Effects of different forms of hazelnuts on blood lipids and α-tocopherol concentrations in mildly hypercholesterolemic individuals A macadamia nut-rich diet reduces total and LDL-cholesterol in mildly hypercholesterolemic men and women. Effects of pistachios on cardiovascular disease risk factors and potential mechanisms of action: a dose-response study. Serum lipid effects of a high-monounsaturated fat diet based on macadamia nuts. Effect of a diet high in vegetables, fruit, and nuts on serum lipids. A monounsaturated fatty acid-rich pecan-enriched diet favorably alters the serum lipid profile of healthy men and women. Pistachio Nut Consumption and Serum Lipid Levels The effect of almonds on anthropometric measurements and lipid profile in overweight and obese females in a weight reduction program: A randomized controlled clinical trial Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: a prospective study. Dose Response of Almonds on Coronary Heart Disease Risk Factors: Blood Lipids, Oxidized Low-Density Lipoproteins, Lipoprotein(a), Homocysteine, and Pulmonary Nitric Oxide: A Randomized, Controlled, Crossover Trial Effects of pistachio nuts consumption on plasma lipid profile and oxidative status in healthy volunteers. Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women Walnut Consumption in Hyperlipidemic Patients Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Almond Consumption and Cardiovascular Risk Factors in Adults with Prediabetes Pistachio intake increases high density lipoprotein levels and inhibits low-density lipoprotein oxidation in rats. Pecans lower low-density lipoprotein cholesterol in people with normal lipid levels. Cholesterol lowering effects of nuts compared with a Canola oil enriched cereal of similar fat composition. Effect of pistachio consumption on plasma lipoprotein subclasses in pre-diabetic subjects. Macadamia nut consumption lowers plasma total and LDL cholesterol levels in hypercholesterolemic men. Measured energy value of pistachios in the human diet. Effects of walnuts on serum lipid levels and blood pressure in normal men. Effect of pistachio nuts on serum lipid levels in patients with moderate hypercholesterolemia. Crossover study of diets enriched with virgin olive oil, walnuts or almonds. Effects on lipids and other cardiovascular risk markers. Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors Effects of pistachios on the lipid/lipoprotein profile, glycemic control, inflammation, and endothelial function in type 2 diabetes: A randomized trial. Effects of hazelnuts consumption on fasting blood sugar and lipoproteins in patients with type 2 diabetes The dose of hazelnuts influences acceptance and diet quality but not inflammatory markers and body composition in overweight and obese individuals. Lipid, lipoprotein, and apolipoprotein profiles in active and sedentary men with tetraplegia. Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). Very-Low-Density Lipoprotein–Associated Apolipoproteins Predict Cardiovascular Events and Are Lowered by Inhibition of APOC-III Effects of walnut consumption as part of a low-fat, low-cholesterol diet on serum cardiovascular risk factors. Nuts as a Replacement for Carbohydrates in the Diabetic Diet Pistachio Nuts Reduce Triglycerides and Body Weight by Comparison to Refined Carbohydrate Snack in Obese Subjects on a 12-Week Weight Loss Program Effects of Ezetimibe/Simvastatin 10/20 mg vs. Atorvastatin 20 mg on Apolipoprotein B/Apolipoprotein A1 in Korean Patients with Type 2 Diabetes Mellitus: Results of a Randomized Controlled Trial Vitamin D3 supplementation has no effect on conventional cardiovascular risk factors: a parallel-group, double-blind, placebo-controlled RCT. Lipoprotein Particle Profiles by Nuclear Magnetic Resonance Compared With Standard Lipids and Apolipoproteins in Predicting Incident Cardiovascular Disease in Women Dietary intervention induces flow of changes within biomarkers of lipids, inflammation, liver enzymes, and glycemic control. Non-HDL cholesterol, apolipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women. Physical Activity and Reduced Risk of Cardiovascular Events: Potential Mediating Mechanisms PREVENTION OF ATHEROSCLEROSIS WITH LDL-C LOWERING - LIPOPROTEIN CHANGES AND INTERACTIONS: THE SANDS STUDY. [Nutrient content and health effects of nuts]. An olive oil-rich diet results in higher concentrations of LDL cholesterol and a higher number of LDL subfraction particles than rapeseed oil and sunflower oil diets. Effects of substituting dietary soybean protein and oil for milk protein and fat in subjects with hypercholesterolemia.
Background / Objectives : Diets high in nuts reduce cholesterol , probably due to their favorable lipid profile and other bioactive substances . However , the physical form of the nut may be important as the cell wall of intact nuts may limit the hypocholesterolemic effect of nuts by reducing lipid bioavailability . Therefore , we investigated the effects on blood lipids of incorporating three different forms of hazelnuts ( ground , sliced and whole ) into the usual diet . Subjects/ Methods : In a r and omized crossover study with three phases , 48 mildly hypercholesterolemic participants were asked to consume 30 g of ground , sliced or whole hazelnuts for 4 weeks . Body weight , plasma total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triacylglycerol ( TAG ) , apolipoprotein ( apo ) A1 , apo B100 and α-tocopherol were measured at baseline and at the end of each dietary phase . Results : There were no significant differences in any outcome variable between the different forms of nuts ( all P⩾0.159 ) . However , compared with baseline , mean values at the end of each hazelnut intervention were significantly higher for HDL-C ( P=0.023 ) and α-tocopherol ( P=0.005 ) , and significantly lower for TC ( P<0.001 ) , LDL-C ( P<0.001 ) , TC : HDL-C ratio ( P<0.001 ) , apo B100 ( P=0.002 ) and apo B100:apo A1 ratio ( P<0.001 ) , with no significant difference in body weight ( P=0.813 ) . Conclusions : The ingestion of three different forms of hazelnuts equally improved the lipoprotein profile and α-tocopherol concentrations in mildly hypercholesterolemic individuals . Hazelnuts can therefore be incorporated into the usual diet as a means of reducing cardiovascular disease risk Epidemiologic studies and clinical trials have demonstrated that the unique fatty acid profile of nuts beneficially affects serum lipids/lipoproteins , reducing cardiovascular disease ( CVD ) risk .  Nuts are low in SFA and high in PUFA and monounsaturated fatty acids ( MUFA ) . Macadamia nuts are a rich source of MUFA . A r and omized , crossover , controlled feeding study ( 5-wk diet periods ) compared a Macadamia nut-rich diet [ 42.5 g ( 1.5 ounces)/8.79 MJ ( 2100 kcal ) ] [ MAC ; 33 % total fat ( 7 % SFA , 18 % MUFA , 5 % PUFA ) ] vs. an average American diet [ AAD ; 33 % total fat ( 13 % SFA , 11 % MUFA , 5 % PUFA ) ] on the lipid/lipoprotein profile of mildly hypercholesterolemic ( n = 25 ; 15 female , 10 male ) subjects .  Serum concentrations of total cholesterol ( TC ) and LDL cholesterol ( LDL-C ) following the MAC ( 4.94 + /- 0.17 mmol/L , 3.14 + /- 0.14 mmol/L ) were lower than the AAD ( 5.45 + /- 0.17 mmol/L , 3.44 + /- 0.14 mmol/L ; P < 0.05 ) . The serum non-HDL cholesterol ( HDL-C ) concentration and the ratios of TC : HDL-C and LDL-C : HDL-C were reduced following consumption of the MAC diet ( 3.83 + /- 0.17 , 4.60 + /- 0.24 , and 2.91 + /- 0.17 , respectively ) compared with the AAD ( 4.26 + /- 0.17 , 4.89 + /- 0.24 , and 3.09 + /- 0.18 , respectively ; P < 0.05 ) . There was no change in serum triglyceride concentration . Thus , macadamia nuts can be included in a heart-healthy dietary pattern that reduces lipid/lipoprotein CVD risk factors . Nuts as an isocaloric substitute for high SFA foods increase the proportion of unsaturated fatty acids and decrease SFA , thereby lowering CVD risk BACKGROUND  Nut consumption lowers cardiovascular disease ( CVD ) risk . Studies are lacking about the effects of pistachios , a nutrient-dense nut , on CVD risk factors , dose-response relations , and lipid-lowering mechanisms . OBJECTIVE We evaluated the effects of 2 doses of pistachios , added to a lower-fat diet , on lipids and lipoproteins , apolipoprotein (apo)-defined lipoprotein subclasses , and plasma fatty acids . To investigate the mechanisms of action , we measured cholesteryl ester transfer protein and indexes of plasma stearoyl-CoA desaturase activity ( SCD ) . DESIGN In a r and omized crossover controlled-feeding study , 28 individuals with LDL cholesterol > or = 2.86 mmol/L consumed 3 isoenergetic diets for 4 wk each . Baseline measures were assessed after 2 wk of a typical Western diet . The experimental diets included a lower-fat control diet with no pistachios [ 25 % total fat ; 8 % saturated fatty acids ( SFAs ) , 9 % monounsaturated fatty acids ( MUFAs ) , and 5 % polyunsaturated fatty acids ( PUFAs ) ] , 1 serving/d of a pistachio diet ( 1 PD ; 10 % of energy from pistachios ; 30 % total fat ; 8 % SFAs , 12 % MUFAs , and 6 % PUFAs ) , and 2 servings/d of a pistachio diet ( 2 PD ; 20 % of energy from pistachios ; 34 % total fat ; 8 % SFAs , 15 % MUFAs , and 8 % PUFAs ) . RESULTS The 2 PD decreased ( P < 0.05 compared with the control diet ) total cholesterol ( -8 % ) , LDL cholesterol ( -11.6 % ) , non-HDL cholesterol ( -11 % ) , apo B ( -4 % ) , apo B/apo A-I ( -4 % ) , and plasma SCD activity ( -1 % ) . The 1 PD and 2 PD , respectively , elicited a dose-dependent lowering ( P < 0.05 ) of total cholesterol/HDL cholesterol ( -1 % and -8 % ) , LDL cholesterol/HDL cholesterol ( -3 % and -11 % ) , and non-HDL cholesterol/HDL cholesterol ( -2 % and -10 % ) . CONCLUSIONS Inclusion of pistachios in a healthy diet beneficially affects CVD risk factors in a dose-dependent manner , which may reflect effects on SCD BACKGROUND Recent studies have identified potential beneficial effects of eating nuts , most of which have substantial amounts of monounsaturated fats . Macadamia nuts are 75 % fat by weight , 80 % of which is monounsaturated . OBJECTIVE To examine variations in serum lipid levels in response to a high-monounsaturated fat diet based on macadamia nuts . METHODS A r and omized crossover trial of three 30-day diets was conducted in 30 volunteers aged 18 to 53 years from a free-living population . Each was fed a " typical American " diet high in saturated fat ( 37 % energy from fat ) ; an American Heart Association Step 1 diet ( 30 % energy from fat ) ; and a macadamia nut-based monounsaturated fat diet ( 37 % energy from fat ) in r and om order . Serum total cholesterol , high-density lipoprotein cholesterol , and triglyceride levels were measured . RESULTS Mean total cholesterol level after the typical American diet was 5.20 mmol/L ( 201 mg/dL ) . After the Step 1 diet and the macadamia nut diet , total cholesterol level was 4.99 mmol/L ( 193 mg/dL ) and 4.95 mmol/L ( 191 mg/dL ) , respectively . Low-density lipoprotein cholesterol level was 3.37 mmol/L ( 130 mg/dL ) ( typical diet ) , 3.21 mmol/L ( 124 mg/dL ) ( Step 1 diet ) , and 3.22 mmol/L ( 125 mg/dL ) ( macadamia nut diet ) . High-density lipoprotein cholesterol level was 1.43 mmol/L ( 55 mg/dL ) ( typical ) , 1.34 mmol/L ( 52 mg/dL ) ( Step 1 ) , and 1.37 mmol/L ( 53 mg/dL ) ( macadamia nut ) . Lipid values after the Step 1 and macadamia nut diets were significantly different from those after the typical diet ( P<.05 ) . CONCLUSIONS The macadamia nut-based diet high in monounsaturated fat and the moderately low-fat diet both had potentially beneficial effects on cholesterol and low-density lipoprotein cholesterol levels when compared with a typical American diet We assessed the effect of a diet high in leafy and green vegetables , fruit , and nuts on serum lipid risk factors for cardiovascular disease . Ten healthy volunteers ( seven men and three women aged 33 + /- 4 years [ mean + /- SEM ] ; body mass index , 23 + /- 1 kg/m2 ) consumed their habitual diet ( control diet , 29 % + /- 2 % fat calories ) and a diet consisting largely of leafy and other low-calorie vegetables , fruit , and nuts ( vegetable diet , 25 % + /- 3 % fat calories ) for two 2-week periods in a r and omized crossover design . After 2 weeks on the vegetable diet , lipid risk factors for cardiovascular disease were significantly reduced by comparison with the control diet ( low-density lipoprotein [ LDL ] cholesterol , 33 % + /- 4 % , P < .001 ; ratio of total to high-density lipoprotein [ HDL ] cholesterol , 21 % + /- 4 % , P < .001 ; apolipoprotein [ apo ] B : A-I , 23 % + /- 2 % , P < .001 ; and lipoprotein ( a ) [ Lp(a ) ] , 24 % + /- 9 % , P = .031 ) . The reduction in apo B was related to increased intakes of soluble fiber ( r = .84 , P = .003 ) and vegetable protein ( r = -.65 , P = .041 ) . On the vegetable compared with the control diet , the reduction in total serum cholesterol was 34 % to 49 % greater than would be predicted by differences in dietary fat and cholesterol . A diet consisting largely of low-calorie vegetables and fruit and nuts markedly reduced lipid risk factors for cardiovascular disease . Several aspects of such diets , which may have been consumed early in human evolution , have implication s for cardiovascular disease prevention Frequent consumption of nuts is associated with decreased risk of cardiovascular disease . We investigated the effect of pecans rich in monounsaturated fat as an alternative to the Step 1 diet in modifying serum lipids and lipoproteins in men and women with normal to moderately high serum cholesterol . In a single-blind , r and omized , controlled , crossover feeding study , we assigned 23 subjects ( mean age : 38 y ; 9 women , 14 men ) to follow two diets , each for 4 wk : a Step I diet and a pecan-enriched diet ( accomplished by proportionately reducing all food items in a Step I diet by one fifth for a 20 % isoenergetic replacement with pecans ) . The percentage of energy from fat in the two diets was 28.3 and 39.6 % , respectively . Both diets improved the lipid profile ; however , the pecan-enriched diet decreased both serum total and LDL cholesterol by 0.32 mmol/L ( 6.7 and 10.4 % , respectively ) and triglyceride by 0.14 mmol/L ( 11.1 % ) beyond the Step I diet , while increasing HDL cholesterol by 0.06 mmol/L ( 2.5 mg/dL ) . Serum apolipoprotein B and lipoprotein(a ) decreased by 11.6 and 11.1 % , respectively , and apolipoprotein A1 increased by 2.2 % when subjects consumed the pecan compared with the Step I diet . These differences were all significant ( P < 0.05 ) . A 20 % isoenergetic replacement of a Step I diet with pecans favorably altered the serum lipid profile beyond the Step I diet , without increasing body weight .  Nuts such as pecans that are rich in monounsaturated fat may therefore be recommended as part of prescribed cholesterol-lowering diet of patients or habitual diet of healthy individuals Objective : Clinical and epidemiological studies have reported the beneficial effects of tree nuts and peanuts on serum lipid levels . We studied the effects of consuming 15 % of the daily caloric intake in the form of pistachio nuts on the lipid profiles of free-living human subjects with primary , moderate hypercholesterolemia ( serum cholesterol greater than 210 mg/dL ) . Methods : Design : R and omized crossover trial . Setting : Outpatient dietary counseling and blood analysis . Subjects : 15 subjects with moderate hypercholesterolemia . Intervention : Fours weeks of dietary modification with 15 % caloric intake from pistachio nuts . Measures of Outcome : Endpoints were serum lipid levels of total cholesterol , HDL-C , LDL-C , VLDL-C , triglycerides and apolipoproteins A-1 and B-100 . BMI , blood pressure , and nutrient intake ( total energy , fat , protein , and fiber ) were also measured at baseline , during , and after dietary intervention . Results : No statistically significant differences were observed for total energy or percent of energy from protein , carbohydrate or fat . On the pistachio nut diet , a statistically significant decrease was seen for percent energy from saturated fat ( mean difference , −2.7 % ; 95 % CI , −5.4 % to −0.08 % ; p = 0.04 ) . On the pistachio nut diet , statistically significant increases were seen for percent energy from polyunsaturated fat ( mean difference , 6.5 % ; 95 % CI , 4.2 % to 8.9 % ; p<.0001 ) and fiber intake ( mean difference , 15 g ; 95 % CI , 8.4 g to 22 g ; p = 0.0003 ) . On the pistachio diet , statistically significant reductions were seen in TC/HDL-C ( mean difference , −0.38 ; 95 % CI , −0.57 to −0.19 ; p = 0.001 ) , LDL-C/HDL-C ( mean difference , −0.40 ; 95 % CI , −0.66 to −0.15 ; p = 0.004 ) , B-100/A-1 ( mean difference , −0.11 ; 95 % CI , −0.19 to −0.03 ; p = 0.009 ) and a statistically significant increase was seen in HDL-C ( mean difference , 2.3 ; 95 % CI , 0.48 to 4.0 ; p = 0.02 ) . No statistically significant differences were seen for total cholesterol , triglycerides , LDL-C , VLDL-C , apolipoprotein A-1 or apolipoprotein B-100 . No changes were observed in BMI or blood pressure . Conclusion : A diet consisting of 15 % of calories as pistachio nuts ( about 2–3 ounces per day ) over a four week period can favorably improve some lipid profiles in subjects with moderate hypercholesterolemia and may reduce risk of coronary disease Background : Due to the wholesome benefits of nuts increased consumption of them has been recommended . However , because of nut 's high energy density , the role of them in the treatment of overweight and obesity is vague . This current clinical trial study aims to investigate the effects of a balanced hypocaloric almond-enriched diet ( AED ) ( almond group ) in comparison to a balanced hypocaloric nut-free diet ( NFD ) ( nut-free group ) on body weight and cardiovascular disease risk factors in women with body mass index ( BMI ) > 25 for 3-month . Material s and Methods : A total of 108 overweight and obese women were assigned in our 3-month r and omized controlled trial . The subjects were r and omly divided into two groups regarding a balanced hypocaloric diet with or without almond . The planned reduced calorie diets for both groups were identical except for the almond group who consumed 50 g of almonds daily . Anthropometric and laboratory measurements of the participants who completed the study were made prior to and at the end of the study . Results : A total of 100 subjects completed the study .  Weight , BMI , waist circumference , waist to hip circumference ratio , total cholesterol , and triglyceride , total : High density lipoprotein-cholesterol ( HDL-C ) , fasting blood sugar and diastolic blood pressure decreased significantly in the almond group compared to the nut-free group ( P > 0.001 ) . Greater reduction in low density lipoprotein-cholesterol ( P > 0.002 ) and systolic blood pressure ( P > 0.001 ) and greater increase in HDL-C ( P = 0.001 ) were found in the nut-free group . Conclusion : The balanced hypocaloric AED in comparison to the balanced hypocaloric NFD led to a greater weight-loss and overall better improvements in studied cardiovascular disease risk factors OBJECTIVE Recent studies have suggested that nuts have favorable effects beyond lipid lowering . We aim ed to investigate effect of the Antep pistachio ( Pistacia vera L. ) on blood glucose , lipid parameters , endothelial function , inflammation , and oxidation in healthy young men living in a controlled environment . METHODS A Mediterranean diet was administered to normolipidemic 32 healthy young men ( mean age 22 y , range 21 - 24 ) for 4 wk . After 4 wk , participants continued to receive the Mediterranean diet but pistachio was added for 4 wk by replacing the monounsaturated fat content constituting approximately 20 % of daily caloric intake . Fasting blood sample s and brachial endothelial function measurements were performed at baseline and after each diet . RESULTS Compared with the Mediterranean diet , the pistachio diet decreased glucose ( P<0.001 , -8.8+/-8.5 % ) , low-density lipoprotein ( P<0.001 , -23.2+/-11.9 % ) , total cholesterol ( P<0.001 , -21.2+/-9.9 % ) , and triacylglycerol ( P=0.008 , -13.8+/-33.8 % ) significantly and high-density lipoprotein ( P=0.069 , -3.1+/-11.7 % ) non-significantly . Total cholesterol/high-density lipoprotein and low-density lipoprotein/high-density lipoprotein ratios decreased significantly ( P<0.001 for both ) . The pistachio diet significantly improved endothelium-dependent vasodilation ( P=0.002 , 30 % relative increase ) , decreased serum interleukin-6 , total oxidant status , lipid hydroperoxide , and malondialdehyde and increased superoxide dismutase ( P<0.001 for all ) , whereas there was no significant change in C-reactive protein and tumor necrosis factor-alpha levels . CONCLUSION In this trial , we demonstrated that a pistachio diet improved blood glucose level , endothelial function , and some indices of inflammation and oxidative status in healthy young men . These findings are in accordance with the idea that nuts , in particular pistachio nuts , have favorable effects beyond lipid lowering that deserve to be evaluated with prospect i ve follow-up studies Background —Although recent studies have indicated that nut consumption may improve levels of blood lipids , nuts are not generally recommended as snacks for hyperlipidemic subjects because of their high fat content . Furthermore , the effective dose is still unknown . Methods and Results —The dose-response effects of whole almonds , taken as snacks , were compared with low-saturated fat ( < 5 % energy ) whole-wheat muffins ( control ) in the therapeutic diets of hyperlipidemic subjects . In a r and omized crossover study , 27 hyperlipidemic men and women consumed 3  isoenergetic ( mean 423 kcal/d ) supplements each for 1 month . Supplements provided 22.2 % of energy and consisted of full-dose almonds ( 73±3 g/d ) , half-dose almonds plus half-dose muffins , and full-dose muffins  . Fasting blood , expired air , blood pressure , and body weight measurements were obtained at weeks 0 , 2 , and 4 . Mean body weights differed < 300 g between treatments . The full-dose almonds produced the greatest reduction in levels of blood lipids . Significant reductions from baseline were seen on both half- and full-dose almonds for LDL cholesterol ( 4.4±1.7 % , P = 0.018 , and 9.4±1.9 % , P < 0.001 , respectively ) and LDL : HDL cholesterol ( 7.8±2.2 % , P = 0.001 , and 12.0±2.1 % , P < 0.001 , respectively ) and on full-dose almonds alone for lipoprotein(a ) ( 7.8±3.5 % , P = 0.034 ) and oxidized LDL concentrations ( 14.0±3.8 % , P < 0.001 ) , with no significant reductions on the control diet . No difference was seen in pulmonary nitric oxide between treatments . Conclusions —Almonds used as snacks in the diets of hyperlipidemic subjects significantly reduce coronary heart disease risk factors , probably in part because of the nonfat ( protein and fiber ) and monounsaturated fatty acid components of the nut BACKGROUND AND AIM Effects of pistachio nuts consumption on plasma lipid profile and oxidative status were investigated in healthy volunteers with normal lipid levels . METHODS AND RESULTS The study was conducted in 24 healthy men and 20 healthy women . All subjects consumed their regular diets during a 1-week period . After this period , half of the subjects ( 12 men and 10 women , mean age 32.8 + /- 6.7 years ) were r and omized to a regular diet group and the other half ( 12 men and 10 women , mean age 33.4 + /- 7.2 years ) were r and omized to a pistachio group which involved substituting pistachio nuts for 20 % of their daily caloric intake for 3 weeks . Plasma total cholesterol , low-density lipoprotein ( LDL ) , high-density lipoprotein ( HDL ) , triglyceride , malondialdehyde ( MDA ) and antioxidant potential ( AOP ) were measured before and after the dietary modification from all the subjects . After 3 weeks , with the pistachio diet , the mean plasma total cholesterol , MDA levels and , total cholesterol/HDL and LDL/HDL ratios were found to be significantly decreased ( P < 0.05 , P < 0.05 , P < 0.001 and P < 0.01 , respectively ) ; on the contrary , HDL and AOP levels , and AOP/MDA ratios were significantly increased ( P < 0.001 , P < 0.05 and P < 0.01 , respectively ) . Triglyceride and LDL levels also decreased but this was not statistically significant ( P > 0.05 ) . CONCLUSION These results indicated that consumption of pistachio nuts decreased oxidative stress , and improved total cholesterol and HDL levels in healthy volunteers Lifestyle modification is the cornerstone of population -based strategies for prevention of coronary heart disease and is the first line of therapy in patients with hypercholesterolemia . Diets low in saturated fatty acids and cholesterol have long been recommended to decrease low-density lipoprotein ( LDL ) cholesterol levels and reduce cardiovascular risk ( 1 ) . Ample evidence suggests that polyunsaturated fatty acids and monounsaturated fatty acids have a similar cholesterol-lowering effect when substituted for saturated fatty acids ( 2 - 4 ) . However , most studies of fatty acids and blood lipids have been done with fats and oils , rarely with whole fatty foods . Because people usually buy and consume whole food products , it is desirable to know the effects of specific foods on risk factors for coronary heart disease . Recent reports suggest that the regular consumption of nuts might reduce cardiovascular risk ( 5 ) . Walnuts are particularly rich in polyunsaturated fatty acids ( 6 ) , and epidemiologic evidence suggests that frequent walnut consumption protects against coronary heart disease ( 7 ) . In a controlled feeding trial by Sabat and colleagues ( 8) , a diet in which walnuts represented 55 % of the energy from fat reduced blood cholesterol levels in normal young men when compared with a st and ard low-fat diet . However , the results can not easily be extrapolated to the population at risk for coronary heart disease because women , older age groups , and hypercholesterolemic persons were not studied ( 8) . In addition , because meals were served at a metabolic kitchen , the study did not address the question of whether free-living persons would incorporate substantial quantities of walnuts into their diets . Because oxidized LDL plays a key role in atherogenesis ( 9 ) and oxidative damage involves peroxidation of polyunsaturated fatty acids in LDL lipids ( 10 ) , there is concern that walnut intake may promote LDL oxidation . Therefore , we design ed a dietary intervention study in free-living adult men and women with polygenic hypercholesterolemia to compare the effects of a walnut-rich diet with those of a cholesterol-lowering Mediterranean diet on serum lipid levels , lipoprotein levels , and LDL resistance to oxidation . Methods Patients Adult men and women with polygenic hypercholesterolemia attending the Lipid Clinic of the Hospital Clnic of Barcelona were eligible if they had serum LDL cholesterol concentrations greater than 3.36 mmol/L ( 130 mg/dL ) and triglyceride concentrations less than 2.82 mmol/L ( 250 mg/dL ) ; no evidence of alcohol , tobacco , or drug abuse ; absence of diabetes mellitus and liver , kidney , thyroid , or other endocrine diseases , as assessed by medical history , a complete physical examination , and laboratory tests ; no intake in the previous 8 weeks of medications known to affect lipid metabolism , including hypolipidemic agents and estrogen compounds in women ; infrequent consumption of nuts and no known history of allergy to them ; and no use of multivitamin or vitamin E supplements  . Because the target population had common ( polygenic ) hypercholesterolemia , we excluded persons whose elevated blood cholesterol levels had a strong genetic basis ( such as heterozygous familial hypercholesterolemia or familial combined hyperlipidemia ) , as established by st and ard criteria . On admission to the Lipid Clinic , all patients were advised to follow a  Mediterranean-type hypolipidemic diet ( 11 ) . For a crossover design , statistical power calculations indicated that to detect mean differences of 0.39 mmol/L ( 15 mg/dL ) , 34 patients would need to complete the two treatment periods ( statistic , 0.05 ; power>0.8 ) . From a computerized register of clinical records , 75 hypercholesterolemic patients ( 35 women and 40 men ) who initially met the eligibility criteria were selected for screening and were asked to participate in the study . They were offered free walnuts but no monetary compensation . Study Design A crossover design was used . Patients were r and omly assigned to the two diet sequences by using a computer-generated r and om-number table , with stratification by sex . Because patients followed each diet for 6 weeks and lipoprotein changes due to dietary intervention stabilize in less than 4 weeks ( 12 ) , we did not incorporate a washout period between diets . In their crossover feeding study with walnuts , Sabat and colleagues ( 8) did not observe a carryover effect . In the week before the trial began , patients received expert dietary counseling individually and in a group class . Twice during the pretrial week and on weeks 5 and 6 of each one of the two dietary periods , patients came to the clinic for a medical visit , an interview with the dietitian , anthropometric measurements , and blood extraction . The main outcomes of the study were changes in serum levels of total and LDL cholesterol from the control diet period to the walnut diet period . Secondary outcomes were changes in other lipid variables and oxidizability of LDL particles . The study protocol was approved by the institutional review board of the Hospital Clnic of Barcelona , and all patients gave informed consent . Diets The experimental diets were individually prescribed and were based on estimated energy requirements . Because participants ate on their own , detailed dietary information was provided to them and , if appropriate , to their partners .  Diets were calculated in increments of 200 kcal to cover the range from 1600 to 2200 kcal . The control diet was Mediterranean and was composed of natural foodstuffs . Red meat and eggs were limited , vegetable products and fish were emphasized , olive oil was indicated for culinary use , and no nuts were allowed . The walnut diet was similar to the control diet , but walnuts partially replaced olive oil and other fatty foods . Prepackaged daily allowances of raw , shelled walnuts were provided daily in amounts varying from 41 g to 56 g ( the equivalent of 8 to 11 walnuts ) , according to the participants ' total energy intake . Walnuts were consumed as snacks or with meals in desserts or salads . In the walnut diet , walnuts contributed approximately 18 % of the total energy and 35 % of the total fat . To improve compliance , each family unit was given 1000-g packs of walnuts at the beginning of the walnut diet period .  Adherence to the study diets was carefully monitored . Unannounced 24-hour diet recalls were performed weekly by telephone during the two dietary periods , for a total of 12 recalls per patient . This method allows reliable estimations of food intake ( 13 ) . The nutrient composition of the diets was calculated with Food Processor Plus software , version 5.0 ( ESHA Research , Salem , Oregon ) , which was adapted to nutrient data bases of specific Mediterranean foods when appropriate . We defined noncompliance as at least 20 % deviation from dietary instructions regarding walnut or nutrient intake . Compliance during the walnut diet was also assessed at each clinic visit by a count of the empty walnut packages . The fatty acid content of LDL lipids was analyzed as a biological measure of adherence to the prescribed diets . Laboratory Measurements Blood sample s were obtained after an overnight fast , and serum and EDTA plasma were collected and processed immediately . Serum lipid and apolipoprotein levels were determined as described elsewhere ( 11 ) . In brief , serum cholesterol and triglyceride levels were measured by using enzymatic reagents ( Trinder , Bayer Diagnostics , Tarrytown , New York ) adapted to a Cobas Mira automated analyzer ( Hoffmann-LaRoche , Basel , Switzerl and ) . High-density lipoprotein ( HDL ) cholesterol was quantified after precipitation with phosphotungstic acid and magnesium chloride . Levels of apolipoprotein A-I and apolipoprotein B were determined by an immunoturbidimetric method ( Unimate 3 , Roche Diagnostic Systems , Basel , Switzerl and ) . Measurements of the cholesterol content of very-low-density lipoprotein particles and LDL particles were based on preparative ultracentrifugation ( 11 ) . Lipoprotein(a ) levels were measured by using an immunoturbidimetric method ( Lipoprotein[a ] SPQ II Test Kit , DiaSorin , Stillwater , Minnesota ) . To obtain the LDL fraction for fatty acid and oxidizability studies , lipoproteins were fractionated by sequential centrifugation adjusting with NaBr to separate very-low-density lipoprotein particles ( d=1.006 g/mL ) and to obtain LDL particles ( d=1.063 g/mL ) , as described elsewhere ( 14 ) . Low-density lipoprotein fatty acids were measured by capillary gas chromatography in the cholesteryl ester , phospholipid , and triglyceride lipid fractions ( 14 ) . Low-density lipoprotein susceptibility to oxidation was determined by measuring the -tocopherol content of LDL particles and conjugated diene kinetics after incubation of 50 g of LDL protein with 5 mol of copper sulfate at 37 C ( 15 , 16 ) . Statistical Analysis The two measurements obtained at baseline and at the end of each dietary period were averaged . Means and SDs are presented for each measurement . With methods described by Fleiss ( 17 ) , two-tailed t-tests were used to compare changes in outcome variables in response to dietary treatment and diet period and carryover effects for the two-period crossover design . Differences between the walnut and control diets were also tested by analysis of covariance using general linear models ; baseline values or sex were used as covariates . Analyses were performed by using SAS software ( SAS , Inc. , Cary , North Carolina ) ( 18 ) . Role of the Funding Sources The California Walnut Commission provided funding and walnuts . Research grants were also obtained from national and local nonprofit agencies . The funding sources were not involved in the design of the study and had no role in the collection , analysis , or interpretation of the data or in the decision to su bmi t the manuscript for publication . None of the authors has any financial interest in the nut food industry . Results Patient Characteristics Of the 75 eligible patients , 20 left the study before r and omization for Walnut ( Juglans regia L. ) is described as an anticancer , tonic , blood purifier , and detoxifier agent . It is said that nuts have favorable fatty acids and nutrients . This study was performed to determine the lipid-lowering properties of walnut in a population in Shiraz , Southern Iran . In a r and omized case-control study , 52 volunteers were divided into 2 groups : Group A consumed walnuts , 20 grams per day for 8 weeks and the control group ( group B ) consumed no walnuts .  Triglycerides , total high-density lipoprotein ( HDL ) , and low-density lipoprotein ( LDL ) levels were checked for each subject prior to , after 4 weeks , and at 8 weeks after the beginning of the study . In group A , the mean plasma TG level dropped by 17.1 % from the baseline and HDL cholesterol also increased significantly by 9 % . It was shown that frequent consumption of nuts in the daily diet was associated with a potentially decreased risk of coronary artery disease by decreasing the level of triglyceride and increasing the level of HDL BACKGROUND Frequent consumption of nuts may lower the risk of cardiovascular disease by favorably altering serum lipid and lipoprotein concentrations . OBJECTIVE We compared the effects of 2 amounts of almond intake with those of a National Cholesterol Education Program Step I diet on serum lipids , lipoproteins , apolipoproteins , and glucose in healthy and mildly hypercholesterolemic adults . DESIGN In a r and omized crossover design , 25 healthy subjects ( 14 men , 11 women ) with a mean ( + /- SD ) age of 41 + /- 13 y were fed 3 isoenergetic diets for 4 wk each after being fed a 2-wk run-in diet ( containing 34 % of energy from fat ) . The experimental diets included a Step I diet , a low-almond diet , and a high-almond diet , in which almonds contributed 0 % , 10 % , and 20 % of total energy , respectively . RESULTS Inverse relations were observed between the percentage of energy in the diet from almonds and the subject 's total cholesterol ( P value for trend < 0.001 ) , LDL-cholesterol ( P < 0.001 ) , and apolipoprotein B ( P < 0.001 ) concentrations and the ratios of LDL to HDL cholesterol ( P < 0.001 ) and of apolipoprotein B to apolipoprotein A ( P < 0.001 ) . Compared with the Step I diet , the high-almond diet reduced total cholesterol ( 0.24 mmol/L or 4.4 % ; P = 0.001 ) , LDL cholesterol ( 0.26 mmol/L or 7.0 % ; P < 0.001 ) , and apolipoprotein B ( 6.6 mg/dL or 6.6 % ; P < 0.001 ) ; increased HDL cholesterol ( 0.02 mmol/L or 1.7 % ; P = 0.08 ) ; and decreased the ratio of LDL to HDL cholesterol ( 8.8 % ; P < 0.001 ) . CONCLUSIONS Isoenergetic incorporation of approximately 68 g of almonds ( 20 % of energy ) into an 8368-kJ ( 2000-kcal ) Step I diet markedly improved the serum lipid profile  of healthy and mildly hypercholesterolemic adults .  Total and LDL-cholesterol concentrations declined with progressively higher intakes of almonds , which suggests a dose-response relation Objective : The authors tested the hypothesis that in adults with prediabetes , an almond-enriched American Diabetes Association ( ADA ) diet improves measures of insulin sensitivity and other cardiovascular risk factors compared with an ADA nut-free diet . Methods : Design : R and omized parallel-group trial . Setting : Outpatient dietary counseling and blood analysis . Subjects : Sixty-five adult participants with prediabetes . Intervention : Sixteen weeks of dietary modification featuring an ADA diet containing 20 % of energy from almonds ( approximately 2 oz per day ) . Measures of Outcome : Outcomes included fasting glucose , insulin , total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , triglycerides , TC : HDL-C , and HbA1c , which were measured at weeks 0 , 8 , and 16 . Body weight , body mass index ( BMI ) , waist circumference , blood pressure , and nutrient intake were measured at weeks 0 , 4 , 8 , 12 , and 16 . Results : The almond-enriched intervention group exhibited greater reductions in insulin ( −1.78 µU/ml vs. + 1.47 µU/ml , p = 0.002 ) , homeostasis model analysis for insulin resistance ( −0.48 vs. + 0.30 , p = 0.007 ) , and homeostasis model analysis for beta-cell function ( −13.2 vs. + 22.3 , p = 0.001 ) compared with the nut-free control group . Clinical ly significant declines in LDL-C were found in the almond-enriched intervention group ( −12.4 mg/dl vs. −0.4 mg/dl ) as compared with the nut-free control group . No changes were observed in BMI ( −0.4 vs. −0.7 kg/m2 , p = 0.191 ) , systolic blood pressure ( −4.4 mm Hg vs. −3.5 mm Hg , p = 0.773 ) , or for the other measured cardiovascular risk factors . Conclusions : An ADA diet consisting of 20 % of calories as almonds over a 16-week period is effective in improving markers of insulin sensitivity and yields clinical ly significant improvements in LDL-C in adults with prediabetes There is increasing evidence that nuts have protective effects against coronary artery disease by improving lipid profile and inhibiting lipid oxidation . However , data about pistachio nuts are limited , and to our knowledge , there is no study investigating the effects of pistachio intake on lipid oxidation and serum antioxidant levels . This study , therefore , sought to determine the effects of pistachio intake on serum lipids and determine whether consumption of pistachio would alter serum antioxidant levels . Rats were r and omly divided into three groups ( n=12 for each ) : control group fed basic diet for 10 weeks and treated groups fed basic diet plus pistachio which constituted 20 % and 40 % of daily caloric intake , respectively . Consumption of pistachio as 20 % of daily caloric intake increased high-density lipoprotein ( HDL ) levels and decreased total cholesterol (TC)/HDL ratio , compared with those not taking pistachio . However , TC , low-density lipoprotein ( LDL ) cholesterol and triglyceride levels were unaffected by pistachio consumption . Consumption of pistachio as 20 % of daily caloric intake increased serum paraoxonase activity by 35 % and arylesterase activity by 60 % , which are known to inhibit LDL cholesterol oxidation , compared with the control group . However , increased antioxidant activity was blunted when pistachio intake was increased to 40 % of daily caloric intake . In conclusion , the present results show that consumption of pistachio as 20 % of daily caloric intake leads to significant improvement in HDL and TC/HDL ratio and inhibits LDL cholesterol oxidation . These results suggest that pistachio may be beneficial for both prevention and treatment of coronary artery disease OBJECTIVE To compare serum lipid profiles and dietary intakes of people with normal lipid levels who consumed pecans and those who did not consume nuts .  DESIGN Eight-week , r and omized , controlled study of pecan treatment group vs control group . SUBJECT Nineteen people with normal lipid levels completed the study ; 10 had been r and omly assigned to the pecan treatment group ( 7 women , 3 men , mean age = 45 + /- 10 years ) and 9 to the control group ( 8 women , 1 man , mean age = 37 + /- 12 years ) . INTERVENTION The pecan treatment group consumed 68 g pecans per day for 8 weeks plus self-selected diets . The pecans contributed 459 kcal and 44 g fat daily . The control group avoided nuts and consumed self-selected diets . MAIN OUTCOME MEASURES Total serum cholesterol , low-density lipoprotein cholesterol ( LDL-C ) , high-density lipoprotein cholesterol ( HDL-C ) , and total triglyceride levels were measured at the time of entrance to the study ( baseline ) , week 4 , and week 8 . Computer analyses were done on five 3-day food records . STATISTICAL ANALYSIS Comparisons were made using analysis of variance or paired t test . RESULTS LDL-C was lowered in the pecan treatment group from 2.61 + /- 0.49 mmol/L at baseline to 2.35 + /- 0.49 at week 4 ( P < .05 ) and to 2.46 + /- 0.59 at week 8 ( P < .05 ) . At week 8 , total cholesterol and HDL-C in the pecan treatment group were significantly lower ( P < .05 ) than in the control group ( total cholesterol : 4.22 + /- 0.83 vs 5.02 + /- 0.54 mmol/L ; HDL-C : 1.37 + /- 0.23 vs 1.47 + /- 0.34 mmol/L ) . Dietary fat , monounsaturated fat , polyunsaturated fat , insoluble fiber , magnesium , and energy were significantly higher in the pecan treatment group than in the control group . Body mass indexes and body weights were unchanged in both groups . APPLICATIONS Pecans can be included in a healthful diet when energy intake and potential weight gain are addressed BACKGROUND AND AIM Small quantities of nuts protect against subsequent cardiovascular risk . There is speculation that the cholesterol lowering effect associated with nut consumption arises primarily from the fatty acid composition of nuts but may be caused by some other component . To evaluate this possibility we compared the effect of various nuts , against a Canola oil based cereal with a comparable fatty acid profile , on lipids , lipoproteins and fatty acids to determine whether the fatty acid profile of nuts explains their cholesterol lowering effects . METHODS AND RESULTS Twenty-eight men and women with mean ( s.d . ) levels of total and low density lipoprotein cholesterol of 6.0 ( 1.1 ) mmol/L , and 4.1 ( 1.0 ) mmol/L , respectively and a mean body mass index ( BMI ) of 26.9 ( 3.2 ) kg/m2 took part in a r and omised cross over trial . For two periods of six weeks , separated by a four-week washout , participants were asked to consume a low saturated fat diet , which included either 30 g/d nuts ( nut diet ) or one serving of a cereal containing Canola oil ( cereal diet ) . There were no significant differences in the lipids , lipoproteins , plasma fatty acids or other variables between the two diets at the end of the study . Total cholesterol ( TC ) and low density lipoprotein cholesterol ( LDL-C ) were lower on both experimental diets than at baseline , 0.51 mmol/L and 0.40 mmol/L ( p<0.001 , p<0.01 ) , respectively on the nut diet and 0.42 mmol/L and 0.37 mmol/L ( p<0.001 , p<0.01 ) , respectively on the cereal diet . CONCLUSION A 30 g serving of nuts , or a serving of a Canola oil enriched cereal with a similar fatty acid composition reduced total and LDL cholesterol to a similar extent when consumed as part of a lipid lowering diet . Results suggest that foods with a similar fatty acid composition to nuts can produce comparable decreases in lipoprotein mediated cardiovascular risk BACKGROUND AND AIMS Nuts have been demonstrated to improve several cardiovascular risk factors and the lipid profile in diabetic and pre-diabetic subjects . However , analysis of conventional serum lipid profiles does not completely explain the atherogenic risk associated with pre-diabetes . We therefore investigated whether chronic consumption of pistachio modifies the lipoprotein subclasses to a healthier profile in pre-diabetic subjects . METHODS AND RESULTS R and omized cross-over clinical trial in 54 subjects with pre-diabetes . Subjects consumed a pistachio-supplemented diet ( PD , 50 % carbohydrates , 33 % fat , including 57 g/d of pistachios daily ) and a control diet ( CD , 55 % carbohydrates , 30 % fat ) for 4 months each , separated by a 2-week wash-out . Diets were isocaloric and matched for protein , fiber and saturated fatty acids . Nuclear magnetic resonance ( NMR ) was performed to determine changes in plasma lipoprotein subclasses . Small low-density lipoprotein particles ( sLDL-P ) significantly decreased after pistachio consumption compared to the nut-free diet ( P = 0.023 ) . The non-high-density lipoprotein particles ( non-HDL-P i.e. VLDL-P plus LDL-P ) significantly decreased under the PD compared to CD ( P = 0.041 ) . The percentage of sHDL-P increased by 2.23 % after the PD compared with a reduction of 0.08 % after the CD ( P = 0.014 ) . Consequently , the overall size of HDL-P significantly decreased in the PD ( P = 0.007 ) . CONCLUSION Chronic pistachio consumption could modify the lipoprotein particle size and subclass concentrations independently of changes in total plasma lipid profile , which may help to explain the decreased risk of cardiovascular disease and mortality associated with those individuals who frequently consumed nuts . REGISTRATION NUMBER This study is registered at www . clinical trials.gov as NCT01441921 This study was conducted to assess the cholesterol-lowering potential of macadamia nuts .  Seventeen hypercholesterolemic men ( mean age 54 y ) were given macadamia nuts ( 40 - 90 g/d ) , equivalent to 15 % energy intake , for 4 wk . Plasma total cholesterol , LDL cholesterol , HDL cholesterol , triglycerides and homocysteine concentrations and the fatty acid composition of plasma lipids were determined before and after treatment . Plasma MUFA 16:1(n-7 ) , 18:1(n-7 ) and 20:1(n-9 ) were elevated after intervention with macadamia nuts .  Plasma ( n-6 ) and ( n-3 ) PUFA concentrations were unaffected by macadamia nut consumption . Plasma total cholesterol and LDL cholesterol concentrations decreased by 3.0 and 5.3 % , respectively , and HDL cholesterol levels increased by 7.9 % in hypercholesterolemic men after macadamia nut consumption . Plasma triglyceride and homocysteine concentrations were not affected by treatment . Macadamia nut consumption was associated with a significant increase in the relative intake of MUFA and a reduced relative intake of saturated fatty acids and PUFA . This study demonstrates that macadamia nut consumption as part of a healthy diet favorably modifies the plasma lipid profile in hypercholesterolemic men despite their diet being high in fat Previous studies have suggested that lipid from nuts is more poorly absorbed than that from other food sources . If lipid from nuts is poorly absorbed , then the metabolisable energy contained in the nuts is less than that predicted by the Atwater general factors . A crossover feeding study was conducted in which sixteen volunteers consumed pistachios for 3 weeks as part of a controlled diet . Pistachio doses were 0 , 42 and 84 g/d . Urine and faecal sample s were collected , and urine , faeces and diet were analysed for N , fat , total dietary fibre , ash and combustible energy . Blood was also collected after each treatment period and analysed for plasma lipids . Energy value of pistachio nuts was calculated from differences in energy excretion during the different dietary treatments . The measured energy density  of pistachios was found to be 22·6 kJ/g , which is 5 % less than the currently accepted energy value of 23·7 kJ/g , as calculated using the Atwater general factors . The pistachio nut intervention lowered LDL-cholesterol by 6 % , but did not significantly change plasma total cholesterol , HDL-cholesterol or TAG . In conclusion , pistachio nuts contain less metabolisable energy than that calculated from the Atwater general factors . Accurate information about metabolisable energy content of foods is important for reliable food labelling BACKGROUND In a recent six-year follow-up study , we found that frequent consumption of nuts was associated with a reduced risk of ischemic heart disease .  To explore possible explanations for this finding , we studied the effects of nut consumption on serum lipids and blood pressure . METHODS We r and omly placed 18 healthy men on two mixed natural diets  , each diet to be followed for four weeks . Both diets conformed to the National Cholesterol Education Program Step 1 diet and contained identical foods and macronutrients , except that 20 percent of the calories of one diet ( the walnut diet ) were derived from walnuts ( offset by lesser amounts of fatty foods , meat , and visible fat [ oils , margarine , and butter ] ) . RESULTS With the reference diet , the mean ( + /- SD ) serum values for total , low-density lipoprotein ( LDL ) , and high-density lipoprotein ( HDL ) cholesterol were , respectively , 182 + /- 23 , 112 + /- 16 , and 47 + /- 11 mg per deciliter ( 4.71 + /- 0.59 , 2.90 + /- 0.41 , and 1.22 + /- 0.28 mmol per liter ) . With the walnut diet , the mean total cholesterol level was 22.4 mg per deciliter ( 0.58 mmol per liter ) lower than the mean level with the reference diet ( 95 percent confidence interval , 28 to 17 mg per deciliter [ 0.72 to 0.44 mmol per liter ] ) ; the LDL and HDL cholesterol levels were , respectively , 18.2 mg per deciliter ( 0.47 mmol per liter ) ( P < 0.001 ) and 2.3 mg per deciliter ( 0.06 mmol per liter ) ( P = 0.01 ) lower . These lower values represented reductions of 12.4 , 16.3 , and 4.9 percent in the levels of total , LDL , and HDL cholesterol , respectively . The ratio of LDL cholesterol to HDL cholesterol was also lowered ( P < 0.001 ) by the walnut diet .  Mean blood-pressure values did not change during either dietary period . CONCLUSIONS Incorporating moderate quantities of walnuts into the recommended cholesterol-lowering diet while maintaining the intake of total dietary fat and calories decreases serum levels of total cholesterol and favorably modifies the lipoprotein profile in normal men . The long-term effects of walnut consumption and the extension of this finding to other population groups deserve further study BACKGROUND Elevated serum cholesterol levels play an important role in the development of coronary artery disease . Previous studies have suggested that nut consumption benefits lipid profile .  Pistachio nuts are widely available , inexpensive and frequently consumed by the general population . OBJECTIVE To determine whether substituting 20 % of the daily caloric intake in the form of pistachio nuts will improve the lipid profiles of humans with primary , moderate hypercholesterolemia . DESIGN Controlled , r and omized crossover design . SETTING Outpatient dietary modification , counseling and blood analysis . PATIENTS Ten patients with moderate hypercholesterolemia . INTERVENTION Three weeks of dietary modification with 20 % caloric intake from pistachio nuts . MEASUREMENTS Body weight , blood pressure , total cholesterol , LDL , HDL , and triglycerides were monitored . Lipid profiles were analyzed prior to , during and after dietary modification . RESULTS After three weeks , there was a decrease in total cholesterol ( p<0.04 ) , an increase in HDL ( p<0.09 ) , a decrease in the total cholesterol/HDL ratio ( p<0.01 ) and a decrease in the LDL/HDL ratio ( p<0.02 ) . Triglycerides and LDL levels decreased , but not significantly . Body weight and blood pressure remained constant throughout the study . CONCLUSIONS Results suggest that eating pistachio nuts instead of other dietary fat calories can improve lipid profiles , thereby decreasing coronary risk . Further studies will be required to confirm these results and to determine the mechanism of this effect BACKGROUND AND AIMS Virgin olive oil ( VOO ) and nuts are basic components of the Mediterranean diet , a heart-healthy dietary pattern . Nuts have well known cholesterol lowering effects , while evidence is unclear for VOO . We design ed a study in hypercholesterolemic patients to assess the effects on serum lipids and other intermediate markers of cardiovascular risk of replacing 40 % of the fat in the background diet with VOO , walnuts or almonds . METHODS AND RESULTS After a 4 week run-in period with a healthy diet , eligible c and i date s were r and omized into three diet sequences in a crossover design , with a common background diet enriched with VOO , walnuts or almonds , lasting 4 weeks each . Outcomes were changes of serum lipids and oxidation and inflammation markers , measured by st and ard methods . Plasma fatty acids were determined by gas chromatography to assess compliance . In 18 participants completing the study ( 9 women , mean age 56 y , BMI 25.7 kg/m(2 ) ) , LDL-cholesterol was reduced from baseline by 7.3 % , 10.8 % and 13.4 % after the VOO , walnut and almond diets , respectively ( P = 0.001 , Friedman test ) . Total cholesterol and LDL/HDL ratios decreased in parallel . LDL-cholesterol decreases were greater than predicted from dietary fatty acid and cholesterol exchanges among diets . No changes of other lipid fractions , oxidation analytes or inflammatory biomarkers were observed . Plasma fatty acid changes after each diet sequence supported good compliance . CONCLUSION The results confirm the cholesterol lowering properties of nut-enriched diets . They also suggest that phenolic-rich VOO has a cholesterol lowering effect independently of its fatty acid content , which clearly deserves further study Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 mmol/L [ 160 mg/dL ] [ or treatment with hypolipidemic drugs ] , high-density lipoprotein [ HDL ] cholesterol level 1.04 mmol/L [ 40 mg/dL ] , body mass index [ BMI ] 25 kg/m2 , or a family history of premature CHD ) . Exclusion criteria were history of cardiovascular disease , any severe chronic illness , drug or alcohol addiction , history of allergy or intolerance to olive oil or nuts , or low predicted likelihood of changing dietary habits according to the stages-of-change model ( 18 ) . The primary care physicians based participants ' eligibility on review of clinical records and a screening visit . They obtained a list of c and i date s from computer-based records of patients who attended each participating center and review ed their clinical records to exclude those who did not meet eligibility criteria . They then invited suitable c and i date s by telephone to attend a screening visit . The visit included an interview with administration of a 26-item question naire to inquire about medical conditions and risk factors related to eligibility . Of the eligible c and i date s who met entry requirements , 95 % agreed to participate and provided informed consent . R and omization and Intervention After the screening visit , each center r and omly assigned eligible participants to 1 of 3 diet groups by using a computer-generated r and om-number sequence . The coordinating center constructed the r and omization table , and participants were r and omly assigned into blocks of 50 participants balanced by center , sex , and age group ( < 70 years and 70 years ) . We concealed allocation into the intervention groups by using closed envelopes with correlative numbers by prespecified subgroups of sex and age . The baseline examination included the administration of a 14-item question naire , an extension of a previously vali date d question naire ( 19 ) , that assessed the degree of adherence to the traditional Mediterranean diet . We assigned values of 0 or 1 to each item ( Appendix Table 1 ) . We also administered a 137-item vali date d food frequency question naire ( 20 ) ; the vali date d Spanish version ( 21 ) of the Minnesota Leisure Time Physical Activity Question naire ; and a 47-item question naire about education , lifestyle , history of illnesses , and medication use . We performed anthropometric and blood pressure measurements and obtained sample s of fasting blood and spot urine . We repeated all examinations at 3 months . The same dietitian delivered the interventions to the 3 r and omized groups in each center . On the basis of the assessment of individual Mediterranean diet scores , the dietitian gave personalized dietary advice during a 30-minute session to each participant , with recommendations on the desired frequency of intake of specific foods . We advised participants who were allocated to the low-fat diet to reduce intake of all types of fat , and we gave them a leaflet with written recommendations according to the American Heart Association guidelines ( 22 ) . For total fat intake , these recommendations were opposite to those given to participants in the 2 Mediterranean diet groups , who received instructions intended to increase the 14-item Mediterranean diet score , including increased consumption of vegetable fats and oils . We did not suggest any energy restriction . While the participants who were allocated to the low-fat diet did not receive further intervention , those assigned the 2 Mediterranean diet groups had access to more intense intervention in 2 ways . First , they were given a free provision of typical Mediterranean fatty foods ( olive oil or nuts ) . Depending on group assignment , participants were given either free virgin olive oil ( 15 L [ 1 L/wk ] for 3 months ) or free sachets of walnuts , hazelnuts , and almonds ( 1350 g of walnuts [ 15 g/d ] , 675 g of hazelnuts [ 7.5 g/d ] , and 675 g of almonds [ 7.5 g/d ] for 3 months ) . To improve adherence and account for family needs , participants in the corresponding Mediterranean diet groups were given excess olive oil or additional 1000-g packets of nuts . We analyzed the nutrient composition of the olive oil and nuts used in the study by st and ard methods in a reference laboratory ( Appendix Table 2 ) ) . Second , 1 week after inclusion , the dietitian delivered a 1-hour group session with up to 20 participants , with separate sessions for each Mediterranean diet group . Each group session consisted of informative talks and provision of written material s with elaborate descriptions of typical Mediterranean foods and seasonal shopping lists , meal plans , and cooking recipes . Throughout the study , all participants had free and continuous access to their center dietitian for advice and consultation . Measurements Trained personnel measured weight and height by using calibrated scales and a wall-mounted stadiometer , respectively ; waist circumference midway between the lowest rib and the iliac crest by using an anthropometric tape ; and blood pressure in triplicate with a vali date d semiautomatic oscillometer ( Omron HEM-705CP , Hoofddorp , the Netherl and s ) . We calculated energy and nutrient intake from Spanish food composition tables ( 23 ) . At the 3-month visit and when consulted by participants , dietitians assessed any adverse effects from the interventions by administering a checklist of symptoms and gave advice on how to remedy them . The checklist included mouth symptoms ; bloating , fullness , or indigestion ; altered bowel OBJECTIVE The health benefits of regular nut consumption have been well-documented ; however , effects on cardiovascular risk in diabetes are emerging . This study examined the effects of daily pistachio consumption on the lipid/lipoprotein profile , glycemic control , markers of inflammation , and endothelial function in adults with type 2 diabetes . MATERIAL S/ METHODS We enrolled 30 adults ( 40 - 74 years ) with well-controlled type 2 diabetes ( mean glycated hemoglobin 6.2 % ) in a r and omized , crossover , controlled feeding study . After a 2-week run-in period , participants consumed nutritionally-adequate diets with pistachios ( contributing 20 % of total energy ) or without pistachios for 4 weeks each , separated by a 2-week washout . We assessed fasting lipids/lipoproteins , glycemic measures ( while fasted and during a 75 g oral glucose tolerance test ) , inflammatory markers , and endothelial function after each diet period . RESULTS Total cholesterol and the ratio of total to HDL cholesterol were significantly lower ( p<0.05 ) following the pistachio diet ( 4.00 mmol/L and 4.06 mmol/L , respectively ) compared to the control diet ( 4.15 mmol/L and 4.37 mmol/L , respectively ) . Triglycerides were significantly lower ( p=0.003 ) following the pistachio diet ( 1.56 mmol/L ) compared to the control diet ( 1.84 mmol/L ) . There were no treatment differences in fasting glucose and insulin , but fructosamine was significantly lower ( p=0.03 ) following the pistachio diet ( 228.5 μmol/l ) compared to the control diet ( 233.5 μmol/l ) . Inflammatory markers and endothelial function were unchanged . CONCLUSION Daily pistachio consumption can improve some cardiometabolic risk factors in adults with well-controlled type 2 diabetes . Our findings support recommendations that individuals with diabetes follow healthy dietary patterns that include nuts Background : Previous studies have demonstrated that nuts consumption have beneficial effects on serum lipid profiles in hyperlipidemic or normolipidemic subjects . However , similar studies in diabetes field are quite rare . So , we aim ed to investigate the effects of hazelnut consumption on fasting blood sugar ( FBS ) and lipid profiles in patients with type 2 Diabetes . Material s and Methods : An 8-week controlled r and omized parallel study in patients with type 2 diabetes . Fifty eligible volunteers were assigned to either the control or intervention groups . 10 % of total daily calorie intake was replaced with hazelnuts in intervention group . Blood sample s were collected from fasting patients at the start and at the end of the study . Results : After 8 weeks , there were significant differences in high-density lipoprotein-cholesterol ( HDL-C ) concentrations between two groups , using analyses of covariance ( P = 0.009 ) , which was due to the larger HDL-C reduction in control group ( P = 0.003 ) . Although , Hazelnut group achieved greater reduction in triglyceride ( TG ) concentrations than control group , these changes were not statistically significant . Neither between-group changes nor within-group changes were significant for FBS , total cholesterol ( TC ) , TG , and low-density lipoprotein-cholesterol ( LDL-C ) levels . Conclusion : Results of this study indicated that incorporation of hazelnuts into diet can prevent reduction of HDL-C concentrations in patients with type 2 diabetes , but had no effect on FBS or other lipid profile indices Regular nut consumption may improve markers of inflammation and endothelial dysfunction . The quantity of nuts required to achieve these health benefits without compromising body weight and acceptance is unknown . This study compared the effects of incorporating hazelnuts at 2 different doses with a diet without nuts on inflammatory markers , cell adhesion molecules , and body composition in 107 overweight and obese individuals . This was a r and omized , controlled , parallel 12-wk intervention including 3 treatment arms : no nuts ( control group ) , 30 g/d of hazelnuts , or 60 g/d of hazelnuts .  Blood pressure , body composition , plasma high-sensitivity C-reactive protein ( hs-CRP ) , interleukin 6 ( IL-6 ) , intercellular adhesion molecule 1 ( ICAM-1 ) , vascular cell adhesion molecule 1 ( VCAM-1 ) , lipid , and apolipoprotein ( apo ) profiles were assessed at baseline and at 6 and 12 wk . " Desire " and " liking " for nuts were assessed during the intervention . Results showed no significant differences in follow-up clinical outcomes between groups after adjusting for baseline values , age , sex , and BMI ( all P ≥ 0.10 ) , except for a tendency toward improvement in VCAM-1 concentration in the 60-g/d nut group ( P = 0.07 ) . Hazelnut consumption significantly improved diet quality in a dose-response manner . Desire and liking for nuts remained stable in the 30-g/d group , whereas these ratings decreased significantly over time in the 60-g/d group ( both P < 0.001 ) . In conclusion , 12 wk of hazelnut consumption appears to have minimal effect on inflammatory markers and cell adhesion molecules in this group of healthy , normocholesterolemic overweight and obese individuals . Nut consumption improves diet quality without adversely affecting body composition . Consuming 30 g/d of nuts regularly is achievable , whereas 60 g/d appears to compromise desire and liking OBJECTIVE To investigate whether the risk profile of coronary heart disease ( CHD ) is more favorable in physically active men with tetraplegia compared with sedentary men with tetraplegia . DESIGN Using a cross-sectional design , the lipid and (apo)lipoprotein concentrations of 11 active and 13 sedentary men with tetraplegia were compared . Regression analysis was applied to investigate the influence of subject characteristics and behavioral factors on the risk profile of CHD . MAIN OUTCOME MEASURES Total plasma cholesterol ( TC ) , high-density lipoprotein cholesterol ( HDL-C ) , triglycerides , apolipoprotein-A1 ( ApoA1 ) , and apolipoprotein-B ( ApoB ) concentrations were determined . Low-density lipoprotein cholesterol ( LDL-C ) and the ratios TC/HDL-C , LDL-C/HDL-C , ApoA1/ApoB , and HDL-C/ApoA1 were calculated . RESULTS A significantly higher HDL-C and ApoA1/ApoB and lower TC/HDL-C were found in the active group . Age and body mass index were important determinants of the lipids and (apo)lipoproteins .  Sport activity was the only significant determinant of HDL-C. CONCLUSIONS Results suggest a positive influence of sport activity on HDL-C in men with tetraplegia , which may reduce the risk of CHD OBJECTIVE the aim of this study was to investigate the effects of a healthy Nordic diet ( ND ) on cardiovascular risk factors . DESIGN AND SUBJECTS in a r and omized controlled trial ( NORDIET ) conducted in Sweden , 88 mildly hypercholesterolaemic subjects were r and omly assigned to an ad libitum ND or control diet ( subjects ' usual Western diet ) for 6 weeks . Participants in the ND group were provided with all meals and foods . Primary outcome measurements were low-density lipoprotein ( LDL ) cholesterol , and secondary outcomes were blood pressure ( BP ) and insulin sensitivity ( fasting insulin and homeostatic model assessment -insulin resistance ) . The ND was rich in high-fibre plant foods , fruits , berries , vegetables , whole grains , rapeseed oil , nuts , fish and low-fat milk products , but low in salt , added sugars and saturated fats . RESULTS the ND contained 27 % , 52 % , 19 % and 2 % of energy from fat , carbohydrate , protein and alcohol , respectively . In total , 86 of 88 subjects r and omly assigned to diet completed the study . Compared with controls , there was a decrease in plasma cholesterol ( -16 % , P < 0.001 ) , LDL cholesterol ( -21 % , P < 0.001 ) , high-density lipoprotein ( HDL ) cholesterol ( -5 % , P < 0.01 ) , LDL/HDL ( -14 % , P < 0.01 ) and apolipoprotein (apo)B/apoA1 ( -1 % , P < 0.05 ) in the ND group . The ND reduced insulin ( -9 % , P = 0.01 ) and systolic BP by -6.6 ± 13.2 mmHg ( -5 % , P < 0.05 ) compared with the control diet . Despite the ad libitum nature of the ND , body weight decreased after 6 weeks in the ND compared with the control group ( -4 % , P < 0.001 ) . After adjustment for weight change , the significant differences between groups remained for blood lipids , but not for insulin sensitivity or BP . There were no significant differences in diastolic BP or triglyceride or glucose concentrations . CONCLUSIONS a healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinical ly relevant levels in hypercholesterolaemic subjects Background Routine apolipoprotein ( apo ) measurements for cardiovascular disease ( CVD ) are restricted to apoA-I and apoB. Here , the authors measured an unprecedented range of apolipoproteins in a prospect i ve , population -based study and relate their plasma levels to risk of CVD . Objectives This study sought to measure apolipoproteins directly by mass spectrometry and compare their associations with incident CVD and to obtain a system-level underst and ing of the correlations of apolipoproteins with the plasma lipidome and proteome . Methods Associations of 13 apolipoproteins , 135 lipid species , and 211 other plasma proteins with incident CVD ( 91 events ) , defined as stroke , myocardial infa rct ion , or sudden cardiac death , were assessed prospect ively over a 10-year period in the Bruneck Study ( N = 688 ) using multiple-reaction monitoring mass spectrometry . Changes in apolipoprotein and lipid levels following treatment with volanesorsen , a second-generation antisense drug targeting apoC-III , were determined in 2 human intervention trials , one of which was r and omized . Results The apolipoproteins most significantly associated with incident CVD were apoC-II ( hazard ratio per 1 SD [ HR/SD ] : 1.40 ; 95 % confidence interval [ CI ] : 1.17 to 1.67 ) , apoC-III ( HR/SD : 1.38 ; 95 % CI : 1.17 to 1.63 ) , and apoE ( HR/SD : 1.31 ; 95 % CI : 1.13 to 1.52 ) . Associations were independent of high-density lipoprotein ( HDL ) and non-HDL cholesterol , and extended to stroke and myocardial infa rct ion . Lipidomic and proteomic profiles implicated these 3 very-low-density lipoprotein (VLDL)-associated apolipoproteins in de novo lipogenesis , glucose metabolism , complement activation , blood coagulation , and inflammation . Notably , apoC-II/apoC-III/apoE correlated with a pattern of lipid species previously linked to CVD risk . ApoC-III inhibition by volanesorsen reduced plasma levels of apoC-II , apoC-III , triacylglycerols , and diacylglycerols , and increased apoA-I , apoA-II , and apoM ( all p < 0.05 vs. placebo ) without affecting apoB-100 ( p = 0.73 ) . Conclusions The strong associations of VLDL-associated apolipoproteins with incident CVD in the general community support the concept of targeting triacylglycerol-rich lipoproteins to reduce risk of CVD Serum components , such as lipoproteins , coagulation factors ( factor VII , tissue plasminogen activator ( tPA ) , plasminogen activator inhibitor-1 ( PAI-1 ) , fibrinogen ) , and homocysteine have been associated with cardiovascular disease . Dietary intervention with a low-fat , low-cholesterol diet has favorably influenced cardiovascular disease and certain food , specifically the consumption of nuts , has been associated with reduced cardiovascular risks . The effects of walnuts , as part of a low-fat , low-cholesterol diet , on serum cardiovascular risk factors were determined . Sixty-seven ( 67 ) out patients with borderline high total cholesterol following a low-fat , low-cholesterol diet for six weeks before being r and omly assigned to continue the diet or have 64 grams/day of walnuts in conjunction with the diet . After six weeks , the patients ' diets were switched . Therefore , all patients consumed 64 grams/day of walnuts for six weeks during part of the trial as part of a low-fat , low cholesterol diet .  Serum lipids demonstrated a significant reduction in triacyglycerols and favorable trend with decreases in total cholesterol , low-density lipoprotein ( LDL ) cholesterol , and a slight increase in high-density lipoprotein ( HDL ) cholesterol . No statistical effects on homocysteine or the coagulation factors were observed . However , there was a slight favorable trend for tPA and PAI-1 . This study demonstrated that walnuts , when consumed as part of a low fat , low-cholesterol diet , have a beneficial effect on serum cardiovascular risk factors . However , these changes may not explain all of the beneficial effects that walnut consumption has on cardiovascular disease OBJECTIVE Fat intake , especially monounsaturated fatty acid ( MUFA ) , has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control , yet the exact sources have not been clearly defined . Therefore , we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA1c in type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 117 type 2 diabetic subjects were r and omized to one of three treatments for 3 months . Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts ( 75 g/day ) , muffins , or half portions of both . The primary outcome was change in HbA1c . RESULTS The relative increase in MUFAs was 8.7 % energy on the full-nut dose compared with muffins . Using an intention-to-treat analysis ( n = 117 ) , full-nut dose ( mean intake 73 g/day ) reduced HbA1c ( −0.21 % absolute HbA1c units , 95 % CI −0.30 to −0.11 , P < 0.001 ) with no change after half-nut dose or muffin . Full-nut dose was significantly different from half-nut dose ( P = 0.004 ) and muffin ( P = 0.001 ) , but no difference was seen between half-nut dose and muffins . LDL cholesterol also decreased significantly after full-nut dose compared with muffin . The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments . Apolipoprotein ( apo ) B and the apoB : apoA1 ratio behaved similarly . Nut intake related negatively to changes in HbA1c ( r = −0.20 , P = 0.033 ) and LDL cholesterol ( r = −0.24 , P = 0.011 ) . CONCLUSIONS Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes Objective : There is a widely held view that , due to high fat content , snacking on nuts will lead to weight gain , ultimately causing unhealthy changes in lipid profiles . This study is design ed to study the effects of pistachio snack consumption on body weight and lipid levels in obese participants under real-world conditions . Methods : Participants were r and omly assigned to consume 1 of 2 isocaloric weight reduction diets for 12 weeks , with each providing 500 cal per day less than resting metabolic rate . Each diet included an afternoon snack of either 53 g ( 240 cal ) of salted pistachios ( n = 31 ) or 56 g of salted pretzels ( 220 cal ; n = 28 ) . Results : Both groups lost weight during the 12-week study ( time trend , p < 0.001 ) , but there were significant differences in the changes in body mass index between the pretzel and pistachio groups ( pistachio , 30.1 ± 0.4 to 28.8 ± 0.4 vs. pretzel , 30.9 ± 0.4 to 30.3 ± 0.5 ) . At 6 and 12 weeks , triglycerides were significantly lower in the pistachio group compared with the pretzel group ( 88.04 ± 9.80 mg/dL vs. 144.56 ± 18.86 mg/dL , p = 0.01 at 6 weeks and 88.10 ± 6.78 mg/dL vs. 132.15 ± 16.76 mg/dL , p = 0.02 at 12 weeks ) , and there was a time trend difference between the 2 groups over the 12 weeks ( p < 0.01 ) . There were no significant differences in total cholesterol , high-density lipoprotein cholesterol , low-density lipoprotein cholesterol , insulin , or glucose between the 2 groups . Conclusion : Pistachios can be consumed as a portion-controlled snack for individuals restricting calories to lose weight without concern that pistachios will cause weight gain . By comparison to refined carbohydrate snacks such as pretzels , pistachios may have beneficial effects on triglycerides as well Background Although the efficacy of ezetimibe/simvastatin and atorvastatin on traditional lipid parameters has been studied extensively , the apolipoprotein B/apolipoprotein A1 ( ApoB/ApoA1 ) ratio , which has a better predictive value for cardiovascular events , has not previously been used as a primary endpoint in these two treatment groups . Objective Our objective was to compare the efficacy and safety of ezetimibe/simvastatin 10/20 mg versus atorvastatin 20 mg once daily in Korean patients with type 2 diabetes mellitus . Study Design This study was an open-label , r and omized , controlled study . Type 2 diabetes patients with high levels of low-density lipoprotein ( LDL ) cholesterol ( > 100 mg/dL ) were r and omized to receive ezetimibe/simvastatin or atorvastatin . Main Outcome MeasureThe primary endpoint was the difference in the percent change of ApoB/ApoA1 at 12 weeks , and secondary endpoints were changes in lipid profiles , glycosylated hemoglobin ( HbA1c ) , homeostatic model assessment ( HOMA ) index , and C-reactive protein . Results In total , 132 patients ( 66 for each group ) were enrolled and r and omized . After 12 weeks of treatment , the ApoB/ApoA1 ratio was significantly reduced in both groups ; however , the difference of changes between the two groups was not statistically significant ( ezetimibe/simvastatin −38.6 ± 18.0 % vs. atorvastatin −34.4 ± 15.5 % ; p = 0.059 ) . There were no significant differences in changes to total cholesterol , LDL cholesterol , high-density lipoprotein cholesterol , triglycerides , ApoB , and ApoB48 between the two groups . However , the increments of ApoA1 were significantly greater in the ezetimibe/simvastatin group than in the atorvastatin group ( 2.8 ± 10.0 vs. −1.8 ± 9.8 % ; p = 0.002 ) . In the per- protocol analysis , improvement in ApoB/ApoA1 was significantly greater in the ezetimibe/simvastatin group ( −42.8 ± 11.8 vs. −36.7 ± 13.2 % ; p = 0.019 ) . The changes in HbA1c , HOMA index , and C-reactive protein were comparable between the two groups . The adverse reaction rate was similar between the two groups ( 24.2 vs. 34.9 % ; p = 0.180 ) . Conclusion Ezetimibe/simvastatin 10/20 mg is comparable to atorvastatin 20 mg for the management of dyslipidemia , and may have more favorable effects on apolipoprotein profiles than atorvastatin 20 mg in Korean patients with type 2 diabetes mellitus CONTEXT Observational studies show an association between low vitamin D status assessed by circulating 25-hydroxyvitamin D and cardiovascular events and mortality . Data from r and omized controlled trials are limited . OBJECTIVE The aim of this study was to test whether daily doses of vitamin D(3 ) at 400 or 1000 IU/d for 1 yr affected conventional markers of cardiovascular disease ( CVD ) risk . DESIGN We conducted a parallel-group , double-blind , placebo-controlled r and omized controlled trial . R and omization was computer generated . Participants and study investigators were blinded to intervention groupings throughout the trial . SETTING The study was conducted at the Clinical Research Facility , University of Aberdeen , United Kingdom . PARTICIPANTS A total of 305 healthy postmenopausal women aged 60 - 70 yr were recruited for the study . INTERVENTION Each woman received a daily capsule of 400 or 1000 IU vitamin D(3 ) or placebo r and omly allocated . MAIN OUTCOME MEASURES Primary outcomes were serum lipid profile [ total , high-density lipoprotein , and low-density lipoprotein cholesterol ; triglycerides ; and apolipoproteins A-1 and B100 ] , insulin resistance ( homeostatic model assessment ) , inflammatory biomarkers ( high-sensitivity C-reactive protein , IL-6 , soluble intracellular adhesion molecule-1 ) , and blood pressure . RESULTS A total of 265 ( 87 % ) participants completed all study visits . Small differences between groups for serum apolipoprotein B100 change [ repeated measures ANOVA , P=0.04 ; mean ( sd ) , -1.0 ( 10.0 ) mg/dl ( 400 IU ) ; -1.0 ( 10.0 ) mg/dl ( 1000 IU ) ; and + 0.02 ( 10.0 ) mg/dl ( placebo ) ] were not considered clinical ly significant . Other systemic markers for CVD risk remained unchanged . There was significant seasonal variation in systolic and diastolic blood pressure independent of vitamin D dose ( P<0.001 , linear mixed model ) . Mean ( sd ) reduction in systolic blood pressure from winter to summer was -6.6 ( 10.8 ) mm Hg . CONCLUSIONS Improving vitamin D status through dietary supplementation is unlikely to reduce CVD risk factors . Confounding of seasonality should be recognized and addressed in future studies of vitamin Background — Nuclear magnetic resonance ( NMR ) spectroscopy measures the number and size of lipoprotein particles instead of their cholesterol or triglyceride content , but its clinical utility is uncertain . Methods and Results — Baseline lipoproteins were measured by NMR in 27 673 initially healthy women followed up for incident cardiovascular disease ( n=1015 ) over an 11-year period . After adjustment for nonlipid risk factors , hazard ratios and 95 % confidence intervals for the top versus the bottom quintile of NMR-measured lipoprotein particle concentration ( measured in particles per liter ) were 2.51 ( 1.91 to 3.30 ) for low-density lipoprotein ( LDLNMR ) , 0.91 ( 0.75 to 1.12 ) for high-density lipoprotein ( HDLNMR ) , 1.71 ( 1.38 to 2.12 ) for very low – density lipoprotein ( VLDLNMR ) , and 2.25 ( 1.80 to 2.81 ) for the LDLNMR/HDLNMR ratio . Similarly adjusted results for NMR-measured lipoprotein particle size ( measured in nanometers ) were 0.64 ( 0.52 to 0.79 ) for LDLNMR size , 0.65 ( 0.51 to 0.81 ) for HDLNMR size , and 1.37 ( 1.10 to 1.70 ) for VLDLNMR size . Hazard ratios for NMR measures were comparable but not superior to st and ard lipids ( total cholesterol 2.08 [ 1.63 to 2.67 ] , LDL cholesterol 1.74 [ 1.40 to 2.16 ] , HDL cholesterol 0.52 [ 0.42 to 0.64 ] , triglycerides 2.58 [ 1.95 to 3.41 ] , non-HDL cholesterol 2.52 [ 1.95 to 3.25 ] , total/HDL cholesterol ratio 2.82 [ 2.23 to 3.58 ] ) and apolipoproteins ( B100 2.57 [ 1.98 to 3.33 ] , A-1 0.63 [ 0.52 to 0.77 ] , and B100/A-1 ratio 2.79 [ 2.21 to 3.54 ] ) . Essentially no reclassification improvement was found with the addition of the LDLNMR particle concentration or apolipoprotein B100 to a model that already included the total/HDL cholesterol ratio and nonlipid risk factors ( net reclassification index 0 % and 1.9 % , respectively ) , nor did the addition of either variable result in a statistically significant improvement in the c-index . Conclusions — In this prospect i ve study of healthy women , cardiovascular disease risk prediction associated with lipoprotein profiles evaluated by NMR was comparable but not superior to that of st and ard lipids or apolipoproteins OBJECTIVE To determine how changes in lipids , liver enzymes , and inflammatory and glycemia markers intercorrelate during prolonged dietary intervention in obese participants with or without type 2 diabetes ( T2D ) . METHODS We examined the dynamics and intercorrelations among changes in biomarkers during the 2-y Dietary Intervention R and omized Controlled Trial ( DIRECT ) in 322 participants ( including 46 with T2D ; 52 y of age , body mass index 31 kg/m(2 ) ) throughout rapid weight loss ( 0 - 6 mo ) and weight-maintenance/regain ( 7 - 24 mo ) phases . RESULTS The 2-y increase of high-density lipoprotein cholesterol was greater in participants with T2D ( + 9.41 versus+6.57 mg/dL , P < 0.05 ) , although they tended to have smaller waist circumferences ( -2.1 versus -4.0 cm , P = 0.08 ) . In models adjusted for age , sex , and weight loss , the 2-year decrease of triacylglycerols was associated with increases of low-density and high-density lipoprotein cholesterol . An increase of apolipoprotein A1 was associated with a decrease in high-sensitive C-reactive protein ( P < 0.05 for all comparisons ) . Exclusively in participants with T2D , the 2-year decrease in triacylglycerols was further correlated with decreases in apolipoprotein B100 and liver enzymes , and a decrease in fasting glucose correlated with decreases in low-density lipoprotein cholesterol , apolipoprotein B100 , and alanine aminotransferase ( P < 0.05 for all comparisons ) . In the entire group , multivariate models adjusted for age , sex , intervention group , and 6-mo weight loss identified decreased high-sensitive C-reactive protein at 6 mo as an exclusive predictor of a greater decrease in triacylglycerols ( β = 0.154 , P = 0.008 ) and a greater increase in high-density lipoprotein cholesterol ( β = -0.452 , P = 0.005 ) during the subsequent 18 mo . CONCLUSIONS Long-term dietary intervention induces a flow of changes within biomarkers and the cross-talk is likely to be stronger in T2D . A decrease in systemic inflammation during the weight-loss phase may predict greater long-term improvement in lipids ( www . Clinical Trials.gov , identifier NCT00160108 ) CONTEXT Current guidelines for cardiovascular risk detection are controversial with regard to the clinical utility of different lipid measures , non-high-density lipoprotein cholesterol ( non-HDL-C ) , lipid ratios , apolipoproteins , and C-reactive protein ( CRP ) . OBJECTIVE To directly compare the clinical utility of total cholesterol , low-density lipoprotein cholesterol ( LDL-C ) , HDL-C , non-HDL-C , apolipoproteins A-I and B(100 ) , high-sensitivity CRP , and the ratios of total cholesterol to HDL-C , LDL-C to HDL-C , apolipoprotein B(100 ) to apolipoprotein A-I , and apolipoprotein B(100 ) to HDL-C as predictors of future cardiovascular events in women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 15,632 initially healthy US women aged 45 years or older ( interquartile range , 48 - 59 years ) who were enrolled between November 1992 and July 1995 . All participants were followed up over a 10-year period for the occurrence of future cardiovascular events . MAIN OUTCOME MEASURE Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for first-ever major cardiovascular events ( N = 464 ) according to baseline levels of each biomarker . RESULTS After adjustment for age , smoking status , blood pressure , diabetes , and body mass index , the HRs for future cardiovascular events for those in the extreme quintiles were 1.62 ( 95 % CI , 1.17 - 2.25 ) for LDL-C , 1.75 ( 95 % CI , 1.30 - 2.38 ) for apolipoprotein A-I , 2.08 ( 95 % CI , 1.45 - 2.97 ) for total cholesterol , 2.32 ( 95 % CI , 1.64 - 3.33 ) for HDL-C , 2.50 ( 95 % CI , 1.68 - 3.72 ) for apolipoprotein B(100 ) , 2.51 ( 95 % CI , 1.69 - 3.72 ) for non-HDL-C , and 2.98 ( 95 % CI , 1.90 - 4.67 ) for high-sensitivity CRP ( P<.001 for trend across all quintiles ) . The HRs for the lipid ratios were 3.01 ( 95 % CI , 2.01 - 4.50 ) for apolipoprotein B(100 ) to apolipoprotein A-I , 3.18 ( 95 % CI , 2.12 - 4.75 ) for LDL-C to HDL-C , 3.56 ( 95 % CI , 2.31 - 5.47 ) for apolipoprotein B(100 ) to HDL-C , and 3.81 ( 95 % CI , 2.47 - 5.86 ) for the total cholesterol to HDL-C ( P<.001 for trend across all quintiles ) . The correlation coefficients between high-sensitivity CRP and the lipid parameters ranged from -0.33 to 0.15 , and the clinical cut points for CRP of less than 1 , 1 to 3 , and higher than 3 mg/L provided prognostic information on risk across increasing levels of each lipid measure and lipid ratio . CONCLUSIONS Non-HDL-C and the ratio of total cholesterol to HDL-C were as good as or better than apolipoprotein fractions in the prediction of future cardiovascular events . After adjustment for age , blood pressure , smoking , diabetes , and obesity , high-sensitivity CRP added prognostic information beyond that conveyed by all lipid measures Background — Higher levels of physical activity are associated with fewer cardiovascular disease  (  CVD ) events . Although the precise mechanisms underlying this inverse association are unclear , differences in several cardiovascular risk factors may mediate this effect . Methods and Results — In a prospect i ve study of 27 055 apparently healthy women , we measured baseline levels of hemoglobin A1c , traditional lipids ( total , low-density lipoprotein , and high-density lipoprotein cholesterol ) , novel lipids [ lipoprotein(a ) and apolipoprotein A1 and B-100 ] , creatinine , homocysteine , and inflammatory/hemostatic biomarkers  ( high-sensitivity C-reactive protein , fibrinogen , soluble intracellular adhesion molecule-1 ) and used women 's self-reported physical activity , weight , height , hypertension , and diabetes . Mean follow-up was 10.9±1.6 years , and 979 incident CVD events occurred . The risk of CVD decreased linearly with higher levels of activity ( P for linear trend < 0.001 ) . Using the reference group of < 200 kcal/wk of activity yielded age- and treatment-adjusted relative risk reductions associated with 200 to 599 , 600 to 1499 , and ≥1500 kcal/wk of 27 % , 32 % , and 41 % , respectively . Differences in known risk factors explained a large proportion ( 59.0 % ) of the observed inverse association . When sets of risk factors were examined , inflammatory/hemostatic biomarkers made the largest contribution to lower risk ( 32.6 % ) , followed by blood pressure ( 27.1 % ) . Novel lipids contributed less to CVD risk reduction compared with traditional lipids ( 15.5 % and 19.1 % , respectively ) . Smaller contributions were attributed to body mass index ( 10.1 % ) and hemoglobin A1c/diabetes ( 8.9 % ) , whereas homocysteine and creatinine had negligible effects ( < 1 % ) . Conclusions — The inverse association between  physical activity  and CVD risk is mediated in substantial part by known risk factors , particularly inflammatory/hemostatic factors and blood pressure BACKGROUND : Lowering low-density lipoprotein cholesterol ( LDL-C ) with statins reduces atherosclerosis . LDL and high-density lipoprotein ( HDL ) are commonly measured by their cholesterol content , but non-HDL cholesterol , LDL particle number ( LDL-P ) , or total apolipoprotein B ( apoB ) may better predict cardiovascular risk . Few studies have examined relations among lipoprotein levels and composition before and after interventions to lower LDL-C and non-HDL-C. OBJECTIVE : To measure changes in carotid artery intimal media thickness ( CIMT ) and lipid concentration and composition during 36 months of statin therapy . METHODS : Analyses were conducted on 418 diabetic individuals , with complete data and no prior cardiovascular events , who were r and omized to aggressive ( AG ) versus st and ard ( STD ) treatment for LDL-C , non-HDL-C , and systolic blood pressure ( SBP ) as part of the Stop Atherosclerosis in Native Diabetics Study ( S AND S ) . RESULTS : The AG group achieved average LDL-C and non-HDL-C of 71mg/dL and 100mg/dL and a decrease in CIMT . No significant interactions were observed between treatment effect and initial levels of LDL-C , non-HDL-C , HDL-C , triglycerides , apoB , or LDL-P. Decreases in LDL-C ( p<.005 ) and non-HDL-C ( p<.001 ) were independently correlated with CIMT regression in the AG group . Changes in apoB and LDL-P showed borderline correlations with CIMT regression ( p=.07 and p=.09 ) . CONCLUSIONS : In diabetic adults with no prior cardiovascular events , treatment to current targets for lipids and SBP reduces atherosclerosis progression and when more aggressive targets are met , atherosclerosis regresses . The aggressive targets for LDL-C and non-HDL-C appeared to be the main determinants of CIMT regression and were more predictive of this outcome than changes in LDL-P or Nuts are foods with a high energy density , due in part to its small water content . They also present a low saturated fat content ( < 7 % ) but a high unsaturated fat contribution ( 40 - 60 % ) . They represent one of the richest sources of dietary fiber , which is basically of the insoluble type . The effects of nut intake on health have been widely studied . Several prospect i ve epidemiological studies performed on large cohorts have consistently shown that regular consumption of small amounts of nuts is negatively related to the risk of cardiovascular disease and to the risk of cardiovascular or all-cause mortality . From these studies can be concluded that regular consumption of small amounts of nuts leads to a 30 - 50 % reduction in the risk of cardiovascular disease . Additionally , intervention studies have shown a positive effect of nut intake on lipid profile with significant reductions in total and LDL cholesterol levels and small or null effects on the HDL fraction . More recently , some studies have focused on the effect of  nuts on body weight . At present , no evidence s support a detrimental effect of nut consumption on body weight . On the contrary some weight loss studies suggest a beneficial effect of nut intake on body weight regulation We investigated the effect of olive oil , rapeseed oil , and sunflower oil on blood lipids and lipoproteins including number and lipid composition of lipoprotein subclasses .  Eighteen young , healthy men participated in a double-blinded r and omized cross-over study ( 3-week intervention period ) with 50 g of oil per 10 MJ incorporated into a constant diet .  Plasma cholesterol , triacylglycerol , apolipoprotein B , and very low density lipoprotein ( VLDL ) , intermediate density lipoprotein ( IDL ) , and low density lipoprotein ( LDL ) cholesterol concentrations were 10;-20 % higher after consumption of the olive oil diet compared with the rapeseed oil and sunflower oil diets [ analysis of variance ( ANOVA ) , P < 0.05 ] . The size of IDL , VLDL , and LDL subfractions did not differ between the diets , whereas a significantly higher number ( apolipoprotein B concentration ) and lipid content of the larger and medium-sized LDL subfractions were observed after the olive oil diet compared with the rapeseed oil and sunflower oil diets ( ANOVA , P < 0.05 ) . Total HDL cholesterol concentration did not differ significantly , but HDL(2a ) cholesterol was higher after olive oil and rapeseed oil compared with sunflower oil ( ANOVA , P < 0.05).In conclusion , rapeseed oil and sunflower oil had more favorable effects on blood lipids and plasma apolipoproteins as well as on the number and lipid content of LDL subfractions compared with olive oil . Some of the differences may be attributed to differences in the squalene and phytosterol contents of the oils OBJECTIVES To determine whether , in individuals with hypercholesterolemia , substituting dietary soybean products for cows ' milk products improves the plasma lipid profile and whether any change in the profile is due partially to soy oil . DESIGN R and omized 3-treatment crossover trial . SETTING Family practice clinics and an outpatient clinic in London , Ont . PARTICIPANTS Seventeen healthy men and 17 healthy women with elevated plasma levels of total and low-density-lipoprotein ( LDL ) cholesterol and with normal plasma levels of triglycerides . INTERVENTIONS Participants incorporated into their normal diet either 2 % cows ' milk products , soybean products or a combination of skim milk products and soy oil , each over period of 4 weeks , with 22-week wash-out periods . Plasma lipid profile , blood pressure and body weight were assessed after each dietary and wash-out period . OUTCOME MEASURES Plasma levels of total and lipoprotein cholesterol , plasma levels of triglycerides , apolipoprotein B and A1 levels , blood pressure and plasma lipid peroxidation . RESULTS The change in diet had no effect on body mass index , levels of apolipoproteins B and A1 and most plasma lipids . During the soybean period , the subjects ' mean level of high-density-lipoprotein ( HDL ) cholesterol increased 9 % ( p < 0.04 ) and their mean LDL/HDL cholesterol ratio decreased 14 % ( p < 0.007 ) . These effects were less pronounced during the skim milk/soy oil period . In the 24 subjects with the highest initial LDL cholesterol level and LDL/HDL cholesterol ratio , the mean LDL cholesterol level decreased 11 % after the soybean period . In all subjects , changes in the LDL/HDL cholesterol ratio induced by a soybean diet were negatively correlated with the initial LDL/HDL cholesterol ratio and positively correlated with the initial HDL cholesterol level . CONCLUSIONS In people with hypercholesterolemia , the plasma lipid profile improved after treatment with a soybean-product diet , and this improvement was partially due to soy oil . The degree of responsiveness was associated with initial risk factors for coronary artery disease
Significant heterogeneity was not observed by nut type or other factors .
Tree nut intake  lowers total cholesterol , LDL cholesterol , ApoB , and triglycerides .
The major determinant of cholesterol lowering appears to be nut dose rather than nut type .
BACKGROUND The effects of nuts on major cardiovascular disease ( CVD ) risk factors , including dose-responses and potential heterogeneity by nut type or phytosterol content , are not well established .
OBJECTIVES We examined the effects of tree nuts ( walnuts , pistachios , macadamia nuts , pecans , cashews , almonds , hazelnuts , and Brazil nuts ) on blood lipids [ total cholesterol , low-density lipoprotein ( LDL ) cholesterol , high-density lipoprotein , and triglycerides ] , lipoproteins [ apolipoprotein A1 , apolipoprotein B ( ApoB ) , and apolipoprotein B100 ] , blood pressure , and inflammation ( C-reactive protein ) in adults aged ≥18 y without prevalent CVD .