Asia Pacific Clinical Nutrition Society Award for 2010
Author:
Keywords:
Abstract:
Asia Pac J Clin Nutr. 2010;19(1):i.doi:
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Economic analysis of a diabetes-specific nutritional meal replacement for patients with type 2 diabetes
Author:Stephen Randolph MBA, Vikkie A Mustad PhD, James L
Keywords:nutrition therapy, type 2 diabetes mellitus, computer simulation, cost analysis, quality adjusted life years
Abstract:This study extends nutritional intervention results reported by short-term clinical trials of a diabetes-specific nutritional meal replacement by assessing the ten-year impact of the interventions on patient outcomes and costs
compared to usual care. We developed and validated a computer simulation of type 2 diabetes based on published data from major clinical trials. The model tracks patients through microvascular and macrovascular health
states and reports cumulative costs and quality adjusted life years. We modeled different scenarios that include a
diabetes-specific nutritional meal replacement as part of a structured lifestyle intervention, and also as the only
difference between the intervention and usual care treatment groups, and compared them to usual care with diet
and physical activity recommendations. We used sensitivity analysis to explore the robustness of results. When a
diabetes-specific nutritional meal replacement is the only treatment difference and is considered an equal cost
meal replacement, the diabetes-specific nutritional meal replacement interventions are less costly and more effective than usual care. As an added cost meal replacement, the diabetes-specific nutritional meal replacement
has an incremental cost-effectiveness ratio between $50,414 and $55,036 depending on improvement in percent
glycated hemoglobin. A hypothetical lifestyle intervention using a diabetes-specific nutritional meal replacement
has an incremental cost-effectiveness ratio of $47,917. The diabetes-specific nutritional meal replacement was
found to be cost-effective under the various conditions simulated.
Asia Pac J Clin Nutr. 2010;19(1):1-7.doi:
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Composition of weight gain during nutrition rehabilitation of severely under nourished children in a hospital based study from India
Author:Kankipati Vijay Radhakrishna DCH, Bharati Kulkarni
Keywords:protein energy malnutrition, nutrition rehabilitation, body composition, fat mass, fat free mass
Abstract:Concerns are raised that rapid catch up growth during nutrition rehabilitation of severely malnourished children
may be associated with disproportionately higher amounts of body fat deposition. This study examined the composition of weight gain in severely undernourished children who underwent nutrition rehabilitation in a hospital
from India. Body composition of 80 severely malnourished children (age 6-60 months) was assessed using skinfold thickness measurements on admission and after 1 month of supplementary feeding. On admission, children
had severe weight and height deficits and were severely wasted. The mean weight for age z score, height for age
z score and weight for height z score (WHZ) were -5.0, -4.2 and -4.1 respectively. Children consumed a mixed
diet and mean energy intake was 177 kcal/kg/day with a protein energy ratioof 13. Overall, the mean weight
gain was 6.1 g/kg/day and fat mass contributed to about 40% of the weight gain. When the composition of
weight gain was analysed in tertiles of baseline WHZ score, children in the lowest tertile of WHZ score had significantly higher weight gain and fat free mass (FFM) gain. Gain in fat mass did not differ in relation to the baseline WHZ score. The study demonstrates that it is possible toachieve rapid weight gain with recovery of lost tissue in severely malnourished children with mixed diets. Children with lowest WHZ scores at baseline gained
higher FFM during nutrition rehabilitation when compared to the children with relatively higher WHZ score
probably in an attempt to recover the lost tissue.
Asia Pac J Clin Nutr. 2010;19(1):8-13.doi:
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Correspondence of two procedures to measure abdominal circumference in a convenience sample of urban, middle-class schoolchildren in Guatemala City
Author:Virginia J Alvarado BS, Evelyn Mayorga BS, Susana
Keywords:juvenile central obesity, natural waist circumference, umbilical abdominal circumference, body mass index, Guatemala
Abstract:Background: Given an emerging concern for juvenile overweight and obesity, even in populations of developing
countries, techniques to assess central obesity, such as abdominal circumference (AC), are of increasing interest.
Objective: To compare two procedures for measuring AC in schoolchildren from a convenience sample of middle-class, urban children aged 72 to 131 months in Guatemala City. Methods: We conducted a cross-sectional
study (August 2004- April 2005) in 363 schoolchildren; 190 boys and 173 girls. The AC was recorded using
both the conventional natural waist circumference (NWC) and the umbilical-level abdominal circumference
(UAC) methods; each of which was measured over a thin T-shirt. Height and weightwere also measured. The
NWC and UAC methods were compared between genders and age groups. In addition, correlation coefficients
and Bland-Altman regression were performed. A reproducibility study was performed on a subsample of 50
children. Results: Mean NWC was 63.2±10.0 cm for boys and 60.2±7.7 cm for girls (p=0.001), and mean UAC
was 65.9±11.0 cm for boys and 63.2±8.8 cm for girls (p=0.008). Both measures of ACgenerally increased with
age. The UAC - NWC difference increasedwith abdominal girth. The Pearson correlation coefficient of BMI vs.
NWC and BMI vs. UAC was r=0.92, CV=0.46±0.27%. A high test-retest reproducibility (r > 0.98, CV=
0.50±0.24%) of the NWC and UAC measurements was found. Conclusion: Reliable NWC and UAC measurements may be obtained by applying a correction term to account for light clothing. Both measurements are applicable methodologies for the collection of datain populations withcultural limitations.
Asia Pac J Clin Nutr. 2010;19(1):14-21.doi:
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Dietary patterns by reduced rank regression predicting changes in obesity indices in a cohort study: Tehran Lipid and Glucose Study
Author:Roya Sherafat-Kazemzadeh MD, Shahryar Egtesadi PhD
Keywords:dietary patterns, anthropometry, obesity, reduced rank regression, cohort
Abstract:Objective: To examine the association between dietary patterns and obesity indices (BMI, WC, WHR) among
Tehranian adults in a 6-year follow-up study. Methods: Within frame of a cohort study in Tehran (mean follow
up 6.6±0.9 years), 141 adults were recruited with: two 24 hourdietary recalls at the beginning, as well as obesity
indices at the beginning and end of the study period. Dietary intakes were converted into grams of intakes of
food items and categorized into 16 groups. Reduced rank regression analysis derived fivepatterns with total and
polyunsaturated-to-saturated fat intake, cholesterol, fiber and calcium intake as response variables. Factors (dietary patterns) were generated retaining a corresponding factor loading ≥|0.17| on the food groups. Changes in
obesity indices were scrutinized within quintiles of factor scores. Results: There were high loadings on refined
carbohydrates, whole grain, starchy vegetables, other vegetables, red and refined meat, saturated/trans fat, and
egg for the first factor named “traditional”. All obesityindices had increasing trend across quintiles of pattern
score. The fifth pattern (namely egg pattern) had high loading for eggs, salty snacks, as well as fruits and dry
fruits, and negative loadings for red and processed meat, saturated and trans fat, plant oils, and dairy products.
This pattern showed increasing trends for WC and WHR after adjustment for potential confounders. Other patterns showed non-significant trends for obesity indices. Conclusions: The results were indicative of a traditional
pattern which is dominated in the Tehran region and associated with increase in obesity indices.
Asia Pac J Clin Nutr. 2010;19(1):22-32.doi:
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Effect of soy isoflavone extract supplements on bone mineral density in menopausal women: meta-analysis of randomized controlled trials
Author:Kyoko Taku PhD, Melissa K Melby PhD, Jun Takebayas
Keywords:meta-analysis, isoflavones, dietary supplements, menopause, bone density
Abstract:This study was conducted to clarify the effect of ingesting soy isoflavone extracts (not soy protein or foods containing isoflavones) on bone mineral density (BMD) in menopausal women. PubMed, CENTRAL, ICHUSHI,
CNKI, Wanfang Data, CQVIP, and NSTL were searched for randomized controlled trials published in English,
Japanese, or Chinese reporting the effects of soy isoflavone extracts on lumbar spine or hip BMD in menopausal
women. Trials were identified and reviewed for inclusion and exclusion eligibility. Data on study design, participants, interventions, and outcomes were extracted. Eleven, seven, five, and five trials were finally selected for
estimation of the effects on spine, femoral neck, hip total, and trochanter BMD, respectively. Meta-analysis including data from1240 menopausal women revealed that daily ingestion of an average of 82 (47–150) mg soy
isoflavones (aglycone equivalent) for 6–12 months significantly increased spine BMD by 22.25 mg/cm
2
(95% CI:
7.62, 32.89; p=0.002), or by 2.38% (95% CI: 0.93, 3.83; p=0.001) compared with controls (random-effects
model). Subgroup analyses indicated that the varying effects of isoflavones on spine BMD across trials might be
associated with study characteristics of intervention duration (6 vs. 12 months), region of participant (Asian vs.
Western), and basal BMD (normal bone mass vs. osteopenia or osteoporosis).No significant effects on femoral
neck, hip total, and trochanter BMD were found. Soy isoflavone extract supplements increased lumbar spine
BMD in menopausal women. Further studies are needed toaddress factors affecting the magnitudes of effect on
spine and to verify the effect on hip.
Asia Pac J Clin Nutr. 2010;19(1):33-42.doi:
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Serum 25-hydroxyvitamin D concentration of Indigenous-Fijian and Fijian-Indian women
Author:Christina Heere BSc, C Murray Skeaff PhD, Lepani W
Keywords:vitamin D status, women, Fijian, Indigenous, Indian
Abstract:Background: Serum 25-hydroxyvitamin D (25OHD) concentrations are lower in Pacific people compared to
Caucasians living in New Zealand. However, there are no data on the 25OHD concentrations of Pacific people
living in the Pacific Islands. Aim: To assess the vitamin D status of indigenous and Indian Fijian women living
in Fiji by measuring 25OHD concentrations. Methods: 25OHD concentrations ina national sample of 511 Fijian
women (15-44 y). Results: The mean 25OHD concentration of Fijian women was 76 nmol/L (95% CI: 73, 78).
25OHD was lower in Fijian Indian [70 (66, 74) nmol/L; n=205] women compared to indigenous Fijians [80 (76,
84) nmol/L; n=306] (p<0.0001). The mean 25OHD was higher in rural [77 (74, 80) nmol/L; n=392] than urban
[70 (65, 76) nmol/L; n=119] women (p<0.0001). Body mass index (BMI) and age were not predictors of 25OHD
concentrations. Of Fijian females, 3%, 11%, and 56% had 25OHD concentrations indicative of 25OHD insufficiency using cut-offs of ≤37.5, ≤50 and ≤80 nmol/L, respectively. Conclusion: Mean 25OHD in Fijian women
was generally adequate and exceed concentrations reported in Pacific females living in New Zealand.
Asia Pac J Clin Nutr. 2010;19(1):43-48.doi:
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Hypovitaminosis D and K are highly prevalent and independent of overall malnutrition in the institutionalized elderly
Author:Akiko Kuwabara PhD, Masako HimenoMSc, Naoko Tsugaw
Keywords: hypovitaminosis D, hypovitaminosis K, principal component analysis, adequate intake, institutionalized elderly
Abstract:There have been methodological problems for studying hypovitaminosis D and K in the elderly. First, studies
were done either by evaluating food intake or measuring their circulating levels, but rarelyby both in Japan. In
this paper, vitamin D and K intakes and their circulating levels were simultaneously determined. Second issue is
whether hypovitaminosis D and K are independent of general malnutrition, prevalent in the elderly. We tried to
statistically discriminate them by principal component analysis(PCA). Fifty institutionalized elderly were evaluated for their circulating 25 hydroxy-vitamin D (25OH-D), intact parathyroid hormone (PTH), phylloquinone
(PK), menaquinone-7 (MK-7) levels, and their food intake. Although average vitamin D intake (7.0 μg/day) exceeded the Japanese Adequate Intake (AI) of 5.0 μg/day, average serum 25OH-D concentration was in the hypovitaminosis D range (11.1 ng/mL). Median vitamin K intake was 168 μg/day, approximately 2.5 times as high
as AI for vitamin K. Nevertheless, plasma PK and MK-7 concentrations were far lower than those of healthy
Japanese elderly over 70 years old. PCA yielded four components; each representing overall nutritional, vitamin
K2, vitamin D, and vitamin K
1status, respectively. Since these components are independent of each other, vitamin D- and K-deficiency in these subjects could not be explained by overall malnutrition alone. In summary, institutionalized elderly had a high prevalence of hypovitaminosis D and K, and the simultaneous determination of
their circulating level and dietary intake is mandatory insuch studies. PCA would yield fruitful results for eliminating the interference by confounders in a cross-sectional study.
Asia Pac J Clin Nutr. 2010;19(1):49-56.doi:
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High prevalence of low HDL-c in the Philippines compared to the US: population differences in associations with diet and BMI
Author:Julienne N Rutherford PhD, Thomas W McDade PhD, Al
Keywords:risk factors, dyslipidemia, low HDL-c, women, epidemiology
Abstract:Cardiovascular disease (CVD) is a leading cause of death in the Philippines, although few studies here have examined the lipid profiles underlying disease risk. The isolated low high density lipoprotein cholesterol (HDL-c)
phenotype has been implicated as a CVD risk factor, the prevalence of which exhibits significant variation
across populations. To assess population variation in individual lipid components and their associations with diet
and anthropometric characteristics, we compare lipid profiles in a population of adult Filipino women (n=1877)
to US women participating in the National Healthand Nutrition Examination Survey (NHANES, n=477). We
conducted multiple regression models to assess the relationship between lipid components,body mass index, and
dietary variables in the two populations. We measured the prevalence of lipid phenotypes, and logistic regression
models determined the predictors of the isolated low HDL-c phenotype. High density lipoprotein cholesterol was
lower in the Philippines (40.8±0.2 mg/dL) than in NHANES (60.7±0.7 mg/dL). The prevalence of the isolated
low HDL-c phenotype was 28.8%, compared to 2.10% in NHANES. High prevalence among Filipinos was relatively invariant across all levels of BMI, but was strongly inversely related to BMI in NHANES and exhibited
only at the BMI>25 kg/m2 threshold. Diet did not consistently predict the low-HDL phenotype in Filipinos. Filipino women exhibit a high prevalence of the isolated low HDL-c phenotype, which is largely decoupled from
anthropometric factors. The relationship of CVD to population variation in dyslipidemia and body composition
needs further study, particularly in populations where the burden of cardiovascular and metabolic disease is rapidly increasing.
Asia Pac J Clin Nutr. 2010;19(1):57-67.doi:
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Family nutritional support improves survival, immune restoration and adherence in HIV patients receiving ART in developing country
Author:Charlotte Serrano MD, Remi Laporte MD, Moussa IdeM
Keywords:AIDS, developing country, nutritionalsupport, survival, immunologic restoration
Abstract:In developing countries, access to antiretroviral treatment for persons living with HIV is still in progress. Malnutrition represents another cause of acquired immunodeficiency and premature death. This evaluation program estimated the impact of family nutritional support during the first year of antiretroviral treatment in West Africa's
sub-Sahara region. Family nutritional support was proposed to patients with CD-4 cell count <200 /mm
3
and/or
developing a WHO stage III/IV or with body mass index <18.5 kg/m² and receiving antiretroviral treatment. Follow-up of 62 patients receiving support was compared to 118 patients who had only received antiretroviral
treatment the year before. Average body mass index, CD-4 cell count were 20.7 and 20.5, 217 and 191/mm
3
respectively in supported and control groups (NS). Twenty-two (36%) and 56 (48%) were WHO stage III/IV (NS)
respectively in supported and control groups. One patient who received support and twelve controls died (Mortality Ratio=0.19;p<0.05). Increase in CD-4 cell count was around 1.7 times higher (+ 114 vs. + 68 CD-4
cells/mm
3
respectively in supported and control groups; p<0.05) and observance was improved in supported
group (p<0.005). The evolutions of WHO stage and body mass index were not different but the study period was
short. Family nutritional support for persons living with HIV initiating antiretroviral treatment in a developing
country showed a positive impact after six months. This family intervention could be integrated into AIDS interventions as an effective and comprehensive community-based primary care.
Asia Pac J Clin Nutr. 2010;19(1):68-75.doi:
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Dietary habits and overweight/obesity in adolescents in Xi’an City, China
Author:Ming Li PhD, Michael J Dibley PhD, David W Sibbrit
Keywords:dietary habits, adolescents, overweight and obesity, cross-sectional, China
Abstract:This study explored the association between dietary habits and overweight and obesity in adolescents from Xi’an
City, China. A cross-sectional sample of 1804 adolescentswas recruited in 2004 from 30 junior high schools in
six districts of Xi’an City, northwest China. Weight and height was measured and eating habits assessed using a
self-administered questionnaire. Logisticregression was used to identify dietary patterns associated with overweight and obesity and adjusted for socio-demographic factors. Consumption of foods and beverages outside
three main meals, and potato chips was more popular in boys than in girls,while girls consumed more fried food
and soft drinks than boys. In boys, anincreased consumption of soft drinks was associated with increased risk of
overweight and obesity (1100 mL/day, OR: 1.9, 95% CI: 1.1-3.8), while consuming preserved fruit was associated with decreased risk (OR: 0.6, 95% CI: 0.5-0.9). Ingirls, having breakfast outside the home (OR: 1.7, 95%
CI: 1.1-2.3) and an increased consumption of energy-dense foods (OR: 1.7, 95% CI: 1.04-2.9), was associated
with increased risk of overweight and obesity, while frequently having foods and beverages outside the three
main meals (OR: 0.6, 95% CI: 0.4-0.9) was associated with decreased risk. The consumption of breakfast outside the home, soft drinks and energy-dense fast foods were positively associated with overweight and obesity in
adolescents. Future health education programs to prevent excess weight gainshould target such unhealthy eating
habits.
Asia Pac J Clin Nutr. 2010;19(1):76-82.doi:
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Maintained total body water content and serum sodium concentrations despite body mass loss in female ultrarunners drinking ad libitum during a 100 km race
Author:Beat Knechtle MD, Oliver SennMD, MPH, Reinhard Imo
Keywords:body composition, dehydration, ultra-endurance, water, performance
Abstract:We investigated in 11 female ultra-runners during a 100 km ultra-run, the association between fluid intake and
prevalence of exercise-associated hyponatremia in a cross-sectional study. Athletes drank ad libitumand recorded their fluid intake. They competed at 8.0 (1.0) km/hand finished within 762 (91) min. Fluid intake was 4.1
(1.3) L during the race, equal to 0.3 (0.1) L/h. Body mass decreased by 1.5 kg (p<0.01); pre race body mass was
related to speed in the race (r = -0.78, p<0.05); and change (∆) in body mass was not associated with speed in the
race. Change in body mass was positively (r= 0.70; p<0.05), and ∆urinary specific gravity negatively (r= -0.67;
p<0.05), correlated to ∆percent total body water. Changes in body mass were not related to fluid intake during
the race. Fluid intake was not correlated to running speed and showed no association with either ∆percent total
body water nor ∆[Na] in plasma. Fluid intake showed no relationship with both ∆haematocrit and ∆plasma
volume. No exercise-associated hyponatremia occurred. Female ultra- runners consuming fluids ad libitumduring the race experienced no fluid overload, and ad libitumdrinking protects against exercise-associated hyponatremia. The reported higher incidence of exercise-associated hyponatremia in women is not really a gender effect
but due to women being more prone to overdrink.
Asia Pac J Clin Nutr. 2010;19(1):83-90.doi:
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Male ironman triathletes lose skeletal muscle mass
Author:Beat Knechtle MD, Barbara Baumann, Andrea Wirth, P
Keywords:body fat, body mass, dehydration, ultra-endurance, triathlon
Abstract:We investigated whether male triathletes in an Ironman triathlon lose body mass in the form of fat mass or skeletal muscle mass in a field study at the Ironman Switzerland in 27 male Caucasian non-professional Ironman triathletes. Pre- and post-race body mass, fat mass and skeletal muscle mass were determined. In addition, total
body water, hematological and urinary parameters were measured in order to quantify hydration status. Body
mass decreased by 1.8 kg (p<0.05), skeletal muscle decreased by 1.0 kg (p<0.05) whereas fat mass showed no
changes. Urinary specific gravity, plasma urea and plasma volume increased (p<0.05). Pre- to post-race change
(∆) in body mass was not associated with ∆skeletal muscle mass. Additionally, there was no association between ∆plasma urea and ∆skeletal muscle mass; ∆plasma volume was not associated with ∆total body water
(p>0.05). We concluded that male triathletes in an Ironmantriathlon lose 1.8 kg of body mass and 1 kg of skeletal muscle mass, presumably due to a depletion of intramyocellular stored glycogen and lipids.
Asia Pac J Clin Nutr. 2010;19(1):91-97.doi:
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Prevalence and characteristics of the metabolic syndrome among adults in Beijing, China
Author:Gang Li MD, Maximilian de Courten MPH, Shufang Jia
Keywords:metabolic syndrome, prevalence, current smoking, China
Abstract:This study was performed to investigate the prevalence of the metabolic syndrome using a large representative
sample in Beijing. Data from a total of 16442 adults (6489 men and 9953 women) aged ≥18 years from a survey
of behavioral risk factors for chronic diseases in Beijing, in 2005, was analyzed. The prevalence of the metabolic
syndrome increased with age and the age-standardized prevalence of the metabolic syndrome defined by International Diabetes Federation IDF and National Cholesterol Education ProgramAdult Treatment Panel III ATPIII
criteria were 23.2% (24.5% in men and 22.7% in women)and 16.2% (16.1% in men and 16.6% in women), respectively. The metabolic syndrome was higher in semi-urban areas and associated with higher rates of hypertension, central obesity, salt intake and smoking.
Asia Pac J Clin Nutr. 2010;19(1):98-102.doi:
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Folate intake associated with lung function, breathlessness and the prevalence of chronic obstructive pulmonary disease
Author:Fumi Hirayama PhD, Andy H Lee PhD, Koji Terasawa P
Keywords:breathlessness, chronic obstructive pulmonary disease, folate, Japan, lung function
Abstract:A case-control study was conducted in central Japan to investigate the relationship between dietary intake of
folate and lung function, breathlessness and chronic obstructive pulmonary disease (COPD). A total of 278 referred patients (244 men and 34 women) aged 50-75 years with COPD diagnosed within the past four years and
340 community-based controls (272 men and 68 women) were assessed for dyspnoea and undertook spirometric
measurements of lung function.A structured questionnaire was administered face-to-face to obtain information
on demographics, lifestyle and habitualfood consumption. Folate intake was derived from the Japanese food
composition tables. The COPD patients had significantly lower habitual intake offolate (mean 231, SD 90
μg/day) than control subjects (mean 261, SD 110 μg/day), p<0.001. Lung function measures were found to be
positively associated with dietary folate level. Reductionsin prevalence of COPD and especially breathlessness
were observed, the respective adjusted odds ratio (OR) being 0.74 (95% confidence interval (CI) 0.35 to 1.58)
and 0.43 (95% CI 0.21 to 0.91) for the highest versus lowest quartile of folate intake. The corresponding tests for
linear trend were also significant (p<0.05). In conclusion, an inverse association was evident between dietary
folate intake and the prevalence of breathlessness for Japanese adults, together witha significant dose-response
relationship for the COPD risk. Moreover, increased folate intake might be beneficial to lung function.
Asia Pac J Clin Nutr. 2010;19(1):103-109.doi:
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Health benefits of nuts in prevention and management of diabetes
Author:Cyril WC Kendall PhD, Amin Esfahani MSc, Jennifer
Keywords:nuts, cardiovascular disease, coronary heart disease, diabetes, glycemia
Abstract:The effects of tree nuts on risk factors for coronary heart disease (CHD), in particular blood lipids, have been investigated in a number of studies and the beneficial effects are now recognized. The beneficial effects of nuts on
CHD in cohort studies have also been clearly demonstrated. However, while there is also reason to believe the
unique micro- and macronutrient profiles of nuts may help to control blood glucose levels, relatively few studies
have investigated their role in diabetes control and prevention. Nuts are low in available carbohydrate, have a
healthy fatty acid profile, and are highin vegetable protein, fiber and magnesium. Acute feeding studies indicate
that when eaten alone nuts have minimal effects on raising postprandial blood glucose levels. In addition, when
nuts are consumed with carbohydrate rich foods, they blunt the postprandial glycemic response of the carbohydrate meal. Despite the success of these acute studies, only a limited number of trials have been conducted with
nuts in type 2 diabetes. These studies have either been of insufficient duration to observe changes in HbA1c, as
the standard measure of glycemic control, or have been underpowered. Therefore, more long-term clinical trials
are required to examine the role of nuts on glycemic control in patients with prediabetes and diabetes. Overall,
there are good reasons to justify further exploration of the use of nuts in the prevention of diabetes and its micro-
and macrovascular complications.
Asia Pac J Clin Nutr. 2010;19(1):110-116.doi:
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The phytochemical composition and antioxidant actions of tree nuts
Author:Bradley W Bolling PhD, Diane L McKay PhD, Jeffrey
Keywords:tree nuts, phytochemicals, flavonoids, resveratrol, antioxidants
Abstract:In addition to being a rich source of several essential vitamins and minerals, mono- and polyunsaturated fatty acids, and fiber, most tree nuts provide an array of phytochemicals that may contribute to the health benefits attributed to this whole food. Although manyof these constituents remain to befully identified and characterized,
broad classes include the carotenoids, hydrolyzable tannins, lignans, naphthoquinones, phenolic acids, phytosterols, polyphenols, and tocopherols. These phytochemicals have been shown to possess a range of bioactivity,
including antioxidant, antiproliferative, anti-inflammatory, antiviral, and hypocholesterolemic properties. This
review summarizes the current knowledge of the carotenoid, phenolic, and tocopherol content of tree nuts and
associated studies of their antioxidant actions in vitro and in human studies. Tree nuts are a rich source of tocopherols and total phenols and contain a wide variety of flavonoids and proanthocyanidins. In contrast, most tree
nuts are not good dietary sources of carotenoids and stilbenes. Phenolic acids are present in tree nutsbut a systematic survey of the content and profile of these compounds is lacking. A limited number of human studies indicate these nut phytochemicals are bioaccessible and bioavailable and have antioxidant actions in vivo.
Asia Pac J Clin Nutr. 2010;19(1):117-123.doi:
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Nuts, inflammation and insulin resistance
Author:Patricia Casas-AgustenchBSc, Mònica Bulló BSc, PhD
Keywords:nuts, inflammation, insulin resistance, type 2 diabetes, cardiovascular disease
Abstract:The beneficial effects of nut consumption on cardiovascular disease (CVD) have been widely documented.
These protective effects are mainly attributed to the roleof nuts in the metabolism of lipids and lipoproteins. As
chronic inflammation is a key early stage in the atherosclerotic process that predicts future CVD events and is
closely related to the pathogenesis of insulin resistance, many recent studies have focused on the potential effect
of nut consumption on inflammation and insulin resistance. Through different mechanisms, some components of
nuts such as magnesium, fiber, α-linolenic acid, L-arginine, antioxidants and MUFA may protect against inflammation and insulin resistance. This review evaluates the epidemiologic and experimental evidence in humans demonstrating an association between nut consumption and these two emergent cardio-protective mechanisms.
Asia Pac J Clin Nutr. 2010;19(1):124-130.doi:
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Nuts, blood lipids and cardiovascular disease
Author:Joan Sabaté MD, DrPHand Michelle Wien DrPH, RD
Keywords:nuts, fatty acids, cardiovascular disease, blood lipids, cholesterol
Abstract:The aim of this paper is to evaluate nut-related epidemiological and human feeding study findings and to discuss
the important nutritional attributes of nuts and their link to cardiovascular health. Frequent nut consumption has
been found to be protective against coronary heart disease in five large epidemiological studies across two continents. A qualitative summary of the data from four of these studies found an 8.3% reduction in risk of death
from coronary heart disease for each weekly serving of nuts. Over 40 dietary intervention studies have been conducted evaluating the effect of nut containing diets on blood lipids. These studies have demonstrated that intake
of different kinds of nuts lower total and LDL cholesterol and the LDL: HDL ratio in healthy subjects or patients
with moderate hypercholesterolaemia, even in the context of healthy diets. Nuts have a unique fatty acid profile
and feature a high unsaturated to saturated fatty acid ratio, an important contributing factor to the beneficial
health effects of nut consumption. Additional cardioprotective nutrients found in nuts include vegetable protein,
fiber, α-tocopherol, folic acid, magnesium, copper, phytosterols and other phytochemicals.
Asia Pac J Clin Nutr. 2010;19(1):131-136.doi:
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Nuts and healthy body weight maintenance mechanisms
Author:Richard D Mattes PhD, RD and Mark L DreherPhD
Keywords:nuts, body weight, satiation, metabolizable energy, energy expenditure
Abstract:Nuts are rich sources of multiple nutrients and phytochemicals associated with health benefits, including reduced
cardiovascular disease risk. This has prompted recommendations to increase their consumption. However, they
are also high in fat and are energy dense. The associations between these properties, positive energy balance and
body weight raise questions about such recommendations. Numerous epidemiological and clinical studies show
that nuts are not associated with weight gain. Mechanistic studies indicate this is largely attributable to the high
satiety and low metabolizable energy (poor bioaccessibility leading to inefficient energy absorption) properties
of nuts. Compensatory dietary responses account for 55-75%of the energy provided by nuts. Limited data suggest that routine nut consumption is associated with elevated resting energy expenditure and the thermogenic effect of feeding, resulting in dissipation of another portion of the energy they provide. Additionally, trials contrasting weight loss through regimens that include or exclude nuts indicate improved compliance and greater
weight loss when nuts are permitted. Nuts may be included in the diet, in moderation, to enhance palatability,
nutrient quality, and chronic disease risk reduction without compromising weightloss or maintenance.
Asia Pac J Clin Nutr. 2010;19(1):137-141.doi:
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Tree nut consumption improves nutrient intake and diet quality in US adults: an analysis of National Health and Nutrition Examination Survey (NHANES) 1999-2004
Author:Carol E O’Neil PhD, MPH, RD, Debra R Keast PhD, Vi
Keywords:tree nuts, nutrient intake, dietary adequacy, healthy eating index-2005, NHANES
Abstract:Recent epidemiologic studies assessing tree nut (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts) consumption and the association with nutrient intake and diet quality
are lacking. This study determined the association of tree nut consumption and nutrient intake and diet quality
using a nationally representative sample of adults. Adults 19+ years (y) (n=13,292) participating in the 1999-2004 National Health and Nutrition Examination Survey wereused. Intake was determined from 24-hour diet recalls; tree nut consumers weredefined as those consuming ≥¼ ounce/day (7.09 g). Means, standard errors, and
ANOVA (adjusted for covariates) were determined using appropriate sample weights. Diet quality was measured
using the Healthy Eating Index-2005. Among consumers, mean intake of tree nuts/tree nut butters was 1.19 +
0.04 oz/d versus 0.01 +0.00 oz/d for non-consumers. In this study,5.5 ± 0.3 % of individuals 19-50 y (n=7,049)
and 8.4 ± 0.6 % of individuals 51+ y (n=6,243) consumed tree nuts/tree nut butters. Mean differences (p<0.01)
between tree nut consumers and non-consumers of adult shortfall nutrients were: fiber (+5.0 g/d), vitamin E
(+3.7 mg AT/d), calcium (+73 mg/d),magnesium (+95 mg/d), and potassium(+260 mg/d). Tree nut consumers
had lower sodium intake (-157 mg/d, p<0.01). Diet quality was significantly higher in tree nut consumers
(58.0±0.4 vs. 48.5±0.3, p<0.01). Tree nut consumption was associatedwith a higher overall diet quality score
and improved nutrient intakes. Specific dietary recommendations for nut consumption should be provided for
consumers.
Asia Pac J Clin Nutr. 2010;19(1):142-150.doi:
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