or 30 min intervals after consumption. Two hours after snack consumption, an ad libitum lunch was offered to participants and consumption was recorded. Participants also recorded food intake for the remainder of the day. The mean area under the blood glucose response curve was statistically and practically significantly lower for almonds than biscuits (mean (95% CI) difference: 53 mmol/L.min (45, 61), p < 0.001). Only the composite appetite score at 90 min was higher in the almond treatment compared to the biscuit treatment (45.7 mm vs. 42.4 mm, p = 0.035 without adjustment for multiple comparisons). There was no evidence of differences between the snacks for all other appetite ratings or for energy intake at the ad libitum lunch. However, mean energy intakes following snack consumption were significantly lower, both statistically and in practical terms, for the almond treatment compared to the biscuit (mean (95% CI) diff: 638 kJ (44, 1233), p = 0.035). Replacing popular snacks with almonds may have advantages in terms of glycaemia and energy balance.
... Pistachio nuts' high content of antioxidant components has been proposed to be involved in their beneficial effects on insulin sensitivity [417]. A positive impact of a very high daily dose (85 g/day) of pistachio nuts on postprandial insulinemia has been reported, particularly when consumed with a high carbohydrate diet [418,419]. Also, their monounsaturated fatty acids have been suggested to reduce oxidative stress and improve the insulin-signaling pathway and IR, by maintaining membrane translocation of glucose transporters along with buffering β-cell hyperactivity [420,421]. Moreover, it has been suggested that consumption of high daily doses of pistachio nuts (>57 g/day) may have an up-regulatory effect on GLP-1 secretion in healthy subjects [418], thus explaining the improvement in postprandial insulin secretion. ...
... Also, their monounsaturated fatty acids have been suggested to reduce oxidative stress and improve the insulin-signaling pathway and IR, by maintaining membrane translocation of glucose transporters along with buffering β-cell hyperactivity [420,421]. Moreover, it has been suggested that consumption of high daily doses of pistachio nuts (>57 g/day) may have an up-regulatory effect on GLP-1 secretion in healthy subjects [418], thus explaining the improvement in postprandial insulin secretion. One study conducted on almond nuts reported improvements in glycemic control and lipid profiles in T2DM, without differences in IR vs controls [422]. ...
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As years progress, we are found more often in a postprandial than a postabsorptive state. Chrononutrition is an integral part of metabolism, pancreatic function, and hormone secretion. Eating most calories and carbohydrates at lunch time and early afternoon, avoiding late evening dinner, and keeping consistent number of daily meals and relative times of eating occasions seem to play a pivotal role for postprandial glycemia and insulin sensitivity. Sequence of meals and nutrients also play a significant role, as foods of low density such as vegetables, salads, or soups consumed first, followed by protein and then by starchy foods lead to ameliorated glycemic and insulin responses. There are several dietary schemes available, such as intermittent fasting regimes, which may improve glycemic and insulin responses. Weight loss is important for the treatment of insulin resistance, and it can be achieved by many approaches, such as low-fat, low-carbohydrate, Mediterranean-style diets, etc. Lifestyle interventions with small weight loss (7–10%), 150 min of weekly moderate intensity exercise and behavioral therapy approach can be highly effective in preventing and treating type 2 diabetes. Similarly, decreasing carbohydrates in meals also improves significantly glycemic and insulin responses, but the extent of this reduction should be individualized, patient-centered, and monitored. Alternative foods or ingredients, such as vinegar, yogurt, whey protein, peanuts and tree nuts should also be considered in ameliorating postprandial hyperglycemia and insulin resistance. This review aims to describe the available evidence about the effects of diet, chrononutrition, alternative dietary interventions and exercise on postprandial glycemia and insulin resistance.
... Nuts affect glycaemic response in a dose-dependent manner (77). According to the previous investigations, nuts help decrease glycaemic excursions; moreover, consuming nuts with carbohydrate-rich foods could reduce the postprandial impact on the insulin demand (77)(78)(79)(80). The dose and duration of supplementation in studies that observed a significant effect of nuts consumption on glycaemic factors ranged from 30-60 g/day and 4-24 weeks, respectively (17,18,33,35,49,52). ...
... The dose-dependent improvement in the glycaemic response to the meal has been revealed in previous investigations. In a study conducted on 10 healthy volunteers, it has been shown that the addition of 28 g of pistachios to white bread could improve glycaemic response, and this improvement was greater with the addition of 84 g of pistachios (79). In another study conducted on normo-glycaemic and individuals with T2D, adding 30, 60, and 90 g nuts to white bread reduced the glycaemic response of the meal by 11.2 ± 11.6% (P = 0.354), 29.7 ± 12.2% (P = 0.031), and 53.5 ± 8.5% (P < 0.001) (80). ...
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Background Nuts are in the spotlight because of their association with improved health outcomes. We aimed to summarize the findings of previous studies to evaluate the impact of nuts consumption on glycaemic and lipid profile, inflammation, and oxidative stress. Methods Electronic searches for observational and intervention studies were undertaken in PubMed, Embase, Web of Science, and Science Direct until 2022 for searching the studies aiming the application of different types of nuts and the beneficial effects of nuts in improving glycemia, dyslipidemia, inflammation, and oxidative stress. Results Results from 56 interventional, 9 narrative and 3 systematic reviews, and 12 meta-analysis studies, aiming at the evaluating beneficial effects of different types of nuts on metabolic markers, showed that nut consumption could improve metabolic markers, including glycaemic factors, lipid profile, and inflammatory and oxidative stress parameters in both healthy and individuals with metabolic disorders in a type-, dose- and duration-dependent manner. According to their unique nutrient components, nuts can be known as a part of a healthy diet, resulting in improved metabolic biomarkers. Conclusion Considering the efficacy of nuts in improving metabolic markers, incorporation of, incorporating nuts the effectiveness of nuts in improving metabolic markers, incorporating nuts in the diet may prevent the incidence or aggravation of chronic metabolic diseases. Considering the health benefits of the nuts' components, including essential micronutrients, if consumed in the appropriate dose and duration to provide the necessary amount of effective micronutrients to improve health, we will see an improvement in metabolic factors. At the same time, more research is required to determine the optimal type, dose, and duration of nut intervention with regards to metabolic control and reducing the risk of developing metabolic disorders.
... Several epidemiological studies and clinical trials suggested that the regularity of nut consumption is inversely related to an increased risk of T2DM [65][66][67][68][69][70], mainly attributed to the relatively high content in dietary fibre, the presence of healthy fats and antioxidants components [69]. Specifically, the effect of consuming pistachio alone or combined with meals was evaluated on postprandial glycaemia [71,72]. Pistachios consumed alone had a minimal effect on postprandial glycaemia, and when 28, 56, or 84 g of pistachios were taken with a carbohydrate meal attenuated in a dose-dependent manner the glycaemic response [71]. ...
... Specifically, the effect of consuming pistachio alone or combined with meals was evaluated on postprandial glycaemia [71,72]. Pistachios consumed alone had a minimal effect on postprandial glycaemia, and when 28, 56, or 84 g of pistachios were taken with a carbohydrate meal attenuated in a dose-dependent manner the glycaemic response [71]. These authors evaluated pistachio consumption's acute effects on postprandial glucose and insulin levels in a randomized crossover study conducted on subjects with MetS. ...
Article
The pistachio is regarded as a relevant source of biologically active components that, compared to other nuts, possess a healthier nutritional profile with low-fat content composed mainly of monounsaturated fatty acids, a high source of vegetable protein and dietary fibre, remarkable content of minerals, especially potassium, and an excellent source of vitamins, such as vitamins C and E. A rich composition in terms of phytochemicals, such as tocopherols, carotenoids, and, importantly, phenolic compounds, makes pistachio a powerful food to explore its involvement in the prevention of prevalent pathologies. Although pistachio has been less explored than other nuts (walnut, almonds, hazelnut, etc.), many studies provide evidence of its beneficial effects on CVD risk factors beyond the lipid-lowering effect. The present review gathers recent data regarding the most beneficial effects of pistachio on lipid and glucose homeostasis, endothelial function, oxidative stress, and inflammation that essentially convey a protective/preventive effect on the onset of pathological conditions, such as obesity, type 2 diabetes, CVD, and cancer. Likewise, the influence of pistachio consumption on gut microbiota is reviewed with promising results. However, population nut consumption does not meet current intake recommendations due to the extended belief that they are fattening products, their high cost, or teething problems, among the most critical barriers, which would be solved with more research and information.
... Incremental areas under the curves (iAUCs) for blood glucose and appetite parameters (satiety and fullness) were calculated using the trapezoidal method, ignoring area below zero (incremental baseline value).Similarly, incremental areas over the curves (iAOCs) for appetite parameters (hunger and prospective food intake) were calculated by the same method, ignoring the area above zero (incremental baseline value). The glycaemic index (GI) was calculated by expressing each subject's glucose iAUC for the test meal as a percentage of the same subject's response after consuming the reference white bread meal(Kendall, Josse, Esfahani, & Jenkins, 2011). The resulting individual subjects' GI values were then averaged. ...
... Research has demonstrated that nuts are associated with beneficial glycemic responses in healthy individuals. For example, almonds are shown to reduce the glycemic impact of carbohydrate foods 72 ; pistachio nuts can attenuate the relative glycemic response when taken with a carbohydrate meal 73 ; and nuts were demonstrated to have a dose-dependent effect on the glycemic response. 74 Nuts have also been shown to contain a high proportion of unsaturated fatty acids, 9 and nut consumption is inversely associated with circulating inflammatory cytokines and positively associated with plasma adiponectin. ...
Article
The identification of foods that can decrease the risk of cancer and type 2 diabetes may be helpful in reducing the burden of these diseases. Although nut consumption has been suggested to have a disease-preventive role, current evidence remains inconsistent. The aim of this systematic review and meta-analysis was to clarify the association between nut consumption and risk of cancer or type 2 diabetes. Six databases were searched for relevant studies from the time of database inception to August 2014. Reference lists of relevant review articles were hand searched, and authors were contacted when data were insufficient. Eligible studies included epidemiological studies (case-control and cohort) or clinical trials that reported an association between nut consumption and the outcome of type 2 diabetes or specific cancers. Two investigators independently extracted descriptive, quality, and risk data from included studies. Random-effects meta-analysis was used to pool relative risks from the included studies. The I(2) statistic was used to assess heterogeneity. A total of 36 eligible observational studies, which included 30 708 patients, were identified. The studies had fair methodological quality, and length of follow-up ranged between 4.6 years and 30 years. Comparison of the highest category of nut consumption with the lowest category revealed significant associations between nut consumption and decreased risk of colorectal cancer (3 studies each with separate estimates for males and females, RR 0.76, 95% confidence interval [95%CI] 0.61-0.96), endometrial cancer (2 studies, RR 0.58, 95%CI 0.43-0.79), and pancreatic cancer (1 study, RR 0.68, 95%CI 0.48-0.96). No significant association was found with other cancers or type 2 diabetes. Overall, nut consumption was significantly associated with a reduced risk of cancer incidence (RR 0.85, 95%CI 0.76-0.95). Nut consumption may play a role in reducing cancer risk. Additional studies are needed to more accurately assess the relationship between nut consumption and the prevention of individual types of cancer, given the scarcity of available data. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute.All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
... Previous research has shown that a single dose of pistachios reduces postprandial glycemia in healthy adults and adults with metabolic syndrome [25,26]. Two recent meta-analyses have examined whether daily nut consumption for ≥3 weeks affected glucose and measures of glycemic control in all participants [5] and those with type 2 diabetes [16]. ...
Article
Objective: The health benefits of regular nut consumption have been well-documented; however, effects on cardiovascular risk in diabetes are emerging. This study examined the effects of daily pistachio consumption on the lipid/lipoprotein profile, glycemic control, markers of inflammation, and endothelial function in adults with type 2 diabetes. Materials/methods: We enrolled 30 adults (40-74years) with well-controlled type 2 diabetes (mean glycated hemoglobin 6.2%) in a randomized, crossover, controlled feeding study. After a 2-week run-in period, participants consumed nutritionally-adequate diets with pistachios (contributing 20% of total energy) or without pistachios for 4weeks each, separated by a 2-week washout. We assessed fasting lipids/lipoproteins, glycemic measures (while fasted and during a 75g oral glucose tolerance test), inflammatory markers, and endothelial function after each diet period. Results: Total cholesterol and the ratio of total to HDL cholesterol were significantly lower (p<0.05) following the pistachio diet (4.00mmol/L and 4.06mmol/L, respectively) compared to the control diet (4.15mmol/L and 4.37mmol/L, respectively). Triglycerides were significantly lower (p=0.003) following the pistachio diet (1.56mmol/L) compared to the control diet (1.84mmol/L). There were no treatment differences in fasting glucose and insulin, but fructosamine was significantly lower (p=0.03) following the pistachio diet (228.5μmol/l) compared to the control diet (233.5μmol/l). Inflammatory markers and endothelial function were unchanged. Conclusion: Daily pistachio consumption can improve some cardiometabolic risk factors in adults with well-controlled type 2 diabetes. Our findings support recommendations that individuals with diabetes follow healthy dietary patterns that include nuts.
... Aunque los resultados de los estudios de cohortes puedan parecer controvertidos, los FS podrían reducir el riesgo de diabetes controlando crónicamente los incrementos en la glicemia postprandial, mejorando así la sensibilidad a la insulina a través de diferentes mecanismos, especialmente en individuos con prediabetes, como se ha probado en diversos estudios clínicos agudos [26][27][28][29][30] . También se han demostrado efectos positivos sobre el metabolismo de la glucosa del consumo de FS 31-34 en diversos estudios realizados a medio o largo plazo sobre sujetos sanos, obesos y diabéticos. ...
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Several epidemiological studies have shown that consumption of tree nuts is associated with lower cardiovascular risk, specific cause of mortality and total mortality. Clinical feeding trials have demonstrated that tree nuts protect from cardiovascular disease risk through different mechanisms: regulating inflammatory processes, oxidative stress and endothelial function, thereby improving various cardiovascular risk factors. In the context of meals high in carbohydrates, tree nuts reduce the postprandial glucose peaks, improving insulin resistance. Frequent consumption of nuts has been associated with a lower risk of diabetes in women, but the effect was not yet elucidated in men. Although tree nuts are energetically dense and they are high in fat, nut consumption does not imply appreciable weight gain nor has been associated with a higher risk of abdominal obesity. Tree nut consumption reduces LDL cholesterol levels, but its effects on atherogenic dyslipidemia associated to metabolic syndrome (MetS) are less clear. The effect of consumption of nuts on LDL cholesterol in subjects with MetS neither has been well established, but it seems that in these patients could lower plasma triglyceride levels. Some studies suggest an inverse association between tree nut consumption and blood pressure or endothelial function, especially in non-diabetic individuals. Nut consumption was inversely related to the prevalence and incidence of MetS. Including tree nuts in the context of a healthy dietary pattern way increase the health benefits. It has been observed a lower prevalence of MetS and a lower incidence of diabetes in people who adhered to a Mediterranean diet supplemented with nuts. Future nutrition intervention studies are needed on large samples of subjects and long follow-up to affirm that tree nut consumption has beneficial effects on the prevention and treatment of MetS. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
... Thus, nut consumption has been demonstrated to exert beneficial metabolic effects due to their action on post-prandial glycemia an insulin sensitivity. A number of RCTs have demonstrated positive effects of nut consumption on post-prandial glycemia in healthy individuals [33][34][35][36][37][38]. Moreover, a meta-analysis of RCTs on the effects of nut intake on glycemic control in diabetic individuals including 12 trials and a total of 450 participants showed that diets with an emphasis on nuts (median dose = 56 g/d) significantly lowered HbA1c (Mean Difference [MD] : -0.07%; 95% confidence interval [CI]: -0.10, -0.03%; P = 0.0003) and fasting glucose (MD : -0.15 mmol/L; 95% CI: -0.27, -0.02 mmol/L; P = 0.03) compared with control diets [39]. ...
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Current knowledge on the effects of nut consumption on human health has rapidly increased in recent years and it now appears that nuts may play a role in the prevention of chronic age-related diseases. Frequent nut consumption has been associated with better metabolic status, decreased body weight as well as lower body weight gain over time and thus reduce the risk of obesity. The effect of nuts on glucose metabolism, blood lipids, and blood pressure is still controversial. However, significant decreased cardiovascular risk has been reported in a number of observational and clinical intervention studies. Thus, findings from cohort studies show that increased nut consumption is associated with a reduced risk of cardiovascular disease and mortality (especially that due to cardiovascular-related causes). Similarly, nut consumption has been also associated with reduced risk of certain cancers, such as colorectal, endometrial, and pancreatic neoplasms. Evidence regarding nut consumption and neurological or psychiatric disorders is scarce, but a number of studies suggest significant protective effects against depression, mild cognitive disorders and Alzheimer's disease. The underlying mechanisms appear to include antioxidant and anti-inflammatory actions, particularly related to their mono- and polyunsaturated fatty acids (MUFA and PUFA, as well as vitamin and polyphenol content). MUFA have been demonstrated to improve pancreatic beta-cell function and regulation of postprandial glycemia and insulin sensitivity. PUFA may act on the central nervous system protecting neuronal and cell-signaling function and maintenance. The fiber and mineral content of nuts may also confer health benefits. Nuts therefore show promise as useful adjuvants to prevent, delay or ameliorate a number of chronic conditions in older people. Their association with decreased mortality suggests a potential in reducing disease burden, including cardiovascular disease, cancer, and cognitive impairments.
... They are able to blunt the glycaemic response when eaten in combination with carbohydrate-rich foods. [43][44][45] Nuts may also help control body weight, 46-48 despite their highenergy content. In a meta-analysis of four prospective cohort studies, Luo et al. ...
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Background/objectives: Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes (T2D) risk, but studies on foods high in fat per unit weight are sparse. We assessed whether the intake of vegetable oil, butter, margarine, nuts and seeds and cakes and cookies is related to incident T2D. Subjects/methods: A case-cohort study was conducted, nested within eight countries of the European Prospective Investigation into Cancer (EPIC), with 12,403 incident T2D cases and a subcohort of 16,835 people, identified from a cohort of 340,234 people. Diet was assessed at baseline (1991-1999) by country-specific questionnaires. Country-specific hazard ratios (HRs) across four categories of fatty foods (nonconsumers and tertiles among consumers) were combined with random-effects meta-analysis. Results: After adjustment not including body mass index (BMI), nonconsumers of butter, nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption. Among consumers, cakes and cookies were inversely related to T2D (HRs across increasing tertiles 1.14, 1.00 and 0.92, respectively; P-trend <0.0001). All these associations attenuated upon adjustment for BMI, except the higher risk of nonconsumers of cakes and cookies (HR 1.57). Higher consumption of margarine became positively associated after BMI adjustment (HRs across increasing consumption tertiles: 0.93, 1.00 and 1.12; P-trend 0.03). Within consumers, vegetable oil, butter and nuts and seeds were unrelated to T2D. Conclusions: Fatty foods were generally not associated with T2D, apart from weak positive association for margarine. The higher risk among nonconsumers of cakes and cookies needs further explanation.
... 6,10,46,47 In addition, among all nuts, pistachios have a low glycemic index, suggesting that they may reduce postprandial glycemia and insulinemia and therefore contribute to reducing the T2DM risk. 48 Pistachios consumed alone had a minimal effect on postprandial glycemia, but the addition of pistachios to a meal containing foods rich in carbohydrates with a high glycemic index (eg, pasta, parboiled rice, or instant mashed potatoes) 49 or bread 48 reduces postprandial glycemia in a dose-dependent response. ...
Article
Human beings have known about pistachio nuts since 6000 BC. Since then, pistachios have been systematically incorporated into the diet of various cultures. They are nutrient-dense nuts with a healthy nutritional profile that contains fiber, unsaturated fatty acids and antioxidant compounds. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC- ND),where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. Copyright
... Lower peak glucose responses were also observed for pasta meals. In the only study that was conducted in healthy overweight adults [28], the authors observed lower glucose iAUC after pasta consumption than after white bread or instant mashed potato consumption, but the results did not reach statistical significance. Using the SMD meta-analysis, we quantitatively confirmed that the postprandial glucose response difference between pasta and bread was statistically significant (Fig. 1a) (SMD Z À0.96, 95% CI: À1.52, À0.40, ...
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Aims The traditional Italian dish pasta is major food source of starch with low glycemic index (GI), and also an important low-GI component of the Mediterranean diet. This systematic review aimed at assessing comprehensively and in-depth the potential benefit of pasta on cardio-metabolic disease risk factors. Data Synthesis Following a standard protocol, we conducted a systematic literature search of PubMed, CINAHL, and Cochrane Central Register of Controlled Trials, for prospective cohort studies and randomized controlled dietary intervention trials that examined pasta, and pasta-related fiber and grain intake in relation to cardio-metabolic risk factors of interest. Studies evaluating postprandial glucose response to pasta compared to bread or potato were quantitatively summarized using meta-analysis of standardized mean difference. Evidence from studies with pasta as part of low-GI dietary intervention and studies investigating different types of pasta were qualitatively summarized. Conclusions Pasta meals have significant lower postprandial glucose response compared to bread or potato meals, but evidence was lacking in terms of how the intake of pasta can influence cardio-metabolic disease risk. More long-term randomized controlled trials are needed where investigators directly contrast the cardio-metabolic effects of pasta and bread or potato. Long-term prospective cohort studies with required data available should also be analyzed regarding the effect of pasta intake on disease endpoints.
... Pistachios have also been associated with improvements in fasting blood glucose and insulin levels (Sari et al., 2010), and hemodynamics (Sauder, McCrea, Ulbrecht, Kris-Etherton, & West, 2014). Improved fasting blood glucose and insulin levels may help reduce the risk of T2DM (a risk factor for CVD) (Kendall, Josse, Esfahani, & Jenkins, 2011), and the beneficial effects of pistachios on multiple hemodynamic measures such as stroke volume, cardiac output, and total peripheral resistance may be associated with a reduced risk of CVD outcomes (Sauder et al., 2014). ...
Article
Cardiovascular disease (CVD) is the leading cause of death in the United States and has negative impacts at both the individual- and population-level through reduced quality of life, economic burden, and strain on the healthcare system. Dietary modifications, such as pistachio consumption, may help prevent CVD and two of its leading risk factors: dyslipidemia and overweight/obesity. The objective of this study was to determine the effects of pistachio consumption (20% daily energy need) on measures of adiposity and blood lipids in healthy young adult females. This study utilized 10-week crossover feeding trials at California Polytechnic State University, San Luis Obispo (CP-SLO) and California State Polytechnic University, Pomona (CP-P). Participants (n=48, mean age 21 ± 0.51 years) served as their own controls. Mean body mass index (BMI) was 21.9 ± 2.32 kg/m2 and mean total cholesterol (TC) was 155.0 ± 27.7 mg/dL. Pistachio diet participants consumed 20% of their daily energy needs of pistachios each day, whereas control diet participants maintained their usual diet without consuming nuts. The two diet treatments were separated by a 15-week washout period during which all participants resumed their usual diets. No significant differences were found between diet treatments for triacylglycerols (TAG) (p=0.6), TC (p=0.5), low-density lipoprotein cholesterol (LDL-C) (p=0.4), high-density lipoprotein cholesterol (HDL-C) (p=0.9), TC/HDL-C (p=0.7), body weight (p=0.8), BMI (p=0.9), waist circumference (WC) (p=0.4), or total body fat percentage (p=0.9). Likewise, no significant differences were found during the pistachio treatment or during the control treatment for any measured variable. Strengths of this study were the crossover design, utilization of dual-energy x-ray absorptiometry (DXA) for precise body composition measurements, and the use of individually measured bags of pistachios to help with compliance. Limitations of the study included the relatively small sample size and short intervention period. Pistachio supplementation was not associated with significant changes in measures of adiposity or the lipid profile. Longer interventions with more participants are needed to test the long-term effects of pistachio consumption with greater power to detect differences.
... Conversely, nut consumption also affects fasting glucose through non-insulin-mediated mechanisms. Evidence suggests that nuts lower postprandial glucose excursions owing to delayed gastric emptying, which may also explain improvements in fasting glucose particularly when nuts are consumed as part of a meal (56,57). One previous systematic review (7) and several narrative reviews (58)(59)(60) have suggested that nut consumption ...
Article
Background: Observational evidence suggests higher nut consumption is associated with better glycemic control; however, it is unclear if this association is causal. Objectives: We aimed to conduct a systematic review and meta-analysis of randomized controlled trials to examine the effect of tree nuts and peanuts on markers of glycemic control in adults. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. A total of 1063 potentially eligible articles were screened in duplicate. From these articles, 40 were eligible for inclusion and data from these articles were extracted in duplicate. The weighted mean difference (WMD) between the nut intervention and control arms was determined for fasting glucose, fasting insulin, glycated hemoglobin (HbA1c), and homeostasis model assessment of insulin resistance (HOMA-IR) using the DerSimonian and Laird random-effects method. For outcomes where a limited number of studies were published, a qualitative synthesis was presented. Results: A total of 40 randomized controlled trials including 2832 unique participants, with a median duration of 3 mo (range: 1-12 mo), were included. Overall consumption of tree nuts or peanuts had a favorable effect on HOMA-IR (WMD: -0.23; 95% CI: -0.40, -0.06; I2 = 51.7%) and fasting insulin (WMD: -0.40 μIU/mL; 95% CI: -0.73, -0.07 μIU/mL; I2 = 49.4%). There was no significant effect of nut consumption on fasting blood glucose (WMD: -0.52 mg/dL; 95% CI: -1.43, 0.38 mg/dL; I2 = 53.4%) or HbA1c (WMD: 0.02%; 95% CI: -0.01%, 0.04%; I2 = 51.0%). Conclusions: Consumption of peanuts or tree nuts significantly decreased HOMA-IR and fasting insulin; there was no effect of nut consumption on HbA1c or fasting glucose. The results suggest that nut consumption may improve insulin sensitivity. In the future, well-designed clinical trials are required to elucidate the mechanisms that account for these observed effects.
... Of specific importance to individuals with type 1 diabetes, we observed better glycaemic control with increasing nut intake. While a number of previous trials have shown reduced post-prandial blood glucose concentrations related to nut consumption, suggestive of at least a short-term beneficial glycaemic effect [28][29][30], the effects on other measures of glucose control are mixed. For example, in the cross-sectional analyses of the PREDIMED data, nut consumption was not associated with the fasting blood glucose concentration but compared to individuals consuming less than one weekly serving of nuts, those with over three weekly servings had lower odds of diabetes [10]. ...
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Although nut consumption has been associated with several health benefits, it has not been investigated in individuals with type 1 diabetes. Therefore, our aim was to assess nut consumption and its association with metabolic syndrome in adult individuals with type 1 diabetes taking part in the Finnish Diabetic Nephropathy Study. The nut intake of the 1058 participants was assessed from 3-day food records that were completed twice, and the number of weekly servings, assuming a serving size of 28.4 g, was calculated. Metabolic syndrome was defined as the presence of ≥3 of the cardiovascular risk factors: central obesity, high blood pressure (≥130/85 mmHg or use of antihypertensive medication), high triglyceride concentration (≥1.70 mmol/L or use of lipid-lowering medication), low HDL-cholesterol concentration (7.5%) was used as a criterion for suboptimal glycaemic control. Of the 1058 (mean age 46 years, 41.6% men) participants, 689 (54.1%) reported no nut intake. In the remaining sample, the median weekly nut intake was 40.8 g. In the adjusted models, higher nut intake, as the continuous number of weekly servings and the comparison of those with
... Reasons for exclusion were as follows: participants did not have T2DM (n ¼ 14), 26,28,30,[39][40][41][42][43][44][45][46][47][48][49] the study was not an RCT (n ¼ 4), 19,24,50,51 the study did not assess the primary outcomes of interest (n ¼ 2), 52,53 the study was a duplicate of an already included trial (n ¼ 1), 54 or the article was retracted (n ¼ 1). 55 Of these exclusions, the authors of one trial 54 were contacted for more information; however, no response was received, and it could not be included in the review. ...
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Objective: The objective of this review was to synthesize the best available research evidence regarding the effectiveness of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus. Introduction: There has been an increase in the use of complementary therapy, particularly botanical products, for management of type 2 diabetes mellitus. It has been reported that increasing mono- and polyunsaturated fatty acids in diet effectively lowers the risk of development of type 2 diabetes mellitus. Hence, it was hypothesized that consumption of nuts, which are high in polyunsaturated fatty acids and mono-unsaturated fatty acids, may aid in preventing diabetes and reducing levels of blood glucose by reducing glycemic load by displacing dietary carbohydrates present in diet. Inclusion criteria: This systematic review included randomized controlled trials that compared the consumption of any type and form of tree nut with a placebo or any other intervention in adults with type 2 diabetes mellitus. Trials were included if they measured fasting blood glucose, post prandial blood glucose, and/or glycated hemoglobin. Trials that assessed triglyceride levels and weight post intervention were also considered for inclusion. Trials were restricted to the English language. Methods: A three step search of PubMed, CINAHL, Embase, Tripdatabase, and Cochrane Central Register of Controlled Trials (CENTRAL) was done in July 2019. To find unpublished studies, the National Institute of Health Clinical Database and Google Scholar were searched. Studies from the search were uploaded to EndNote X8 and reviewed against the inclusion criteria by two reviewers. The JBI critical appraisal checklist for randomized controlled trials was used to assess the potential studies for methodological quality. A meta-analysis and subgroup analysis was conducted among trials with the same type of intervention and outcome measures. Results are presented in a narrative format where statistical pooling was not possible. The a priori protocol was registered in PROSPERO (CRD42019133558). Results: Fifteen trials were included with a total sample size of 667. Consumption of pistachios demonstrated a significant reduction in triglyceride levels (mmol/L) at three months or earlier follow-up (MD -0.28; CI -0.33, -0.23; P = <0.00001). The meta-analysis including all tree nuts combined showed reduction in both fasting blood glucose and glycated hemoglobin (MD -0.26 mmol/L and -0.11% respectively) at three months or earlier follow-up. The subgroup analysis demonstrated mean difference of -0.45, -0.16, and -0.90 mmol/L in fasting blood glucose following ingestion of walnuts, almonds, and hazelnuts, and -0.17% in glycated hemoglobin following ingestion of walnuts for three months or earlier follow-up. Although not clinically significant, these figures give an indication that further research with larger sample sizes and longer follow-up may show encouraging results. Conclusions: The authors found that pistachio consumption for three months or fewer significantly reduced triglycerides. Other tree nuts (walnuts, almonds, and hazelnuts) reduced fasting blood glucose and glycated hemoglobin by varying degrees. Further robust randomized controlled trials with power calculation based sample size, comparing same type, dose, and method of nut intervention will provide more evidence. For now, clinical decisions should be based on standard practice local guidelines.
... This could be important in the prevention of hyperinsulinemia. Lowering of post-prandial glucose in response to a rice meal can also be induced despite an overall increase in caloric content as exemplified in the addition of dried fruits, almonds and pistachio (Kendall, Josse, Esfahani, & Jenkins, 2011). The postprandial response to rice can also be reduced by simply introducing a small amount of pre-loads prior to the main meal (Table 2, Supplementary Table S2). ...
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Background The global shift in food consumption patterns accompanied by a sedentary lifestyle has been driving the upsurge of non-communicable diseases, projected to remain as a global health challenge for the coming decades. Sustainable food-centric interventions should be developed and strengthened to mitigate the growing health concerns with huge socio-economic implications. Scope and approach Milled white rice is typically starch-rich, serves as the major daily caloric source for a majority of the world population especially in Asia. Most rice varieties are of high glycemic index (GI), a food quality inferenced to contribute to the health problems surrounding high-calorie intake and dysregulated glucose metabolism. Manipulation of GI through various approaches will significantly help in the fight against diabetes and related diseases. Key findings and conclusions A multidisciplinary approach of (a) introducing low to moderate GI property to modern varieties of rice through genetic manipulations, and (b) diet-based diversification solutions in a healthy plate of well-balanced portions of macronutrients with low GI food matrix together with elevated nutrient density and dietary fibre (DF) offers a sustainable solution to address the growing concern in meeting double burden nutritional challenges.
... Given the relationship between postprandial plasma glucose and postprandial dysfunctions, the glycemic index (GI) is expected to be an important factor in the adverse effect of carbohydrates, however, findings are scarce and conflicting [56,97,98]. For instance, nuts have shown potential to manage post-meal glucose when consumed with high GI food content [99] but not with low GI foods [100]. Also, the acute ingestion of low-fat milk has been shown to protect adults with metabolic syndrome from endothelial dysfunction when compared to rice milk (high GI). ...
Article
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The purpose of this review is to provide an overview of diets, food, and food components that affect postprandial inflammation, endothelial function, and oxidative stress, which are related to cardiometabolic risk. A high-energy meal, rich in saturated fat and sugars, induces the transient appearance of a series of metabolic, signaling and physiological dysregulations or dysfunctions, including oxidative stress, low-grade inflammation, and endothelial dysfunction, which are directly related to the amplitude of postprandial plasma triglycerides and glucose. Low-grade inflammation and endothelial dysfunction are also known to cluster together with insulin resistance, a third risk factor for cardiovascular diseases (CVD) and type-II diabetes, thus making a considerable contribution to cardiometabolic risk. Because of the marked relevance of the postprandial model to nutritional pathophysiology, many studies have investigated whether adding various nutrients and other substances to such a challenge meal might mitigate the onset of these adverse effects. Some foods (e.g., nuts, berries, and citrus), nutrients (e.g., l-arginine), and other substances (various polyphenols) have been widely studied. Reports of favorable effects in the postprandial state have concerned plasma markers for systemic or vascular pro-inflammatory conditions, the activation of inflammatory pathways in plasma monocytes, vascular endothelial function (mostly assessed using physiological criteria), and postprandial oxidative stress. Although the literature is fragmented, this topic warrants further study using multiple endpoints and markers to investigate whether the interesting candidates identified might prevent or limit the postprandial appearance of critical features of cardiometabolic risk.
... For example, almonds reduced the glycemic impact, calculated as the incremental area under the 2-hour blood glucose curve, of carbohydrate foods in a dosedependent manner [9]. Moreover it has been reported that pistachio nuts can attenuate the relative glycemic response when taken with a carbohydrate meal (co-consumed) [10]; and another study stated that mixed nuts (30, 60 and 90 g) were demonstrated to have a dose-dependent effect on the glycemic response [11]. Additionally to the results of several studies that suggested that nuts may play a protective role in type 2 diabetes, a significant association between nut consumption and the risk of type 2 diabetes was also not found in a meta-analysis, in which the authors included case-control, cohort and clinical trials [12]. ...
Article
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Background Inconclusive results have been published regarding the impact of nut consumption on glucose/insulin homeostasis and inflammatory factors. Furthermore, it remains unanswered whether adiposity factors could mediate the association between nut consumption, glucose/insulin homeostasis and inflammatory markers; this is what the current study aims to investigate. Results From a total of 16,784 individuals, 48.2% participants were men; overall mean age was 47.2 years. Age-, sex-, energy intake and race-adjusted mean of serum C-reactive protein (CRP)(0.49 to 0.26 mg/dl), apolipoprotein-β (apo- β) (95.6 to 90.8 mg/dl), glucose/insulin homeostasis parameters and triglyceride-glucose index (TyG) index (8.32 to 7.95) significantly decreased as the quartile of nut intake increased (all p < 0.001). We found that all evaluated potential mediators had significant and positive associations with markers of glucose/insulin homeostasis or inflammation (all p < 0.001). With regard to BMI, the mediated effects were significant for the associations between nut consumption and CRP, fasting blood glucose, insulin, hemoglobin A1c (HbA1c), triglyceride to high-density lipoprotein (TG:HDL) ratio and TyG index (all p < 0.001). As for WC, it had mediator impact on CRP, fasting blood glucose, HbA1c, TG:HDL ratio and TyG index (all p < 0.001). apVAT played no mediation role for any association (all p > 0.05). Conclusions This is the first study which quantify the role of nut consumption on inflammatory and glucose/insulin homeostasis markers. Nut intake was inversely associated with inflammatory and glucose/insulin homeostasis markers. Certain adiposity indexes (i.e. BMI and WC) mediated these associations. These findings convey an important message for the crucial role of weight management with dietary recommendations. Method We extracted data from the National Health and Nutrition Examination Survey (2005–2010) on nut consumption to evaluate the association between nut intake and markers of glucose/insulin homeostasis and inflammation. We assessed whether this link, if any, is mediated or affected by adiposity factors, including body mass index (BMI), waist circumference (WC, marker of central adiposity), anthropometrically predicted visceral adipose tissue (apVAT), visceral adiposity index (VAI, indicator of adipose distribution) and lipid accumulation product (LPA, novel index of central lipid accumulation). Analysis of co-variance and conceptus causal mediation analysis were conducted based on survey design and sample weights.
... Dietary fiber in nuts slows gastric emptying and subsequent glucose absorption [26]. Acute nut ingestion usually blunts the postprandial glucose response to carbohydrate foods due to their high fat content as well [27,28]. A pooled analysis of 25 intervention studies showed that the nut consumption of 67 g/day reduced fasting triglyceride concentrations by 10.2% only in people with hypertriglyceridemia but no overall triglyceride-lowering effect of nuts was seen [29]. ...
Article
Epidemiological studies suggest that a diet high in processed meat, with a high glycemic index is associated with an increased risk of type 2 diabetes. It is not clear if this is due to altered insulin sensitivity or an enhanced postprandial glucose. We aimed to compare the acute metabolic response of two different types of meals after ingestion of the matching diet for four weeks. The study was a randomized, crossover acute meal study. Volunteers consumed either a red meat/refined grain meal or a dairy/chicken/nuts/wholegrain meal after four weeks of the matching diet. After a three-week washout period and four weeks of the alternate diet, they consumed the matching meal. The diets differed with respect to both protein and carbohydrate sources. Blood samples were taken for 180 min for the measurement of glucose, insulin, C-peptide and triglyceride. Fifty-one participants (age: 35.1 15.6 years; body mass index: 27.7 6.9 kg/m², 17 with normal and 34 with impaired glucose tolerance) completed two meal tests. The area under the curve (p < 0.001) and incremental area under the curve (p = 0.001) for insulin was significantly higher after the red meat/refined grain diet than after the dairy/chicken/nuts/whole grain diet. There was an interaction between meal and glucose tolerance group (p < 0.05) in the area under the curve (AUC) and the incremental area under the curve (iAUC) of glucose; the red meat/refined grain diet increased glucose relative to the dairy/chicken/nuts/whole grain diet only in the normal group (+2.5 mmol/L/3 h). The red meat/refined grain diet increased glucose and insulin responses compared with the dairy/chicken/nuts/whole grain diet. This meal pattern would increase pancreatic stress long term and may account for the increased risk of type 2 diabetes with this diet.
Article
Die Publikationen der vergangenen paar Jahre unterstreichen: Körperliche Aktivität und ausgewogene Ernährung beugen Krankheiten vor. Wahrscheinlich reicht schon eine geringe Steigerung der täglichen Bewegung aus, um Typ-2-Diabetes und kardiovaskulären Erkrankungen entgegenzuwirken. Nicht einzelne Nahrungskomponenten sondern Ernährungsmuster mit mehr pflanzlichen Fetten und weniger raffiniertem Zucker und künstlichen Süßstoffen sind entscheidend. Und Alkohol in Maßen sowie das Kaffeetrinken sind nicht mehr zu verteufeln.
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Industrial breadmaking equipment typically processes batches of 200 kg or more of raw ingredients, while scaled down versions are widely used for research and development studies. A literature review shows that the use of domestic breadmakers has become routine to enable cheaper and more convenient small batch production of bread which facilitates assessment of new ingredients and formulations, and for other studies on bread and the breadmaking process. However, whilst recipe formulations can be scaled down, the process in a breadmaker may not be an accurate representation of industrial processes, leading to differences in aspects of bread quality and the nature and direction of ingredient effects. This short communication assesses whether breadmaker-produced bread is representative of bread produced using industrial methods, and therefore if the results of studies conducted on breadmaker-produced breads are representative of those that would be obtained on industrial equipment. A study of some quality parameters in breads made using a household breadmaker versus scaled down industrial breadmaking equipment showed an opposing trend for the relationship between sugar content and specific volume, and between sugar content and crumb firmness, in loaves made from both methods. The differing quality parameters of breadmaker-produced loaves compared to loaves produced in scaled down industrial breadmaking equipment suggested that breadmaker-produced breads can give misleading indications of likely ingredient effects at industrial scale.
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Background Results of previous clinical trials evaluating the effect of pistachio supplementation on endothelial reactivity (ER) are controversial. Aims We aimed to assess the impact of pistachio on ER through systematic review of literature and meta-analysis of available randomized, controlled-feeding clinical studies (RCTs). Methods The literature search included SCOPUS, PubMed-Medline, ISI Web of Science and Google Scholar databases up to 1st August 2017 to identify RCTs investigating the impact of pistachio on ER. Two independent reviewers extracted data on study characteristics, methods and outcomes. Overall, the impact of pistachio on ER was reported in 4 trials. Results The meta-analysis did not suggest a significant change in brachial artery flow-mediated dilatation (FMD) (WMD: +0.28%; 95%CI: −0.58, 1.13; p = 0.525) while brachial artery diameter (BAD) improved (WMD: +0.04%; 95%CI: 0.03, 0.06; p<0.001) following pistachios consumption. Conclusion The present meta-analysis suggests a significant effect of pistachios on ER, affecting BAD but not FMD.
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Nuts have had an important place in human nutrition since ancient times. Nuts have been consumed as raw or roasted and have been the main component of many food products as ingredients. With the revealing of the health-promoting effects of long-term consumption, the popularity of nuts has increased. Providing safe products to the consumer has become an essential implementation in this growing nut industry. The microbial contamination of nuts is one of the major problems of food safety. The consumption of microbiologically contaminated nuts causes outbreaks of foodborne illness, resulting in social and economic impacts. Microbial decontamination treatments target to produce safe products with acceptable quality. This chapter discusses the various treatments for the decontamination of nuts under three different headings: physical, chemical, and biological methods.KeywordsNutsDecontamination techniquesMicrobial risksFood safety
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Type 2 diabetes mellitus is an important preventable disease and a growing public health problem. Epidemiologic and clinical studies suggest that healthy eating, physical activity, and BW control are the main driving forces to reduce diabetes risk. Owing to their low available carbohydrate content, favorable fat and protein profile as well as phytonutrient content, nut consumption has been associated with a reduced risk of development and management of diabetes. Nuts, by virtue of its cardioprotective actions, have also been shown to reduce biomarkers of risk factors for diabetic complications. Although more studies are warranted, the emerging picture is that nut consumption beneficially influences diabetes risk and management beyond blood glucose control.
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Pistachio (Pistacia vera L.) belongs to Anacardiaceae family (cashew family). Pistachio is the only nut in the 11 species of the genus Pistacia containing an edible kernel covered in a hard shell, while all other species produce resins. Pistachio is a native of minor Asia and is largely dispersed in the Mediterranean region that includes the United States and Turkey also. Pistachio nuts are abundantly rich in antioxidants and are being placed recently in the list of 50 foods which are high in antioxidant capacity. Pistachios are also rich source of nutrients such as phenolic compounds, healthy fatty acids and proteins. Pistachios have grabbed the attention of researchers due to the extensive study on the different parts of this plant such as leaves, hulls, kernel, gums and hull which indicate carious beneficial activities such as antimicrobial and anti-inflammatory which are mainly attributed to the presence of flavonoids and phenolic compounds. The present chapter provides information about the antioxidants present in different parts of pistachio nut, its related food products and health beneficial effects on human health.
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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.
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The consumption of dried fruit is a dietary habit that is growing year by year. Nutrition specialists and others have carried out numerous studies confirming that the introduction of a controlled daily intake in the diet can bring benefits both in the prevention of major metabolic and cardiovascular diseases and in the well-being of the microbiome. The intake of dried fruit plays an important role in improving the quality and quantity of the microbial families of our intestine, leading to an increased production of short-chain fatty acids, which participate in numerous pathophysiological mechanisms and in the prevention of numerous diseases. The present review chapter compares numerous articles focusing on the characteristics and behavior of fibers and other main components of nuts.
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Objective: To examine prospectively the relationship between glycemic diets, low fiber intake, and risk of non-insulin-dependent diabetes mellitus. Design: Cohort study. Setting: In 1986, a total of 65173 US women 40 to 65 years of age and free from diagnosed cardiovascular disease, cancer, and diabetes completed a detailed dietary questionnaire from which we calculated usual intake of total and specific sources of dietary fiber, dietary glycemic index, and glycemic load. Main outcome measure: Non-insulin-dependent diabetes mellitus. Results: During 6 years of follow-up, 915 incident cases of diabetes were documented. The dietary glycemic index was positively associated with risk of diabetes after adjustment for age, body mass index, smoking, physical activity, family history of diabetes, alcohol and cereal fiber intake, and total energy intake. Comparing the highest with the lowest quintile, the relative risk (RR) of diabetes was 1.37 (95% confidence interval [CI], 1.09-1.71, P trend=.005). The glycemic load (an indicator of a global dietary insulin demand) was also positively associated with diabetes (RR= 1.47; 95% CI, 1.16-1.86, P trend=.003). Cereal fiber intake was inversely associated with risk of diabetes when comparing the extreme quintiles (RR=0.72, 95% CI, 0.58-0.90, P trend=.001). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of diabetes (RR=2.50, 95% CI, 1.14-5.51) when compared with a low glycemic load and high cereal fiber intake. Conclusions: Our results support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of diabetes.
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It continues to be essential that individual outcomes from MNT be monitored so that appropriate changes in the overall management plan for diabetes can be implemented. There are many aspects of MNT for diabetes that require additional research.
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Background: Recent studies have concluded that the carbohydrate content and glycemic index (GI) of individual foods do not predict the glycemic and insulinemic effects of mixed meals. We hypothesized that these conclusions may be unwarranted because of methodologic considerations. Objective: The aim was to ascertain whether the GI and carbohydrate content of individual foods influence glucose and insulin responses elicited by realistic mixed meals in normal subjects. Design: With the use of a crossover design, we determined the glucose and insulin responses of 6 test meals in 16 subjects in Sydney and the glucose responses of 8 test meals in 10 subjects in Toronto and then the results were pooled. The 14 different test meals varied in energy (220–450 kcal), protein (0–18 g), fat (0–18 g), and available carbohydrate (16–79 g) content and in GI (35–100; values were rounded). Results:The glucose and insulin responses of the Sydney test meals varied over a 3-fold range (P < 0.001), and the glucose responses of the Toronto test meals varied over a 2.4-fold range (P < 0.001). The glucose responses were not related to the fat or protein content of the test meal. Carbohydrate content (P = 0.002) and GI (P = 0.022) alone were related to glucose responses; together they accounted for 88% of the variation in the glycemic response (P < 0.0001). The insulin response was significantly related to the glucose response (r = 0.94, P = 0.005). Conclusions: When properly applied in realistic settings, GI is a significant determinant of the glycemic effect of mixed meals in normal subjects. For mixed meals within the broad range of nutrient composition that we tested, carbohydrate content and GI together explained ≈90% of the variation in the mean glycemic response, with protein and fat having negligible effects.
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Most dietary interventions have metabolic effects in the short term, but long-term effects may require dietary fat changes to influence body composition and insulin action. This study assessed the effect of sustained high polyunsaturated fatty acids (PUFA) intake through walnut consumption on metabolic outcomes in type II diabetes. Fifty overweight adults with non-insulin-treated diabetes (mean age 54+/-8.7 years) were randomized to receive low-fat dietary advice +/-30 g per day walnuts targeting weight maintenance (around 2000 kcal, 30% fat) for 1 year. Differences between groups were assessed by changes in anthropometric values (body weight, body fat, visceral adipose tissue) and clinical indicators of diabetes over treatment time using the general linear model. The walnut group consumed significantly more PUFA than the control (P=0.035), an outcome attributed to walnut consumption (contributing 67% dietary PUFA at 12 months). Most of the effects were seen in the first 3 months. Despite being on weight maintenance diets, both groups sustained a 1-2 kg weight loss, with no difference between groups (P=0.680). Both groups showed improvements in all clinical parameters with significant time effects (P<0.004), bar triacylglycerol levels, but these were just above normal to begin with. The walnut group produced significantly greater reductions in fasting insulin levels (P=0.046), an effect seen largely in the first 3 months. Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels. Long-term effects are also apparent but subject to fluctuations in dietary intake if not of the disease process.
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Pistachios are high in lutein, beta-carotene, and gamma-tocopherol relative to other nuts; however, studies of the effects of pistachios on oxidative status are lacking. We conducted a randomized, crossover controlled-feeding study to evaluate 2 doses of pistachios on serum antioxidants and biomarkers of oxidative status in 28 hypercholesterolemic adults (LDL-cholesterol >or=2.86 mmol/L). Participants consumed 3 isoenergetic diets for 4 wk each after a 2-wk baseline Western diet. Experimental diets included a lower-fat control diet without pistachios (25% total fat) with 1 serving/d (i.e. 32-63 g/d; energy adjusted) of pistachios (1 PD; 10% energy from pistachios; 30% total fat) or with 2 servings/d (63-126 g/d; energy adjusted) of pistachios (2 PD; 20% energy from pistachios; 34% total fat). When participants consumed the pistachio-enriched diets, they had higher plasma lutein (P < 0.0001), alpha-carotene, and beta-carotene (P < 0.01) concentrations than after the baseline diet. After consuming the pistachio diets, participants had greater plasma lutein (P < 0.001) and gamma-tocopherol (P < 0.05; 2 PD only) relative to the lower-fat control diet. After the 2 PD diet period, participants also had lower serum oxidized-LDL concentrations than following the baseline diet period (P < 0.05). After both the 1 PD and 2 PD diet periods, they had lower serum oxidized-LDL concentrations than after the control diet period (P < 0.05). The change in oxidized-LDL from baseline correlated positively with the change in LDL-cholesterol across all treatments (r = 0.42; P < 0.005). After controlling for the change in serum LDL-cholesterol as a covariate, increases in serum lutein and gamma-tocopherol following the 2 PD period were still modestly associated with decreases in oxidized-LDL (r = -0.36, P = 0.06 and r = -0.35, P = 0.08, respectively). This suggests that a heart-healthy diet including pistachios contributes to the decrease in the serum oxidized-LDL concentration through cholesterol-lowering and may provide an added benefit as a result of the antioxidants the pistachios contain.
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Knowledge of the effect of nut consumption on metabolic syndrome (MetS) components is limited. We assessed the effects of nut intake on adiposity, serum lipids, insulin resistance, and inflammatory biomarkers in patients with MetS. In a randomized, parallel-group, 12-week feeding trial, 50 patients with MetS were given recommendations for a healthy diet with or without supplementation with 30 g/day of raw nuts (15 g walnuts, 7.5 g almonds and 7.5 g hazelnuts) (Nut and Control diet groups, respectively). Adiposity measures, serum lipids, insulin, Homeostasis Model Assessment (HOMA), interleukin-6 (IL-6) and other inflammatory biomarkers, and 48-h fecal fat were determined basally and at study's completion. Moderate weight loss, decreased adiposity, and lower blood pressure occurred similarly after both diets. The Control, but not the Nut diet, was associated with significant (P<0.05) reduction of LDL-cholesterol, with mean changes of -0.36 versus -0.13 mmol/L, respectively (between-group differences, P=0.154). The Nut diet reduced fasting insulin by 2.60 μU/mL (95% CI, -4.62 to -0.59) and HOMA-insulin resistance by 0.72 (-1.28 to -0.16) (P<0.05 versus Control diet; both). Among inflammatory markers, the Nut diet resulted in changes of median plasma IL-6 of -1.1 ng/L (-2.7 to -0.1; P=0.035 versus Control diet), but adjustment for weight loss attenuated the significance of the association. Stool fat decreased with the Control diet and slightly increased with the Nut diet (P<0.05 for between-group differences). Patients with MetS show decreased lipid responsiveness but improved insulin sensitivity after daily intake of 30 g of mixed nuts.
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To determine the effects of daily walnut consumption on endothelial function, cardiovascular biomarkers, and anthropometric measures in type 2 diabetic individuals. This study was a randomized, controlled, single-blind, crossover trial. Twenty-four participants with type 2 diabetes (mean age 58 years; 14 women and 10 men) were randomly assigned to one of the two possible sequence permutations to receive an ad libitum diet enriched with 56 g (366 kcal) walnuts/day and an ad libitum diet without walnuts for 8 weeks. Subjects underwent endothelial function testing (measured as flow-mediated dilatation [FMD]) and assessment of cardiovascular biomarkers before and after each 8-week treatment phase. The primary outcome measure was the change in FMD after 8 weeks. Secondary outcome measures included changes in plasma lipids, A1C, fasting glucose, insulin sensitivity, and anthropometric measures. Endothelial function significantly improved after consumption of a walnut-enriched ad libitum diet compared with that after consumption of an ad libitum diet without walnuts (2.2 +/- 1.7 vs. 1.2 +/- 1.6%; P = 0.04). The walnut-enriched diet increased fasting serum glucose and lowered serum total cholesterol and LDL cholesterol from baseline (10.0 +/- 20.5 mg/dl, P = 0.04; -9.7 +/- 14.5 mg/dl, P < 0.01; and -7.7 +/- 10 mg/dl, P < 0.01, respectively), although these changes were not significant compared with those for an ad libitum diet without walnuts. There were no significant changes in anthropometric measures, plasma A1C, and insulin sensitivity. A walnut-enriched ad libitum diet improves endothelium-dependent vasodilatation in type 2 diabetic individuals, suggesting a potential reduction in overall cardiac risk.
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Recent studies have suggested that nuts have favorable effects beyond lipid lowering. We aimed to investigate effect of the Antep pistachio (Pistacia vera L.) on blood glucose, lipid parameters, endothelial function, inflammation, and oxidation in healthy young men living in a controlled environment. A Mediterranean diet was administered to normolipidemic 32 healthy young men (mean age 22 y, range 21-24) for 4 wk. After 4 wk, participants continued to receive the Mediterranean diet but pistachio was added for 4 wk by replacing the monounsaturated fat content constituting approximately 20% of daily caloric intake. Fasting blood samples and brachial endothelial function measurements were performed at baseline and after each diet. Compared with the Mediterranean diet, the pistachio diet decreased glucose (P<0.001, -8.8+/-8.5%), low-density lipoprotein (P<0.001, -23.2+/-11.9%), total cholesterol (P<0.001, -21.2+/-9.9%), and triacylglycerol (P=0.008, -13.8+/-33.8%) significantly and high-density lipoprotein (P=0.069, -3.1+/-11.7%) non-significantly. Total cholesterol/high-density lipoprotein and low-density lipoprotein/high-density lipoprotein ratios decreased significantly (P<0.001 for both). The pistachio diet significantly improved endothelium-dependent vasodilation (P=0.002, 30% relative increase), decreased serum interleukin-6, total oxidant status, lipid hydroperoxide, and malondialdehyde and increased superoxide dismutase (P<0.001 for all), whereas there was no significant change in C-reactive protein and tumor necrosis factor-alpha levels. In this trial, we demonstrated that a pistachio diet improved blood glucose level, endothelial function, and some indices of inflammation and oxidative status in healthy young men. These findings are in accordance with the idea that nuts, in particular pistachio nuts, have favorable effects beyond lipid lowering that deserve to be evaluated with prospective follow-up studies.
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Higher nut consumption has been associated with lower risk of coronary heart disease (CHD) events in several epidemiologic studies. The study examined the association between intake of nuts and incident cardiovascular disease (CVD) in a cohort of women with type 2 diabetes. For the primary analysis, there were 6309 women with type 2 diabetes who completed a validated FFQ every 2-4 y between 1980 and 2002 and were without CVD or cancer at study entry. Major CVD events included incident myocardial infarction (MI), revascularization, and stroke. During 54,656 person-years of follow-up, there were 452 CHD events (including MI and revascularization) and 182 incident stroke cases. Frequent nut and peanut butter consumption was inversely associated with total CVD risk in age-adjusted analyses. After adjustment for conventional CVD risk factors, consumption of at least 5 servings/wk of nuts or peanut butter [serving size, 28 g (1 ounce) for nuts and 16 g (1 tablespoon) for peanut butter] was significantly associated with a lower risk of CVD (relative risk = 0.56; 95% CI: 0.36-0.89). Furthermore, when we evaluated plasma lipid and inflammatory biomarkers, we observed that increasing nut consumption was significantly associated with a more favorable plasma lipid profile, including lower LDL cholesterol, non-HDL cholesterol, total cholesterol, and apolipoprotein-B-100 concentrations. However, we did not observe significant associations for HDL cholesterol or inflammatory markers. These data suggest that frequent nut and peanut butter consumption is associated with a significantly lower CVD risk in women with type 2 diabetes.
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Although a wealth of literature links dietary factors and coronary heart disease (CHD), the strength of the evidence supporting valid associations has not been evaluated systematically in a single investigation. We conducted a systematic search of MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures in relation to CHD. We used the Bradford Hill guidelines to derive a causation score based on 4 criteria (strength, consistency, temporality, and coherence) for each dietary exposure in cohort studies and examined for consistency with the findings of randomized trials. Strong evidence supports valid associations (4 criteria satisfied) of protective factors, including intake of vegetables, nuts, and "Mediterranean" and high-quality dietary patterns with CHD, and associations of harmful factors, including intake of trans-fatty acids and foods with a high glycemic index or load. Among studies of higher methodologic quality, there was also strong evidence for monounsaturated fatty acids and "prudent" and "western" dietary patterns. Moderate evidence (3 criteria) of associations exists for intake of fish, marine omega-3 fatty acids, folate, whole grains, dietary vitamins E and C, beta carotene, alcohol, fruit, and fiber. Insufficient evidence (< or =2 criteria) of association is present for intake of supplementary vitamin E and ascorbic acid (vitamin C); saturated and polyunsaturated fatty acids; total fat; alpha-linolenic acid; meat; eggs; and milk. Among the dietary exposures with strong evidence of causation from cohort studies, only a Mediterranean dietary pattern is related to CHD in randomized trials. The evidence supports a valid association of a limited number of dietary factors and dietary patterns with CHD. Future evaluation of dietary patterns, including their nutrient and food components, in cohort studies and randomized trials is recommended.
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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 antiinflammatory 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 nitric oxide, alpha-linolenic acid, and phenolic antioxidants. Although more studies are warranted, the emerging picture is that nut consumption beneficially influences cardiovascular risk beyond cholesterol lowering.
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Plant cell walls are known to influence the rate and extent of lipid release from plant food tissues during digestion; however, the effect of cell wall structure on postprandial lipemia is unknown. The objective was to investigate the effects of lipid release (bioaccessibility) on postprandial lipemia by comparing lipid encapsulated by cell walls with lipid present as free oil. A randomized crossover trial (n = 20 men) compared the effects of 3 meals containing 54 g fat provided as whole almond seed macroparticles (WA), almond oil and defatted almond flour (AO), or a sunflower oil blend as control (CO) on postprandial changes in oxidative stress (8-isoprostane F(2)alpha concentrations), vascular tone (peripheral augmentation index), and plasma triacylglycerol, glucose, and insulin concentrations. The postprandial increase in plasma triacylglycerol was lower [74% and 58% lower incremental area under curve (iAUC)] after the WA meal than after the AO and CO meals (P < 0.001). Increases in plasma glucose concentrations (0-180 min) were significantly higher after the WA meal (iAUC: 114; 95% CI: 76, 153) than after the AO meal (iAUC: 74; 95% CI: 48, 99) (P < 0.05), but no significant differences from the CO meal were observed (iAUC: 88; 95% CI: 66, 109). The peak reductions in peripheral augmentation index after the WA, AO, and CO meals (-9.5%, -10.1%, and -12.6%, respectively, at 2 h) were not significantly different between meals. Plasma 8-isoprostane F(2)alpha and insulin concentrations did not differ significantly between meals. The bioaccessibility of lipid in almond seeds, which is regulated by the structure and properties of cell walls, plays a primary role in determining postprandial lipemia.
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To systematically tabulate published and unpublished sources of reliable glycemic index (GI) values. A literature search identified 205 articles published between 1981 and 2007. Unpublished data were also included where the data quality could be verified. The data were separated into two lists: the first representing more precise data derived from testing healthy subjects and the second primarily from individuals with impaired glucose metabolism. The tables, which are available in the online-only appendix, list the GI of over 2,480 individual food items. Dairy products, legumes, and fruits were found to have a low GI. Breads, breakfast cereals, and rice, including whole grain, were available in both high and low GI versions. The correlation coefficient for 20 staple foods tested in both healthy and diabetic subjects was r = 0.94 (P < 0.001). These tables improve the quality and quantity of GI data available for research and clinical practice.
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Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relatively sparse. The Adventist Health Study is a prospective cohort investigation of 31,208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal myocardial infarction. Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point. Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect.
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Intake of carbohydrates that provide a large glycemic response has been hypothesized to increase the risk of NIDDM, whereas dietary fiber is suspected to reduce incidence. These hypotheses have not been evaluated prospectively. We examined the relationship between diet and risk of NIDDM in a cohort of 42,759 men without NIDDM or cardiovascular disease, who were 40-75 years of age in 1986. Diet was assessed at baseline by a validated semiquantitative food frequency questionnaire. During 6-years of follow-up, 523 incident cases of NIDDM were documented. The dietary glycemic index (an indicator of carbohydrate's ability to raise blood glucose levels) was positively associated with risk of NIDDM after adjustment for age, BMI, smoking, physical activity, family history of diabetes, alcohol consumption, cereal fiber, and total energy intake. Comparing the highest and lowest quintiles, the relative risk (RR) of NIDDM was 1.37 (95% CI, 1.02-1.83, P trend = 0.03). Cereal fiber was inversely associated with risk of NIDDM (RR = 0.70; 95% CI, 0.51-0.96, P trend = 0.007; for > 8.1 g/day vs. < 3.2 g/day). The combination of a high glycemic load and a low cereal fiber intake further increased the risk of NIDDM (RR = 2.17, 95% CI, 1.04-4.54) when compared with a low glycemic load and high cereal fiber intake. These findings support the hypothesis that diets with a high glycemic load and a low cereal fiber content increase risk of NIDDM in men. Further, they suggest that grains should be consumed in a minimally refined form to reduce the incidence of NIDDM.
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To examine the relation between nut consumption and risk of coronary heart disease in a cohort of women from the Nurses' Health Study. Prospective cohort study. Nurses' Health Study. 86 016 women from 34 to 59 years of age without previously diagnosed coronary heart disease, stroke, or cancer at baseline in 1980. Major coronary heart disease including non-fatal myocardial infarction and fatal coronary heart disease. 1255 major coronary disease events (861 cases of non-fatal myocardial infarction and 394 cases of fatal coronary heart disease) occurred during 14 years of follow up. After adjusting for age, smoking, and other known risk factors for coronary heart disease, women who ate more than five units of nuts (one unit equivalent to 1 oz of nuts) a week (frequent consumption) had a significantly lower risk of total coronary heart disease (relative risk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009) than women who never ate nuts or who ate less than one unit a month (rare consumption). The magnitude of risk reduction was similar for both fatal coronary heart disease (0.61, 0.35 to 1.05, P for trend=0.007) and non-fatal myocardial infarction (0.68, 0.47 to 1.00, P for trend=0.04). Further adjustment for intakes of dietary fats, fibre, vegetables, and fruits did not alter these results. The inverse association persisted in subgroups stratified by levels of smoking,use of alcohol, use of multivitamin and vitamin E supplements, body mass index, exercise, and intake of vegetables or fruits. Frequent nut consumption was associated with a reduced risk of both fatal coronary heart disease and non-fatal myocardial infarction. These data, and those from other epidemiological and clinical studies, support a role for nuts in reducing the risk of coronary heart disease.
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Little is known about the effects of the amount and type of carbohydrates on risk of coronary heart disease (CHD). The objective of this study was to prospectively evaluate the relations of the amount and type of carbohydrates with risk of CHD. A cohort of 75521 women aged 38-63 y with no previous diagnosis of diabetes mellitus, myocardial infarction, angina, stroke, or other cardiovascular diseases in 1984 was followed for 10 y. Each participant's dietary glycemic load was calculated as a function of glycemic index, carbohydrate content, and frequency of intake of individual foods reported on a validated food-frequency questionnaire at baseline. All dietary variables were updated in 1986 and 1990. During 10 y of follow-up (729472 person-years), 761 cases of CHD (208 fatal and 553 nonfatal) were documented. Dietary glycemic load was directly associated with risk of CHD after adjustment for age, smoking status, total energy intake, and other coronary disease risk factors. The relative risks from the lowest to highest quintiles of glycemic load were 1.00, 1.01, 1. 25, 1.51, and 1.98 (95% CI: 1.41, 2.77 for the highest quintile; P for trend < 0.0001). Carbohydrate classified by glycemic index, as opposed to its traditional classification as either simple or complex, was a better predictor of CHD risk. The association between dietary glycemic load and CHD risk was most evident among women with body weights above average ¿ie, body mass index (in kg/m(2)) >/= 23. These epidemiologic data suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD, independent of known coronary disease risk factors.
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