Nuts and Whole Grains for Cardiometabolic Health. Penny Kris-Etherton, PhD, RD Distinguished Professor of Nutrition The Pennsylvania State University

Transcription

1 Nuts and Whole Grains for Cardiometabolic Health Penny Kris-Etherton, PhD, RD Distinguished Professor of Nutrition The Pennsylvania State University

2 Outline

3 Tree Nuts and Peanuts Almonds Brazil Nuts Cashews Hazelnuts Macadamia Nuts Pecans Pine Nuts Pistachios Walnuts Peanuts

4 Whole Grain Foods Whole wheat and whole wheat flour Whole oats and whole oat flour Whole cornmeal and whole corn flour Brown rice and brown rice flour Whole rye and whole rye flour Whole barley Bulgur Buckwheat Popcorn Amaranth Psyllium

5 Prospective Cohort Studies of Relative Risk of CVD and Consumption of Nuts, Fruits and Vegetables, or Whole Grains Comparison between highest and lowest consumption groups Hu et al. JAMA 2002;288:

6 Relationships between Changes in Food and Beverage Consumption and Weight Changes Every 4 Years, According to Study Cohort Mozaffarian. N Engl J Med 2011; 364:

7 Frequency of Nut Consumption and CHD Risk Reduction in a Dose-Response Manner Taken from DGAC 2010 Report.

8 Nut Consumption and CHD Risk - Epidemiologic Studies Fatal CHD 0.43 Total CHD Non-fatal MI Fatal CHD Total CHD Total CHD All-cause mortality All-cause mortality Non-fatal MI Fatal CHD CHD Total CHD Relative Risk (RR) Iowa Women s Health Nurses Health Adventist Health CARE

9 Effect of Nut-Enriched Diets on Serum Lipids and Lipoproteins by Level of Nut Intake: A Pooled Analysis of 25 Feeding Trials (1284 Data Points) 0 TC LDL-C LDL/HDL TG* -1 P ercent Change Calories in the diet from nuts 10% 12.2%** 20% *TG>150 mg/dl ** 43 g Sabaté J, Oda K, Ros E. Arch Intern Med. 2010;170:

10 Observed Changes in LDL-C is Greater than Predicted in Select Tree Nut Studies 0 Sabate #10 Ros #12 Change in LDL-C from Control Diet (mmol/l) Zambon #13 Iwamoto #14 Chisholm #15 Zhao #16 Abbey #17 Abbey #17 Wien #18 Jenkins #19 Sabate #20 Lovejoy #21 Colquhoun #22 Curb #23 Morgan #24 Rajaram # Alphan #26 Predicted Observed Griel & Kris-Etherton. BrJ Nutr. 2006;96(Suppl. 2):S68-S78.

11 Acute Effects of Walnut Consumption on Reverse Cholesterol Transport Penny M. Kris-Etherton 1,2, J.A. Grieger 1, J. Zhang 1,2, C.E. Berryman 1, J.P. Vanden Heuvel 1,2,3, S.G. West 1,4 Department of Nutritional Sciences 1, Center of Excellence in Nutrigenomics 2, Departments of Veterinary and Biomedical Sciences 3, Biobehavioral Health 4 The Pennsylvania State University, University Park, PA, USA

12 Serum from Subjects Consuming Whole Walnuts Increases Cholesterol Efflux 0h 4h 0h 4h *Serum from subjects after whole walnut consumption; serum was added as an efflux inducer to culture media after ABCA1 upregulation by camp. Assays conducted by Dr. George Rothblat.

13 Nurses Health Study BMI of Women According to Frequency of Nut Consumption (1 oz. serving) at Baseline Almost Never (n=29,899) 1-3/mos- 1/wk (n=43,948) 2-4 times/wk (n=7746) > 5 times/wk (n=4423) BMI Hu et al., BMJ 317: 1341, 1998.

14 BMI and Energy Intake (kcal) of Nut Eaters and Non-nut Eaters Nut eaters (n=1993) Non-nut eaters (n=10,095) BMI (kg/m 2 ) Energy (kcal/d) Sabaté. AJCN. 2003;78(Suppl):647S-650S.

15 Mean BMI of Peanut Users and Nonusers * Users Nonusers Men Women *P<0.05 Griel et al., J Am Col Nutr. 23: , 2004.

16 Out-of-Hand Nut Consumption is Associated with Improved Nutrient Intake & Health Risk Markers (Adults) Diet Quality: Higher calories, MUFA, PUFA, fiber, copper, magnesium and lower CHO, cholesterol and sodium Health Markers: Higher HDL-C, RBC & serum folate and lower insulin, glycohemoglobin and CRP Health Status: 19% decreased risk hypertension, 21% decreased risk low HDL-C O Neil et al. Nutr Research. 2012;32:

17 Whole Grains

18 Multivariable-adjusted Relative Risk (RR) of Type 2 Diabetes and CVD comparing the highest and lowest categories of whole-grain intake in prospective cohort studies Type 2 Diabetes CVD Ye E Q et al. J. Nutr. 2012;142:

19 Weighted mean difference in post-treatment metabolic biomarker concentrations comparing whole-grain intervention groups to controls Metabolic biomarkers Studies, n Weighted mean difference (95% CI) Fasting insulin, pmol/l ( 0.59, 0.01) Fasting glucose, mmol/l ( 1.65, 0.21) Total cholesterol, mmol/l ( 1.24, 0.42) LDL-cholesterol, mmol/l ( 1.34, 0.11) Systolic blood pressure, mm Hg ( 0.21, 0.10) Diastolic blood pressure, mm Hg ( 0.21, 0.11) Weight gain, kg ( 0.54, 0.18) Ye E Q et al. J. Nutr. 2012;142:

20 Summary of Large-Scale Observational Studies Showing a Benefit of Increased Whole Grain Consumption on CVD Risk* Study Data Source Reported Association/Outcome Reference Health Professionals Follow-Up (42,850 adult men), 14 years of followup Nurse s Health Study (75,521 adult women), up to 12 years follow-up Iowa Women s Health Study (38,470 postmenopausal women), 9 years of follow-up 18% reduction in coronary heart disease (Jensen et al 2004) 36% reduction in ischemic stroke (Liu et al 2000) 18% reduction in all cardiovascular disease deaths 18% reduction in coronary heart disease (Jacobs et al 1999) Iowa Women s Health Study (34,491 postmenopausal women), 9 years of follow-up U.S., Boston adult 535 men and women Atherosclerosis Risk in Communities (ARIC) Study (15,972 adult men and women), 11 year follow-up 30% reduction in ischemic heart disease death (Jacobs et al 1998) 52% reduction in CVD mortality (Sahyoun et al 2006) 23% reduction in all-cause mortality 28% reduction in incident coronary artery *Only significant differences are reported unless otherwise stated (P < 0.05). (Steffen et al 2003) Seal & Brownlee. Cereal Chem. 2010;87:

21 Inverse Association Between Whole Grain Intake and Type 2 Diabetes Summary: 2 sv/day WG decreased risk 21% de Munter et al. PLOS Medicine. 2007;4;e261:

22 Prevalence of Prediabetes 12 BL ISO HYPO Number of participants with Prediabetes(n) % decrease 90% decrease 0 Refined Grain Whole Grain Data presented by KA Harris at Experimental Biology, 2012

23 Individuals with Prediabetes had Greater Reductions in Fasting Glucose on the Whole Grain Compared to the Refined Grain Diet RG, Normal RG, PreDiabetic WG, Normal WG, Prediabetic Glucose (mg/dl) n=8 Prediabetes cut point n= n=17 n=15 88 BL ISO HYPO P-value for time x treatment x prediabetic status interaction from repeated measures ANCOVA (mixed model) including age, sex and BMI at baseline as covariates. Data presented by KA Harris at Experimental Biology, 2012

24 Whole Grain Intake and Incident of Hypertension In Men: Health Professionals Follow-Up Study, Quintile of whole grain intake P for trend Median intake (g/d) No. of cases Person-years 61,137 68,966 72,196 73,184 69,877 Age- and energyadjusted RR Multivariateadjusted RR < < Flint. et al. Am J Clin Nutr. 2009;90:

25 Relative risks (RRs) and 95% CIs of Incident Hypertension in 31,684 Men by Quintile of Whole-grain Intake: Health Professionals Follow-Up Study, Quintile of whole-grain intake P for trend Median intake (g/d) (0 6.5) 9.8 ( ) 17.1 ( ) 26.9 ( ) 46.0 ( ) No. of cases Person-years 61,137 68,966 72,196 73,184 69,877 Age- and energyadjusted RR (0.84, 0.96) 0.83 (0.78, 0.89) 0.81 (0.76, 0.87) 0.72 (0.67, 0.77) < Multivariateadjusted RR 3, (0.88, 1.01) 0.89 (0.83, 0.95) 0.89 (0.84, 0.96) 0.81 (0.75, 0.87) < RRs derived from proportional hazards models. 2 Ranges in parentheses. 3 95% CIs in parentheses. 4 Adjusted for age, energy, family history of coronary heart disease, family history of hypertension, smoking, alcohol, marital status, profession, height, fruit and vegetable intakes, sodium intake, physical activity, multivitamin use, and cholesterol screening. Flint et al. Am J Clin Nutr. 2009;90:

26 Whole Grains & Stroke: Epidemiologic Evidence Harvard Nurses Health Study (75,000 women) 3 servings of whole grain food/day 36% risk of ischemic stroke (24% after controlling for fiber) Liu et al. JAMA. 2000;284:

27 Whole Grains & Obesity: Epidemiologic Evidence NHANES Whole Grain (WG) Intake Inversely Associated with BMI and Waist Circumference in Adult Women WG = 0 O < WG <1 WG >1 BMI 29.0 ± ± ± 0.5 a Waist Circumference 93.9 ± ± ± 1.3 a a Means with superscripts are significantly different from 0 WG servings, p<0.05 Good et al. JACN 2008;27:80-87.

28 Whole Grains and Waist Circumference: Epidemiologic Studies Higher Whole Grain (WG) Intake (3 servings/day) is associated with Lower Central Adiposity Mean difference (and 95% confidence interval, CI) in waist:hip ratio (WHR) or waist circumference (WC) when low or no whole-grain intake is compared with high intake Harland & Garton. Public Health Nutrition. 2008;11:

29 Means and percentages of body mass index and insulin, by category of whole grain intake, MESA Median whole grain intake Whole Grain Intake Category P trend N BMI < Insulin <0.002 Lutsey et al. Br J Nutr. 2007;98:

30 Whole-grain intake is inversely associated with the metabolic syndrome in older adults The study population was composed of 179 (33%) men and 356 (67%) women with an average age of 72.1 y for men and 73.4 y for women Whole grain Variables Grain intake Q1 Q2 Q3 Q4 n P for trend 1 Median whole grain intake (servings/d) 2 BMI (kg/m 2 ) Glucose (mg/dl) Metabolic syndrome (Odds ratios) Sahyoun et al. Am J Clin Nutr. 2006;83:

31 Markers of Cardiovascular Risk in the WHOLEheart Study (RCT) N = 316 there were no significant differences in any markers of CVD risk between groups. Control vs WG (60g/day) Difference (%) from control group mean Significance Lipid Profile Insulin Sensitivity Inflammatory Status Anthropometric Measures Total Cholesterol NS HDL NS LDL (calculated) NS TAG 2.24 NS Glucose NS Insulin 1.84 NS CRP NS IL-6 ND NS Systolic BP NS Diastolic BP NS Weight NS Waist 0.1 NS Body Fat Percentage 0 NS Brownlee et al. Br J Nutr. 2010;104:

32 Cholesterol lowering effects of oat ß-glucan Othman RA et al. Cholesterol-lowering effects of oat ß-glucan. Nutr Rev Jun; 69(6):

33 Whole Grain & Total Mortality: Epidemiologic Studies Harvard Male Health Professionals (86,000) 1 or more serving/day of whole grain cereal (compared to none) Mortality RR 0.80 Iowa Women s Health Study (34,333) 3 or more servings/day of whole grain foods Hazard RR 0.86 Liu et al. AJCN. 2003;77: ; Jacobs et al. Am J Pub Health. 1999;89:

34 Phytonutrients Small but powerful disease fighters found naturally in plant and plant-based foods. Whole grains contain significant amounts of the phytonutrients lignan, phytic acid, and phytosterols. Aim to get a variety of whole grains in your diet that way you re more likely to get all of the phytonutrients your body needs!

35 Summary

36 Consume Fiber- Rich Whole Grains!

37 Enjoy Nuts for Health!