Level 1 Epidemiological Evidence 2/2/2016. Disclosure. Richard D. Mattes, MPH, PhD, RD. Affiliations: Purdue University and West Lafayette, IN, USA

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1 Disclosure 2 Richard D. Mattes, MPH, PhD, RD Affiliations: Purdue University and West Lafayette, IN, USA Disclosure: Dr. Mattes has received grants/research support and honorarium from Almond Board of California. 3 Level 1 Epidemiological Evidence 1

2 Body Mass Index (kg/m 2 ) ) 2/2/2016 Nurses Health Study Nut Consumption versus BMI Never 1-3X/mo to 1X/wk 2-4X/wk >5X/wk (Hu et al, BMJ, 1998) Physicians Health Study (N=21,454) 5 Body Mass Index (kg/m 2 Average Frequency of Dietary Nut Intake Rarely/ Never 1-3X/mo 1X/wk > 2X/wk (Albert et al, Arch Intern Med, 2002) 6 Level 2 Clinical Evidence 2

3 Nuts and Weight Change 2/2/2016 Nut Subjects Duration (months) Weight Change Abby, 1994 Almond/Macadamia NS Spiller, 1998 Almond 48 1 NS Fraser, 2002 Almond 81 6 NS Hyson, 2002 Almond NS Jenkins, 2002 Almond 27 1 L Lovejoy, 2002 Almond <1Kg Spiller, 2003 Almond 38 1 NS Sabate, 2003 Almond 25 1 NS Wein, 2003 Almond 65 6 L Hollis, 2007 Almond NS Curb, 2000 Macadamia 30 1 NS Garg, 2003 Macadamia 17 1 L Kris-Etherton, 1999 Peanut NS Alper, 2002 Peanut NS Morgan, 2001 Pecan 19 2 NS Rajaram, 2001 Pecan 23 1 L Edwards, 1999 Pistachio NS Almario, 2001 Walnut NS Sabate, 1993 Walnut 19 2 L Zambon, 2000 Walnut NS Iwamoto,2002 Walnut 80 1 L Sabate, 2005 Walnut Kg 7 8 Figure: Weekly change in weight in the two study groups. Data are leastsquares means and 95% CL; CHO=carboyhdrate; LCD=low-calorie diet. (Wien et al, Int J Obes Relat Metab Discord, 2003) 9 Figure: Mean (±SE) weight change at 6 and 18 mo in a weight-management population after a hypocaloric almond-enriched diet (n=62) or a nut-free diet (n=61). Weight change data were analyzed by using intent-to-treat linear mixed-effects models. These analyses included all observed data on all participants, regardless of attrition. (Foster et al, Am J Clin Nutr, 2012) 3

4 10 Level 3 Mechanistic Evidence Mechanisms 11 Appetite Energy yield Energy Expenditure 12 Appetite 4

5 Appetitive Effects of Nuts 13 Suppression of Hunger Eating initiation Suppression of Desire to Eat Eating in the absence of hunger Enhancement of Fullness Meal size Dietary Compensation 14 Study Nut % Compensation Fraser et al., 2002 Almonds 54, 75 LoveJoy et al., 2002 Almonds 63 Hollis & Mattes Almonds 76 Curb et al., 1992 Macadamias 58, 113 Kirkmeyer & Mattes, 2000 Peanuts 104% Alper & Mattes, 2001 Peanuts 66% Almario et al., 2001 Walnuts 96% Abbey et al., 1994 Walnuts 55% Tey et al., 2011 Hazelnuts 100% Factors Contributing to Satiety 15 Energy Fatty Acids Rheology Macronutrient Profile Fiber Cognition 5

6 16 The Satiety value of nuts appears to stem from the synergy of their components 17 Snacking A Critical Issue for Nutrition & Health 18 Concerns: Positive energy balance Diet quality Opportunities: Enhanced nutrient density of diet Improved metabolic profile 6

7 2.5 Mean # Daily Snacks ~ NHANES I NHANES II NHANES III % Energy from snacks (Men) NHANES % Energy from snacks (Women) NHANES NHANES Men Women (Kant and Graubard, J Acad Nutr Diet, 2015) % Energy from Snacks increased whereas that from Main Meals decreased. % Energy from main meals (Men) % Energy from main meals (Women) 15 NHANES I NHANES II NHANES III NHANES NHANES NHANES NHANES I NHANES II NHANES III NHANES NHANES NHANES Snacking Increased Among U.S. Adults between 1977 and N=44,754 adults 19 y from four national surveys combined. (Piernas and Popkin, J Nutr, 2010) 21 (Duffey and Popkin, PLoS Med, 2011) 7

8 Percentages of Selected Nutrients Contributed by Food and Beverages Consumed at Snack Occasions, NHANES Men Women (What We Eat in America, NHANES, ) Desirable Properties of Snacks 23 Palatable/Affordable Satisfying Energy neutrality Nutrient contribution/health promoting overweight/obese males 12 week intervention (Zaveri and Drummond, J Humn Nutr Dietet, 2009) 8

9 Healthy Snacks Can the right snack have an impact on satiety and reduce energy intake? 25 A (28g almonds) B (42g almonds) Breakfast Test product Ad libitum lunch Ad libitum dinner Screening Training Session Day (2 week wash out period between sessions) Health Questionnaires Eating behaviour questionnaires BMI Subjective ratings of appetite (VAS) Variable Mean (± SEM) n=32 Age 48.4 ± 1.0 years Gender Female BMI 22.7 ± 0.26 kg/m 2 SCOFF 0.0 ± 0.03 Eating Behaviour score 7.9 ± 0.59 Leatherhead Food Research 26 (Hull et al, Eur J Nutr, 2014) Dietary Energy Compensation: Meal VS. Snack 27 (Devitt et al, J Nutr Metab, 2011) 9

10 Study Design 28 Four-week randomized, controlled, parallel-arm Healthy adults with increased risk for T2DM y-o, non-diabetic Overweight (BMI>25) and/or family history Five study groups: Control (CL), Meal (BF & LN), Snack (MS & AS) Study Visits 29 Acute-feeding sessions (Clinical): Started between 7am and 8am (overnight fasting) Lasted for 515 minutes Standard breakfast (0 min) and lunch (240 min) Almond Consumption and Energy Intake 30 (Tan and Mattes, Eur J Clin Nutr, 2013) 10

11 Almond Consumption and Body Weight 31 (Tan and Mattes, Eur J Clin Nutr, 2013) Theoretical Energy Balance Energy Expenditure 11

12 kj/d 2/2/2016 Resting Energy Expenditure Before Peanut Consumption a After Peanut Consumption b (Alper and Mattes, Int J Obes, 2002) Resting Energy Expenditure 35 Figure: Median REE for lean and overweight participants at baseline and after 8 weeks of peanut oil ingestion. L = lean, O = overweight, M = male, F = female, T = total subjects (male and female). Medians with different letters are significantly different in the same group (p<0.01) Theoretical Energy Balance 36 12

13 % Fecal fat excretion Change in kcal excreted (control - trt) 2/2/ Absorption Efficiency Inefficient Absorption Levine and Silvas, 1980 * Haddad and Sabate, 2000 * Zemaitis and Sabate, 2001 Control Nut Treatment * Ellis et. al., 2004 Peanuts= 95% dietary fat for 6 d Pecans=31% dietary fat for 4wk Almonds= 40% dietary fat for 4wk Almonds approx 30-45% dietary fat for 3 d Inefficient Absorption kcal / d supplement for 4wks Full dose Almonds Half almond/ Half Muffin Full dose muffin (Kendall et al, FASEB J, 2003) 13

14 % Fecal fat 2/2/2016 Inefficient Absorption day controlled diet with 70 g of peanuts/ peanut butter/ peanut flour/ peanut oil Control Treatment Peanuts Peanut Butter Peanut Oil Peanut Flour (Traoret et al, Int J Obes (Lond), 2008) 41 (Ellis et al, Am J Clin Nutr, 2004) Almond Particle Size after Mastication By Number of Chews 42 (Cassady et al, Am J Clin Nutr, 2009) 14

15 Fecal Fat and Energy Lost By Number of Chews 43 (Cassady et al, Am J Clin Nutr, 2009) Food Forms & Metabolizable Energy Value Almonds ~ 80% Walnuts ~ 80% Pistachios ~ 95% 44 (Baer et al, Br J Nutr, 2012; Novotny et al, Am J Clin Nutr, 2012) Theoretical Energy Balance 45 15

16 Palatability (0=did not like at all, 10=liked extremely) Hedonic Rating (mm) 2/2/2016 Nuts and Energy Balance 46 Component of Energy Balance Predicted body weight gain (kg) 3.1 Actual body weight gained (kg) 0 % Almond Energy Dissipated Dietary compensation (KJ) Fecal excretion (KJ) 84 7 Energy Expenditure (KJ) REE TEF Physical Activity Total Energy (DLW) Total Energy Explained 95 (Hollis and Mattes, Br J Nutr, 2007) Nuts and Monotony: Change of Palatability N=51 Single Variety All Week 2 Week 4 Week 6 Week 8 Week 10 Week 12 Time Flavors Honey Roasted Salted Spicy Raw Hedonic Ratings of Almonds Over 12 Weeks of Daily Consumption 48 Extremely Pleasant Week 1 Week 12 16

17 Almonds Baseline Almonds Post-Diet Control Baseline Control Post-Diet 49 No Oral Stimulation 50 * Summary 51 Epidemiological, clinical and mechanistic data indicate nuts pose limited threat to positive energy balance due to: Strong satiety properties, precise dietary compensation especially as a snack Limited energy bioaccessibility Elevated resting energy expenditure Nuts may be a healthful snack as they add nutrients with limited impact on energy balance 17

18 52 Cheryl Forberg RD Chef and Nutritionist for NBC s The Biggest Loser, James Beard awardwinning chef, New York Times bestselling author, Huffington Post Blogger Disclosure: Cheryl serves as a consultant to American Pistachio Growers 52 The Biggest Loser Show 53 Common Denominators of Cast x 12 years 54 calories? breakfast fruit or vegetables lean protein whole grains too much white stuff; flour; pasta, sugar, rice, simple carbs no time to plan ahead so they find themselves grabbing something quick for a meal, which is often consumed in the car or at their desk caloric beverages water exercise they prioritize their spouse, partner, children and/or their jobs over their own health and well-being Snackwells Paradox 18

19 Medical Expert Team 55 Nutrition Consult 56 Training in Cooking and Nutrition 57 19

20 Provide Healthy Food The Dietary Advice Macronutrient Ratio 60 20

21 The Biggest Loser Pyramid 61 Healthy Protein 62 5 Servings Daily 3 meals and 2 snack size servings Whole Grains 63 2 cups maximum 21

22 White Stuff 64 Vegetables and Fruits 65 4 cups MINIMUM Good Fats 66 22

23 Calorie Budget 1200 calories per day / 4 = 300 cals Breakfast 300 Lunch 300 Dinner /2 = two 150 calorie snacks (or three 100 calorie snacks) % CHO 30% PRO 25% Fat 68 Daily Calorie Budget 1200 Kcal per meal 300 Kcal per snack 150 Pro kcals q day 360 Pro grams per meal 23 Pro grams per snack 11 Fat grams per day 33 Every Meal and Every Snack 69 Contains balance of CHO, PRO and FAT to Promote healthy blood sugar level Increase satiety Fuel to build lean body mass 23

24 Sample 1200 cal Menu 70 Breakfast 2 servings Mediterranean Scrambled Eggs (page 131) 1/2 medium banana 8 ounces green tea, ice water or fat-free milk Mid-Morning Snack Lunch Mid-Afternoon Snack 1/2 thin sandwich bun or 1 small whole-wheat pita stuffed with 1/4 cup hummus, 2 slices tomato and 4 slices cucumber 1 serving Spinach Salad with Smoked Turkey Pistachios and Currants (page 135) 1 small peach 1/2 cup fat-free 72.5 g cottage cheese with 1/2 medium apple, chopped, 2 tablespoons chopped walnuts, and 2 tablespoons chopped celery Dinner 1 serving Best Bison Burger (page 115) 1 serving Chili Ranch Dressing (page 120) 1 cup steamed Swiss chard 8 ounces green tea or water with lemon Calorie Counter and Diary 71 Calorie Counter & Diary The Weight Loss 72 24

25 Q&A Richard D. Mattes, MPH, PhD, RD Cheryl Forberg, RD Credit Claiming 75 You must complete a brief evaluation of the program in order to download your certificate. The evaluation survey will be available on for 1 year following the live presentation. RDs should list CPE activity type 175 in their professional development portfolio. 25