Nuts and Cardio-Metabolic Disease: A Review of Meta-Analyses

Legumes and nuts intake in relation to metabolic health status, serum brain derived neurotrophic factor and adropin levels in adults

There is controversial evidence about the relationship between consumption of legumes and nuts with metabolic disturbances. The present study was undertaken to explore the association of legumes and nuts intake with metabolic health status among Iranian adults. This cross-sectional study was conducted on 527 adults (45.7% female, aged 20-65 years) chosen through a multistage cluster random-sampling approach. Dietary intakes of individuals were assessed using a validated food frequency questionnaire. Fasting blood samples were gathered to evaluate biochemical parameters. Metabolic health status of subjects was determined according to the criteria defined by Wildman. Data of covariates were collected using pre-tested procedures. The overall prevalence of metabolic unhealthy (MU) phenotype was 42.5%. After controlling all confounders, participants with highest intake of legumes and nuts had lower odds of MU status, compared with the lowest intake (OR 0.35; 95% CI 0.18-0.71). This association was stronger in normal-weight rather than overweight/obese adults and also in women rather than men. Higher consumption of legumes and nuts was additionally related to decreased odds of hyperglycemia, hypertriglyceridemia, and hypertension. A marginally inverse association was observed between legumes and nuts intake with low brain-derived neurotrophic factor (BDNF) levels, in fully-adjusted model (ORT3 vs. T1 0.50; 95% CI 0.25-1.01). Each tertile increase in legumes and nuts intake was marginally related to higher adropin levels ([Formula: see text] = 4.06; P = 0.07). In conclusion, this study demonstrated that higher intake of legumes and nuts is associated with lower chance of MU both in normal weight and overweight/obese adults. The association may be facilitated through serum BDNF and adropin.

Perspective: Challenges and Future Directions in Clinical Research with Nuts and Berries

Consumption of nuts and berries are considered part of a healthy eating pattern. Nuts and berries contain a complex nutrient profile consisting of essential vitamins and minerals, fiber, polyunsaturated fatty acids, and phenolics in quantities that improve physiological outcomes. The spectrum of health outcomes that may be impacted by the consumptions of nuts and berries includes cardiovascular, gut microbiome, and cognitive, among others. Recently, new insights regarding the bioactive compounds found in both nuts and berries have reinforced their role for use in precision nutrition efforts. However, challenges exist that can affect the generalizability of outcomes from clinical studies, including inconsistency in study designs, homogeneity of test populations, variability in test products and control foods, and assessing realistic portion sizes. Future research centered on precision nutrition and multi-omics technologies will yield new insights. These and other topics such as funding streams and perceived risk-of-bias were explored at an international nutrition conference focused on the role of nuts and berries in clinical nutrition. Successes, challenges, and future directions with these foods are presented here.

Higher versus lower nut consumption and changes in cognitive performance over two years in a population at risk of cognitive decline: a cohort study

BACKGROUND

Tree nuts and peanuts (henceforth, nuts) are nutrient-dense foods rich in neuroprotective components; thus, their consumption could benefit cognitive health. However, evidence to date is limited and inconsistent regarding the potential benefits of nuts for cognitive function.

OBJECTIVE

To prospectively evaluate the association between nut consumption and 2-y changes in cognitive performance in older adults at cognitive decline risk.

METHODS

A total of 6,630 participants aged 55 to 75 y (mean age 65.0±4.9 y, 48.4% women) with overweight/obesity and metabolic syndrome completed a validated semi-quantitative food frequency questionnaire and a comprehensive battery of neuropsychological tests at baseline and a 2-y follow-up. Composite cognitive scores were used to assess global, general, attention, and executive function domains. Nut consumption was categorized as <1, ≥1 to <3, ≥3 to <7, and ≥7 servings/wk (1 serving=30 g). Multivariable-adjusted linear regression models were fitted to assess associations between baseline nut consumption and 2-y cognitive changes.

RESULTS

Nut consumption was positively associated with 2-y changes in general cognitive function (P-trend <0.001). Compared with participants consuming <1 serving/wk of nuts, those categorized as consuming ≥3 to <7 and ≥7 servings/wk showed more favorable changes in general cognitive performance (β z-score [95% CI] = 0.06 [0.00,0.12] and 0.13 [0.06,0.20], respectively). No significant changes were observed in the multivariable-adjusted models for other cognitive domains assessed.

CONCLUSION

Frequent nut consumption was associated with a smaller decline in general cognitive performance over 2 y in older adults at risk of cognitive decline. Randomized clinical trials to verify our findings are warranted.

Nutritional recommendations in the prevention and treatment of atherogenic dyslipidemia

The incorporation of a healthy diet, regular physical exercise and smoking cessation are the initial measures to reduce cardiovascular risk in patients with atherogenic dyslipidemia. In these patients, the nutritional quality of their diet should be improved, replacing foods with a greater atherogenic effect for others with a healthier effect. There is strong evidence that plant-based dietary patterns, low in saturated fatty acids, cholesterol and sodium, with a high content of fiber, potassium and unsaturated fatty acids, are beneficial and reduce the expression of cardiovascular risk factors. This document focuses on the role of nutrition in the prevention and treatment of atherogenic dyslipidemia, providing current evidence to serve as a tool for health professionals in its clinical management. To facilitate the reading of these recommendations, they are presented in a user-friendly table format, with a hierarchy of different levels of evidence.

The Role of Diet in Children with Psoriasis: Emerging Evidence and Current Issues

Psoriasis is an immune-mediated inflammatory systemic disease with skin tropism and chronic relapsing course; it is associated with an increased cardiovascular risk and with many metabolic comorbidities, emerging during childhood in 22–33% of cases. Diet influences the presentation and the clinical course of inflammatory diseases, including psoriasis; in particular, it was shown that a Mediterranean, gluten-free, or low-calorie diet may positively affect disease control in adult patients with psoriasis and adequate pharmacological therapy. These three dietary regimens may play a role also in children with psoriasis. It has been demonstrated that pediatric psoriasis is associated with psychological stress, celiac disease, and obesity, which may be positively influenced by these dietary regimens, respectively. Therefore, the expertise of multiple health figures (gastroenterologists, nutritionists, pediatricians, dermatologists) is required to plan a tailor-made dietary strategy, ensuring good growth, through an adequate intake of essential micro- and macronutrients and, at the same time, impacting the pro-inflammatory biochemical profile and on the associated cardiovascular risk of psoriasis disease.

Phytochemicals and Biological Activities of Walnut Septum: A Systematic Review

In the last few decades, scientific evidence has stressed the importance of plants in the prevention and/or supportive treatment of a plethora of diseases, many of them chronic, age-associated disorders. Juglans regia L. is a traditional plant that has been integrated into traditional medicine since ancient times. Due to the presence of biologically active compounds, walnut was used in the treatment of various maladies. Recently, investigations have focused on the walnut by-products and waste products, with research on their valuable constituents and active properties. Among these secondary products, walnut septum was analyzed in several studies, its phytochemical profile described, and some of the biological activities examined. However, compared to other walnut by-products, no comprehensive review to gather all the pertinent scientific knowledge was found in the literature. Therefore, the aim of this study was to critically assess the information furnished by peer-reviewed articles regarding the walnut septum chemical composition and the related biological activities, including antioxidant activities, anti-inflammatory effects, antimicrobial properties, antidiabetic activities, anti-tumor properties, and anti-aging potential. In conclusion, as these preclinical studies showed that walnut septum metabolites were responsible for a wide range of preventive and therapeutic uses, further research should confirm the beneficial outcomes in clinical trials.

Effect of Nuts on Markers of Inflammation and Oxidative Stress: A Narrative Review

Oxidative stress and inflammation are mediators in the pathophysiology of several non-communicable diseases (NCDs). Tree nuts and peanuts lower risk factors of cardiometabolic disease, including blood lipids, blood pressure and insulin resistance, among others. Given their strong antioxidant/anti-inflammatory potential, it is plausible that nuts may also exert a favorable effect on inflammation and oxidative stress. Evidence from systematic reviews and meta-analyses of cohort studies and randomized controlled trials (RCTs) suggest a modest protective effect of total nuts; however, the evidence is inconsistent for specific nut types. In this narrative review, the state of evidence to date is summarized for the effect of nut intake on biomarkers of inflammation and oxidative stress, and an attempt is made to define the gaps in research while providing a framework for future research. Overall, it appears that some nuts, such as almonds and walnuts, may favorably modify inflammation, and others, such as Brazil nuts, may favorably influence oxidative stress. There is a pressing need for large RCTs with an adequate sample size that consider different nut types, and the dose and duration of nut intervention, while evaluating a robust set of biomarkers for inflammation and oxidative stress. Building a stronger evidence base is important, especially since oxidative stress and inflammation are mediators of many NCDs and can benefit both personalized and public health nutrition.

Nuts and seeds consumption and risk of cardiovascular disease, type 2 diabetes and their risk factors: a systematic review and meta-analysis

Objectives

We aimed to systematically review studies and evaluate the strength of the evidence on nuts/seeds consumption and cardiometabolic diseases and their risk factors among adults.

Methods

A protocol was pre-registered in PROSPERO (CRD42021270554). We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials and Scopus up to September 20, 2021 for prospective cohort studies and ≥12-week randomized controlled trials (RCTs). Main outcomes were cardiovascular disease (CVD), coronary heart disease (CHD), stroke and type 2 diabetes (T2D), secondary total-/low density lipoprotein (LDL)-cholesterol, blood pressure and glycaemic markers. Data extraction and risk of bias (RoB) assessments (using RoB 2.0 and RoB-NObS) were performed in duplicate. Effect sizes were pooled using random-effects meta-analyses and expressed as relative risk (RR) or weighted mean differences with 95% confidence intervals (CI); heterogeneity quantified as I ². One-stage dose-response analyses assessed the linear and non-linear associations with CVD, CHD, stroke and T2D. The strength of evidence was classified per the World Cancer Research Fund criteria.

Results

After screening 23,244 references, we included 42 papers from cohort studies (28 unique cohorts, 1,890,573 participants) and 18 RCTs (2,266 participants). In the cohorts, mainly populations with low consumption, high versus low total nuts/seeds consumption was inversely associated with total CVD (RR 0.81; 95% CI 0.75, 0.86; I ² = 67%), CVD mortality (0.77; 0.72, 0.82; I ² = 59.3%), CHD (0.82; 0.76, 0.89; I ² = 64%), CHD mortality (0.75; 0.65, 0.87; I ² = 66.9%) and non-fatal CHD (0.85; 0.75, 0.96; I ² = 62.2%). According to the non-linear dose-response analyses, consumption of 30 g/day of total nuts/seeds was associated with RRs of similar magnitude. For stroke and T2D the summary RR for high versus low intake was 0.91 (95% CI 0.85, 0.97; I ² = 24.8%) and 0.95 (0.75, 1.21; I ² = 82.2%). Intake of nuts (median ~50 g/day) lowered total (-0.15 mmol/L; -0.22, -0.08; I ² = 31.2%) and LDL-cholesterol (-0.13 mmol/L; -0.21, -0.05; I ² = 68.6%), but not blood pressure. Findings on fasting glucose, HbA1c and insulin resistance were conflicting. The results were robust to sensitivity and subgroup analyses. We rated the associations between nuts/seeds and both CVD and CHD as probable. There was limited but suggestive evidence for no association with stroke. No conclusion could be made for T2D.

Conclusion

There is a probable relationship between consumption of nuts/seeds and lower risk of CVD, mostly driven by CHD, possibly in part through effects on blood lipids. More research on stroke and T2D may affect the conclusions. The evidence of specific nuts should be further investigated.

Cardiometabolic diseases, polygenic risk score, APOE genotype, and risk of incident dementia: A population-based prospective cohort study

Objective We aimed to prospective investigate the association between cardiometabolic diseases (CMDs) with dementia, and to examine whether genetic factors and CMDs jointly contribute to the incidence of dementia. Methods We used data from the UK biobank of 204,646 adults aged 37-73 free of dementia at baseline. Genetic risk for dementia including APOE ε4 status and polygenic risk score (PRS) categorized as low, intermediate, and high. CMDs including ischemic heart disease (IHD), stroke, and type 2 diabetes (T2D) were confirmed by touchscreen questionnaires, medical examinations, and hospital inpatient records. Results Over the follow-up (median: 12.5 years), 5,750 participants developed dementia. The HRs (95% CI) of those with APOE ε4 carriers and high PRS were 3.16 (3.00-3.33) and 1.50 (1.41-1.60), respectively. The risk of dementia was 70% higher among those with CMDs (HR: 1.70; 95% CI: 1.60-1.82). In joint effect analyses, compared to no CMDs and APOE ε4 non-carriers, the HRs (95% CIs) of dementia were 3.53 (3.31-3.76)/2.06 (1.89-2.23) in participants with only APOE ε4 carriers and CMDs, and 5.06 (4.64-5.53) for those with APOE ε4 carriers plus CMDs. Compared to no CMDs and low PRS, the HRs (95% CIs) of dementia were 1.29 (1.19-1.40)/1.60 (1.48-1.73) in participants with only intermediate and high PRS, and 2.00 (1.79-2.23)/2.63 (2.38-2.92) for those with intermediate, and high PRS plus CMDs. Moreover, there were significant additive and multiplication interactions between CMDs and APOE ε4 carriers of dementia, but only multiplication interaction was observed for PRS. Conclusions CMDs were associated with higher risk of dementia regardless of genetic risk for dementia.

Consumption of Nuts and Seeds and Health Outcomes Including Cardiovascular Disease, Diabetes and Metabolic Disease, Cancer, and Mortality: An Umbrella Review

Consumption of nuts and seeds is associated with a range of health outcomes. Summarizing the best evidence on essential health outcomes from the consumption of nuts is essential to provide optimal recommendations. Our objective is to comprehensively assess health outcome associations related to the consumption of nuts and seeds, using a culinary definition including tree nuts and peanuts (registered in PROSPERO: CRD42021258300). Health outcomes of interest include cardiovascular disease, cancer, diabetes, obesity, respiratory disease, mortality, and their disease biomarkers. We present associations for high compared with low consumption, per serving, and dose-response relations. MEDLINE, Embase, Cochrane, and Epistemonikos were searched and screened for systematic reviews and meta-analyses. Evidence was extracted from 89 articles on the consumption of nuts and relevant health outcomes, including 23 articles with meta-analysis on disease and mortality, 66 articles on biomarkers for disease, and 9 articles on allergy/adverse outcomes. Intake of nuts was associated with reduced risk of cardiovascular diseases and related risk factors, with moderate quality of evidence. An intake of 28 g/d nuts compared with not eating nuts was associated with a 21% RR reduction of cardiovascular disease (including coronary heart disease incidence and mortality, atrial fibrillation, and stroke mortality), an 11% risk reduction of cancer deaths, and 22% reduction in all-cause mortality. Nut consumption was also inversely associated with mortality from respiratory diseases, infectious diseases, and diabetes; however, associations between nut consumption and diabetes incidence were mixed. Meta-analyses of trials on biomarkers for disease generally mirrored meta-analyses from observational studies on cardiovascular disease, cancers, and diabetes. Allergy and related adverse reactions to nuts were observed in 1-2% of adult populations, with substantial heterogeneity between studies. Overall, the current evidence supports dietary recommendations to consume a handful of nuts and seeds per day for people without allergies to these foods.

A Slight Adjustment of the Nutri-Score Nutrient Profiling System Could Help to Better Reflect the European Dietary Guidelines Regarding Nuts

The consumption of nuts remains low among European populations despite widespread inclusion as a recommended food group across European dietary guidelines. Front-of-Pack nutrition labelling systems are designed to support consumers make healthier choices and to stimulate product improvement, thus representing a pivotal opportunity to reduce the gap between intakes and recommendations. This study examined how the Nutri-Score algorithm treats nuts and nut-containing products and tested whether slight adjustments could better recognise and motivate nut inclusion in foods and diets. The nutritional score (ScN) and corresponding Nutri-Score letter of 68 nuts and nut-containing products were calculated, using the initial algorithm and slight adjustments, where nut weight was doubled (S1), saturated fats (S2) or energy (S3) from nuts were discounted, or saturated fats were replaced by the saturated fats/lipid ratio (S4). The correlation between the nuts’ content and the ScN was moderate for the initial algorithm (R² = 0.34) and S1 (R² = 0.36), but improved for S2, S3 and S4 (R² = 0.54, 0.55 and 0.52, respectively). Four plain nuts, initially labelled as “B” or “C” obtained a Nutri-Score “A” with S2, S3 and S4. Slight adjustments could better align the Nutri-Score with food-based dietary guidelines, reassure consumers on healthfulness of nuts and nut-containing products, whilst incentivising the inclusion of nuts in diverse foods.

Nuts and Metabolic Syndrome: Reducing the Burden of Metabolic Syndrome in Menopause

Menopause imposes a dramatic fall in estrogens, which is followed by an increase in the proportion of fat. The rising androgen/estrogen ratio along the menopause transition favors the accumulation of central fat, which contributes to insulin resistance and a series of concatenated effects, leading to a higher incidence of metabolic syndrome. The modulatory effect of diet on the metabolic syndrome phenotype has been shown for the Mediterranean diet, and nuts are key determinants of these health benefits. This review of the impact of nuts on the risk factors of the metabolic syndrome cluster examined studies—prioritizing meta-analyses and systemic reviews—to summarize the potential benefits of nut ingestion on the risk of metabolic syndrome associated with menopause. Nuts have a general composition profile that includes macronutrients, with a high proportion of unsaturated fat, bioactive compounds, and fiber. The mechanisms set in motion by nuts have shown different levels of efficacy against the disturbances associated with metabolic syndrome, but a beneficial impact on lipids and carbohydrate metabolism, and a potential, but minimal reduction in blood pressure and fat accumulation have been found.

Nuts as a Part of Dietary Strategy to Improve Metabolic Biomarkers: A Narrative Review

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.

Perspective: Is it Time to Expand Research on "Nuts" to Include "Seeds"? Justifications and Key Considerations

The health benefits of nuts reported throughout the literature are extensive and well established for reducing the risk of, and managing several chronic conditions such as cardiovascular disease, type 2 diabetes, nonalcoholic fatty liver disease, and cognition. Despite their comparable nutrient profile to nuts, seeds are often not assessed in clinical and epidemiological studies. Interestingly, dietary guidelines and recommendations often refer to "nuts and seeds" collectively, even though they are not consistently examined together in nutrition research when determining associated health benefits. The purpose of this review is to call for future nutrition research to consider combining nuts and seeds. This review provides justification for this proposal by summarizing current definitions for nuts and seeds and highlighting the similarities or dissimilarities in their nutrient compositions. Following this, we summarize current evidence on the health benefits of nuts and seeds, research gaps that should be addressed, and considerations for future research using both epidemiological and interventional study designs.

The Regular Consumption of Nuts Is Associated with a Lower Prevalence of Abdominal Obesity and Metabolic Syndrome in Older People from the North of Spain

Background: The aim of this study was to relate the adherence to nut consumption (30 g) three or more days per week to the prevalence of abdominal obesity and metabolic syndrome (MetS) in an elderly population from the north of Spain. Methods: The study consists of an observational, descriptive, cross-sectional, and correlational study conducted in 556 non-institutionalised individuals between 65 and 79 years of age. To define the consumption recommendation of nuts the indication of the questionnaire MEDAS-14 was followed. The diagnosis of MetS was conducted using the International Diabetes Federation (IDF) criteria. Results: In 264 subjects aged 71.9 (SD: ±4.2) years old, 39% of whom were men, the adherence to nut consumption recommendations was 40.2%. Of these individuals, 79.5% had abdominal obesity. The prevalence of MetS was 40.2%, being 47.6% in men and 35.4% in women (p < 0.05). A nut consumption lower than recommended was associated with a 19% higher prevalence of abdominal obesity (Prevalence Ratio: 1.19; 95% CI: 1.03−1.37; p < 0.05) and a 61% higher prevalence of MetS (Prevalence Ratio: 1.61; 95% CI: 1.16−2.25; p = 0.005) compared to a consumption of ≥3 servings per week. Conclusion: An inverse relationship was established between nut consumption and the prevalence of abdominal obesity and metabolic syndrome.

Consumption of pistachio nuts positively affects lipid profiles: A systematic review and meta-analysis of randomized controlled trials

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of consuming pistachio nuts on lipid profiles (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglyceride [TG]). Databases of PubMed, Scopus, ISI Web of Science, and Cochrane Library were searched from inception to June 2019 to identify RCTs documenting the effects of consuming pistachio nuts on blood lipid profiles in adults. Effect sizes were reported as weighted mean difference (WMD) and 95% confidence interval (CI) using the random-effects models (DerSimonian-Laird method). Twelve eligible RCTs were included. Consumption of pistachio nuts decreased TC (WMD: -7.48 mg/dL; 95% CI, -12.62 to -2.34), LDL-C (WMD: -3.82 mg/dL; 95% CI, -5.49 to -2.16) and TG (WMD: -11.19 mg/dL; 95% CI, -14.21 to -8.17) levels. However, HDL-cholesterol levels (WMD: 2.45 mg/dL; 95% CI, -2.44 to 7.33) did not change following pistachio consumption. Consuming pistachio nuts may improve lipid profiles (TC, LDL-C, TG) in adults and may be protective against cardiometabolic diseases. However, further studies with larger sample sizes are required to confirm these results.

Mediterranean diet and cognitive function: From methodology to mechanisms of action

The traditional Mediterranean diet (MedDiet), rich in minimally processed plant foods and fish, has been widely recognized to be one of the healthiest diets. Data from multiple randomized clinical trials have demonstrated its powerful effect against oxidative stress, inflammation and the development and progression of cardiovascular disease, type 2 diabetes, and other metabolic conditions that play a crucial role in the pathogenesis of neurodegenerative diseases. The protecting effects of the MedDiet against cognitive decline have been investigated in several observational and experimental studies. Data from observational studies suggest that the MedDiet may represent an effective dietary strategy for the early prevention of dementia, although these findings require further substantiation in clinical trials which have so far produced inconclusive results. Moreover, as we discuss in this review, accumulating data emphasizes the importance of: 1) maintaining an optimal nutritional and metabolic status for the promotion of healthy cognitive aging, and 2) implementing cognition-sparing dietary and lifestyle interventions during early time-sensitive windows before the pathological cascades turn into an irreversible state. In summary, components of the MedDiet pattern, such as essential fatty acids, polyphenols and vitamins, have been associated with reduced oxidative stress and the current evidence from observational studies seems to assign to the MedDiet a beneficial role in promoting brain health; however, results from clinical trials have been inconsistent. While we advocate for longitudinal analyses and for larger and longer clinical trials to be conducted, we assert our interim support to the use of the MedDiet as a protective dietary intervention for cognitive function based on its proven cardiovascular and metabolic benefits.

Nut Consumption Is Associated with Lower Risk of Metabolic Syndrome and Its Components in Type 1 Diabetes

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 (<1.00 mmol/L in men and <1.30 mmol/L in women or use of lipid-lowering medication), and hyperglycaemia. Overweight/obesity was defined as a BMI ≥25 kg/m². HbA_1c > 59 mmol/mol (>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 <2 and ≥2 weekly servings, was associated with lower metabolic syndrome score, waist circumference, HbA_1c, and BMI. Nut consumption as a continuous variable was negatively associated with the presence of metabolic syndrome, its blood pressure, triglyceride, and HDL-cholesterol components, and suboptimal glycaemic control. Consumption of ≥2 weekly servings was associated with lower odds of suboptimal glycaemic control (by 51.5%), overweight/obesity (by 33.4%), and metabolic syndrome (by 51.8%) and meeting the waist (by 37.3%), blood pressure (by 44.5%), triglyceride (by 37.7%), and HDL-cholesterol (by 36.2%) components of the metabolic syndrome. In conclusion, a weekly nut intake of ≥2 servings was beneficially associated with all the components of the metabolic syndrome in type 1 diabetes. The causality of this association will need to be investigated.

Plant-based snacking: research and practical applications of pistachios for health benefits

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.

Nuts: Natural Pleiotropic Nutraceuticals

Common nuts (tree nuts and peanuts) are energy-dense foods that nature has gifted with a complex matrix of beneficial nutrients and bioactives, including monounsaturated and polyunsaturated fatty acids, high-quality protein, fiber, non-sodium minerals, tocopherols, phytosterols, and antioxidant phenolics. These nut components synergize to favorably influence metabolic and vascular physiology pathways, ameliorate cardiovascular risk factors and improve cardiovascular prognosis. There is increasing evidence that nuts positively impact myriad other health outcomes as well. Nut consumption is correlated with lower cancer incidence and cancer mortality, and decreased all-cause mortality. Favorable effects on cognitive function and depression have also been reported. Randomized controlled trials consistently show nuts have a cholesterol-lowering effect. Nut consumption also confers modest improvements on glycemic control, blood pressure (BP), endothelial function, and inflammation. Although nuts are energy-dense foods, they do not predispose to obesity, and in fact may even help in weight loss. Tree nuts and peanuts, but not peanut butter, generally produce similar positive effects on outcomes. First level evidence from the PREDIMED trial shows that, in the context of a Mediterranean diet, consumption of 30 g/d of nuts (walnuts, almonds, and hazelnuts) significantly lowered the risk of a composite endpoint of major adverse cardiovascular events (myocardial infarction, stroke, and death from cardiovascular disease) by ≈30% after intervention for 5 y. Impressively, the nut-supplemented diet reduced stroke risk by 45%. As they are rich in salutary bioactive compounds and beneficially impact various health outcomes, nuts can be considered natural pleiotropic nutraceuticals.

The effect of almond intake on anthropometric indices: a systematic review and meta-analysis

This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of almond intake on anthropometric indices in adult subjects. We searched PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar databases until January 2020 to identify relevant RCTs. Data were reported as weighted mean differences (WMDs) and standard deviations (SDs) to show the magnitude of effects of almond on body weight (BW), body mass index (BMI), waist circumference (WC), fat mass (FM), and fat-free mass (FFM). Out of 2983 reports, 28 RCTs (37 arms) were eligible for including in our meta-analysis. The pooled results, obtained using a random-effects model, showed that almond intake significantly decreased BW (WMD: -0.38 kg, 95% CI: -0.65, -0.10, p = 0.007, I2 = 30.5%) and FM (WMD: -0.58 kg, 95% CI: -0.87, -0.28, p < 0.001, I2 = 4.9%). However, we found no significant effect of almond administration on BMI (WMD: -0.30 kg m-2, 95% CI: -0.67, 0.06, p = 0.101, I2 = 62.6%), WC (WMD: -0.60 cm, 95% CI: -1.28, 0.06, p = 0.078, I2 = 0.0%), and FFM (WMD: 0.23 kg, 95% CI: -0.04, 0.50, p = 0.097, I2 = 49.5%). Overall, the current meta-analysis demonstrated that resveratrol almond intake significantly reduced weight and FM, but did not affect BMI, WC, and FFM. Further studies are still required to confirm our results.

Total Nut, Tree Nut, and Peanut Consumption and Metabolic Status in Southern Italian Adults

Background: Nut consumption has been associated with cardio-metabolic health benefits. However, studies conducted in the Southern Italian population, where adherence to the Mediterranean diet has been reported being relatively high, are rather scarce. The aim of this study was to test the association between consumption of total and specific types of nuts and metabolic status among adults living in Sicily, Southern Italy. Methods: Demographic and dietary characteristics of 2044 adults living in Southern Italy were analyzed. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of the association between nut consumption and metabolic status adjusting for potential confounding factors. Results: The energy-adjusted model revealed that higher nut intake was inversely associated with occurrence of hypertension, type-2 diabetes, and dyslipidemia. However, the association did not remain significant for the latter after adjusting for the main background characteristics, while an inverse association was stably confirmed for hypertension (OR = 0.61, 95% CI: 0.46–0.80 and OR = 0.44, 95% CI: 0.26–0.74, respectively) even after adjusting for adherence to the Mediterranean diet. Among individual nut types, most of the associations were null except for higher almond intake, which was inversely associated with occurrence of hypertension (OR = 0.70, 95% CI: 0.49–0.99). Conclusions: Higher nut consumption is associated with overall better metabolic status in individuals living in the Mediterranean area.

Dietary Strategies by Foods with Antioxidant Effect on Nutritional Management of Dyslipidemias: A Systematic Review

Nutrition plays a fundamental role in the prevention and treatment of dyslipidemias and its oxidative-related complications. Currently, there is evidence about the beneficial effects of isolated antioxidants or foods enriched or added with antioxidant compounds. However, the application of the natural foods is more integrated than the analysis of a single nutrient. Our aim is compiling scientific literature regarding the nutritional strategies by foods with antioxidant effect in blood lipids, enzymatic and non-enzymatic antioxidants, and oxidative and inflammatory markers of subjects with dyslipidemia. We searched in MEDLINE/PubMed, Scopus, and Web of Science. From a total of 263 studies screened, 16 were included. Dietary strategies included walnuts, olive oil, raw almonds, G. paraguayase, white sesame, mate tea, Brazil nut flour, red wine, granulated Brazil nuts, grapes, wolfberry fruit, fermented beverage, coffee, orange, and blackberry juices showed significant differences in blood lipids, antioxidant activity, antioxidant enzymes, and oxidative and inflammatory markers. This systematic review compiling scientific studies about dietary strategies using foods with antioxidant effect to improve the antioxidant status in dyslipidemias.

Fibre Intake Is Associated with Cardiovascular Health in European Children

BACKGROUND

We aimed at analysing the association between dietary fibre intake during childhood and cardiovascular health markers.

METHODS

We used observational longitudinal analysis and recorded diet using 3-day diaries at the ages of 3, 4, 5, 6, and 8 years in children from the EU Childhood Obesity Project Trial. At the age of 8, waist circumference, systolic and diastolic blood pressure (SBP and DBP) and biochemical analyses (lipoproteins, triglycerides and homeostasis model for insulin resistance (HOMA-IR)) were evaluated. Those parameters were combined into a cardiometabolic risk score through the sum of their internal z-scores.

RESULTS

Four-hundred children (51.8% girls) attended to the 8-year visit with a 3-day diary. Adjusted linear regression models showed that children who repeatedly stayed in the lowest tertile of fibre intake during childhood had higher HOMA-IR (p = 0.004), higher cardiometabolic risk score (p = 0.02) and a nonsignificant trend toward a higher SBP at 8 years. The higher the dietary intake of soluble fibre (from fruits and vegetables) at 8 years, the lower the HOMA-IR and the cardiometabolic risk score (p = 0.002; p = 0.004). SBP was directly associated with fibre from potatoes and inversely with fibre from nuts and pulses.

CONCLUSION

A diet rich in dietary fibre from fruits, vegetables, pulses and nuts from early childhood was associated to a healthier cardiovascular profile, regardless of children's weight.

Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials

BACKGROUND

Previous experimental studies have reported that pistachios can elicit positive effects on lipid profile, blood pressure, and inflammation; however, a meta-analysis of the available evidence has yet to be performed.

OBJECTIVE

the aim of this study was to conduct systematic review and meta-analysis of the effect of pistachio enriched diets on cardiometabolic risk factors, such as weight, BMI, blood pressure, serum lipids, blood glucose, and inflammatory biomarkers.

DESIGN

A literature search was carried out for RCTs in medical databases, including PubMed/MEDLINE, Scopus, and Cochrane databases, with no time limitation up to August 2019, and conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines.

RESULTS

11 RCTs, with 506 participants, that reported the effect of pistachios consumption on cardiometabolic risk factors were included in this systematic review and meta-analysis. Our findings indicated that pistachios consumption significantly reduced FBS (WMD: -3.73, 95 % CI: -6.99, -0.46, I² = 99 %), TC/HDL (WMD: -0.46, 95 % CI: -0.76, -0.15, I² = 95 %), LDL/HDL (WMD: -0.24, 95 % CI: -0.38, -0.11, I² = 96 %), HbA1C (WMD: -0.14, 95 % CI: -0.26, -0.02, I² = 60 %), Insulin (WMD: -2.43, 95 % CI: -4.85, -0.001, I² = 58 %), SBP (WMD: -3.10, 95 % CI: -5.35, -0.85, I² = 63 %), and MDA (WMD: -0.36, 95 % CI: -0.49, -0.23, I² = 0%). Importantly, we did not observe adverse effects of pistachios consumption on BMI or blood pressure.

CONCLUSION

This systematic review and meta-analysis demonstrates that pistachios consumption can elicit a beneficial effect on some cardiometabolic risk factors. All previous clinical studies are well designed but some points have still remained unclear including the effects of different pistachios dosages on cardio metabolic risk factors and efficacy of pistachios consumption in preventing endothelial dysfunction. Further examination is required to determine the effect of pistachios consumption on further endothelial function risk factors.

Effects of Pistachio Consumption in a Behavioral Weight Loss Intervention on Weight Change, Cardiometabolic Factors, and Dietary Intake

Epidemiological studies have linked regular nut consumption with lower body mass index and reduced likelihood of weight gain in adulthood. Nuts can displace other foods in the diet, and thus, promote a healthier dietary pattern. The purpose of this study was to examine the effect of pistachio nut consumption in overweight/obese adults. This randomized controlled study enrolled non-diabetic overweight/obese adults (n = 100) assigned to a 4-month behavioral weight loss intervention only group (controls) or also prescribed 1.5 oz/day (42 g/day) of pistachios (pistachio group). Outcomes were change in body weight, cardiometabolic factors, and dietary intake. Percent weight change was similar in the two groups (−5.1 [0.5] (mean [SE])% in the control group and −4.9 [0.6]% in the pistachio group, and body mass index (BMI) and waist circumference were reduced in both groups (time effect p ≤ 0.05). The pistachio group (but not the control group) exhibited a significant reduction in both systolic and diastolic blood pressure (time effect p = 0.01). Plasma alpha-carotene, beta-carotene, and lutein concentrations increased significantly in the pistachio group (time effect p < 0.05). Pistachio consumption was associated with increased dietary fiber intake and decreased consumption of sweets. Regular consumption of pistachios was associated with a comparable degree of weight loss, and similar reductions in BMI and waist circumference, in overweight/obese men and women compared to controls, and favorable changes in the diet, in the context of a behavioral weight loss intervention.

Effects of Aging and Diet on Cardioprotection and Cardiometabolic Risk Markers

The prevalence of several diseases increases by age, including cardiovascular diseases, which are the leading cause of morbidity and mortality worldwide. Aging, as a complex process characterized by senescence, triggers various pathways, such as oxidative stress, systemic inflammation, metabolism dysfunction, telomere shortening, mitochondrial dysfunction and deregulated autophagy. A better understanding of the mechanisms underlying senescence may lead to the development of new therapeutic targets and strategies for age-related pathologies and extend the healthy lifespan. Modulating lifestyle risk factors and adopting healthy dietary patterns remain significant tools in delaying the aging process, decreasing age-associated comorbidities and mortality, increasing life expectancy and consequently, preventing the development of cardiovascular disease. Furthermore, such a strategy represents the most cost-effective approach, and the quality of life of the subjects may be significantly improved. An integrated, personalized approach targeting cardiometabolic aging and frailty is suggested in daily clinical practice. However, it should be initiated from an early age. Moreover, there is a need for further well designed and controlled studies in order to elucidate a link between the time of feeding, longevity and cardiovascular prevention. In the future, it is expected that the pharmacological treatment in cardioprotective management will be necessary, accompanied by equally important lifestyle interventions and adjunctive exercise.

Identification of Polymethylene-Interrupted Polyunsaturated Fatty Acids (PMI-PUFA) by Solvent-Mediated Covalent Adduct Chemical Ionization Triple Quadrupole Tandem Mass Spectrometry

Pine nuts and other edible gymnosperm seeds contain unusual, bioactive polymethylene-interrupted polyunsaturated fatty acids (PMI-PUFAs), a subset of nonmethylene-interrupted PUFA with (-CH₂-)_n≥2 intervening between double bonds. Conventional methods for structure elucidation of PMI-PUFAs require special derivatization risking rearrangement artifacts. Here we introduce a facile solvent-mediated (SM) covalent adduct chemical ionization (CACI) system modified with a triple quadrupole MS, which distinguishes PMI-PUFAs from their analogues in direct methyl ester form. The prominent Δ5 desaturated PMI-PUFAs exhibit characteristic fragmentation at C_6-7 to yield ω diagnostic ions and share their fragmentation pattern with normal methylene interrupted PUFAs for the α diagnostic ion. H^• transfer upon CID dissociation of PMI-PUFAs was found to be dependent on the relative position of isolated lone double bonds and cleavage points. Ginkgo and five species of pine nuts were characterized for their unique Δ5 fatty acid profile, without the need for chemical standards.

Aging Fits the Disease Criteria of the International Classification of Diseases

The disease criteria used by the World Health Organization (WHO) were applied to human biological aging in order to assess whether aging can be classified as a disease. These criteria were developed for the 11th revision of the International Classification of Diseases (ICD) and included disease diagnostics, mechanisms, course and outcomes, known interventions, and linkage to genetic and environmental factors. RESULTS: Biological aging can be diagnosed with frailty indices, functional, blood-based biomarkers. A number of major causal mechanisms of human aging involved in various organs have been described, such as inflammation, replicative cellular senescence, immune senescence, proteostasis failures, mitochondrial dysfunctions, fibrotic propensity, hormonal aging, body composition changes, etc. We identified a number of clinically proven interventions, as well as genetic and environmental factors of aging. Therefore, aging fits the ICD-11 criteria and can be considered a disease. Our proposal was submitted to the ICD-11 Joint Task force, and this led to the inclusion of the extension code for "Ageing-related" (XT9T) into the "Causality" section of the ICD-11. This might lead to greater focus on biological aging in global health policy and might provide for more opportunities for the new therapy developers.

Association of Adherence to Specific Mediterranean Diet Components and Cardiorespiratory Fitness in Young Adults

OBJECTIVE

Cardiorespiratory fitness (CRF) and a healthy diet may be part of an overall healthy lifestyle. The association between cardiorespiratory fitness and adherence to an overall Mediterranean Diet (MedD) pattern and specific MedD foods has been assessed.

DESIGN

Subjects completed a lifestyle survey and dietary pattern, using the validated MedD Adherence 14-item questionnaire and two self-reported 24-h dietary recalls. Participants' height, body weight, waist circumference (WC), and CRF (maximum oxygen uptake, VO2max, ml/kg/min) were measured.

SETTING

University of Cádiz, Spain.

SUBJECTS

A sample of young adults (n = 275, 22.2 ± 6.3 years).

RESULTS

Mean VO2max was 43.9 mL/kg/min (SD 8.5 mL/kg/min). Most participants had healthy CRF (75.9%). The average MedD score was 6.2 points (SD 1.8 points). Participants who consumed more servings of nuts had higher VO2max. Those who showed low CRF performed less physical activity (PA) and had a higher body mass index (BMI) and WC compared with those classified as having healthy CRF. Nut consumption was positively associated with VO2max (β = 0.320; 95% CI 2.4, 10.7; p < 0.002), adjusting for sex, age, smoking PA, BMI, WC, and energy intake, showing the subjects who consumed more nuts were fitter than young adults who consumed less.

CONCLUSIONS

CRF is positively associated with nut consumption but not with the overall MedD pattern and all other MedD foods in the young adults. The subjects who consumed more servings of nuts were fitter than young adults who consumed less. Moreover, fitter subjects performed more PA and had a lower BMI and WC than those who had lower fitness levels.

Effect of fatty fish or nut consumption on concentrations of persistent organic pollutants in overweight or obese men and women: A randomized controlled clinical trial

BACKGROUND AND AIMS

While excess energy intake and physical inactivity constitute the obvious causes of body fat accumulation, persistent organic pollutants (POPs) are novel factors that have been linked to cardiometabolic disorders. Major sources of POPs are animal fats including fatty fish. Given the putative protective effects of fish on cardiovascular disease, we explored whether high consumption of fatty fish increased serum concentrations of POPs.

METHODS AND RESULTS

Men and women aged 35-70 years with body mass index between 25 and 38 kg/m² and at least 1 cardiometabolic component were randomized to high intakes of fatty fish (mostly farmed salmon, ∼630 g/week; n = 45), high intakes of nuts (∼200 g/week; n = 42) or a control group following their usual diet but restricting fatty fish and nuts for 6 months (n = 44). Concentrations of 15 POPs (5 organochlorinated compounds, 2 dioxin-like polychlorinated biphenyls and 8 non-dioxin-like polychlorinated biphenyls) and cardiometabolic risk factors were measured at baseline and end of the study. Results showed that changes in concentrations of individual and classes of POPs did not differ between the dietary groups and controls (p > 0.05). Among cardiometabolic risk factors HDL-cholesterol increased in the fatty fish group compared to controls (+0.10 mmol/L, CI (0.05-0.20); p = 0.005) while no changes were observed in the group consuming nuts.

CONCLUSION

Fatty fish consumption for 6 months did not increase the serum concentrations of POPs in individuals with overweight or obesity and metabolic risk. While this finding appears reassuring regarding short-term intakes of farmed salmon, long term variations in POPs in adipose stores require further study.

Does Nut Consumption Reduce Mortality and/or Risk of Cardiometabolic Disease? An Updated Review Based on Meta-Analyses

Aim We aimed to determine if nut consumption decreases mortality and/or the risk of cardiometabolic diseases based on updated meta-analyses of epidemiological and intervention studies. Methods. An updated electronic search was conducted in PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library databases for original meta-analyses to investigate the effects of nut consumption on cardiometabolic disease in humans. Results. Seven new meta-analyses were included in this updated review. Findings similar to our previous review were observed, showing that nut consumption significantly decreased cardiovascular disease (CVD) mortality (−19% to −25%; n = 4), coronary heart disease (CHD) mortality (−24% to −30%; n = 3), stroke mortality (−17% to −18%; n = 3), CVD incidence (−15% to −19 %; n = 4), CHD [or coronary artery disease (CAD)] incidence (−17% to −34%; n = 8), and stroke incidence (−10% to −11%; n = 6) comparing high with low categories of nut consumption. Fasting glucose levels (0.08 to 0.15 mmol/L; n = 6), total cholesterol (TC; 0.021 to 0.30 mmol/L; n = 10), and low-density lipoprotein cholesterol (LDL-C; 0.017 to 0.26 mmol/L; n = 10) were significantly decreased with nut consumption compared with control diets. Body weight and blood pressure were not significantly affected by nut consumption. Conclusion. Nut consumption appears to exert a protective effect on cardiometabolic disease, possibly through improved concentrations of fasting glucose, total cholesterol, and LDL-C.

Effects of Consuming Almonds on Insulin Sensitivity and Other Cardiometabolic Health Markers in Adults With Prediabetes

Objective: This study was designed to assess the effects of replacing high-carbohydrate (CHO) foods with raw almonds on insulin sensitivity and cardiometabolic health markers in overweight or obese adults with prediabetes.Method: This randomized crossover study consisted of two 6-week dietary intervention periods, separated by a ≥ 4-week washout. Subjects incorporated 1.5 oz of raw almonds twice daily or isocaloric CHO-based foods into their diets, with instructions to maintain body weight. Dietary intakes as well as insulin sensitivity, CHO metabolism indices, lipoprotein lipids and particles, and inflammatory markers were assessed.Results: Thirty-three subjects (17 male, 16 female), mean age 48.3 ± 2.2 years and body mass index 30.5 ± 0.7 kg/m², provided evaluable data. Compared to CHO, almonds resulted in significantly (p < 0.01) higher intakes of protein, fat (unsaturated fatty acids), fiber, and magnesium and significantly (p < 0.001) lower intakes of CHO and sugars. No differences were observed between diet conditions for changes from baseline in the insulin sensitivity index from a short intravenous glucose tolerance test or other indices of glucose homeostasis. No significant differences were observed in biomarkers of cardiovascular risk except that the CHO intervention led to a shift toward a higher concentration of cholesterol in small, dense low-density lipoprotein subfraction 3+4 (LDL3 + 4) particles (p = 0.024 vs almonds).Conclusions: Intake of 3.0 oz/d raw almonds, vs energy-matched CHO foods, improved the dietary nutrient profile, but did not significantly affect insulin sensitivity and most markers of cardiometabolic health in overweight and obese men and women with prediabetes.

Health Benefits of Nut Consumption in Middle-Aged and Elderly Population

Aging is considered the major risk factor for most chronic disorders. Oxidative stress and chronic inflammation are two major contributors for cellular senescence, downregulation of stress response pathways with a decrease of protective cellular activity and accumulation of cellular damage, leading in time to age-related diseases. This review investigated the most recent clinical trials and cohort studies published in the last ten years, which presented the influence of tree nut and peanut antioxidant diets in preventing or delaying age-related diseases in middle-aged and elderly subjects (≥55 years old). Tree nut and peanut ingestion has the possibility to influence blood lipid count, biochemical and anthropometric parameters, endothelial function and inflammatory biomarkers, thereby positively affecting cardiometabolic morbidity and mortality, cancers, and cognitive disorders, mainly through the nuts’ healthy lipid profile and antioxidant and anti-inflammatory mechanisms of actions. Clinical evidence and scientific findings demonstrate the importance of diets characterized by a high intake of nuts and emphasize their potential in preventing age-related diseases, validating the addition of tree nuts and peanuts in the diet of older adults. Therefore, increased consumption of bioactive antioxidant compounds from nuts clearly impacts many risk factors related to aging and can extend health span and lifespan.

Effectiveness of Changes in Diet Composition on Reducing the Incidence of Cardiovascular Disease

PURPOSE OF REVIEW

To highlight dietary changes shown to be associated with a lower risk of cardiovascular events in epidemiological studies and that have been proven to be effective in preventing cardiovascular diseases in clinical trials RECENT FINDINGS: Since dietary changes always involve multiple variables, recent observational and intervention studies on dietary prevention of cardiovascular disease focus not only to the limitation of a single nutrient/food intake but also to the other dietary changes implemented to replace it. The available evidence supports three major dietary strategies for cardiovascular disease prevention: (1) the replacement of saturated fat with unsaturated fat and/or fiber-rich carbohydrate foods; (2) the reduction of salt intake; (3) the implementation of dietary patterns resembling the traditional Mediterranean diet. This support derives not only from RCTs but also from the combination of large observational cohort studies and relatively short-term randomized trials on cardiovascular risk factors.

Effects and Mechanisms of Tea and Its Bioactive Compounds for the Prevention and Treatment of Cardiovascular Diseases: An Updated Review

Cardiovascular diseases (CVDs) are critical global public health issues with high morbidity and mortality. Epidemiological studies have revealed that regular tea drinking is inversely associated with the risk of CVDs. Additionally, substantial in vitro and in vivo experimental studies have shown that tea and its bioactive compounds are effective in protecting against CVDs. The relevant mechanisms include reducing blood lipid, alleviating ischemia/reperfusion injury, inhibiting oxidative stress, enhancing endothelial function, attenuating inflammation, and protecting cardiomyocyte function. Moreover, some clinical trials also proved the protective role of tea against CVDs. In order to provide a better understanding of the relationship between tea and CVDs, this review summarizes the effects of tea and its bioactive compounds against CVDs and discusses potential mechanisms of action based on evidence from epidemiological, experimental, and clinical studies.