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| Name | Class |
|---|---|
| California Walnut Commission | OTHER |
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This study will evaluate the effects of walnut-derived ALA and bioactives on multiple CVD risk factors, including central blood pressure, arterial stiffness indices, inflammatory markers, urinary isoprostanes, vascular adhesion markers, and changes in lipids and lipoproteins. Gut microbiome changes due to walnut consumption will also be assessed using the 16S rRNA gene.
Diets containing nuts likely reduce cardiovascular disease (CVD) risk but the mechanisms remain poorly defined. Walnuts contain substantial amounts of polyunsaturated fatty acids (PUFAs), particularly alpha-linolenic acid (ALA), and are a rich source of bioactives. Many vegetable oils are high in PUFAs but most lack ALA and do not provide the same complement of bioactive compounds as walnuts. ALA is thought to improve cardiovascular health by modulating circulating lipid concentrations, altering membrane structure/function by enhancing the total ω-3 fatty acid content of cell membrane phospholipids, and reducing inflammatory reactions by inhibiting production of arachidonic acid-derived eicosanoids. Consumption of walnuts has consistently been shown to improve blood lipids/lipoproteins and vascular health. However, there remains much debate over what is the preferable replacement for saturated fat in the diet. Because of the ALA and bioactives that they provide, walnuts may confer specific CVD benefits. To study the effects of walnuts, in terms of both their ALA content and bioactive compounds, we will compare two test diets (one containing walnuts and one matched for PUFA and ALA content but devoid of walnuts and their bioactives) to a control diet matched for macronutrient and linoleic acid (LA) content but providing oleic acid in place of ALA. This diet design will provide information about how walnuts affect the selected endpoints of interest due to their bioactives as well as their ALA content, and whether walnut ALA is a superior substitute for dietary saturated fat compared to oleic acid.
Feeding protocol and study treatments:
This study is designed as a double-blind, 3-period, randomized, cross-over controlled feeding study. Prior to randomization, participants will complete a two week run-in on a standard Western diet. Each diet period treatment phase will be 6 weeks in duration, separated by 2-week washout periods. The three test diets are: 1) a walnut diet (WD; providing ~2.0 oz of walnuts per day); 2) a matched walnut control diet (WCD) that will provide the same fatty acid profile as the walnut diet, but will not contain walnuts (and their bioactives); and 3) a low ALA diet (LAD) with a similar macronutrient (and linoleic acid) composition as the WD and WCD, but using oleic acid to replace ALA. Study diets will be prepared in a metabolic kitchen, with three isocaloric meals and a snack provided each day, based on a 7-day rotating menu cycle. Participants will be instructed to consume only the prepared foods and limit their intake of alcohol to 2 drinks/week and caffeinated calorie-free beverages to 40 ounces (5 drinks) per day. Diets will be planned for every subject according to his/her energy requirements and will be nutritionally adequate. This diet design will permit the WD to be compared with the WCD and LAD and, thereby, allow us to ascertain the specific effects that walnuts and their bioactive components (including and beyond ALA) may have on CVD risk factors and artery health.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Walnut Diet | Experimental | Provides ~2 oz. walnuts/day (2-3% of total calories from alpha-linolenic acid [ALA]) |
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| Walnut Control Diet | Active Comparator | Provides same fatty acid profile (<7% SFA, 9% MUFA, 14-15% PUFA, 2-3% ALA) as Walnut Diet, but is devoid of walnuts and their bioactives |
|
| Low ALA Diet | Placebo Comparator | Provides similar macronutrient and linoleic acid profile but replaces ALA with oleic acid (<7% SFA, 12% MUFA, 12% PUFA, 0.5% ALA) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Walnut Diet | Other | 2 oz. walnuts/day (2-3% of total calories from ALA) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in central blood pressure at the end of diet period 1 (week 6), end of diet period 2 (week 14), and end of diet period 3 (week 22) | End of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Measure | Description | Time Frame |
|---|---|---|
| Change in 24-hour ambulatory blood pressure | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) | |
| Change in indices of arterial stiffness (pulse wave velocity) | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Penn State University | University Park | Pennsylvania | 16802 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22332062 | Background | McGuire S. U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. Adv Nutr. 2011 May;2(3):293-4. doi: 10.3945/an.111.000430. Epub 2011 Apr 30. No abstract available. | |
| 8357360 | Background |
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| ID | Term |
|---|---|
| D002318 | Cardiovascular Diseases |
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| Walnut Control Diet |
| Other |
2-3% ALA but no walnuts provided |
|
| Low ALA Diet | Other | ALA replaced by oleic acid |
|
| Change in lipoprotein particle size | The VAP© Test provides a direct measure of the following lipid and lipoprotein classes and subclasses: LDL, Lp(a), IDL, LDL1, LDL2, LDL3, LDL4, HDL, HDL2, HDL3, VLDL, VLDL1+2, VLDL3, TC, TG, Non-HDL, Remnant Lipoproteins, ApoB100, and ApoA1 | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in inflammatory cytokines (tumor necrosis factor-alpha and interleukin-6) | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in the composition of the gut microbiome | This will be assessed via sequencing of microbial 16S rRNA from fecal samples. | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in serum C-reactive protein | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in serum glucose | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in serum insulin | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in urinary F2α-isoprostanes | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in lipid/lipoprotein profile | Total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in heart rate variability | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Change in vascular adhesion markers (VCAM and ICAM) | Week 0, end of diet period 1 (week 6), end of diet period 2 (week 14), end of diet period 3 (week 22) |
| Sabate J, Fraser GE, Burke K, Knutsen SF, Bennett H, Lindsted KD. Effects of walnuts on serum lipid levels and blood pressure in normal men. N Engl J Med. 1993 Mar 4;328(9):603-7. doi: 10.1056/NEJM199303043280902. |
| 15514264 | Background | Zhao G, Etherton TD, Martin KR, West SG, Gillies PJ, Kris-Etherton PM. Dietary alpha-linolenic acid reduces inflammatory and lipid cardiovascular risk factors in hypercholesterolemic men and women. J Nutr. 2004 Nov;134(11):2991-7. doi: 10.1093/jn/134.11.2991. |
| 19458020 | Background | Banel DK, Hu FB. Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr. 2009 Jul;90(1):56-63. doi: 10.3945/ajcn.2009.27457. Epub 2009 May 20. |
| 21677123 | Background | West SG, Krick AL, Klein LC, Zhao G, Wojtowicz TF, McGuiness M, Bagshaw DM, Wagner P, Ceballos RM, Holub BJ, Kris-Etherton PM. Effects of diets high in walnuts and flax oil on hemodynamic responses to stress and vascular endothelial function. J Am Coll Nutr. 2010 Dec;29(6):595-603. doi: 10.1080/07315724.2010.10719898. |
| Background | 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; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279-1290. |
| 21871057 | Background | 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. |
| 37826992 | Derived | Petersen KS, Chandra M, Chen See JR, Leister J, Jafari F, Tindall A, Kris-Etherton PM, Lamendella R. Walnut consumption and gut microbial metabolism: Results of an exploratory analysis from a randomized, crossover, controlled-feeding study. Clin Nutr. 2023 Nov;42(11):2258-2269. doi: 10.1016/j.clnu.2023.09.023. Epub 2023 Sep 28. |
| 31848609 | Derived | Tindall AM, McLimans CJ, Petersen KS, Kris-Etherton PM, Lamendella R. Walnuts and Vegetable Oils Containing Oleic Acid Differentially Affect the Gut Microbiota and Associations with Cardiovascular Risk Factors: Follow-up of a Randomized, Controlled, Feeding Trial in Adults at Risk for Cardiovascular Disease. J Nutr. 2020 Apr 1;150(4):806-817. doi: 10.1093/jn/nxz289. |
| 31039663 | Derived | Tindall AM, Petersen KS, Skulas-Ray AC, Richter CK, Proctor DN, Kris-Etherton PM. Replacing Saturated Fat With Walnuts or Vegetable Oils Improves Central Blood Pressure and Serum Lipids in Adults at Risk for Cardiovascular Disease: A Randomized Controlled-Feeding Trial. J Am Heart Assoc. 2019 May 7;8(9):e011512. doi: 10.1161/JAHA.118.011512. |