Issue 161 Item 7 Almonds Improve Lipid Profiles

Substituting dietary calories with calories from almonds has a significant beneficial effect on lipid profiles, according to the results of a randomized trial

"Epidemiologic studies have consistently reported an inverse relation between the incidence of cardiovascular disease and the frequent consumption of nuts, even after adjustment for confounding variables," write Joan Sabaté, from Loma Linda University in California, and colleagues. "Almonds are unique in that they have significant amounts of protein and have the highest concentration of alpha-tocopherol of all nuts."

For two weeks, 25 healthy and mildly hypercholesterolemic adults (14 men and 11 women), mean age 41 ± 13 years, were fed a run-in diet containing 34% of energy from fat. In a crossover design, subjects then received three isoenergetic diets for four weeks each. These were a (1) National Cholesterol Education Program (NCEP) Step I diet, (2) a low-almond diet, and (3) a high-almond diet, in which almonds contributed 0%, 10%, and 20% of total energy, respectively.

The percentage of energy in the diet from almonds was inversely related to total cholesterol (P for trend < .001), low-density lipoprotein (LDL) cholesterol (P < .001), apolipoprotein B (P < .001) concentrations, ratio of LDL to high-density lipoprotein (HDL) cholesterol (P < .001) and ratio of apolipoprotein B to apolipoprotein A (P < .001).

Compared with the Step I diet, the high-almond diet increased HDL cholesterol (0.02 mmol/L or 1.7%; P = .08), and it reduced total cholesterol (0.24 mmol/L or 4.4%; P = .001), LDL cholesterol (0.26 mmol/L or 7.0%; P < .001), apolipoprotein B (6.6 mg/dL or 6.6%; P < .001), and ratio of LDL to HDL cholesterol (8.8%; P < 0.001).
"Isoenergetic incorporation of approximately 68 g of almonds (20% of energy) into an 8368-kJ (2000-kcal) Step I diet markedly improved the serum lipid profile of healthy and mildly hypercholesterolemic adults," the authors write. "Total and LDL-cholesterol concentrations declined with progressively higher intakes of almonds, which suggests a dose-response relation."

The authors point out that a 7% decrease in LDL cholesterol produced by the high-almond diet corresponds to a reduction in the incidence of cardiovascular disease of approximately 11%, which has important public health implications.

"Our investigation is in general agreement with the new NCEP Adult Treatment Panel III guidelines to liberalize the total amount of fat in the diet. The fatty acid composition of the high-almond diet matches the recommended Therapeutic Lifestyle Changes Diet for saturated fats (< 7%), polyunsaturated fats (< 10%), and up to 20% of total energy as monounsaturated fats," the authors write. "Future dietary strategies for lowering serum cholesterol should focus on the consumption of acceptable and tasty whole foods rather than on the restriction of fat." m J Clin Nutr. 2003;77:1379-1384

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