Effect of almond consumption on vascular function in patients with coronary artery disease: a randomized, controlled, cross-over trial

Nutrition Journal

Joseph A. Vita³  Jeffrey B. Blumberg¹  Paul E. Milbury¹  Bela F. Asztalos¹  Naomi M Hamburg³  Mustali M Dohadwala³  Mai-Ann Duess³  Monika Holbrook³  C-Y. Oliver Chen² 

[1] Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA;Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, 711 Washington Street, Boston 02111, MA, USA;Evans Department of Medicine and the Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA

关键词: Oxidative stress;    Inflammation;    Endothelial function;    Dietary quality;    Coronary arterial disease;    Almonds;   

Others  :  1222652
DOI  :  10.1186/s12937-015-0049-5

 received in 2014-12-15, accepted in 2015-06-10,  发布年份 2015

【 摘 要 】

Objective

Almonds reduce cardiovascular disease risk via cholesterol reduction, anti-inflammation, glucoregulation, and antioxidation. The objective of this randomized, controlled, cross-over trial was to determine whether the addition of 85 g almonds daily to a National Cholesterol Education Program (NCEP) Step 1 diet (ALM) for 6 weeks would improve vascular function and inflammation in patients with coronary artery disease (CAD).

Research design and methods

A randomized, controlled, crossover trial was conducted in Boston, MA to test whether as compared to a control NCEP Step 1 diet absent nuts (CON), incorporation of almonds (85 g/day) into the CON diet (ALM) would improve vascular function and inflammation. The study duration was 22 weeks including a 6-weeks run-in period, two 6-weeks intervention phases, and a 4-weeks washout period between the intervention phases. A total of 45 CAD patients (27 F/18 M, 45–77 y, BMI = 20-41 kg/m²) completed the study. Drug therapies used by patients were stable throughout the duration of the trial.

Results

The addition of almonds to the CON diet increased plasma α-tocopherol status by a mean of 5.8 %, reflecting patient compliance (P ≤0.05). However, the ALM diet did not alter vascular function assessed by measures of flow-mediated dilation, peripheral arterial tonometry, and pulse wave velocity. Further, the ALM diet did not significantly modify the serum lipid profile, blood pressure, C-reactive protein, tumor necrosis factor-α or E-selectin. The ALM diet tended to decrease vascular cell adhesion molecule-1 by 5.3 % (P = 0.064) and increase urinary nitric oxide by 17.5 % (P = 0.112). The ALM intervention improved the overall quality of the diet by increasing calcium, magnesium, choline, and fiber intakes above the Estimated Average Requirement (EAR) or Recommended Dietary Allowance (RDA).

Conclusions

Thus, the addition of almonds to a NECP Step 1 diet did not significantly impact vascular function, lipid profile or systematic inflammation in CAD patients receiving good medical care and polypharmacy therapies but did improve diet quality without any untoward effect.

Trial registration

The trial was registered with the ClinicalTrials.Gov with the identifier: NCT00782015 webcite.

【 授权许可】

   
2015 Chen et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]World Health Organization. The top 10 causes of death - Major causes of death [http://www.who.int/mediacentre/factsheets/fs310/en/index2.html]
• [2]Booth JN, Levitan EB, Brown TM, Farkouh ME, Safford MM, Muntner P. Effect of Sustaining Lifestyle Modifications (Nonsmoking, Weight Reduction, Physical Activity, and Mediterranean Diet) After Healing of Myocardial Infarction, Percutaneous Intervention, or Coronary Bypass (from the REasons for Geographic and Racial Differences in Stroke Study). Am J Cardiol. 2014; 113:1933-1940.
• [3]Keys A. Diet and the epidemiology of coronary heart disease. JAMA. 1957; 164:1912-1919.
• [4]Keys A. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Harvard University Press Cambridge, Cambridge, MA, and London, England; 1980.
• [5]Dalen JE, Devries S. Diets to prevent coronary heart disease 1957–2013: what have we learned? Am J Med. 2014; 127:364-369.
• [6]Jenkins DJ, Jones PJ, Lamarche B, Kendall CW, Faulkner D, Cermakova L, Gigleux I, Ramprasath V, de Souza R, Ireland C, Patel D, Srichaikul K, Abdulnour S, Bashyam B, Collier C, Hoshizaki S, Josse RG, Leiter LA, Connelly PW, Frohlich J. Effect of a dietry portfolio of cholesterol-lowering foods given a 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: A randomized controlled trial. JAMA. 2011; 306:831-839.
• [7]American Heart Association's Diet and Lifestyle Recommendations. [http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp]
• [8]De Lorgeril M, Salen P, Martin JL, Mamelle N, Monjaud I, Touboul P, Delaye J. Effect of a mediterranean type of diet on the rate of cardiovascular complications in patients with coronary artery disease. Insights into the cardioprotective effect of certain nutriments. J Am Coll Cardiol. 1996; 28:1103-1108.
• [9]Kris-Etherton PM, Zhao G, Binkoski AE, Coval SM, Etherton TD. The effect of nuts on coronary heart disease risk. Nutr Rev. 2001; 59:103-111.
• [10]Ros E, Hu FB. Consumption of plant seeds and cardiovascular health: epidemiological and clinical trial evidence. Circulation. 2013; 128:553-565.
• [11]Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013; 368:1279-1290.
• [12]Kamil A, Chen CY. Health benefits of almonds beyond cholesterol reduction. J Agric Food Chem. 2012; 60:6694-6702.
• [13]Griel AE, Kris-Etherton PM. Tree nuts and the lipid profile: a review of clinical studies. Br J Nutr. 2006; 96 Suppl 2:68-78.
• [14]Choudhury K, Clark J, Griffiths HR. An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radic Res. 2014; 48:599-606.
• [15]Gokce N, Holbrook M, Hunter LM, Palmisano J, Vigalok E, Keaney JF, Vita JA. Acute effects of vasoactive drug treatment on brachial artery reactivity. J Am Coll Cardiol. 2002; 40:761-765.
• [16]Jenkins DJ, Kendall CW, Marchie A, Parker TL, Connelly PW, Qian W, Haight JS, Faulkner D, Vidgen E, Lapsley KG, Spiller GA. Dose response of almonds on coronary heart disease risk factors: blood lipids, oxidized low-density lipoproteins, lipoprotein(a), homocysteine, and pulmonary nitric oxide: a randomized, controlled, crossover trial. Circulation. 2002; 106:1327-1332.
• [17]Dohadwala MM, Holbrook M, Hamburg NM, Shenouda SM, Chung WB, Titas M, Kluge MA, Wang N, Palmisano J, Milbury PE, Blumberg JB, Vita JA. Effects of cranberry juice consumption on vascular function in patients with coronary artery disease. Am J Clin Nutr. 2011; 93:934-940.
• [18]Vita JA. Nitric oxide-dependent vasodilation in human subjects. Methods Enzymol. 2002; 359:186-200.
• [19]Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, Deanfield J, Drexler H, Gerhard-Herman M, Herrington D, Vallance P, Vita J, Vogel R. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery. A report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002; 39:257-265.
• [20]Ameho CK, Chen CY, Smith D, Sánchez-Moreno C, Milbury PE, Blumberg JB. Antioxidant activity and metabolite profile of quercetin in vitamin-E-depleted rats. J Nutr Biochem. 2008; 19:467-474.
• [21]Willett WC, Hu FB. The food frequency questionnaire. Cancer Epidemiol Biomarkers Prev. 2007; 16:182-183.
• [22]Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005; 352:1685-1695.
• [23]López-Uriarte P, Nogués R, Saez G, Bulló M, Romeu M, Masana L, Tormos C, Casas-Agustench P, Salas-Salvadó J. Effect of nut consumption on oxidative stress and the endothelial function in metabolic syndrome. Clin Nutr. 2010; 29:373-380.
• [24]Orem A, Yucesan FB, Orem C, Akcan B, Kural BV, Alasalvar C, Shahidi F. Hazelnut-enriched diet improves cardiovascular risk biomarkers beyond a lipid-lowering effect in hypercholesterolemic subjects. J Clin Lipidol. 2013; 7:123-131.
• [25]Katz DL, Davidhi A, Ma Y, Kavak Y, Bifulco L, Njike VY. Effects of walnuts on endothelial function in overweight adults with visceral obesity: a randomized, controlled, crossover trial. J Am Coll Nutr. 2012; 31:415-423.
• [26]Ros E, Nunez I, Perez-Heras A, Serra M, Gilabert R, Casals E, Deulofeu R. A walnut diet improves endothelial function in hypercholesterolemic subjects: a randomized crossover trial. Circulation. 2004; 109:1609-1614.
• [27]Li SC, Liu YH, Liu JF, Chang WH, Chen CM, Chen CY. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism. 2011; 60:474-479.
• [28]Damasceno NR, Pérez-Heras A, Serra M, Cofán M, Sala-Vila A, Salas-Salvadó J, Ros E. Crossover study of diets enriched with virgin olive oil, walnuts or almonds. Effects on lipids and other cardiovascular risk markers. Nutr Metab Cardiovasc Dis. 2011; 21 Suppl 1:S14-20.
• [29]Jalali-Khanabadi BA, Mozaffari-Khosravi H, Parsaeyan N. Effects of almond dietary supplementation on coronary heart disease lipid risk factors and serum lipid oxidation parameters in men with mild hyperlipidemia. J Altern Complement Med. 2010; 16:1279-1283.
• [30]Wien M, Bleich D, Raghuwanshi M, Gould-Forgerite S, Gomes J, Monahan-Couch L, Oda K. Almond consumption and cardiovascular risk factors in adults with prediabetes. J Am Coll Nutr. 2010; 29:189-197.
• [31]Jaceldo-Siegl K, Sabaté J, Batech M, Fraser GE. Influence of body mass index and serum lipids on the cholesterol-lowering effects of almonds in free-living individuals. Nutr Metab Cardiovasc Dis. 2011; 21 Suppl 1:7-13.
• [32]Sabaté J, Haddad E, Tanzman JS, Jambazian P, Rajaram S. Serum lipid response to the graduated enrichment of a Step I diet with almonds: a randomized feeding trial. Am J Clin Nutr. 2003; 77:1379-1384.
• [33]Hyson DA, Schneeman BO, Davis PA. Almonds and almond oil have similar effects on plasma lipids and LDL oxidation in healthy men and women. J Nutr. 2002; 132:703-707.
• [34]Nishi S, Kendall CW, Gascoyne AM, Bazinet RP, Bashyam B, Lapsley KG, Augustin LS, Sievenpiper JL, Jenkins DJ. Effect of almond consumption on the serum fatty acid profile: a dose–response study. Br J Nutr. 2014; 20:1-10.
• [35]Libby P. Inflammation in atherosclerosis. Nature. 2002; 420:868-874.
• [36]Ridker PM, Rifai N, Rose L et al.. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002; 347:1557-1565.
• [37]Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003; 107:363-369.
• [38]Hope SA, Meredith IT. Cellular adhesion molecules and cardiovascular disease. Part II. Their association with conventional and emerging risk factors, acute coronary events and cardiovascular risk prediction. Intern Med J. 2003; 33:450-462.
• [39]Jiang R, Jacobs DR, Mayer-Davis E, Szklo M, Herrington D, Jenny NS, Kronmal R, Barr RG. Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2006; 163:222-231.
• [40]Liu JF, Liu YH, Chen CM, Chang WH, Chen CY. The effect of almonds on inflammation and oxidative stress in Chinese patients with type 2 diabetes mellitus: a randomized crossover controlled feeding trial. Eur J Nutr. 2013; 52:927-935.
• [41]Rajaram S, Connell KM, Sabaté J. Effect of almond-enriched high-monounsaturated fat diet on selected markers of inflammation: a randomised, controlled, crossover study. Br J Nutr. 2010; 103:907-912.
• [42]Tehrani DM, Gardin JM, Yanez D, Hirsch CH, Lloyd-Jones DM, Stein PK, Wong ND. Impact of inflammatory biomarkers on relation of high density lipoprotein-cholesterol with incident coronary heart disease: cardiovascular Health Study. Atherosclerosis. 2013; 231:246-251.
• [43]USDA Full Report (All Nutrients): 12061, Nuts, almonds [http://ndb.nal.usda.gov/ndb/foods/show/3667?fg=&man=&lfacet=&count=&max=35&sort=&qlookup=almond&offset=&format=Full&new=&measureby=]
• [44]Bolling BW, Chen CY, McKay DL, Blumberg JB. Tree nut phytochemicals: composition, antioxidant capacity, bioactivity, impact factors. A systematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts. Nutr Res Rev. 2011; 24:244-275.
• [45]Jaceldo-Siegl K, Sabaté J, Rajaram S, Fraser GE. Long-term almond supplementation without advice on food replacement induces favourable nutrient modifications to the habitual diets of free-living individuals. Br J Nutr. 2004; 92:533-540.
• [46]Kris-Etherton PM, Hecker KD, Bonanome A, Coval SM, Binkoski AE, Hilpert KF, Griel AE, Etherton TD. Bioactive compounds in foods: their role in the prevention of cardiovascular disease and cancer. Am J Med. 2002; 113 Suppl 9B:71-88.
• [47]Vauzour D, Rodriguez-Mateos A, Corona G, Oruna-Concha MJ, Spencer JP. Polyphenols and human health: prevention of disease and mechanisms of action. Nutrients. 2010; 2:1106-1131.
• [48]Vita JA. Polyphenols and cardiovascular disease: effects on endothelial and platelet function. Am J Clin Nutr. 2005; 81 Suppl 1:292-297.
• [49]Berryman CE, Preston AG, Karmally W, Deckelbaum RJ, Kris-Etherton PM. Effects of almond consumption on the reduction of LDL-cholesterol: a discussion of potential mechanisms and future research directions. Nutr Rev. 2011; 69:171-185.