National Pecan Shellers Association Annual Meeting Amelia Island, FL - February 7, 2013 Tufts Pecan Research: An Overview

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1 National Pecan Shellers Association Annual Meeting Amelia Island, FL - February 7, 2013 Tufts Pecan Research: An Overview Diane L. McKay, PhD, FACN Jean Mayer USDA Human Nutrition Research Center on Aging Friedman School of Nutrition Science and Policy Tufts University, Boston, MA

2 Key Points Why nuts are important in the American diet Limited knowledge of pecan health effects Goal: Link pecans with disease prevention

3 Diet and Health Are Linked

4 Why Tree Nuts Are Important

5

6 What are Phytochemicals? Chemical compounds produced naturally by plants Help protect plants against: UV radiation Bacteria, fungi, viruses Parasites, pests Health benefits in humans Antioxidants

7 What Antioxidants Do in the Body

8 Nutrients vs. Phytochemicals Nutrients Phytochemicals Protein, fat, carbohydrates, vitamins and minerals Non-nutrients 33 identified 10,000 estimated RDA established Required by body No RDA - yet Exact needs unknown

9 Amount of Phytochemicals in Tree Nuts vs. Common Plant Foods Tomato 45 Pine Nuts 58 Onion 76 Macadamias Grape Apple Blueberry Cashew Brazil Nuts Spinach Almond Green Bean Hazelnut Pistachios Walnuts (dehulled) Pecans Bolling et al., Nutr Res Rev Total Phenols (mg/100g)

10 Phytochemicals: Examples and Health Effects

11 Health Effects of Nuts: Observational Evidence People who eat at least 5 ounces of nuts per week have a lower risk of: Coronary heart disease Hypertension Type 2 diabetes Mortality vs.

12 Ten Leading Causes of Death in the U.S.

13 One Chronic Disease Leads to Another

14 Trends Among U.S. Adults: Obesity Type 2 Diabetes

15 Defining Overweight and Obesity: BMI

16 Proportion of Overweight and Obese Americans: 69.2%

17 Who Needs to be Informed? Health professionals Nutrition policy-makers

18 Federal Nutrition Policy Dietary Guidelines for Americans USDA Food Guide Graphic Food Labeling

19

20 USDA Food Guide Graphic

21 2010 Dietary Guidelines for Americans: Foods to Increase Protein Foods Consumption of a balanced variety of protein foods can contribute to improved nutrient intake and health benefits. For example, moderate evidence indicates that eating peanuts and certain tree nuts (i.e., walnuts, almonds, and pistachios) reduces risk factors for cardiovascular disease when consumed as part of a diet that is nutritionally adequate and within calorie needs.

22 Nut Research Trials in Humans Number of Clinical Trials Conducted (since 1987) Study outcome: Almonds Walnuts Pistachios Pecans Cholesterol- lowering Body weight control Blood sugar control Oxidative stress Inflammation 5 5 1

23 Policy Requires Supporting Evidence To substantiate health claims and be included in federal nutrition recommendations requires: Well-designed human research studies Randomized, controlled clinical trials preferred

24 Why Conduct a Clinical Trial With Pecans? A growing body of evidence indicates that tree nuts may reduce the risk of cardiovascular disease and type 2 diabetes, though support from well-controlled human studies is limited. Most studies to date have been conducted in subjects who already have high cholesterol or diabetes, rather than those who are generally healthy but at increased risk.

25 Purpose of Tufts Clinical Trial To demonstrate the potential role of pecans in preventing cardiovascular disease and type 2 diabetes in generally healthy adults at increased risk for developing these chronic diseases.

26 Overall Pecan Research Goals Expand our knowledge of pecan health effects beyond cholesterol lowering Fill in knowledge gaps Inform nutrition policy makers and health professionals about the potential benefits of pecan consumption

27 Why? Where? What? Who? How? When?

28 Where Will the Trial Be Conducted? Antioxidants Research Laboratory Metabolic Research Unit Nutrition Evaluation Laboratory

29 What Will We Measure? Effects of pecans on early signs (biomarkers) of: Type 2 diabetes (blood sugar control) Fasting insulin Fasting glucose Heart disease (blood vessel health) Blood pressure Inflammation Oxidative stress Endothelial function

30 What Triggers Damage to Blood Vessels? High blood pressure High blood sugar Free radicals Aging Weight gain Smoking, etc.

31 Who Will We Study? Men and postmenopausal women Age 50 and over Overweight and mildly obese Belly fat Slightly elevated blood pressure

32 U.S. Population is Aging Rapidly

33 BMI and Body Shapes

34 Apples vs. Pears

35 Abdominal Obesity

36 How? Controlled Clinical Trial Design

37 Tufts Pecan Clinical Trial Diets Nutrient/Food Component Control diet Pecan-rich diet Carbohydrate, % energy Protein, % energy Total fat, % energy Cholesterol, mg/2000 kcal Fiber, g/2000 kcal Fruit, # of servings 1 1 Vegetables, # of servings 2 2 Pecans, g/2000 kcal 0 45

38 When? - Estimated Timeline Apr 1, 2013 July 1, 2013 Aug 1, 2013 Sept 1, 2014 Dec 1, 2014 Mar 1, 2015 Mar 31, 2015 Study protocol and all related materials submitted to Tufts Medical Center/Tufts University Health Sciences campus Scientific Review Committee and Institutional Review Board for approval. Initiation of subject recruitment and scheduling at Tufts/HNRCA Initiation of protocol at Tufts/HNRCA Last subject recruited at Tufts/HNRCA Completion of clinical trial at Tufts/HNRCA Completion of laboratory and data analyses at Tufts/HNRCA Final report submitted to NPSA

39 Summary and Expected Outcome Pecans contain essential nutrients, and are high in phytochemicals Conduct well-designed study to measure effects of pecans on biomarkers of heart disease and diabetes Expected outcome: pecans will improve these biomarkers, lower disease risk Substantiate specific health impact of pecans A handful of pecans a day can keep adults healthy, and may prevent both heart disease and diabetes.

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