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| Name | Class |
|---|---|
| California Walnut Commission | OTHER |
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The purpose of this study is to evaluate the acute, postprandial effects and mechanism of action of various walnut components (separated nut skins, de-fatted nut meat, nut oil) versus whole walnuts on oxidative stress, inflammation and measures of platelet and endothelial function in healthy adults with moderately elevated cholesterol levels.
Walnuts contain high contents of polyunsaturated fatty acids (PUFA), particularly linoleic acid and linolenic acid. The high PUFA content has been suggested to reduce CVD risk through decreasing total and LDL-cholesterol concentrations, and increasing HDL-C concentrations. In addition, walnuts are rich in substances such as ellagic acid (a polyphenol), antioxidants, vitamin E, fiber, essential fatty acids, flavanoids, and phenolic acids. Polyphenolic compounds are believed to have multiple biological effects influencing oxidative stress, platelet function, inflammation, and cancer initiation and propagation. There is interest in identifying foods with these and other favorable compounds to test their efficacy in real world settings to further understand their role in the human diet. Despite positive benefits found in consumption of the walnuts, it is not known which specific component of the walnut (i.e., whole walnut, walnut skin, defatted walnut, or walnut oil) is most beneficial to health. The investigators hypothesize that maximum improvements in oxidative stress, inflammatory markers, platelet and endothelial function will be observed following consumption of the whole nut versus isolated walnut components, thereby leading to a recommendation to consume walnuts. In addition, results from the research proposed will provide new information about the antioxidant, inflammatory, platelet activity and endothelial effects of the different walnut components and the synergistic effects these components have in the postprandial state.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Whole walnut | Experimental | 85g whole walnuts, ground, incorporated into inert food carrier |
|
| Walnut "meat" | Experimental | Separated, ground walnut de-fatted nut meat incorporated into inert food carrier |
|
| Walnut oil | Experimental | Walnut oil extracted from nut meat and incorporated into inert food carrier |
|
| Walnut skins | Experimental | Separated, ground walnut skins incorporated into inert food carrier |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Walnut "meat" | Dietary Supplement | Separated, ground walnut de-fatted nut meat incorporated into inert food carrier |
|
| Measure | Description | Time Frame |
|---|---|---|
| Main Effect of Treatment on the Ferric Reducing Antioxidant Potential (FRAP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and FRAP was measured at 0, 60, 120, 240, and 360 min. The FRAP assay was used to determine the reducing ability of plasma in a redox-linked colorimetric reaction. Plasma was incubated with the FRAP reagent at room temperature for 1 h and the absorbance at 593 nm was then recorded. Trolox was used as a reference to construct a standard curve to calculate the FRAP value of the samples. The FRAP assay measures lipophilic and hydrophilic antioxidants (total antioxidant capacity), both of which are present in walnuts. | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
| Main Effect of Treatment by Timepoint on the Ferric Reducing Antioxidant Potential (FRAP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) blood sample was collected. Participants then had 15 min to consume 1 of 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and FRAP was measured at 0, 60, 120, 240, and 360 min. The FRAP assay was used to determine the reducing ability of plasma in a redox-linked colorimetric reaction. Plasma was incubated with the FRAP reagent at room temperature for 1 h and the absorbance at 593 nm was then recorded. Trolox was used as a reference to construct a standard curve to calculate the FRAP value of the samples. The FRAP assay measures lipophilic and hydrophilic antioxidants (total antioxidant capacity), both of which are present in walnuts. Several blood samples (n=3) could not be obtained/measured (walnut skin group at 360 min, walnut oil group at 120 min, whole walnut group at 240 min). | Change from baseline for each timepoint (60, 120, 240, 360 min) |
| Measure | Description | Time Frame |
|---|---|---|
| Main Effect of Treatment on Reactive Hyperemia Index (RHI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. RHI was calculated as the ratio of the average pulse wave amplitude during hyperemia (60 to 120 s of the post occlusion period) to the average pulse wave amplitude during baseline in the occluded hand divided by the same values in the control hand and then multiplied by a baseline correction factor. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Penny M Kris-Etherton, PhD | Penn State University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Penn State General Clinical Research Center | University Park | Pennsylvania | 16802 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 23616506 | Derived | Berryman CE, Grieger JA, West SG, Chen CY, Blumberg JB, Rothblat GH, Sankaranarayanan S, Kris-Etherton PM. Acute consumption of walnuts and walnut components differentially affect postprandial lipemia, endothelial function, oxidative stress, and cholesterol efflux in humans with mild hypercholesterolemia. J Nutr. 2013 Jun;143(6):788-94. doi: 10.3945/jn.112.170993. Epub 2013 Apr 24. | |
| 21871057 |
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Of the individuals (n=246) who were contacted and screened with a semi-structured telephone interview, 50 qualified and were scheduled for a screening visit at the Penn State General Clinical Research Center. After written informed consent was obtained, a fasting blood sample was drawn. Eligible participants (n=20) were randomized to the study.
Participants were recruited through advertisements in the local newspaper and university e-mails from April 2008 to October 2008.
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| ID | Title | Description |
|---|---|---|
| FG000 | Walnut Intervention | Four different treatments were provided to each participant in a randomized-crossover fashion: ground whole walnuts (85 g), walnut skins (5.6 g) derived from whole walnuts, walnut oil (51 g) extracted from whole walnuts, or skinless, defatted walnut nutmeat (34 g) from whole walnuts. Each treatment was incorporated into an inert food carrier. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | All Completed Participants (n=15) | Whole walnut (85 g) Walnut skins (5.6 g) Walnut oil (51 g) Defatted walnut nutmeat (34 g) |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Secondary | Main Effect of Treatment on Reactive Hyperemia Index (RHI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. RHI was calculated as the ratio of the average pulse wave amplitude during hyperemia (60 to 120 s of the post occlusion period) to the average pulse wave amplitude during baseline in the occluded hand divided by the same values in the control hand and then multiplied by a baseline correction factor. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | ratio | Change from baseline at 240 min |
|
During the intervention (0 to 360 min)
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Walnut Oil |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhea | Gastrointestinal disorders | Non-systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Penny Kris-Etherton | Penn State University | pmk3@psu.edu |
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| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
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| Walnut Oil | Dietary Supplement | Walnut oil extracted from nut meat and incorporated into inert food carrier |
|
| Walnut Skins | Dietary Supplement | Separated, ground walnut skins incorporated into inert food carrier |
|
| Whole walnut | Dietary Supplement | 85g whole walnuts, ground, incorporated into inert food carrier |
|
| Main Effect of Treatment on the Changes in Total Thiol Response to 4 Walnut Treatments |
On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and total thiols measured at 0, 60, 120, 240, and 360 min. Total thiols in plasma were determined by the following methods: an aliquot of EDTA plasma was mixed with Tris-EDTA buffer, followed by addition of 10 mmol/L 2,2-dithiobisnitrobenzoic acid and methanol. After incubation at room temperature for 15 min and centrifugation, the absorbance of the supernatant was measured at 412 nm. |
| AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
| Main Effect of Treatment by Timepoint on Total Thiol Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and total thiols measured at 0, 60, 120, 240, and 360 min. Total thiols in plasma were determined by the following methods: an aliquot of EDTA plasma was mixed with Tris-EDTA buffer, followed by addition of 10 mmol/L 2,2-dithiobisnitrobenzoic acid and methanol. After incubation at room temperature for 15 min and centrifugation, the absorbance of the supernatant was measured at 412 nm. Several blood samples (n=3) could not be obtained/measured (walnut skin group at 360 min, walnut oil group at 120 min, whole walnut group at 240 min). | Change from baseline for each timepoint (60, 120, 240, 360 min) |
| Main Effect of Treatment on the Changes in Malondialdehyde (MDA) Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and MDA measured at 0, 60, 120, 240, and 360 min. Plasma MDA was measured by an Agilent 1100 HPLC system with fluorometric detection. | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
| Main Effect of Treatment by Timepoint on Malondialdehyde (MDA) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the clinic after a 12-h overnight fast. A baseline (0 min) blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and MDA measured at 0, 60, 120, 240, and 360 min. Plasma MDA was measured by an Agilent 1100 HPLC system with fluorometric detection. Several blood samples (n=2) could not be obtained (walnut oil group at 120 min and whole walnut group at 240 min). | Change from baseline for each timepoint (60, 120, 240, 360 min) |
| Main Effect of Treatment on the Changes in C-reactive Protein (CRP) Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and CRP measured at 0, 60, 120, 240, and 360 min. Serum CRP was measured by latex-enhanced immunonephelometry. | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
| Main Effect of Treatment by Timepoint on C-reactive Protein (CRP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and CRP measured at 0, 60, 120, 240, and 360 min. Serum CRP was measured by latex-enhanced immunonephelometry. Several blood samples (n=3) could not be obtained/measured (walnut oil/120 min, whole walnut/240 min, and walnut skin/360 min). | Change from baseline for each timepoint (60, 120, 240, 360 min) |
| Change from baseline at 240 min |
| Main Effect of Treatment on Framingham Reactive Hyperemia Index (fRHI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. fRHI is an alternative calculation derived from the same raw data (as RHI) and differs in that it uses the period from 90 to 120 s of postocclusion hyperemia, does not incorporate a baseline correction factor, and has a natural log transformation applied to the resulting ratio. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | Change from baseline at 240 min |
| Main Effect of Treatment on Heart Rate (HR) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | Change from baseline at 240 min |
| Main Effect of Treatment on Augmentation Index (AI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. AI is a measure of vascular stiffness (pulse wave reflection) that is calculated from the shape of the pulse wave recorded during baseline. No endothelial function test data was available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | Change from baseline at 240 min |
| Main Effect of Treatment on Augmentation Index Standardized to a Heart Rate of 75 Beats/Min (AI_75) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. AI is a measure of vascular stiffness (pulse wave reflection) that is calculated from the shape of the pulse wave recorded during baseline. AI can be adjusted to a heart rate of 75 beats/min (AI_75) to correct for the independent effect of heart rate on this measure.No endothelial function test data was available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | Change from baseline at 240 min |
| Main Effect of Treatment on the Triglyceride (TG) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and TG was measured at 0, 30, 60, 120, 240, and 360 min. TG were determined by standard colorimetric and enzymatic procedures with commercially available kits (Alfa Wassermann). | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
| Main Effect of Treatment by Timepoint on Triglyceride (TG) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and TG was measured at 0, 30, 60, 120, 240, and 360 min. TG were determined by standard colorimetric and enzymatic procedures with commercially available kits (Alfa Wassermann). Several blood samples (n=4) could not be obtained/measured [walnut skin group at 360 min (n=1), walnut oil group at 120 min (n=2), whole walnut group at 240 min(n=1)]. | Change from baseline for each timepoint (30, 60, 120, 240, 360 min) |
| Derived |
| Zhang J, Grieger JA, Kris-Etherton PM, Thompson JT, Gillies PJ, Fleming JA, Vanden Heuvel JP. Walnut oil increases cholesterol efflux through inhibition of stearoyl CoA desaturase 1 in THP-1 macrophage-derived foam cells. Nutr Metab (Lond). 2011 Aug 26;8:61. doi: 10.1186/1743-7075-8-61. |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Body mass index | Mean | Standard Deviation | kg/m^2 |
|
| Systolic blood pressure | Mean | Standard Deviation | mm Hg |
|
| Diastolic blood pressure | Mean | Standard Deviation | mm Hg |
|
| Total cholesterol | Mean | Standard Deviation | mmol/L |
|
| LDL-cholesterol | Mean | Standard Deviation | mmol/L |
|
| HDL-cholesterol | Mean | Standard Deviation | mmol/L |
|
| Triglycerides | Mean | Standard Deviation | mmol/L |
|
| Ferric reducing antioxidant potential (FRAP) | Mean | Standard Deviation | umol TE/L |
|
| Total thiols | Mean | Standard Deviation | mmol/L |
|
| Malondialdehyde (MDA) | Mean | Standard Deviation | umol/L |
|
| Reactive hyperemia index (RHI) | RHI was calculated as the ratio of the average pulse wave amplitude during hyperemia (60 to 120 s of the post occlusion period) to the average pulse wave amplitude during baseline in the occluded hand divided by the same values in the control hand and then multiplied by a baseline correction factor. | Mean | Standard Deviation | ratio |
|
| Framingham reactive hyperemia index (fRHI) | fRHI is an alternative calculation derived from the same raw data (as RHI) and differs in that it uses the period from 90 to 120 s of postocclusion hyperemia, does not incorporate a baseline correction factor, and has a natural log transformation applied to the resulting ratio. | Mean | Standard Deviation | ln(ratio) |
|
| OG000 |
| Whole Walnut (85 g) |
| OG001 | Walnut Skins (5.6 g) |
| OG002 | Walnut Oil (51 g) |
| OG003 | Defatted Walnut Nutmeat (34 g) |
|
|
|
| Primary | Main Effect of Treatment on the Ferric Reducing Antioxidant Potential (FRAP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and FRAP was measured at 0, 60, 120, 240, and 360 min. The FRAP assay was used to determine the reducing ability of plasma in a redox-linked colorimetric reaction. Plasma was incubated with the FRAP reagent at room temperature for 1 h and the absorbance at 593 nm was then recorded. Trolox was used as a reference to construct a standard curve to calculate the FRAP value of the samples. The FRAP assay measures lipophilic and hydrophilic antioxidants (total antioxidant capacity), both of which are present in walnuts. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | umol Trolox equivalents (TE)*min/L | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
|
|
|
|
| Primary | Main Effect of Treatment by Timepoint on the Ferric Reducing Antioxidant Potential (FRAP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) blood sample was collected. Participants then had 15 min to consume 1 of 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and FRAP was measured at 0, 60, 120, 240, and 360 min. The FRAP assay was used to determine the reducing ability of plasma in a redox-linked colorimetric reaction. Plasma was incubated with the FRAP reagent at room temperature for 1 h and the absorbance at 593 nm was then recorded. Trolox was used as a reference to construct a standard curve to calculate the FRAP value of the samples. The FRAP assay measures lipophilic and hydrophilic antioxidants (total antioxidant capacity), both of which are present in walnuts. Several blood samples (n=3) could not be obtained/measured (walnut skin group at 360 min, walnut oil group at 120 min, whole walnut group at 240 min). | Posted | Least Squares Mean | Standard Error | umol Trolox equivalents (TE)/L | Change from baseline for each timepoint (60, 120, 240, 360 min) |
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|
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| Primary | Main Effect of Treatment on the Changes in Total Thiol Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and total thiols measured at 0, 60, 120, 240, and 360 min. Total thiols in plasma were determined by the following methods: an aliquot of EDTA plasma was mixed with Tris-EDTA buffer, followed by addition of 10 mmol/L 2,2-dithiobisnitrobenzoic acid and methanol. After incubation at room temperature for 15 min and centrifugation, the absorbance of the supernatant was measured at 412 nm. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | mmol*min/L | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
|
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|
|
| Secondary | Main Effect of Treatment on Framingham Reactive Hyperemia Index (fRHI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. fRHI is an alternative calculation derived from the same raw data (as RHI) and differs in that it uses the period from 90 to 120 s of postocclusion hyperemia, does not incorporate a baseline correction factor, and has a natural log transformation applied to the resulting ratio. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | ln(ratio) | Change from baseline at 240 min |
|
|
|
|
| Secondary | Main Effect of Treatment on Heart Rate (HR) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. No endothelial function test data available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | beats/minute | Change from baseline at 240 min |
|
|
|
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| Primary | Main Effect of Treatment by Timepoint on Total Thiol Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and total thiols measured at 0, 60, 120, 240, and 360 min. Total thiols in plasma were determined by the following methods: an aliquot of EDTA plasma was mixed with Tris-EDTA buffer, followed by addition of 10 mmol/L 2,2-dithiobisnitrobenzoic acid and methanol. After incubation at room temperature for 15 min and centrifugation, the absorbance of the supernatant was measured at 412 nm. Several blood samples (n=3) could not be obtained/measured (walnut skin group at 360 min, walnut oil group at 120 min, whole walnut group at 240 min). | Posted | Least Squares Mean | Standard Error | mmol/L | Change from baseline for each timepoint (60, 120, 240, 360 min) |
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| Primary | Main Effect of Treatment on the Changes in Malondialdehyde (MDA) Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and MDA measured at 0, 60, 120, 240, and 360 min. Plasma MDA was measured by an Agilent 1100 HPLC system with fluorometric detection. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | umol*min/L | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
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| Primary | Main Effect of Treatment by Timepoint on Malondialdehyde (MDA) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the clinic after a 12-h overnight fast. A baseline (0 min) blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and MDA measured at 0, 60, 120, 240, and 360 min. Plasma MDA was measured by an Agilent 1100 HPLC system with fluorometric detection. Several blood samples (n=2) could not be obtained (walnut oil group at 120 min and whole walnut group at 240 min). | Posted | Least Squares Mean | Standard Error | umol/L | Change from baseline for each timepoint (60, 120, 240, 360 min) |
|
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|
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| Primary | Main Effect of Treatment on the Changes in C-reactive Protein (CRP) Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and CRP measured at 0, 60, 120, 240, and 360 min. Serum CRP was measured by latex-enhanced immunonephelometry. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | mg*min/L | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
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| Primary | Main Effect of Treatment by Timepoint on C-reactive Protein (CRP) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and CRP measured at 0, 60, 120, 240, and 360 min. Serum CRP was measured by latex-enhanced immunonephelometry. Several blood samples (n=3) could not be obtained/measured (walnut oil/120 min, whole walnut/240 min, and walnut skin/360 min). | Posted | Least Squares Mean | Standard Error | mg/L | Change from baseline for each timepoint (60, 120, 240, 360 min) |
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| Secondary | Main Effect of Treatment on Augmentation Index (AI) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. AI is a measure of vascular stiffness (pulse wave reflection) that is calculated from the shape of the pulse wave recorded during baseline. No endothelial function test data was available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | Percent change | Change from baseline at 240 min |
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| Secondary | Main Effect of Treatment on Augmentation Index Standardized to a Heart Rate of 75 Beats/Min (AI_75) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. At baseline the endothelial function test was performed using pulse amplitude tonometry (PAT) (Itamar Medical). Participants then had 15 min to consume 1 of the 4 walnut test meals. The endothelial function test was performed again at 240 min postmeal. AI is a measure of vascular stiffness (pulse wave reflection) that is calculated from the shape of the pulse wave recorded during baseline. AI can be adjusted to a heart rate of 75 beats/min (AI_75) to correct for the independent effect of heart rate on this measure.No endothelial function test data was available for one participant within the walnut oil group and one within the defatted walnut nutmeat group. | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | Percent change | Change from baseline at 240 min |
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| Secondary | Main Effect of Treatment on the Triglyceride (TG) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and TG was measured at 0, 30, 60, 120, 240, and 360 min. TG were determined by standard colorimetric and enzymatic procedures with commercially available kits (Alfa Wassermann). | All participants who completed each of the 4 treatment arms | Posted | Least Squares Mean | Standard Error | mmol*min/L | AUC values were calculated with the trapezoidal rule, using the respective fasting baseline value as the line of reference. Measured at 0 to 360 min (baseline to 360min post meal) for each of the 4 walnut treatments. |
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| Secondary | Main Effect of Treatment by Timepoint on Triglyceride (TG) Changes in Response to 4 Walnut Treatments | On the day of each test, participants arrived at the General Clinical Research Center after a 12-h overnight fast. A baseline (0 min) fasting blood sample was collected. Participants then had 15 min to consume 1 of the 4 walnut test meals. Blood samples (∼30 mL) were subsequently taken at 30, 60, 120, 240, and 360 min following the meal and TG was measured at 0, 30, 60, 120, 240, and 360 min. TG were determined by standard colorimetric and enzymatic procedures with commercially available kits (Alfa Wassermann). Several blood samples (n=4) could not be obtained/measured [walnut skin group at 360 min (n=1), walnut oil group at 120 min (n=2), whole walnut group at 240 min(n=1)]. | Posted | Least Squares Mean | Standard Error | mmol/L | Change from baseline for each timepoint (30, 60, 120, 240, 360 min) |
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| 0 |
| 15 |
| 9 |
| 15 |
| EG001 | Whole Walnut | 0 | 15 | 0 | 15 |
| EG002 | Walnut Skins | 0 | 15 | 0 | 15 |
| EG003 | Defatted Walnut Nutmeat | 0 | 15 | 0 | 15 |
Not provided
Not provided
The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons).
| Superiority or Other (legacy) |
| Mixed Models Analysis | 0.35 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.011 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.62 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0002 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0013 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons).
| Superiority or Other (legacy) |
| Mixed Models Analysis | 0.004 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.11 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.004 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.11 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.16 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons).
| Superiority or Other (legacy) |
| Mixed Models Analysis | 0.62 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.14 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.002 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.22 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.074 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons).
| Superiority or Other (legacy) |
| Mixed Models Analysis | 0.99 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.037 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0087 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.64 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.043 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.0083 is considered significant (6 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis |
| 0.91 |
The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). |
| Superiority or Other (legacy) |
| Mixed Models Analysis | 0.21 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0011 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0004 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.11 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.53 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.59 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.31 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.98 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.30 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.91 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.12 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.007 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0089 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.28 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.62 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.48 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | <0.0001 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0003 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.57 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.99 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.71 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.62 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.33 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.65 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.66 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.30 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0005 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.0085 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |
| Mixed Models Analysis | 0.92 | The Bonferroni adjustment was used to correct for multiple treatment comparisons; P < 0.001667 is considered significant (30 comparisons). | Superiority or Other (legacy) |