scholarly journals Almond snack consumption improves endothelial function in adults with moderate risk of cardiovascular disease: a randomised, controlled, parallel trial

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Vita Dikariyanto ◽  
Sarah Berry ◽  
Leanne Smith ◽  
Lucy Francis ◽  
May Robertson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Endothelial Function ◽  
Ldl Cholesterol ◽  
Unsaturated Fatty Acids ◽  
Saturated Fat ◽  
Mean Difference ◽  
Moderate Risk ◽  
Snack Foods ◽  
Randomised Controlled ◽  
The Uk

AbstractEndothelial dysfunction is a predictor for cardiovascular disease risk and is a key feature of atherosclerosis. Poor diet quality, including consumption of saturated fat-rich, high-refined carbohydrate snack foods, may have adverse effects on endothelial function. Thus, snack foods, which contribute an average of 20% of energy intake in the UK adult population, present an easily identifiable target to improve vascular health. Almonds are nutrient-dense foods that are rich in unsaturated fats, fibre, minerals and non-nutrient bioactives (NNB), and may have health benefits by displacing snacks high in refined carbohydrates, enriching the diet with micronutrients and NNB, and/or low lipid bioaccessibility. Human clinical trials have demonstrated LDL cholesterol-lowering effects of daily almond consumption, yet the effects on endothelial function are unclear. This study aimed to investigate whether replacing habitual snacks (20% estimated daily energy requirements) with almonds had any impact on endothelium-dependent vasodilation, measured by flow-mediated dilatation (FMD) using ultrasound imaging of the brachial artery following reactive hyperaemia. A randomised, controlled, parallel trial in adult regular snack consumers aged 30–70 y at moderate risk of cardiovascular disease was conducted, including a 2-week run-in period with control snacks and a 6-week intervention period. Control sweet and savoury mini muffin snacks were developed to replicate the average UK snack nutrient profile, which was calculated from snack foods identified in the UK National Diet and Nutrition Survey (NDNS) database (55% energy from carbohydrate, 36% total fat (14% saturated fat), and 10% protein). One hundred and nine volunteers (77 females and 32 males; mean age 56 y) were enrolled in the study and 107 were randomised to isocaloric treatments, 1) control muffins, or 2) dry roasted whole almonds; 105 participants completed the study. Almonds significantly increased FMD relative to control (mean difference 3.6%, 95% CI 1.7, 5.5; P < 0.001), indicating improved endothelial function, and LDL-cholesterol (mean difference -0.25 mmol/L, 95% CI -0.47, -0.03; P = 0.030) significantly decreased adjusted with sex, age and baseline BMI and baseline dependent outcome values. Snacking on whole almonds as a replacement for snacks high in refined starch and sugar, and low in fibre and unsaturated fatty acids, improves endothelial function. The results of this study provide further evidence for the importance of nuts in dietary strategies to reduce risk of cardiovascular disease.

scholarly journals Almonds Improve Endothelial Function and Lower LDL Cholesterol, But Do Not Affect Liver Fat in Adults at Moderate Risk of Cardiovascular Disease: A Randomized Controlled Trial

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 19-19
Author(s):  
Vita Dikariyanto ◽  
Leanne Smith ◽  
Lucy Francis ◽  
May Robertson ◽  
Eslem Kusaslan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Insulin Sensitivity ◽  
Endothelial Function ◽  
Ldl Cholesterol ◽  
Controlled Trial ◽  
Mean Difference ◽  
Liver Fat ◽  
Moderate Risk ◽  
Night Time ◽  
Pancreatic Fat

Abstract Objectives The ATTIS study aimed to investigate whether substituting almonds for typical snacks (high in refined starch, free sugars and saturated fats, and low in fibre) influenced cardiometabolic risk factors. Primary outcomes, endothelial function and liver fat, were measured in healthy adults aged 30–70 y who were habitual snackers and at moderate risk of developing cardiovascular disease (CVD). It was hypothesized that snacking on almonds would improve endothelial function and decrease liver fat. Methods Following a 2-week run-in period consuming control snacks, a 6-week parallel arm trial was conducted where participants were randomized to isoenergetic treatments: 1) control snacks (mini-muffins) replicating an average snack nutrient profile, calculated from snack foods identified in 4-d food diaries from a national dietary intake database, or 2) dry-roasted whole almonds, providing 20% estimated energy requirement. Endothelial function (via flow-mediated dilation (FMD)); abdominal subcutaneous and visceral fat, and liver, muscle and pancreatic fat (via MRI/MRS); day- and night-time heart rate variability (HRV) and 24 h ambulatory blood pressure (ABP); blood biomarkers of insulin sensitivity and lipid profile; and fecal short chain fatty acids (SCFA) were assessed at baseline and endpoint. A total of 107 participants (75 F, 32 M; mean age 56.2 y, SD 10.4) were randomized and 105 subjects completed the trial. Results Almonds significantly increased FMD (mean difference 4.1%, 95% CI 2.2, 5.9), the long-phase HRV index, night-time very-low frequency power (mean difference 337 ms2, 95% CI 12, 661) and plasma oleic acid levels (mean difference 228 μmol, 95% CI 7, 449) relative to control adjusted for baseline BMI and baseline dependent outcome values, but there were no treatment differences in ABP and subcutaneous, visceral, liver, muscle and pancreatic fat. Plasma LDL cholesterol levels were significantly decreased by almonds (mean difference −0.25 mmol/L, 95% CI −0.45, −0.04), but no differences were found in other blood lipids, insulin sensitivity, nor fecal SCFA levels. Conclusions These novel findings suggest almonds may be cardioprotective by increasing availability of nitric oxide and improving cardiac autonomic function, in addition to their well-established LDL cholesterol-lowering properties. Funding Sources Almond Board of California.

scholarly journals Public health guidelines should recommend reducing saturated fat consumption as much as possible: Debate Consensus

2020 ◽  
Vol 112 (1) ◽  
pp. 25-26 ◽  
Author(s):  
Ronald M Krauss ◽  
Penny M Kris-Etherton
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
General Health ◽  
Ldl Cholesterol ◽  
Saturated Fat ◽  
Research Needs ◽  
Cholesterol Reduction ◽  
Cvd Risk ◽  
Ongoing Debate ◽  
Fat Consumption

ABSTRACT There is ongoing debate as to whether public health guidelines should advocate reducing SFA consumption as much as possible to reduce the risk of chronic diseases, especially cardiovascular disease (CVD). In considering both sides of this question, we identified a number of points of agreement, most notably that the overall dietary patterns in which SFAs are consumed are of greater significance for cardiometabolic and general health than SFA intake alone. Nevertheless, there remained significant disagreements, centered largely on the interpretation of evidence bearing on 4 major questions: 1) does reducing dietary SFAs lower the incidence of CVD, 2) is the LDL-cholesterol reduction with lower SFA intake predictive of reduced CVD risk, 3) do dietary SFAs affect factors other than LDL cholesterol that may impact CVD risk, and 4) is there a sufficient rationale for setting a target for maximally reducing dietary SFAs? Finally, we identified specific research needs for addressing knowledge gaps that have contributed to the controversies.

scholarly journals Brief support and personalised feedback on food shopping to encourage saturated fat reduction: the PC-SHOP randomised controlled trial

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Carmen Piernas ◽  
Paul Aveyard ◽  
Nerys Astbury ◽  
Jason Oke ◽  
Melina Tsiountsioura ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Total Energy ◽  
Energy Intake ◽  
Ldl Cholesterol ◽  
Saturated Fat ◽  
Total Energy Intake ◽  
Grocery Shopping ◽  
Food Shopping ◽  
Personalised Feedback

AbstractReducing saturated fat (SFA) intake can lower low-density lipoprotein (LDL)-cholesterol and thereby cardiovascular disease (CVD) but there are no brief interventions sufficiently scalable to achieve this. The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study developed and tested a behavioural intervention to provide health professional (HP) advice alone or in combination with personalised feedback on food shopping, which was delivered using a bespoke tool that created a nutritional profile of the grocery shopping based on loyalty card data from the UK largest supermarket.Participants with raised LDL-cholesterol were randomly allocated to one of three groups: ‘No Intervention’ (n = 17), ‘Brief Support’ (BS, n = 48), ‘Brief Support plus Shopping Feedback’ (BSSF, n = 48). BS consisted of a 10-minute consultation with a nurse to inform and motivate participants to reduce their SFA intake. The BSSF group received brief support as well as personalised feedback on the SFA content of their grocery shopping including lower SFA swaps. The primary outcome was the between-group difference in the change between baseline and 3 months in SFA intake (% total energy intake) adjusted for baseline SFA intake and GP practice. The trial was powered to detect a reduction in SFA of 3% (SD3).There was no evidence of a difference between the groups. Changes in SFA intake from baseline to follow-up were: -0.7% (SD3.5) in BS, -0.9% (SD3.6) in BSSF and -0.1% (SD3.3) with no intervention. Compared to no intervention, the adjusted difference in SFA intake was -0.33%; 95%CI -2.11, 1.44 with BS and -0.11%; 95%CI -1.92, 1.69 with BSSF. There was no significant difference in total energy intake (BS: -152kcal; 95%CI -513, 209; BSSF: -152kcal; 95%CI -516, 211); body weight (BS: -1.0 kg; 95%CI -2.5, 0.5; BSSF: -0.6 kg 95%CI -2.1, 1.0); or LDL-cholesterol (BS: -0.15mmol/L; 95%CI -0.47, 0.16; BSSF: -0.04mmol/L; 95%CI -0.28, 0.36) compared to no intervention.This trial shows that it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and we have developed a system to provide personalised advice to encourage healthier choices using supermarket loyalty data. This small trial showed no evidence of large benefits but we are unable to exclude more modest benefits. Even a reduction of 1% in SFA intake when replaced by polyunsaturated fat may reduce CVD incidence by 8%, suggesting that a larger trial to assess whether benefits of this size may occur is now warranted.

scholarly journals Reducing weight and increasing physical activity in people at high risk of cardiovascular disease: a randomised controlled trial comparing the effectiveness of enhanced motivational interviewing intervention with usual care

Heart ◽  
2019 ◽  
Vol 106 (6) ◽  
pp. 447-454 ◽  
Author(s):  
Khalida Ismail ◽  
Adam Bayley ◽  
Katherine Twist ◽  
Kurtis Stewart ◽  
Katie Ridge ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Motivational Interviewing ◽  
Controlled Trial ◽  
Mean Difference ◽  
Behaviour Change Techniques ◽  
Cvd Risk ◽  
Secondary Outcomes ◽  
Randomised Controlled

ObjectiveThe epidemic of obesity is contributing to the increasing prevalence of people at high risk of cardiovascular disease (CVD), negating the medical advances in reducing CVD mortality. We compared the clinical and cost-effectiveness of an intensive lifestyle intervention consisting of enhanced motivational interviewing in reducing weight and increasing physical activity for patients at high risk of CVD.MethodsA three-arm, single-blind, parallel-group randomised controlled trial was conducted in consenting primary care centres in south London. We recruited patients aged 40–74 years with a QRisk2 score ≥20.0%, which indicates the probability of having a CVD event in the next 10 years. The intervention was enhanced motivational interviewing which included additional behaviour change techniques and was delivered by health trainers in 10 sessions over 1 year, in either group (n=697) or individual (n=523) format. The third arm received usual care (UC; n=522). The primary outcomes were physical activity (mean steps/day) and weight (kg). Secondary outcomes were changes in low-density lipoprotein cholesterol and CVD risk score. We estimated the relative cost-effectiveness of each intervention.ResultsAt 24 months, the group and individual interventions were not more effective than UC in increasing physical activity (mean difference=70.05 steps, 95% CI −288.00 to 147.90 and mean difference=7.24 steps, 95% CI −224.01 to 238.50, respectively), reducing weight (mean difference=−0.03 kg, 95% CI −0.49 to 0.44 and mean difference=−0.42 kg, 95% CI −0.93 to 0.09, respectively) or improving any secondary outcomes. The group and individual interventions were not cost-effective at conventional thresholds.ConclusionsEnhancing motivational interviewing with additional behaviour change techniques was not effective in reducing weight or increasing physical activity in those at high CVD risk.

scholarly journals Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

2017 ◽  
Author(s):  
Michelle A. Briggs ◽  
Kristina S. Petersen ◽  
Penny M. Kris-Etherton
Keyword(s):  
Cardiovascular Disease ◽  
Fatty Acids ◽  
Unsaturated Fatty Acids ◽  
Saturated Fatty Acids ◽  
Saturated Fat ◽  
Dietary Guidelines ◽  
Dietary Recommendations ◽  
Cvd Risk ◽  
Dairy Fat ◽  
Refined Carbohydrates

Dietary recommendations to decrease the risk of cardiovascular disease (CVD) have focused on reducing intake of saturated fatty acids (SFA) for more than 50 years. While the 2015-2020 Dietary Guidelines for Americans advise substituting both monounsaturated and polyunsaturated fatty acids for SFA, evidence supports other nutrient substitutions that will also reduce CVD risk. For example, replacing SFA with whole grains, but not refined carbohydrates, reduces CVD risk. Replacing SFA with protein, especially plant protein may also reduce CVD risk. While dairy fat (milk, cheese) is associated with a slightly lower CVD risk compared to meat, dairy fat results in a significantly greater CVD risk relative to unsaturated fatty acids. As research continues, we will refine our understanding of dietary patterns associated with lower CVD risk.

P4.03 ORAL LYCOPENE SUPPLEMENTATION IMPROVES ENDOTHELIAL FUNCTION IN PATIENTS WITH CARDIOVASCULAR DISEASE: A RANDOMISED CONTROLLED TRIAL

2012 ◽  
Vol 6 (4) ◽  
pp. 183
Author(s):  
P.R. Gajendragadkar ◽  
A. Hubsch ◽  
K. Mäki-Petäjä ◽  
M. Serg ◽  
I.B. Wilkinson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Randomised Controlled Trial ◽  
Endothelial Function ◽  
Controlled Trial ◽  
Randomised Controlled

scholarly journals Snacking on whole almonds for 6 weeks improves endothelial function and lowers LDL cholesterol but does not affect liver fat and other cardiometabolic risk factors in healthy adults: the ATTIS study, a randomized controlled trial

2020 ◽  
Vol 111 (6) ◽  
pp. 1178-1189 ◽  
Author(s):  
Vita Dikariyanto ◽  
Leanne Smith ◽  
Lucy Francis ◽  
May Robertson ◽  
Eslem Kusaslan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Endothelial Function ◽  
Cardiometabolic Risk ◽  
Ldl Cholesterol ◽  
Mean Difference ◽  
Liver Fat ◽  
Average Risk ◽  
Randomized Controlled

Abstract Background There is convincing evidence that daily whole almond consumption lowers blood LDL cholesterol concentrations, but effects on other cardiometabolic risk factors such as endothelial function and liver fat are still to be determined. Objectives We aimed to investigate whether isoenergetic substitution of whole almonds for control snacks with the macronutrient profile of average snack intakes, had any impact on markers of cardiometabolic health in adults aged 30–70 y at above-average risk of cardiovascular disease (CVD). Methods The study was a 6-wk randomized controlled, parallel-arm trial. Following a 2-wk run-in period consuming control snacks (mini-muffins), participants consumed either whole roasted almonds (n = 51) or control snacks (n = 56), providing 20% of daily estimated energy requirements. Endothelial function (flow-mediated dilation), liver fat (MRI/magnetic resonance spectroscopy), and secondary outcomes as markers of cardiometabolic disease risk were assessed at baseline and end point. Results Almonds, compared with control, increased endothelium-dependent vasodilation (mean difference 4.1%-units of measurement; 95% CI: 2.2, 5.9), but there were no differences in liver fat between groups. Plasma LDL cholesterol concentrations decreased in the almond group relative to control (mean difference −0.25 mmol/L; 95% CI: −0.45, −0.04), but there were no group differences in triglycerides, HDL cholesterol, glucose, insulin, insulin resistance, leptin, adiponectin, resistin, liver function enzymes, fetuin-A, body composition, pancreatic fat, intramyocellular lipids, fecal SCFAs, blood pressure, or 24-h heart rate variability. However, the long-phase heart rate variability parameter, very-low-frequency power, was increased during nighttime following the almond treatment compared with control (mean difference 337 ms2; 95% CI: 12, 661), indicating greater parasympathetic regulation. Conclusions Whole almonds consumed as snacks markedly improve endothelial function, in addition to lowering LDL cholesterol, in adults with above-average risk of CVD. This trial was registered at clinicaltrials.gov as NCT02907684.

scholarly journals Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003385
Author(s):  
Carmen Piernas ◽  
Paul Aveyard ◽  
Charlotte Lee ◽  
Melina Tsiountsioura ◽  
Michaela Noreik ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Ldl Cholesterol ◽  
Controlled Trial ◽  
Saturated Fat ◽  
Personalized Feedback ◽  
Randomized Controlled ◽  
Brief Advice ◽  
Loyalty Card

Background Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data. Methods and findings The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to “Brief Support” (BS, n = 48), “Brief Support + Shopping Feedback” (SF, n = 48) or “Control” (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = −0.1% (95% CI −1.8 to 1.7), BS = −0.7% (95% CI −1.8 to 0.3), SF = −0.9% (95% CI −2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = −0.33% [95% CI −2.11 to 1.44], p = 0.709; SF versus control = −0.11% [95% CI −1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = −0.5% (95% CI −2.3 to 1.2), BS = −1.3% (95% CI −2.3 to −0.3), SF = −1.5% (95% CI −2.5 to −0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = −0.14 mmol/L [95% CI −0.48, 0.19), BS: −0.39 mmol/L [95% CI −0.59, −0.19], SF: −0.14 mmol/L [95% CI −0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings. Conclusions In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level. Trial registration ISRCTN14279335.

scholarly journals Tree nuts and the lipid profile: a review of clinical studies

2006 ◽  
Vol 96 (S2) ◽  
pp. S68-S78 ◽  
Author(s):  
Amy E. Griel ◽  
Penny M. Kris-Etherton
Keyword(s):  
Ldl Cholesterol ◽  
Unsaturated Fatty Acids ◽  
Saturated Fat ◽  
Healthy Foods ◽  
Cvd Risk ◽  
Cholesterol Lowering ◽  
Tree Nuts ◽  
Unsaturated Fat ◽  
Lipids And Lipoproteins ◽  
Fat Diets

Tree nuts have a fatty acid profile that favourably affects blood lipids and lipoproteins. They are low in saturated fat and high in unsaturated fatty acids and are rich sources of other nutrients. An extensive database consistently shows total and LDL cholesterol-lowering effects of diets low in saturated fat and cholesterol and high in unsaturated fat provided by a variety of tree nuts. Collectively, a summary of studies conducted to date shows that tree nuts reduce LDL cholesterol by 3–19 % compared with Western and lower-fat diets. Nuts also contain many nutrients and bioactive compounds that appear to contribute to the favourable effects on lipids and lipoproteins – these include plant sterols, dietary fibre and antioxidants. Because of their unique nutrient profile, nuts can be part of a diet that features multiple heart-healthy foods resulting in a cholesterol lowering response that surpasses that of cholesterol-lowering diets typically used to reduce CVD risk.

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