Nut Consumption and Survival in Patients With Stage III Colon Cancer: Results From CALGB 89803 (Alliance) Prospective study of nut consumption, long-term weight change, and obesity risk in women. Soy Consumption, Markers of Inflammation, and Endothelial Function Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus Impact of a home-based activity and dietary intervention in people with slowly progressive neuromuscular diseases. Design and methods for testing a simple dietary message to improve weight loss and dietary quality The 2015 Dutch food-based dietary guidelines Non-alcoholic fatty liver disease in the Asia-Pacific region: definitions and overview of proposed guidelines. Effects of a Mediterranean-Style Diet on Cardiovascular Risk Factors Metformin versus dietary treatment in nonalcoholic hepatic steatosis: a randomized study Pistachio Nut Consumption and Serum Lipid Levels The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the Generation R study. Postprandial oxidative stress is modified by dietary fat: evidence from a human intervention study. Sentinel lymph node biopsy for patients with early-stage breast cancer: American Society of Clinical Oncology clinical practice guideline update. British Dietetic Association evidence-based guidelines for the dietary management of irritable bowel syndrome in adults. AN INVESTIGATION OF POLLEN EXTRACTS FROM DIFFERENT DECIDUOUS TREES IN PATIENTS WITH SPRINGTIME ALLERGY IN SWEDEN The non-effect of pirenzepine in dietary resistant irritable bowel syndrome Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. Association of 1-y changes in diet pattern with cardiovascular disease risk factors and adipokines: results from the 1-y randomized Oslo Diet and Exercise Study. Effects of adjunctive exercise on physiological and psychological parameters in depression: a randomized pilot trial. Effect of fixed‐dose combinations of ezetimibe plus rosuvastatin in patients with primary hypercholesterolemia: MRS‐ROZE (Multicenter Randomized Study of ROsuvastatin and eZEtimibe) Multicenter Study of Repeat Epinephrine Treatments for Food-Related Anaphylaxis Diagnostic Accuracy of ACR/EULAR 2010 Criteria for Rheumatoid Arthritis in a 2-Year Cohort The impact of usual dietary patterns, selection of significant foods and cuisine choices on changing dietary fat under 'free living' conditions. Household factors, family behavior patterns, and adherence to dietary and physical activity guidelines among children at risk for obesity. Impact of polyunsaturated vegetable oils on adiponectin levels, glycaemia and blood lipids in individuals with type 2 diabetes: a randomised, double-blind intervention study. Blood glucose testing and primary prevention of Type 2 diabetes-evaluation of the effect of evidence-based patient information: a randomized controlled trial. Effects of pistachio nut supplementation on blood glucose in patients with type 2 diabetes: a randomized crossover trial. Food Insufficiency and the Physical and Mental Health of Low-Income Women More Informative Abstracts of Articles Describing Clinical Practice Guidelines Nut Consumption and Risk of Cardiovascular Disease. Brazil nuts intake improves lipid profile, oxidative stress and microvascular function in obese adolescents: a randomized controlled trial Effects of food attributes on hunger and food intake Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women Association of nut and seed intake with colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Nut consumption is inversely associated with both cancer and total mortality in a Mediterranean population: prospective results from the Moli-sani study. Nut consumption and total and cause-specific mortality: results from the Golestan Cohort Study. DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease. Practice guidelines developed by specialty societies: the need for a critical appraisal [Nutrient content and health effects of nuts]. Comparative effect of two Mediterranean diets versus a low-fat diet on glycaemic control in individuals with type 2 diabetes Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. Long-term almond supplementation without advice on food replacement induces favourable nutrient modifications to the habitual diets of free-living individuals.
Purpose Observational studies have reported increased colon cancer recurrence and mortality in patients with states of hyperinsulinemia , including type 2 diabetes , obesity , sedentary lifestyle , and high glycemic load diet . Nut intake has been associated with a lower risk of type 2 diabetes , metabolic syndrome , and insulin resistance . However , the effect of nut intake on colon cancer recurrence and survival is not known . Patients and Methods We conducted a prospect i ve , observational study of 826 eligible patients with stage III colon cancer who reported dietary intake on food frequency question naires while enrolled onto a r and omized adjuvant chemotherapy trial .  Using Cox proportional hazards regression , we assessed associations of nut intake with cancer recurrence and mortality . Results After a median follow-up of 6.5 years , compared with patients who abstained from nuts , individuals who consumed two or more servings of nuts per week experienced an adjusted hazard ratio ( HR ) for disease-free survival of 0.58 ( 95 % CI , 0.37 to 0.92 ; Ptrend = .03 ) and an HR for overall survival of 0.43 ( 95 % CI , 0.25 to 0.74 ; Ptrend = .01 ) . In subgroup analysis , the apparent benefit was confined to  tree nut intake ( HR for disease-free survival , 0.54 ; 95 % CI , 0.34 to 0.85 ; Ptrend = .04 ; and HR for overall survival , 0.47 ; 95 % CI , 0.27 to 0.82 ; Ptrend = .04 ) . The association of total nut intake with improved outcomes was maintained across other known or suspected risk factors for cancer recurrence and mortality . Conclusion Diets with a higher consumption of nuts may be associated with a significantly reduced incidence of cancer recurrence and death in patients with stage III colon cancer BACKGROUND Data concerning the long-term association between nut consumption and weight change in a free-living population are sparse . OBJECTIVE The objective was to determine the relation between nut consumption and long-term weight change . DESIGN The participants were 51,188 women in the Nurses ' Health Study II aged 20 - 45 y , who had no cardiovascular disease , diabetes , or cancer . We prospect ively evaluated the dietary intake of nuts and subsequent weight changes from 1991 to 1999 . RESULTS Women who reported eating nuts > or = 2 times/wk had slightly less mean ( + /- SE ) weight gain ( 5.04 + /- 0.12 kg ) than did women who rarely ate nuts ( 5.55 + /- 0.04 kg ) ( P for trend < 0.001 ) . For the same comparison , when total nut consumption was subdivided into peanuts and tree nuts , the results were similar ( ie , less weight gain in women eating either peanuts or tree nuts > or = 2 times/wk ) . The results were similar in normal-weight , overweight , and obese participants . In multivariate analyses in which lifestyle and other dietary factors were controlled for , we found that greater nut consumption ( > or = 2 times/wk compared with never/almost never ) was associated with a slightly lower risk of obesity ( hazard ratio : 0.77 ; 95 % CI : 0.57 , 1.02 ; P for trend = 0.003 ) . CONCLUSIONS Higher nut consumption was not associated with greater body weight gain during 8 y of follow-up in healthy middle-aged women . Instead , it was associated with a slightly lower risk of weight gain and obesity . The results of this study suggest that incorporating nuts into diets does not lead to greater weight gain and may help weight control OBJECTIVE —To determine the effects of soy consumption on markers of inflammation and endothelial function in postmenopausal women with the metabolic syndrome . RESEARCH DESIGN AND METHODS —This r and omized cross-over clinical trial included 42 postmenopausal women with the metabolic syndrome . Participants were r and omly assigned to consume a control diet ( Dietary Approaches to Stop Hypertension [ DASH ] ) , soy protein diet , or soy nut diet , each for 8 weeks . Red meat in the DASH diet ( one serving/day ) was replaced by soy protein in the soy protein diet and by soy nut in the soy nut diet . RESULTS —For nitric oxide levels , the difference from the control diet was 9.8 % ( P < 0.01 ) on the soy nut and −1.7 % ( P = 0.10 ) on the soy protein diets . The difference from the control diet for serum E-selectin was −11.4 % ( P < 0.01 ) on the soy nut consumption and −4.7 % ( P = 0.19 ) on the soy protein diet . Soy nut consumption reduced interleukin-18 compared with the control diet ( difference from the control diet : −9.2 % , P < 0.01 ) , but soy protein did not ( difference from the control diet : −4.6 % , P = 0.14 ) . For C-reactive protein , the difference from the control diet was −8.9 % ( P < 0.01 ) on the soy nut diet and −1.6 % ( P < 0.01 ) on the soy protein diet . CONCLUSIONS —Short-term soy nut consumption reduced some markers of inflammation and increased plasma nitric oxide levels in postmenopausal women with the metabolic syndrome Rationale : The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited . Objective : To examine intake of total and specific types of nuts , including tree nuts and peanuts , in relation to subsequent risk of cardiovascular disease ( CVD ) , including coronary heart disease and stroke , and all-cause and cause-specific mortality among individuals with diabetes mellitus . Methods and Results : This prospect i ve analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up ( Nurses ’ Health Study : 1980–2014 , Health Professionals Follow-Up Study : 1986–2014 ) .  Nut consumption was assessed using a vali date d food frequency question naire and up date d every 2 to 4 years . During 223 682 and 254 923 person-years of follow-up , there were 3336 incident CVD cases and 5682 deaths , respectively . Higher total nut consumption was associated with a lower risk of CVD incidence and mortality . The multivariate-adjusted hazard ratios ( 95 % CIs ) for participants who consumed 5 or more servings of total nuts per week ( 1 serving=28 g ) , compared with those who consumed < 1 serving per month , were 0.83 ( 0.71–0.98 ; P trend=0.01 ) for total CVD incidence , 0.80 ( 0.67–0.96 ; P trend=0.005 ) for coronary heart disease incidence , 0.66 ( 0.52–0.84 ; P trend < 0.001 ) for CVD mortality , and 0.69 ( 0.61–0.77 ; P trend < 0.001 ) for all-cause mortality .  Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality . For specific types of nuts , higher tree nut consumption was associated with lower risk of total CVD , coronary heart disease incidence , and mortality because of CVD , cancer , and all causes , whereas peanut consumption was associated with lower all-cause mortality only ( all P trend < 0.001 ) . In addition , compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis , participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11 % lower risk of CVD , a 15 % lower coronary heart disease risk , a 25 % lower CVD mortality , and a 27 % lower all-cause mortality . The associations persisted in subgroup analyses stratified by sex/cohort , body mass index at diabetes mellitus diagnosis , smoking status , diabetes mellitus duration , nut consumption before diabetes mellitus diagnosis , or diet quality . Conclusions : Higher consumption of nuts , especially tree nuts , is associated with lower CVD incidence and mortality among participants with diabetes mellitus . These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus OBJECTIVE To determine whether a home-based activity and dietary intervention can increase activity level , reduce caloric intake , and impact positively components of metabolic syndrome  in a disabled population . DESIGN Testing occurred at 3 points during the 6-month intervention period ( baseline , 3mo , 6mo ) and at 6 months postintervention . Each test point included laboratory testing of anthropometric and metabolic variables and 3 days of home-based activity and dietary monitoring . A personally tailored activity and dietary prescription based on baseline testing was implemented during the 6-month intervention period . SETTING Human performance laboratory of a university and each subject 's home . PARTICIPANTS Twenty adult volunteer ambulatory subjects with several types of slowly progressive neuromuscular disease ( NMD ) . INTERVENTION Using a pedometer , subjects were instructed to increase number of steps by 25 % over their baseline determined from home monitoring . An individualized dietary prescription was provided focusing on problematic issues identified from the baseline dietary profile . MAIN OUTCOME MEASURES Body composition , physical activity , dietary intake , energy expenditure , gait efficiency , metabolic variables , and quality of life . RESULTS At the end of the protocol , mean step count increased approximately 27 % above baseline ( P=.001 ) and caloric intake decreased over 300kcal/d ( P=.002 ) . Body fat percentage significantly decreased ( from 33.3%+/-1.5 % to 32.6%+/-1.6 % , P=.032 ) . Gait efficiency did not change , and metabolic variables did not show statistically significant improvement , although 2 of the 5 subjects originally meeting the criteria for metabolic syndrome at baseline no longer met the criteria at the end of the intervention period . Six months after completing the protocol , caloric intake remained significantly reduced ( P=.02 ) , but although mean step count remained elevated , it was not statistically significant . CONCLUSIONS Using a home-based protocol , people with NMD can increase activity and reduce caloric intake . Although this 6-month program showed positive changes , it was insufficient to affect risk factors associated with metabolic syndrome . It remains to be seen if a program longer than 6 months or a more rigorous program could lead to a reduction in the risk factors associated with metabolic syndrome Background The current food pyramid guidelines have been criticized because of their complexity and the knowledge required for users to underst and the recommendations . Simplification of a dietary message to focus on a single key aspect of dietary quality , e.g. , fiber intake , may make the message much easier to comprehend and adhere , such that respondents can achieve greater weight loss , better dietary quality and overall metabolic health . Methods and design This is a r and omized controlled clinical trial with two equal sized arms . In total , 240 obese adults who meet diagnostic criteria for the metabolic syndrome will be r and omized to one of the two conditions : 1 ) a high fiber diet and 2 ) the American Heart Association ( AHA ) diet .  In the high fiber diet condition , patients will be given instruction only on achieving daily dietary fiber intake of 30 g or more . In the AHA diet condition , patients will be instructed to make the several dietary changes recommended by the AHA 2006 guidelines . The trial examines participant weight loss and dietary quality as well as changes in components of the metabolic syndrome , inflammatory biomarkers , low-density lipoprotein cholesterol levels , insulin levels , and glycosolated hemoglobin . Potential mediators , i.e. , diet adherence and perceived ease of the diet , and the intervention effect on weight change will also be examined . Discussion sThe purpose of this paper is to outline the study design and methods for testing the simple message of increasing dietary fiber . If the simple dietary approach is found efficacious for weight loss ; and , improves dietary quality , metabolic health , and adherence , it might then be used to develop a simple public health message . Trial registration The objective of this study was to derive food-based dietary guidelines for the Dutch population . The dietary guidelines are based on 29 systematic review s of English language meta-analyses in PubMed summarizing r and omized controlled trials and prospect i ve cohort studies on nutrients , foods and food patterns and the risk of 10 major chronic diseases : coronary heart disease , stroke , heart failure , diabetes , breast cancer , colorectal cancer , lung cancer , chronic obstructive pulmonary disease , dementia and depression . The committee also selected three causal risk factors for cardiovascular diseases or diabetes : systolic blood pressure , low-density lipoprotein cholesterol and body weight . Findings were categorized as strong or weak evidence , inconsistent effects , too little evidence or effect unlikely for experimental and observational data separately . Next , the committee selected only findings with a strong level of evidence for deriving the guidelines . Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospect i ve cohort studies . Plausible evidence was based on strong evidence from prospect i ve cohort studies only . A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated . There are 10 new guidelines on legumes , nuts , meat , dairy produce , cereal products , fats and oils , tea , coffee and sugar-containing beverages . Three guidelines on vegetables , fruits , fish and alcoholic beverages have been sharpened , and the 2006 guideline on salt stayed the same . A separate guideline has been formulated on  nutrient supplements .  Completely food-based dietary guidelines can be derived in a systematic and transparent way Non-alcoholic fatty liver disease ( NAFLD ) is the most common liver disorder in Western industrialized countries , affecting 20 - 40 % of the general population . Large population -based surveys in China , Japan , and Korea indicate that the prevalence of NAFLD is now 12 % to 24 % in population subgroups , depending on age , gender , ethnicity , and location ( urban versus rural ) . There is strong evidence that the prevalence of NAFLD has increased recently in parallel with regional trends in obesity , type 2 diabetes , and metabolic syndrome ; and that further increases are likely . The relationship between NAFLD , central obesity , diabetes , and metabolic syndrome is clearly evident in retrospective and prospect i ve Asian studies , but the strength of association with these metabolic risk factors is only appreciated when regional definitions of anthropometry are used . Pathological definition of NAFLD , particularly its activity and the extent of liver fibrosis , requires histological examination , but liver biopsy is often not appropriate in this disorder for logistic reasons . An alternative set of operational definitions is proposed here . Clinicians need guidelines as how best to diagnose and manage NAFLD and its associated metabolic disorders in countries with scant healthcare re sources . The Asia-Pacific Working Party ( APWP ) for NAFLD was convened to collate evidence and deliberate these issues . Draft proposals were presented and discussed at Asia-Pacific Digestive Week at Cebu , Philippines , in late November 2006 , and are published separately in this issue of the Journal as an Executive Summary . The present document review s the reasoning and evidence behind the APWP-NAFLD proposals for definition , assessment , and management of NAFLD in the Asia-Pacific region 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 : We aim ed at evaluating whether the addition of low-dose metformin to dietary treatment could be an effective approach in nondiabetic patients with nonalcoholic fatty liver disease ( NAFLD ) . Methods : We carried out a 6-month prospect i ve study in a series of overweight or obese patients with ultrasonographic diagnosis of hepatic steatosis . In total , 50 patients were enrolled and r and omized into two groups : the first group ( n=25 ) was given metformin ( 1 g per day ) plus dietary treatment and the second group ( n=25 ) was given dietary treatment alone . Results : At the end of the study , the proportion of patients with echographic evidence of fatty liver was reduced in both the metformin ( P<0.0001 ) and the diet group ( P=0.029 ) . Moreover , patient body mass index and waist circumference significantly decreased in both groups ( P<0.001 ) . Fasting glucose , insulin resistance ( evaluated as homeostasis model assessment of insulin resistance ( HOMA-IR ) ) and serum adiponectin decreased in both groups , although these changes reached statistical significance only in the metformin group . In this group , HOMA-IR decreased from 3.3±1.6 to 2.4±1.2 ( P=0.003 ) , whereas it decreased from 3.2±1.6 to 2.8±1.1 ( not significant , NS ) in the diet group . Similarly , the proportion of patients with impaired fasting glucose declined from 35 to 5 % ( P=0.04 ) in the metformin and from 32 to 12 % ( NS ) in the diet group . At baseline , ∼40 % of patients in both groups met the diagnostic criteria of metabolic syndrome . This proportion decreased to 20 % in the metformin group ( P=0.008 ) and to 32 % in the diet group ( NS ) . Conclusions : In our 6-month prospect i ve study , both low-dose metformin and dietary treatment alone ameliorated liver steatosis and metabolic derangements in patients with NAFLD . However , metformin was more effective than dietary treatment alone in normalizing several metabolic parameters in these patients 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 OBJECTIVE To examine whether the timing of introduction of the allergenic foods cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten is associated with  eczema and wheezing in children 4 years of age or younger . DESIGN Population -based prospect i ve cohort study from fetal life until young adulthood . SETTING Rotterdam , the Netherl and s , from April 2002 through January 2006 . PARTICIPANTS A total of 6905 preschool children participating in the Generation R study . MAIN EXPOSURE Timing of introduction of cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten collected by question naires at 6 and 12 months of age . MAIN OUTCOME MEASURES Information on the outcomes eczema and wheezing were obtained by questions from the age-adapted version of the " International Study of Asthma and Allergies in Childhood " core question naire and question naire data on parentally reported physician diagnosis for eczema . RESULTS Of 6905 children ,  wheezing was reported in 31 % at age 2 years and in 14 % at ages 3 and 4 years . Eczema was reported in 38 % , 20 % , and 18 % of children at the ages of 2 , 3 , and 4 years , respectively . The introduction of cow 's milk , hen 's egg , peanuts , tree nuts , soy , and gluten before the age of 6 months was not significantly associated with eczema or wheezing at any age after adjustment for potential confounders ( P > .10 for all comparisons ) . The results did not alter after stratification according to the child 's history of cow 's milk allergy and parental history of atopy . CONCLUSION This study does not support the recommendation for delayed introduction of allergenic foods after age 6 months for the prevention of eczema and wheezing Previous evidence supports the concept that increased oxidative stress may play an important role in MetS ( metabolic syndrome)-related manifestations . Dietary fat quality has been proposed to be critical in oxidative stress and the pathogenesis of the MetS. In the present study , we investigated whether oxidative stress parameters are affected by diets with different fat quantity and quality during the postpr and ial state in subjects with the MetS. Patients were r and omly assigned to one of four isoenergetic diets distinct in fat quantity and quality for 12 weeks : a high-saturated-fatty-acid ( HSFA ) diet , a high-mono-unsaturated-fatty-acid ( HMUFA ) diet and two low-fat/high-complex carbohydrate diets [ supplemented with 1.24 g/day of long-chain n-3 polyunsaturated fatty acid ( LFHCC n-3 ) or with 1 g/day of sunflower oil high in oleic acid ( LFHCC ) as placebo ] . The HMUFA diet enhanced postpr and ial GSH ( reduced glutathione ) levels and the GSH/GSSH ( oxidized glutathione ) ratio , compared with the other three diets . In addition , after the HMUFA-rich  diet postpr and ial lipid peroxide levels , protein carbonyl concentrations , SOD ( superoxide dismutase ) activity and plasma H2O2 levels were lower compared with subjects adhering to the HSFA-rich diet . Both LFHCC diets had an intermediate effect relative to the HMUFA and HSFA diets . In conclusion , our data support the notion that the HMUFA diet improves postpr and ial oxidative stress in patients with the MetS. These findings suggest that the postpr and ial state is important for underst and ing the possible cardioprotective effects associated with mono-unsaturated dietary fat , particularly in subjects with the PURPOSE To provide evidence -based recommendations to practicing oncologists , surgeons , and radiation therapy clinicians to up date the 2005 clinical practice guideline on the use of sentinel node biopsy ( SNB ) for patients with early-stage breast cancer . METHODS The American Society of Clinical Oncology convened an Up date Committee of experts in medical oncology , pathology , radiation oncology , surgical oncology , guideline implementation , and advocacy . A systematic review of the literature was conducted from February 2004 to January 2013 in Medline . Guideline recommendations were based on the review of the evidence by Up date Committee . RESULTS This guideline up date reflects changes in practice since the 2005 guideline . Nine r and omized clinical trials ( RCTs ) met systematic review criteria for clinical questions 1 and 2 ; 13 cohort studies informed clinical question 3 . RECOMMENDATIONS Women without sentinel lymph node ( SLN ) metastases should not receive axillary lymph node dissection ( ALND ) .  Women with one to two metastatic SLNs planning to undergo breast-conserving surgery with whole-breast radiotherapy should not undergo ALND ( in most cases ) . Women with SLN metastases who will undergo mastectomy should be offered ALND . These three recommendation are based on RCTs . Women with operable breast cancer and multicentric tumors , with ductal carcinoma in situ ( DCIS ) who will undergo mastectomy , who previously underwent breast and /or axillary surgery , or who received preoperative/neoadjuvant systemic therapy may be offered SNB . Women who have large or locally advanced invasive breast cancer ( tumor size T3/T4 ) , inflammatory breast cancer , or DCIS ( when breast-conserving surgery is planned ) or are pregnant should not undergo SNB . These recommendations are based on cohort studies and /or informal consensus . In some cases , up date d evidence was insufficient to up date previous recommendations BACKGROUND Irritable bowel syndrome ( IBS ) is a chronic debilitating functional gastrointestinal disorder . Diet and lifestyle changes are important management strategies . The aim of these guidelines is to systematic ally review key aspects of the dietary management of IBS , with the aim of providing evidence -based guidelines for use by registered dietitians . METHODS Questions relating to diet and IBS symptom management were developed by a guideline development group . These included the role of milk and lactose , nonstarch polysaccharides ( NSP ) , fermentable carbohydrates in abdominal bloating , probiotics and empirical or elimination diets . A comprehensive literature search was conducted and relevant studies from January 1985 to November 2009 were identified using the electronic data base search engines : Cinahl , Cochrane Library , Embase , Medline , Scopus and Web of Science . Evidence statements , recommendations , good practice points and research recommendations were developed . RESULTS Thirty studies were critically appraised . A dietetic care pathway was produced following a logical sequence of treatment and formed the basis of these guidelines . Three lines of dietary management were identified . first line :  Clinical and dietary assessment , healthy eating and lifestyle management  with some general advice on lactose and NSP . Second line : Advanced dietary interventions to improve symptoms based on NSP , fermentable carbohydrates and probiotics . Third line : Elimination and empirical diets . Research recommendations were also identified relating to the need for adequately powered and well design ed r and omised controlled trials . CONCLUSIONS These guidelines provide evidence -based details of how to achieve the successful dietary management of IBS Allergy to pollen from deciduous trees is a common cause of  allergic rhinitis and asthma during the spring in Sweden . Juhlin-Dannfelt discovered ( z ) that patients with these disorders often get allergic symptoms from eating nuts or raw fruits . Using intracutaneous tests ( i. c. tests ) and , in some cases , provocation tests and Prausnitz-Kiistner tests , he could also detect the kind of tree pollen which usually caused the symptoms , i. e. mainly hirch but also hazel , alder , ash , sailowwillow and oak . Humoral reagins of the IgE class directed against different allergens can be detected with the radioallergosorbent test ( RAST ) ( 4 ) . This test can also be used to study allergenic activities and to obtain information on relationships between various allergens . In the present investigation the RAST , i. c. tests and provocation tests have been used to study pollen extracts from different deciduous trees . The present study has been made in order to compare the extracts and illustrate whether they have any allergens in common Summary No subjective or objective evidence of beneficial effect was observed from the use of Pirenzipine in irritable bowel syndrome ( TBS ) patients who had not responded to a high fibre diet Background : Despite intensive research , there are no universally accepted clinical definitions for acute lung injury ( ALI ) or the acute respiratory distress syndrome ( ARDS ) . A recent joint American-European Consensus Conference on ARDS formally defined the difference between ALI and ARDS based on the degree of oxygenation impairment . However , this definition may not reflect the true prevalence , severity and prognosis of these syndromes . Methods : During a 22-month period , 56 consecutive mechanically ventilated patients who met the American-European Consensus definition for ARDS [ arterial oxygen tension/fractional inspired oxygen ( PaO2/FIO2≤ 200 mmHg regardless of the level of positive end-expiratory pressure ( PEEP ) , bilateral pulmonary infiltrates , and no evidence of left heart failure ] were admitted into the intensive care units ( ICU ) of the Hospital del Pino , Las Palmas , Spain , and prospect ively studied . The diagnosis of ALI and ARDS was made by a PEEP-FIO2 trial , 24 h after patients met the Consensus inclusion criteria . Patients were classified as having ALI–24 h if the PaO2/FIO2 was > 150 mmHg with PEEP = 5 cmH2O , and ARDS–24 h if the PaO2 /FIO2 was ≤ 150 mmHg with PEEP ≥ 5 cmH2O . Results : Overall mortality was 43 % ( 24 of 56 ) . However , 24 h after inclusion , PaO2 response to PEEP 5 cmH2O allowed the separation of our patients into two different groups : 31 patients met our ALI–24 h criteria ( PaO2/FIO2 > 150 mmHg ) and their mortality was 22.6 % ; 25 patients met our ARDS–24 h criteria ( PaO2/FIO2≤ 150 mmHg ) and their mortality was 68 % ( p = 0.0016 ) . The differences in the respiratory severity index during the first 24 h of inclusion , PaO2/FIO2 ratio at baseline and at 24 h , maximum plateau airway pressure , maximum level of PEEP , and number of organ system failures during the ICU stay were statistically significant . Conclusions : Since the use of PEEP in the American-European Consensus criteria for ARDS is not m and atory , that definition does not reflect the true severity of lung damage and outcome . Our data support the need for guidelines based on a specific method of evaluating oxygenation status before the American-European Consensus definition is adopted IMPORTANCE The etiology of the increasing childhood prevalence of peanut or tree nut ( P/TN ) allergy is unknown . OBJECTIVE To examine the association between peripregnancy consumption of P/TN  by mothers and the risk of P/TN allergy in their offspring . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study . The 10,907 participants in the Growing Up Today Study 2 , born between January 1 , 1990 , and December 31 , 1994 , are the offspring of women who previously reported their diet during , or shortly before or after , their pregnancy with this child as part of the ongoing Nurses ' Health Study II . In 2006 , the offspring reported physician-diagnosed food allergy . Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results . Two board-certified pediatricians , including a board-certified allergist/immunologist , independently review ed each potential case and assigned a confirmation code ( eg , likely food allergy ) to each case . Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring . EXPOSURE Peripregnancy consumption of P/TN . MAIN OUTCOMES AND MEASURES Physician-diagnosed P/TN allergy in offspring . RESULTS Among 8205 children , we identified 308 cases of food allergy ( any food ) , including 140 cases of P/TN allergy . The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more  P/TN  in their peripregnancy diet ( ≥ 5 times vs < 1 time per month : odds ratio = 0.31 ; 95 % CI , 0.13 - 0.75 ; P(trend ) = .004 ) . By contrast , a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers ( P(trend ) = .12 ) . The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant ( P(interaction ) = .004 ) . CONCLUSIONS AND RELEVANCE Among mothers without P/TN allergy , higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring . Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy BACKGROUND We hypothesized that favorable changes in dietary patterns would lead to a reduction in body size and an improvement in metabolic status . OBJECTIVE The objective was to study changes in diet patterns relative to changes in body size , blood pressure , and circulating concentrations of lipids , glucose , insulin , adiponectin , and other cytokines in the context of a 1-y r and omized intervention study . DESIGN For 1 y , 187 men aged 45 + /- 2 y , approximately 50 % of whom met the criteria of the metabolic syndrome , were r and omly assigned to a diet protocol ( n = 45 ) , an exercise protocol ( n = 48 ) , a protocol of diet plus exercise ( n = 58 ) , or a control protocol ( n = 36 ) . A previously defined a priori diet score was created by summing tertile rankings of 35 food group variables ; a higher score generally reflected recommended dietary changes in the trial ( mean + /- SD at baseline : 31 + /- 6.5 ; range : 15 - 47 ) . RESULTS Over the study year , the diet score increased by approximately 2 + /- 5.5 in both diet groups , with a decrease of an equivalent amount in the exercise and control groups . The weight change was -3.5 + /- 0.6 kg/10-point change in diet score ( P < 0.0001 ) , similarly within each intervention group , independently of the change in energy intake or baseline age and smoking status . Weight change was attenuated but remained significant after adjustment for intervention group and percentage body fat . Subjects with an increased diet score had more favorable changes in other body size variables , systolic blood pressure , and blood lipid , glucose , insulin , and adiponectin concentrations . Change in diet score was unrelated to resistin and several cytokines . CONCLUSION The change toward a more favorable diet pattern was associated with improved body size and metabolic profile OBJECTIVE Major depressive disorder ( MDD ) is associated with decreased physical activity and increased rates of the metabolic syndrome ( MetS ) , a risk factor for the development of type 2 diabetes and cardiovascular disorders . Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors . Therefore , our study aim ed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors . METHOD Fourty-two in patients with moderate to severe depression were included . Twenty-two patients were r and omized to additional 3x weekly exercise training ( EXERCISE ) and compared to treatment as usual ( TAU ) . Exercise capacity was assessed as peak oxygen uptake ( VO2peak ) , ventilatory anaerobic threshold ( VAT ) and workload expressed as Watts ( W ) . Metabolic syndrome was defined according to NCEP ATPIII panel criteria . RESULTS After 6 weeks of treatment , cardiorespiratory fitness ( VO2peak , VAT , Watt ) , waist circumference and HDL cholesterol were significantly improved in EXERCISE participants . Treatment response expressed as ≥50 % MADRS reduction was more frequent in the EXERCISE group . CONCLUSIONS Adjunctive exercise training in depressed in patients  improves physical fitness , MetS factors , and psychological outcome . Given the association of depression with cardiometablic disorders , exercise training is recommended as an adjunct to st and ard antidepressant treatment Summary Aim We aim ed to compare the effects of fixed‐dose combinations of ezetimibe plus rosuvastatin to rosuvastatin alone in patients with primary hypercholesterolemia , including a subgroup analysis of patients with diabetes mellitus ( DM ) or metabolic syndrome ( MetS ) . Method This multicenter eight‐week r and omized double‐blind phase III study evaluated the safety and efficacy of fixed‐dose combinations of ezetimibe 10 mg plus rosuvastatin , compared with rosuvastatin alone in patients with primary hypercholesterolemia . Four hundred and seven patients with primary hypercholesterolemia who required lipid‐lowering treatment according to the ATP III guideline were r and omized to one of the following six treatments for 8 weeks : fixed‐dose combinations with ezetimibe 10 mg daily plus rosuvastatin ( 5 , 10 , or 20 mg daily ) or rosuvastatin alone ( 5 , 10 , or 20 mg daily ) . Results Fixed‐dose combination of ezetimibe plus rosuvastatin significantly reduced LDL cholesterol , total cholesterol , and triglyceride levels compared with rosuvastatin alone . Depending on the rosuvastatin dose , these fixed‐dose combinations of ezetimibe plus rosuvastatin  provided LDL cholesterol , total cholesterol , and triglyceride reductions of 56%–63 % , 37%–43 % , and 19%–24 % , respectively . Moreover , the effect of combination treatment on cholesterol levels was more pronounced in patients with DM or MetS than in non‐DM or non‐MetS patients , respectively , whereas the effect of rosuvastatin alone did not differ between DM vs non‐DM or MetS vs non‐MetS patients . Conclusion Fixed‐dose combinations of ezetimibe and rosuvastatin provided significantly superior efficacy  to rosuvastatin alone in lowering LDL cholesterol , total cholesterol , and triglyceride levels . Moreover , the reduction rate was greater in patients with DM or OBJECTIVE : We sought to establish the frequency of receiving > 1 dose of epinephrine in children who present to the emergency department ( ED ) with food-related anaphylaxis . PATIENTS AND METHODS : We performed a medical chart review at Boston hospitals of all children presenting to the ED for food-related acute allergic reactions between January 1 , 2001 , and December 31 , 2006 . We focused on causative foods , clinical presentations , and emergency treatments . RESULTS : Through r and om sampling and appropriate weighting , the 605 review ed cases represented a study cohort of 1255 patients . These patients had a median age of 5.8 years ( 95 % confidence interval [ CI ] : 5.3–6.3 ) , and the cohort was 62 % male . A variety of foods provoked the allergic reactions , including peanuts ( 23 % ) , tree nuts ( 18 % ) , and milk ( 15 % ) . Approximately half ( 52 % [ 95 % CI : 48–57 ] ) of the children met diagnostic criteria for food-related anaphylaxis . Among those with anaphylaxis , 31 % received 1 dose and 3 % received > 1 dose of epinephrine before their arrival to the ED . In the ED , patients with anaphylaxis received antihistamines ( 59 % ) , corticosteroids ( 57 % ) , epinephrine ( 20 % ) . Over the course of their reaction , 44 % of patients with food-related anaphylaxis received epinephrine , and among this subset of patients , 12 % ( 95 % CI : 9–14 ) received > 1 dose . Risk factors for repeat epinephrine use included older age and transfer from an outside hospital . Most patients ( 88 % ) were discharged from the hospital . On ED discharge , 43 % were prescribed self-injectable epinephrine , and only 22 % were referred to an allergist . CONCLUSIONS : Among children with food-related anaphylaxis who received epinephrine , 12 % received a second dose . Results of this study support the recommendation that children at risk for food-related anaphylaxis carry 2 doses of epinephrine Objective . To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism ( ACR/EULAR ) and 1987 ACR criteria for rheumatoid arthritis ( RA ) , and the respective role of the algorithm and scoring of the ACR/EULAR . Methods . In total , 270 patients with recent-onset arthritis of < 1 year duration were included prospect ively between 1995 and 1997 and followed for 2 years . RA was defined as the combination , at completion of followup , of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid . We compared the sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) of the criteria sets in the overall population , in the subgroup meeting the tree condition for ACR/EULAR scoring , and in the overall population classified according the full tree . Results . At baseline , 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA ; of the 143 remaining patients , 52 had more than 6 ACR/EULAR 2010 points ( indicating definite RA ) and 91 had fewer than 6 points . After 2 years , 11/16 patients with erosions and 40/52 with more than 6 points had RA . 100 of the 270 patients met the reference st and ard for RA . Sensitivity , specificity , PPV , and NPV of the ACR/EULAR ( full tree ) were 51/100 ( 51 % ) , 153/170 ( 90 % ) , 51/68 ( 75.4 % ) , and 153/202 ( 75.7 % ) , respectively . Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different . Conclusion . Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm Dietary guidelines for the general population and for the management of obesity , diabetes and heart disease suggest a reduction in dietary fat , and in particular dietary saturated fatty acids ( SFA ) . In order to achieve the recommended levels , changes in food choice patterns are required . Foods are consumed in combination with other foods , and these combinations are often recognizable as cuisine patterns . In this study we examined the food choice patterns of a group of 63 adults with existing type 2 diabetes mellitus who completed a 12 month dietary intervention trial aim ed at changing dietary fat under ' free living ' conditions . In both lower fat ( LF , 27 % ) and modified fat ( MF , 37%E ) groups , a reduction in dietary SFA and an increase in polyunsaturated fat were required , with an additional requirement to increase dietary monounsaturated fat in the MF group . The usual diets of the study sample were on average low in total fat ( 27%E ) , but high in saturated fat ( 12%E ) . Those already consuming total fat at the level concordant with their allocation ( LF or MF ) achieved targets faster than those with a discordant allocation , but there was no significant effect of usual diet on time of target achievement at 12 months . At 6 months , those achieving dietary fat targets had changed to low fat dairy products and leaner meats , were having more spreads , oils , and nuts and were consuming takeaway meals less than twice a week . Contributions to dietary fat shifted from takeaway foods , meat , dairy products and cakes to spreads , oils and nuts . The modified fat and low fat groups chose more Mediterranean and South East Asian cuisines respectively . In this study sample , usual dietary patterns had an initial impact on change in the diet , but identifiable changes in food choice patterns and the adoption of certain cuisines that combined foods indicative of the dietary guidelines result ed in successful achievement of dietary fat targets OBJECTIVE To describe the proportion of children adhering to recommended physical activity and dietary guidelines , and examine demographic and household correlates of guideline adherence . DESIGN Cross-sectional ( pre-r and omization ) data from a behavioral intervention trial design ed to prevent unhealthy weight gain in children . PARTICIPANTS A total of 421 children ( aged 5 - 10 years ) at risk for obesity ( body mass index percentile , 70 - 95 ) . MAIN OUTCOMES MEASURED Physical activity ( accelerometry ) , screen time ( parent survey ) , and fruit and vegetable and sugar-sweetened beverage intake ( 24-hour dietary recall ) . ANALYSIS Proportions meeting guidelines were calculated . Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for ( 1 ) physical activity ( ≥ 60 min/d ) , ( 2  ) screen time  ( ≤ 2 h/d ) , ( 3 ) fruit and vegetable intake ( ≥ 5 servings/d ) , and ( 4 ) sugar-sweetened beverage avoidance . RESULTS Few children met more than 1 guideline . Only 2 % met all 4 recommended guidelines and 19 % met none . Each guideline had unique sociodemographic and domain-specific household predictors ( ie , availability of certain foods and beverages , media , and active play and exercise equipment ) . CONCLUSIONS AND IMPLICATION S Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others . Results have implication s for the development of interventions to affect children 's weight-related behaviors and growth trajectories BACKGROUND Low adiponectin levels are discussed as risk factor for cardiovascular events . This is of special importance in individuals with type 2 diabetes ( T2DM ) because they are at higher risk for cardiovascular diseases . The present study aim ed to investigate the effect of two plant oils rich in polyunsaturated fatty acids ( PUFA ) , with different content of omega-3 fatty acids , on adiponectin levels , glucose and lipid metabolism in T2DM individuals treated either with insulin or oral anti-diabetics ( OAD ) . METHODS Ninety-two subjects with T2DM [ 34 treated with insulin ( T2DM-Ins ) and 58 treated with OAD ( T2DM-OAD ) ] participated in this r and omised , double-blind , parallel intervention study . Individuals received either 9 g of nut oil ( n-3:n-6 ratio : 1.3 : 6.1 ) or mixed oil ( n-3:n-6 ratio : 0.6 : 5.7 ) per day for 10 weeks . The fatty acid profile , tocopherol , adiponectin levels and parameters regarding glucose and lipid metabolism were assessed at baseline , during and after the intervention . RESULTS Compliance was confirmed by significant increases in γ-tocopherol and PUFA in both oil groups . An increase in adiponectin levels in T2DM-Ins participants ( + 6.84 % in nut oil and + 4.47 % in mixed oil group after 10 weeks compared to baseline ) was observed , albeit not significantly different from T2DM-OAD individuals ( P = 0.051 ) . Lipid and glucose metabolism were not affected by the intervention . CONCLUSIONS The present study provides evidence that a small and easy change in dietary behaviour towards better fat quality moderately increases adiponectin levels in T2DM-Ins subjects , independently of the administered plant oil AIMS To compare the effect of our newly developed online evidence -based patient information vs. st and ard patient information about sub-threshold elevated blood glucose levels and primary prevention of diabetes on informed patient decision making . METHODS We invited visitors to the cooperating health insurance company , Techniker Krankenkasse , and the German Diabetes Center websites to take part in a web-based r and omized controlled trial . The population after r and omization comprised 1120 individuals aged between 40 and 70 years without known diabetes , of whom 558 individuals were r and omly assigned to the intervention group receiving evidence -based patient information , and 562 individuals were r and omly assigned to the control group receiving st and ard information from the Internet . The primary endpoint was acquired knowledge of elevated blood glucose level issues and the secondary outcomes were attitude to metabolic testing , intention to undergo metabolic testing , decisional conflict and satisfaction with the information . RESULTS Overall , knowledge of elevated glucose level issues and the intention to undergo metabolic testing were high in both groups . Participants who had received evidence -based patient information , however , had significantly higher knowledge scores . The secondary outcomes in the evidence -based patient information subgroup that completed the 2-week follow-up period yielded significantly lower intention to undergo metabolic testing , significantly more critical attitude towards metabolic testing and significantly higher decisional conflict than the control subgroup ( n=466 ) . Satisfaction with the information was not significantly different between both groups . CONCLUSIONS Evidence -based patient information significantly increased knowledge about elevated glucose levels , but also increased decisional conflict and critical attitude to screening and treatment options . The intention to undergo metabolic screening decreased . Future studies are warranted to assess uptake of metabolic testing and satisfaction with this decision in a broader population of patients with unknown diabetes BACKGROUND Diabetes is a chronic , potentially debilitating , and often fatal disease . Dietary strategies to reduce postpr and ial glycemia are important in the prevention and treatment of diabetes . Nuts are rich in mono- and polyunsaturated fatty acids , which may reduce hyperglycemia and improve metabolism . OBJECTIVES To evaluate the effectiveness of pistachio nut supplementation on glycemic and inflammatory measures in patients with type 2 diabetes . METHODS In this double-blind , r and omized , placebo-controlled , crossover trial , 48 diabetic patients were equally assigned to groups A and B. Patients in group A received a snack of 25 g pistachio nuts twice a day for 12 weeks and group B received a control meal without nuts . After 12 weeks of intervention , the patients had an 8-week washout . Then the groups were displaced , and group B received the same amount of pistachios for 12 weeks . RESULTS With respect to the total change in variables over both phases , there was a marked decrease in HbA1c ( -0.4 % ) and fasting blood glucose ( FBG ) concentrations ( -16 mg/dl ) in the pistachio group compared with the control group ( p ≤ 0.001 for both ) . There was no overall significant change in BMI , blood pressure , HOMA-IR , and C-reactive protein ( CRP ) concentrations . Analysis of the two phases separately showed a decrease in FBG by 14 mg/dl and in HbA1c by 0.45 % in the treatment group ( A ) after 12 weeks , while no significant differences were seen in group B ( control group ) . In the second phase , FBG decreased from 151.36 ± 39.22 to 137.28 ± 28.65 mg/dl ( -14 mg/dl ) and HbA1c decreased from 7.42 ± 0.97 to 7.15 ± 0.68 mg/dl ( -0.28 % , p = 0.013 and p = 0.033 , respectively ) in the pistachio group ( B ) . Pistachio consumption reduced systolic blood pressure ( p = 0.007 ) , BMI ( p = 0.011 ) , and CRP ( p = 0.002 ) in patients from the treatment groups , but not insulin resistance . CONCLUSIONS Dietary consumption of pistachio nuts as a snack has beneficial effects on glycemic control , blood pressure , obesity , and inflammation markers in diabetic patients SUMMARY Poor women with children are disproportionately represented among the food insufficient . Recent research has linked food insufficiency with dietary deficiencies , but further research linking this problem to health and mental health problems is needed to inform health and social policy . We analyzed the relationship between food insufficiency and physical and mental health in a r and om sample of 724 single women who were welfare recipients in February , 1997 . Food insufficiency was significantly associated with poor or fair self-rated health and physical limitations , and with respondents ' meeting DSM-III-R criteria for recent major depression . Although the cross-sectional design of this study precludes causal inference , these findings add to a growing body of evidence that food insufficiency is associated with serious adverse physical and mental health consequences Patients hope that their doctors will correctly identify health problems , clearly articulate sensible options for managing each problem , wisely interpret the best available evidence about probable outcomes associated with each option , sensitively solicit patient preferences for each outcome , and thereby implement practice s that are likely to achieve the results patients care about . Groups of patients hope that doctors will work to prevent , detect , and treat health problems in a way that maximizes the public good achieved with available health care re sources . To meet these dual expectations , doctors face forbidding tasks of clinical decision making . Improved methods for preparing , appraising , and abstract ing overviews of available evidence about a clinical topic can bring a broader range of high- quality information within the busy practitioner 's grasp [ 1 - 4 ] . However , even well- design ed overviews often do not synthesize information about benefits , harms , and costs of medical practice s in a way that facilitates clinical decision making . Clinical practice guidelines have been defined as systematic ally developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances [ 5 ] . Guidelines that are based on sound scientific evidence , and a trustworthy process for judging the value of alternative practice s , could help physicians deal with the information overload they face . Existing practice guidelines , however , vary widely in their quality , and clinicians should carefully consider the validity and applicability of each guideline they read . We propose a structured format for abstract s of articles describing practice guidelines that is based on emerging principles of guideline development and evaluation [ 6 - 13 ] . The proposal is design ed to help readers obtain the key information needed to assess the applicability , importance , and validity of any guideline . The proposed structure for more informative abstract s of articles describing clinical practice guidelines has been review ed and pilot-tested by guideline developers , evaluators , and implementors and by groups of practicing clinicians . Early versions of the proposal were sent to consultants at the National Library of Medicine , the Institute of Medicine , the American College of Physicians ( ACP ) , and the Agency for Health Care Policy and Research . Subsequent versions of the proposal were pilot tested on various published guidelines and were assessed by selected health care organizations for applicability to guidelines under development . An improved proposal was sent to 82 persons active in guideline development , evaluation , and implementation . The Internal Medicine Center to Advance Research and Education circulated the proposal to volunteer practitioners , and the authors solicited feedback from physician and health administrator participants at three national workshops about practice guidelines . The proposal that follows represents an integration of the collective wisdom of our external review ers . ( A glossary of terms used in articles on clinical practice guidelines is supplied in the Appendix . ) Proposed Structure and Content for Abstract s of Articles Describing Clinical Practice Guidelines The proposed structure for abstract s of papers describing clinical practice guidelines is summarized in Table 1 . Key elements of the guideline development process are captured with statements about the principal objective and target of the guideline , the main practice options and outcomes that were considered , the nature of the evidence and values that were analyzed , the main benefits and harms expected from guideline implementation , the key recommendations , and a statement of whether the recommendations have been tested and by whom they have been endorsed . If details about guideline development methods or supporting evidence are published separately , then the abstract should indicate the existence of supporting documents and the most relevant parts of those should be summarized in the abstract . To be included in their entirety in the online bibliographic data bases of the National Library of Medicine , structured abstract s of clinical practice guidelines should not exceed 4096 characters ( approximately 500 words ) in length . Individual journals may have different requirements . Table 1 . Proposed Format for Structured Abstract s of Clinical Practice Guidelines Objective The abstract should state the objective of the guideline by identifying the targeted health problem , the targeted patients and physicians , and the main reason or reasons for developing new recommendations concerning this problem for this population . For guidelines primarily concerned with the management of health conditions , the stage of illness and intent to prevent , diagnose , treat , or palliate the disorder should be specified . For guidelines primarily concerned with health procedures , an intervention and its role in patient management should be defined . Targeted providers , setting s , and patients should be specified so that readers can tell who should do what , where it should be done , and to whom . A statement of objective also may specify why a new guideline is needed and how it should be used . Practice guidelines may be written to clarify or resolve clinical controversies , to communicate important new findings from clinical studies , or to promote more effective , efficient , or consistent physician practice s at less cost or risk to patients . Guidelines may be used concurrently to help physicians and patients make choices ( for example , clinical algorithms ) , retrospectively to compare physician choices to pre-established criteria ( for example , utilization review ) , or prospect ively to set limits on physician choices ( for example , preprocedure approval ) . Options Clinical practice guidelines pertain to clinical decisions . The nature of those decisions should be made explicit by disclosing the main management options considered . The abstract should list principal alternative preventive , diagnostic , or therapeutic strategies available to targeted clinicians and patients . Outcomes The abstract also should specify which health outcomes , such as death , morbidity , quality of life , economic costs , or changes in the process of health care were considered . Evidence To estimate the probable effect of a health intervention on an outcome , relevant data must be defined , gathered , and appraised . Readers need to know what kind of evidence was considered and what methods were used to select and combine evidence from different sources . Potential sources of evidence about clinical outcomes include the results of clinical studies ( published or unpublished ) , expert opinion , information contained in public or private health data bases , and direct input from patients or providers . Potential sources of evidence about economic outcomes include the results of cost-effectiveness studies , various fee schedules , and information contained in public or private health cl aims data bases . Potential methods of gathering evidence include computerized search es for articles that satisfy predetermined criteria , review s of bibliographies of relevant articles , and surveys of relevant persons or organizations [ 1 ] . The abstract should state whether explicit methods were used to combine results from scientific studies ( for example , meta- analysis ) or opinions of experts ( for example , Delphi technique ) [ 14 , 15 ] . The abstract may also indicate whether specific criteria were used to gauge the quality of information from different sources [ 16 , 17 ] . Scientific evidence regarding the likelihood of certain outcomes is often missing or conflicting . It is desirable for the strength of evidence supporting a guideline to be gauged in some way [ 16 ] . If gaps in the evidence were bridged formally ( for example , through use of decision- analysis models ) or informally ( for example , best guess of clinical experts ) , then major assumptions or areas of uncertainty should be acknowledged [ 11 ] . Because of the extraordinary time required to properly assemble and review evidence and then to achieve consensus about practice recommendations , the abstract of a practice guideline should specify the publication date s of the most recent evidence considered . If a sensitivity analysis was performed , then any major vulnerability of the guideline to weaknesses in the evidence should be acknowledged . These considerations may be summarized by qualifying a guideline as provisional by specifying date s for expiration or review , by listing studies in progress that could affect the guideline , or by identifying key research priorities . Values The declaration of a recommended practice presumes an implicit or explicit process for judging the relative desirability of the health , economic , and process outcomes associated with alternative practice s. These are matters of opinion and value . For example , in developing guidelines for breast cancer screening , it is necessary to weigh the value of preventing a death from breast cancer against the value of avoiding unnecessary harm or anxiety in women who do not have breast cancer . A high value placed on maximizing detection of asymptomatic malignancy may motivate an organization to recommend teaching self-examination of breasts to young women [ 18 ] . A relatively greater value placed on avoiding false-positive results may motivate others to not promote such programs [ 19 ] . Consequently , the principal sources of such values and the method by which judgments were made should be reported in guideline abstract s. At a minimum , the abstract should identify the major groups that participated in the process of assigning values to outcomes ( for example , generalist or specialist physicians , other health care providers , insurers , representatives of health organizations , and special-interest groups ) and whether patient preferences were represented . The abstract may also indicate the method used to synthesize opinions from BACKGROUND The associations between specific types of nuts , specifically peanuts and walnuts , and cardiovascular disease remain unclear . OBJECTIVES The authors sought to analyze the associations between the intake of total and specific types of nuts and cardiovascular disease , coronary heart disease , and stroke risk . METHODS The authors included 76,364 women from the Nurses ' Health Study ( 1980 to 2012 ) , 92,946 women from the Nurses ' Health Study II ( 1991 to 2013 ) , and 41,526 men from the Health Professionals Follow-Up Study ( 1986 to 2012 ) who were free of cancer , heart disease , and stroke at baseline .  Nut consumption was assessed using food frequency question naires at baseline and was up date d every 4 years . RESULTS During 5,063,439 person-years of follow-up , the authors documented 14,136 incident cardiovascular disease cases , including 8,390 coronary heart disease cases and 5,910 stroke cases . Total nut consumption was inversely associated with total cardiovascular disease and coronary heart disease after adjustment for cardiovascular risk factors . The pooled multivariable hazard ratios for cardiovascular disease and coronary heart disease among participants who consumed 1 serving of nuts ( 28 g ) 5 or more times per week , compared with the reference category ( never or almost never ) , were 0.86 ( 95 % confidence interval : 0.79 to 0.93 ; p for trend = 0.0002 ) and 0.80 ( 95 % confidence interval : 0.72 to 0.89 ; p for trend < 0.001 ) , respectively . Consumption of peanuts and tree nuts ( 2 or more times/week ) and walnuts ( 1 or more times/week ) was associated with a 13 % to 19 % lower risk of total cardiovascular disease and 15 % to 23 % lower risk of coronary heart disease . CONCLUSIONS In 3 large prospect i ve cohort studies , higher consumption of total and specific types of nuts was inversely associated with total cardiovascular disease and coronary heart disease Background Obesity is a chronic disease associated to an inflammatory process result ing in oxidative stress that leads to morpho-functional microvascular damage that could be improved by some dietary interventions . In this study , the intake of Brazil nuts ( Bertholletia excelsa ) , composed of bioactive substances like selenium , α- e γ- tocopherol , folate and polyunsaturated fatty acids , have been investigated on antioxidant capacity , lipid and metabolic profiles and nutritive skin microcirculation in obese adolescents . Methods Obese female adolescents ( n = 17 ) , 15.4 ± 2.0 years and BMI of 35.6 ± 3.3 kg/m2 , were r and omized 1:1 in two groups with the diet supplemented either with Brazil nuts [ BNG , n = 08 , 15 - 25 g/day ( equivalent to 3 to 5 units/day ) ] or placebo [ PG ( lactose ) , n = 09 , one capsule/day ] and followed for 16 weeks . Anthropometry , metabolic-lipid profiles , oxidative stress and morphological ( capillary diameters ) and functional [ functional capillary density , red blood cell velocity ( RBCV ) at baseline and peak ( RBCVmax ) and time ( TRBCVmax ) to reach it during post-occlusive reactive hyperemia , after 1 min arterial occlusion ] microvascular variables were assessed by nailfold videocapillaroscopy at baseline ( T0 ) and after intervention ( T1 ) . Results T0 characteristics were similar between groups . At T1 , BNG ( intra-group variation ) had increased selenium levels ( p = 0.02 ) , RBCV ( p = 0.03 ) and RBCVmax ( p = 0.03 ) and reduced total ( TC ) ( p = 0.02 ) and LDL-cholesterol ( p = 0.02 ) . Compared to PG , Brazil nuts intake reduced TC ( p = 0.003 ) , triglycerides ( p = 0.05 ) and LDL-ox ( p = 0.02 ) and increased RBCV ( p = 0.03 ) . Conclusion Brazil nuts intake improved the lipid profile and microvascular function in obese adolescents , possibly due to its high level of unsaturated fatty acids and bioactive substances . Trial Registration Clinical OBJECTIVE : To explore the relative importance of a food 's macronutrient composition , energy value , energy density , fiber content , weight , volume , sensory properties and rheology on hunger and food intake . DESIGN : Preloads of peanuts , peanut butter ( rheology control ) , almonds ( tree nut ) , chestnuts ( macronutrient control ) , chocolate ( sensory control ) , rice cakes ( volume control ) , pickles ( weight control ) and no load ( time control ) were consumed by subjects in r and om order at weekly intervals and hunger was assessed over the subsequent 180 min . Free-feeding energy and macronutrient intake were monitored 24 h before and following preload ingestion . SUBJECTS : Twelve male and 12 female healthy , normal weight ( 12–28 % body fat ) , adults ( mean ( s.d . ) age 22±2.5 y ) with low dietary restraint . RESULTS : Hunger ratings following consumption of the 2092 kJ ( 500 kcal ) preloads of peanuts , peanut butter , almonds , chestnuts and chocolate were significantly lower than the low energy preloads or no preload condition , but with the exception of peanut butter , did not vary from each other . The rate of hunger recovery was consistent across all preloads so the overall impact of each food on hunger was determined by the initial drop it evoked . Total energy , but not macronutrient , compensation was observed with all preloads . Consequently , the fatty acid profile of the total diet reflected the composition of the preloads . CONCLUSIONS : Energy content may be the primary determinant of a food 's impact on hunger . Because macronutrient compensation is weak , a dietary supplement or substitute may influence the daily dietary nutrient profile 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 A link between unsaturated fatty acids or phytonutrients and reduced risk of colorectal cancer  has been suggested . However , the effects of higher intake of dietary sources of these nutrients , such as the nuts and seeds food group , are less clear . The objective of this study was to determine the effects of nut and seed intake on colorectal cancer risk within the European Prospect i ve Investigation into Cancer and Nutrition study , a large prospect i ve cohort study involving 10 European countries .  Total nut and seed intake was determined from country-specific dietary question naires . The data set included 478,040 subjects ( 141,988 men , 336,052 women ) with a total of 855 ( 327 men , 528 women ) colon and 474 ( 215 men , 259 women ) rectal cancer cases . A multivariate Cox proportional hazards model , stratified by center and controlled for fruit intake , dietary fiber , energy , height , weight , sex , age , physical activity , and smoking , was used . The data show no association between higher intake of nuts and seeds  and risk of colorectal , colon , and rectal cancers in men and women combined , but a significant inverse association was observed in subgroup analyses for colon cancer in women at the highest ( > 6.2 g/d ) versus the lowest ( nonconsumers ; hazard ratio , 0.69 ; 95 % confidence interval , 0.50 - 0.95 ) category of intake and for the linear effect of log-transformed intake ( hazard ratio , 0.89 ; 95 % confidence interval , 0.80 - 0.98 ) , with no associations in men . It is not evident from this data why there may be a stronger association in women or why it may be limited to the colon , suggesting that much further research is necessary Nut intake has been associated with reduced inflammatory status and lower risk of CVD and mortality . The aim of this study was to examine the relationship between nut consumption and mortality and the role of inflammation . We conducted a population -based prospect i ve investigation on 19 386 subjects enrolled in the Moli-sani study . Food intake was recorded by the Italian version of the European Project Investigation into Cancer and Nutrition FFQ . C-reactive protein , leucocyte and platelet counts and the neutrophil : lymphocyte ratio were used as biomarkers of low- grade inflammation . Hazard ratios ( HR ) were calculated using multivariable Cox proportional hazard models . During a median follow-up of 4·3 years , 334 all-cause deaths occurred . As compared with subjects who never ate nuts , rare intake ( ≤2 times/month ) was inversely associated with mortality ( multivariable HR=0·68 ; 95 % CI 0·54 , 0·87 ) . At intake ≥8 times/month , a greater protection was observed ( HR=0·53 ; 0·32 , 0·90 ) . Nut intake ( v. no intake ) conveyed a higher protection to individuals poorly adhering to the Mediterranean diet ( MD ) . A significant reduction in cancer deaths ( HR=0·64 ; 95 % CI 0·44 , 0·94 ) was also observed , whereas the impact on CVD deaths was limited to an inverse , but not significant , trend . Biomarkers of low- grade inflammation were reduced in nut consumers but did not account for the association with mortality . In conclusion , nut intake was associated with reduced cancer and total mortality . The protection was stronger in individuals with lower adherence to MD , whereas it was similar in high-risk groups ( diabetics , obese , smokers or those with the metabolic syndrome ) , as compared with low-risk subjects . Inflammation did not explain the observed relationship Background A number of prospect i ve studies have observed inverse associations between nut consumption and chronic diseases . However , these studies have predominantly been conducted in Western countries , where nut consumption tends to be more common among individuals with healthier lifestyles . It is important to examine the association in other parts of the world , and particularly among population s with different patterns of disease , socioeconomic status , lifestyles and disease risk factors . Our objective was to examine the association between nut consumption and mortality in a population whose nut consumption does not track with a healthy lifestyle . Methods We examined the association between nut consumption and all-cause and cause-specific mortality in the 50 045 participants of the Golestan Cohort Study . Participants were aged 40 and older at baseline in 2004 , and have been actively followed since that time . Dietary data were collected using a vali date d semi-quantitative food frequency question naire that was administered at baseline . Results During 349 677 person-years of follow-up , 3981 cohort participants died , including 1732 women and 2249 men . Nut consumption was associated inversely with all-cause mortality . The pooled multivariate adjusted hazard ratios for death among participants who ate nuts , as compared with those who did not , were 0.89 [ 95 % confidence interval ( CI ) , 0.82 - 0.95 ] for the consumption of less than one serving of nuts per week , 0.75 ( 95 % CI , 0.67 - 0.85 ) for one to less than three servings per week and 0.71 ( 95 % CI , 0.58 - 0.86 ) for three or more servings per week ( P < 0.001 for trend ) . Among specific causes , significant inverse associations were observed between nut consumption and deaths due to cardiovascular disease , all cancers and gastrointestinal cancers . Conclusions This study provides evidence for an inverse association between nut consumption and mortality in a developing country , where nut consumption does not track with a healthy lifestyle . Further work is needed to establish the underlying mechanisms responsible for this association BACKGROUND There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention . Evidence is lacking for effective dietary patterns for kidney disease prevention . STUDY DESIGN Prospect i ve cohort study . SETTING & PARTICIPANTS Atherosclerosis Risk in Communities ( ARIC ) Study participants with baseline estimated glomerular filtration rate ( eGFR ) ≥ 60mL/min/1.73m2 ( N=14,882 ) . PREDICTOR The Dietary Approaches to Stop Hypertension ( DASH ) diet score was calculated based on self-reported dietary intake of red and processed meat , sweetened beverages , sodium , fruits , vegetables , whole grains , nuts and legumes , and low-fat dairy products , averaged over 2 visits . OUTCOMES Cases were ascertained based on the development of eGFRs<60mL/min/1.73m2 accompanied by ≥25 % eGFR decline from baseline , an  International Classification of Diseases , Ninth/Tenth Revision code for a kidney disease-related hospitalization or death , or end-stage renal disease from baseline through 2012 . RESULTS 3,720 participants developed kidney disease  during a median follow-up of 23 years . Participants with a DASH diet score in the lowest tertile were 16 % more likely to develop kidney disease than those with the highest score tertile ( HR , 1.16 ; 95 % CI , 1.07 - 1.26 ; P for trend < 0.001 ) , after adjusting for sociodemographics , smoking status , physical activity , total caloric intake , baseline eGFR , overweight/obese status , diabetes status , hypertension status , systolic blood pressure , and antihypertensive medication use . Of the individual components of the DASH diet score , high red and processed meat intake was adversely associated with kidney disease and high nuts , legumes , and low-fat dairy products intake was associated with reduced risk for kidney disease . LIMITATIONS Potential measurement error due to self-reported dietary intake and lack of data for albuminuria . CONCLUSIONS Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics , established kidney risk factors , and baseline kidney function . Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention BACKGROUND There is increasing concern about the quality , reliability , and independence of practice guidelines . Because no information is available on the method ological quality of the guidelines developed by specialty societies , we undertook a survey on those published in peer- review ed journals . METHODS Practice guidelines produced by specialty societies and published in English between January , 1988 , and July , 1998 , where identified through MEDLINE . Their quality was assessed in terms of whether they reported : the type of professionals and stakeholders involved in the development process ; the strategy to identify primary evidence ; and an explicit grading of recommendations according to the quality of supporting evidence . FINDINGS Overall , 431 guidelines were eligible for the study . Most did not meet the criteria : 67 % did not report any description of the type of stakeholders , 88 % gave no information on search es for published studies , and 82 % did not give any explicit grading of the strength of recommendations . There was improvement over time for search es ( from 2 % to 18 % , p<0.001 ) and explicit grading of evidence ( from 6 % to 27 % , p<0.001 ) . All three criteria for quality were met in only 22 ( 5 % ) guidelines . INTERPRETATION Despite improvement over time , the quality of practice guidelines developed by specialty societies is unsatisfactory . Explicit method ological criteria for the production of guidelines shared among public agencies , scientific societies , and patients ' associations need to be set up . Common st and ards of reporting , following the same principles that led to the CONSORT statement for r and omised clinical trials , should be promoted 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 Background / Objectives : Although benefits have been attributed to the Mediterranean diet , its effect on glycaemic control has not been totally eluci date d. The aim of this work was to compare the effect of two Mediterranean diets versus a low-fat diet on several parameters and indices related to glycaemic control in type 2 diabetic subjects . Subjects/ Methods : A multicentric parallel trial was conducted on 191 participants ( 77 men and 114 women ) of the PREDIMED study in order to compare three dietary interventions : two Mediterranean diets supplemented with virgin olive oil ( n=67 ; body mass index ( BMI ) = 29.4±2.9 ) or mixed nuts ( n=74 ; BMI = 30.1±3.1 ) and a low-fat diet ( n=50 ; BMI = 29.8±2.8 ) . There were no drop-outs . Changes in body weight and waist circumference were determined . Insulin resistance was measured by HOMA-IR index , adiponectin/leptin and adiponectin/HOMA-R ratios after 1 year of follow-up . Results : Increased values of adiponectin/leptin ratio ( P=0.043 , P=0.001 and P<0.001 for low-fat , olive oil and nut diets , respectively ) and adiponectin/HOMA-IR ratio ( P=0.061 , P=0.027 and P=0.069 for low-fat , olive oil and nut diets , respectively ) and decreased values of waist circumference ( P=0.003 , P=0.001 and P=0.001 for low-fat , olive oil and nut diets , respectively ) were observed in the three groups . In both Mediterranean  diet groups , but not in the low-fat diet group , this was associated with a significant reduction in body weight ( P=0.347 , P=0.003 and P=0.021 for low-fat , olive oil and nut diets , respectively ) . Conclusions : Mediterranean diets supplemented with virgin olive oil or nuts  reduced total body weight and improved glucose metabolism to the same extent as the usually recommended low-fat diet OBJECTIVE This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and published by Pregnancy Hypertension ( http://www.pregnancyhypertension.org/article/S2210-7789(14)00004-X/fulltext ) to provide a reasonable approach to the diagnosis , evaluation , and treatment of the hypertensive disorders of pregnancy . EVIDENCE Published literature was retrieved through search es of Medline , CINAHL , and The Cochrane Library in March 2012 using appropriate controlled vocabulary ( e.g. , pregnancy , hypertension , pre-eclampsia , pregnancy toxemias ) and key words ( e.g. , diagnosis , evaluation , classification , prediction , prevention , prognosis , treatment , postpartum follow-up ) . Results were restricted to systematic review s , r and omized control trials , controlled clinical trials , and observational studies published in French or English between January 2006 and February 2012 . Search es were up date d on a regular basis and incorporated in the guideline to September 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology-related agencies , clinical practice guideline collection s , clinical trial registries , and national and international medical specialty societies . VALUES The quality of evidence in the guideline summarized here was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care ( Table 1 ) Epidemiological and metabolic studies have shown that regular nut consumption may protect against risk of heart disease and diabetes . None has investigated the effect of adding nuts to a self-selected habitual diet ( containing little or no nuts ) on dietary patterns . The present study evaluated the impact of long-term almond supplementation in healthy men ( n 43 ) and women ( n 38 ) aged 25 - 70 years on nutrient profile and nutrient displacement . All subjects were followed for 1 year . During the first 6 months , subjects followed their habitual diets ; in the second 6 months , subjects added almonds to their diets . Diets were assessed by seven r and om 24 h telephone diet recalls during each diet period . On average , the almond supplement was 52 g/d ( about forty-two nuts ) containing 1286 kJ. When subjects changed from their habitual diet to the almond-supplemented diet , the intakes of MUFA , PUFA , fibre , vegetable protein , alpha-tocopherol , Cu and Mg significantly ( P<0.05 ) increased by 42 , 24 , 12 , 19 , 66 , 15 and 23 % respectively ; the intakes of trans fatty acids , animal protein , Na , cholesterol and sugars significantly ( P<0.05 ) decreased by 14 , 9 , 21 , 17 and 13 % respectively . These spontaneous nutrient changes closely match the dietary recommendations to prevent cardiovascular and other chronic diseases . Displacement estimates for total energy , total protein , total fat , SFA , MUFA , PUFA , total fibre , Ca , Fe , Mg , P , K , Zn and alpha-tocopherol ranged from 16 to 98 % ; the estimates for total food weight , carbohydrate , sugars and Se were > 245 % . A daily supplement of almonds can induce favourable nutrient modifications for chronic disease prevention to an individual 's habitual diet
There was no effect on waist circumference , high-density lipoprotein cholesterol or blood pressure with the direction of effect favouring tree nuts for waist circumference .
Pooled analyses show a MetS benefit of tree nuts through modest decreases in triglycerides and fasting blood glucose with no adverse effects on other criteria across nut types .
OBJECTIVE To provide a broader evidence summary to inform dietary guidelines of the effect of tree nuts on criteria of the metabolic syndrome ( MetS ) .