Almond Nutrition Research

24 Pages·2013·1.15 MB·English

Almond Nutrition Research:
State of the Science
October 2013
table of contentS
ReseARch summARies
heart health .............................................3
Diabetes ....................................................5
Weight management ............................7
RefeReNce TAbles
• Heart Health .........................................9
• Diabetes ................................................15
• Weight Management .......................20
Almond Nutrition Research: State of the Science heart health
effectS of almondS on outcomeS generalizability of the findings to free-living conditions (Sabaté et
Related to caRdiovaSculaR RiSk al., 2003; Jia et al., 2006). Although subjects prepared their own
meals in the study by Kurlandsky et al. (2006), the study was
conducted in women only.
Heart disease is the leading cause of death in the United
States and Canada, with approximately 1 out of every 4 deaths Subjects with elevated blood lipid levels
attributed to cardiovascular diseases. The cost of health care
A total of four randomized controlled studies showing the effects
services, medications, and lost productivity due to heart disease
of almonds on blood lipid measures have been conducted in
totals $108.9 billion annually in the U.S. and 20.9 billion in subjects with elevated blood lipid levels; all were 4 weeks in
Canada. Diet is integral to managing cardiovascular risk, and duration, a sufficient time period to determine effects.(Spiller et
nearly two decades of research support the role of almonds in al., 1998; Easwaran et al., 2002; Jenkins et al., 2002; Tamizifar
helping to maintain a healthy heart and healthy cholesterol levels. et al., 2005). In three of these four studies, the daily consumption
The nutrient profile of almonds (high in monounsaturated fat,1 low of 0.9 to 3.5 oz (25 to 100 g) of almonds resulted in favorable
in saturated fat, cholesterol free and a source of nutrients like fiber changes in blood lipids, namely, significant reductions in total
(4 g/oz), Vitamin E (7.4 g/oz) and magnesium (76 mg)/oz)) makes and LDL cholesterol levels (Spiller et al., 1998; Jenkins et al.,
them an ideal fit in a heart-healthy lifestyle. In fact, in 2003, the 2002; Tamizifar et al., 2005). The Jenkins et al (2002) study
U.S. Food and Drug Administration released a qualified health demonstrated that patients consuming an average of 2.8 oz (78
claim recognizing that Almonds, as part of a diet low in saturated g/day) of almonds reduced LDL by 9.4% and those consuming
fat and cholesterol, may reduce the risk of heart disease.1 1.3 oz (37 g/day) reduced LDL cholesterol by 4.4%. Significant
increases in HDL levels and decreases in Apo B levels,
Many randomized controlled studies have been conducted to
lipoprotein A levels, and several lipid ratios were also observed.
examine the effects of almonds, consumed as part of a sensible
These findings are remarkable, especially considering that the
eating plan, on blood lipid levels [e.g., total cholesterol (TC),
subjects in two of these three studies were consuming healthy
low-density lipoprotein cholesterol (LDL), high-density lipoprotein
diets, such as the NCEP Step I or II diets (Jenkins et al., 2002;
cholesterol (HDL), triglycerides (TG), apolipoprotein B (ApoB),
Tamizifar et al., 2005).
apolipoprotein A (ApoA), etc.]. These studies were conducted in
different population groups, including people with normal blood In the fourth study, no detrimental effects on blood lipids were
lipid levels, people with elevated blood lipid levels, and people observed in men who consumed a small amount of almonds
with other diet-related diseases (e.g., obesity, pre-diabetes, type 2 (0.16 oz or 4.5 g) relative to men who did not consume almonds
diabetes). An overall summary of these studies is presented below, (Easwaran et al., 2002). Although almonds were not reported to
and additional details about the design and results can be found in have favorable effects on blood lipid levels in this study, there
the Heart Health reference table on page 9 of this brochure. were several noteworthy limitations, namely a very small sample
size of only men (only 6 males per group) and lack of reporting
Subjects with normal blood lipid levels
on the dietary intakes In the majority of studies, the subjects were
A total of three randomized controlled studies investigating the not taking lipid-lowering medications. However, in the study by
effects of almonds on blood lipid measures have been conducted Jenkins et al. (2002), 2 of the 27 subjects consumed statins, and
in subjects with normal blood lipid levels; two were 4-week 6 other subjects consumed a variety of medications indicated for
studies (Sabaté et al., 2003; Jia et al., 2006), and one was a hypertension and/or hormone replacement therapy.
6-week study (Kurlandsky et al., 2006). These three studies Subjects With other diet-Related diseases
cumulatively suggest that almonds have no detrimental effects
on blood lipids. In fact, in one study, the daily consumption of 2.4 A total of six randomized controlled studies investigating the
oz (68 g) of almonds for a period of 4 weeks actually improved effects of almonds on blood lipid measures have been conducted
the blood lipid profiles of healthy men and women by significantly in subjects who had other diet-related diseases. In four studies,
reducing TC levels, LDL levels, the ratio of LDL to HDL, ApoB the subjects had pre-diabetes or type 2 diabetes, and the study
levels, and the ratio of ApoB to ApoA relative to no almond durations ranged from 4 to 16 weeks (Lovejoy et al., 2002; Wien
consumption (Sabaté et al., 2003). et al., 2010; Cohen and Johnston, 2011; Li et al., 2011). The
remaining two studies were conducted in overweight and obese
These findings are remarkable given that all subjects were
adults, and the study durations were 6 and 18 months (Wien et
consuming the National Cholesterol Education Program (NCEP)
al., 2003; Foster et al., 2012).
Step I diet (Sabaté et al., 2003). All three studies were of a
sufficient duration to discern the effects of almonds on blood The blood lipid profiles were maintained or improved in all four
lipids, but there were some limitations. In two of the studies, the studies conducted in pre-diabetic or diabetic subjects. The
subjects were provided all of their meals, thereby limiting the participants in these studies consumed 1 oz (28 g) of almonds
1 u.s. Dietary Guidelines recommend that the majority of your fat in-
take be unsaturated. One serving of almonds (28g) has 13g of unsat-
urated fat and only 1g of saturated fat. scientific evidence suggests,
but does not prove, that eating 1.5 oz of most nuts, such as almonds,
as part of a diet low in saturated fat and cholesterol may reduce the
risk of heart disease.
3
Almond Nutrition Research: State of the Science heart health
daily, 5 days per week for 12 weeks (Cohen and Johnston, 2011)
or 2 to 4 oz (56 to 113 g) of almonds daily for 4 or 16 weeks
(Lovejoy et al., 2002; Wien et al., 2010; Li et al., 2011). These RefeRences
findings are remarkable, given that in two of the studies, subjects Cohen, A.E.; Johnston, C.S. (2011). Almond ingestion at mealtime
consumed the almonds as part of a healthy diet, such as the reduces postprandial glycemia and chronic ingestion reduces
hemoglobin A(1c) in individuals with well-controlled type 2
American Diabetes Association diet (Wien et al., 2010) or the
diabetes mellitus. Metabolism 60 (9):1312-1317.
NCEP Step II diet (Li et al., 2011). Other strengths of the studies
Easwaran, P.P.; Vidhya Krishnamurthy; Mangai, S.A.; &
include the adequate control of the total energy intake between
Vasanthamani, G. (2002). Impact of antioxidant vitamins E and C
the control and almond diets and sufficient study duration to on the lipid profile of hyperlipidemics Indian Journal of Nutrition
discern effects on blood lipids. Limitations include a small and Dietetics (Indian Journal of Nutrition and Dietetics) 39(1):
1-10.
sample size and limited generalizability to free-living conditions
in the studies in which meals were provided to the participants. Foster, G.D.; Shantz, K.L.; Vander Veur, S.S.; Oliver, T.L.; Lent, M.R.;
Although the majority of the subjects in these studies were not Virus, A.; Szapary, P.O.; Rader, D.J.; Zemel, B.S.; & Gilden-Tsai,
A. (2012). A randomized trial of the effects of an almond-enriched,
taking lipid-lowering medications, many subjects were consuming hypocaloric diet in the treatment of obesity (American journal of
oral hypoglycemic agents, for which the effects on blood lipids clinical nutrition) 96(2): 249-254.
are unclear.
Jenkins, D.J.A.; Kendall, C.W.C.; Marchie, A.; Parker, T.L.; Connelly,
P.W.; Qian, W.; Haight, J.S.; Faulkner, D.; Vidgen, E.; Lapsley,
In the two remaining studies conducted in overweight and
K.G.; & Spiller, G.A. (2002). Dose response of almonds on
obese adults, the blood lipid profiles of the subjects essentially coronary heart disease risk factors: blood lipids, oxidized low-
remained unchanged following the daily consumption of 2 or 3 density lipoproteins, lipoprotein(a), homocysteine, and pulmonary
nitric oxide: a randomized, controlled, crossover trial (Circulation)
oz (56 or 84 g) of almonds as part of a low-calorie diet for 6 or
106(11): 1327-1332.
18 months (Wien et al., 2003; Foster et al., 2012). In the study
Jia, X.; Li, N.; Zhang, W.; Zhang, X.; Lapsley, K.; Huang, G.;
by Wien et al. (2003), a significant difference in HDL levels was
Blumberg, J.; Ma, G.; Chen, J. (2006) A pilot study on the effects
observed between the control and almond groups, wherein the of almond consumption on DNA damage and oxidative stress in
HDL levels decreased by 6% in the almond group, but increased smokers. (Nutr Cancer) 54(2):179-83.
by 15% in the control group. Generally, strengths of the studies
Kurlandsky, S.B.; & Stote, K.S. (2006). Cardioprotective effects of
include a robust sample size, a sufficient study duration to chocolate and almond consumption in healthy women (Journal
discern the long-term effects on blood lipids, and the absence of Nutrition Research) 26(10): 509-516.
confounding due to the use of lipid-lowering medications, though Li, S.C.; Liu, Y.H.; Liu, J.F.; Chang, W.H.; Chen, C.M.; Chen, C.Y.
some of the subjects consumed hypoglycemic and/or anti- (2011). Almond consumption improved glycemic control and lipid
profiles in patients with type 2 diabetes mellitus. Metabolism.
hypertensive medications. The primary outcomes of both studies
2011 Apr;60(4):474-9.
were related to anthropometry and body composition, assessed
Lovejoy, J.C.; Most, M.M.; Lefevre, M.; Greenway, F.L.; & Rood, J.C.
as part of a weight reduction or management program, and not
(2002). Effect of diets enriched in almonds on insulin action and
lipid profiles. Neither study reported on dietary intakes. serum lipids in adults with normal glucose tolerance or type 2
diabetes. Am. J. Clin. Nutr. 76 (5):1000-1006.
Sabaté, J.; Haddad, E.; Tanzman, J.S.; Jambazian, P.; & Rajaram,
S. (2003). Serum lipid response to the graduated enrichment of
concluSionS a Step I diet with almonds: a randomized feeding trial American
journal of clinical nutrition (American journal of clinical nutrition)
Based on the totality of scientific evidence from
77 (6):1379-1384.
randomized controlled studies, almonds, when
Spiller, G.A.; Jenkins, D.A.; Bosello, O.; Gates, J.E.; Cragen, L.N.; &
incorporated into a sensible eating plan do not harm
Bruce, B. (1998). Nuts and plasma lipids: an almond-based diet
and may even have beneficial effects on blood lipids, lowers LDL-C while preserving HDL-C Journal of the American
especially in adults with elevated blood lipid levels. College of Nutrition (Journal of the American College of Nutrition)
17(3): 285-290.
Dietary changes are often the first and one of the most
effective ways to reduce the risk of cardiovascular Tamizifar, B.; Rismankarzadeh, M.; Vosoughi, A.A.; Rafieeyan, M.; &
disease, and the body of research suggests that eating Aminzade, A. (2005). A low-dose almond-based diet decreases
LDL-C while preserving HDL-C Archives of Iranian Medicine
almonds may be a satisfying way to help maintain a
(Archives of Iranian Medicine) 8(1): 45-51.
healthy blood lipid profile.
Wien, M.; Bleich, D.; Raghuwanshi, M.; Gould-Forgerite, S.; Gomes,
J.; Monahan-Couc, H.L.; & Oda, K. (2010). Almond consumption
and cardiovascular risk factors in adults with prediabetes. J. Am.
Coll. Nutr. 29 (3):189-197.
Wien, M.A.; Sabate, J.M.; Ikle, D.N.; Cole, S.E.; & Kandeel, F.R.
(2003). Almonds vs complex carbohydrates in a weight reduction
program. Int. J. Obes. Relat. Metab. Disord. 27 (11):1365-1372.
4
Almond Nutrition Research: State of the Science DiabeteS
effectS of almondS on outcomeS Subjects with Pre-diabetes
Related to diabeteS RiSk Two randomized controlled studies of the effects of almonds
on blood glucose control have been conducted in subjects with
pre-diabetes; one was a post-meal study (Mori et al., 2010), and
The prevalence of type 2 diabetes is rapidly increasing in the
the other was a 16-week study (Wien et al., 2010). In the Mori
United States and Canada. During the past three and a half
study, the consumption of a 580-kcal breakfast meal containing
decades, the number of Americans with diagnosed diabetes has
1.5 oz (44.5 g) of almonds resulted in significant reductions in
more than tripled from 5.6 million to 25.8 million. Similarly, from
blood glucose levels in the morning and throughout the day
1999 to 2009, the prevalence of diagnosed diabetes among
relative to the consumption of a 347-kcal control breakfast meal,
Canadians increased by 70%. Diabetes is also a contributing
which differed in total dietary energy but provided the same
risk factor for other chronic diseases such as heart disease and
amount of available carbohydrate. In Wien study, subjects who
stroke. Dietary and lifestyle interventions are among the first lines
consumed 60 g (approximately 2 oz)/day of almonds as part
of prevention and treatment of type 2 diabetes, and the nutrient
of an American Diabetes Association (ADA) diet experienced
profile of almonds (low-glycemic index and good source of fiber)
significant improvements in fasting insulin and measures of
makes them an ideal snack and addition to meals for individuals
insulin resistance relative to subjects who consumed the ADA diet
with impaired glucose tolerance or type 2 diabetes (T2D).
without almonds. The study by Wien et al. (2010) was of sufficient
Many randomized controlled studies have been conducted to duration to examine effects on markers of long-term blood
examine the effects of almonds, consumed as part of a sensible glucose control; however, reliance on a single fasting sample for
eating plan, on outcomes related to blood glucose control. measurement of insulin resistance is an analytical limitation.
These studies were conducted in different population groups,
including people with normal blood glucose control, people with Subjects with t2d
pre-diabetes, and people with type 2 diabetes (T2D). An overall Five randomized controlled studies of the effects of almonds on
summary of these studies is presented below, and additional measures related to blood glucose control have been conducted
details about the design and results can be found in the Diabetes in subjects with T2D; one was a post-meal study (Cohen and
reference table on page 15 of this brochure. Johnston, 2011) and the other four studies were at least four weeks
in duration (Lovejoy et al., 2002; Wien et al., 2003; Cohen and
Subjects with normal blood Glucose control
Johnston, 2011; Li et al., 2011). Cohen and Johnston (2011) reported
A total of seven randomized controlled studies showing the significant reductions in peak blood glucose levels and in blood
effects of almonds on measures related to blood glucose control glucose levels over a 2-hour period following the consumption of a
have been conducted in healthy or hyperlipidemic subjects test meal containing 1 oz (28 g) of almonds compared to an almond-
with normal blood glucose control; five were post-meal studies free test meal similar in calories, fat and available carbohydrate.
(Burton-Freeman et al., 2004; Jenkins et al., 2006; Josse et al.,
In three of the four longer term studies, eating an almond-enriched
2007; Berry et al., 2008; Cohen and Johnston, 2011), and two
diet resulted in significant reductions in fasting glucose and insulin
were 4-week studies (Sabaté et al., 2003; Jenkins et al., 2008).
levels, including HbA1C, a measure of long-term glucose control,
The five post-meal studies cumulatively suggest that almonds when compared to an almond-free diet. Subjects in these studies
have neutral or beneficial effects on post-meal blood glucose and consumed 3 oz (84 g)/day of almonds for 24 weeks (Wien et al.,
insulin responses; in some studies, almonds actually reduced 2003), 2 oz (56 g)/day of almonds for 4 weeks, or 1 oz (28 g) of
post-meal blood glucose and insulin spikes as well as blood almonds for 12 weeks (Cohen and Johnston, 2011).
glucose and insulin levels over a 2-hour time period relative to an
These findings are remarkable, especially considering that
almond-free meal. In the majority of the five post-meal studies,
the subjects in the control groups of two of these studies were
the dietary energy and/or carbohydrate content between the
consuming healthy diets, such as a low-calorie diet with complex
control and almond meals were similar and the primary outcome
carbohydrates (Wien et al., 2003) or a National Cholesterol
of the study was related to glycemic control.
Education Program (NCEP) Step II diet (Li et al., 2011). In the
In the 4-week studies, the consumption of about 1.2 or 2.5 oz remaining long-term study conducted by Lovejoy et al. (2002),
(35 or 70 g)/day almonds resulted in significant reductions in four different healthy diets (i.e., low-fat almond, high-fat almond,
a marker of insulin secretion, suggesting a decrease in insulin low-fat control, high-fat control)1 had similar effects on blood
resistance (Jenkins et al., 2008), as well as significant dose- glucose and cholesterol levels. Strengths of these studies include
dependent improvements in total cholesterol and other blood the adequate control of the energy and/or carbohydrate content
lipids (Sabaté et al. 2003). In the two 4-week studies, dietary between the control and almond meals and a sufficient duration
energy intakes were similar between the control and almond to discern effects on long-term glycemic control. The studies are
diets; however, their duration was too short to discern effects on limited by their small sample size and limited generalizability to
long-term blood glucose control. In the study by Sabaté et al. free-living conditions in the studies in which meals were provided
(2003), the primary objective was to assess effects on serum to the participants throughout the study.
lipids (not blood glucose control), and the subjects were provided
all of their meals, thereby limiting the generalizability of the
findings to free-living conditions. 1 canola oil, which is rich in monounsaturated fatty acids, was used to
prepare the high-fat diets.
5
Almond Nutrition Research: State of the Science DiabeteS
concluSionS RefeRences
Based on the totality of scientific evidence from Berry, S.E.E.; Tydeman, E.A.; Lewis, H.B.; Phalora, R.; Rosborough,
randomized controlled studies, almonds, when J.; Picout, D.R.; & Ellis, P.R. (2008). Manipulation of lipid
bioaccessibility of almond seeds influences postprandial lipemia
incorporated into a sensible eating plan do not harm and
in healthy human subjects. Am. J. Clin. Nutr. 88 (4):922-929.
may even have beneficial effects on blood glucose and
Burton-Freeman, B.; Davis, P.A.; Schneeman, B.O. (2004).
insulin responses, both in the short-term after consuming
Interaction of fat availability and sex on postprandial satiety and
a meal, and over the longer term. Dietary changes are cholecystokinin after mixed-food meals. Am J Clin Nutr. 2004
often the first and one of the most effective ways to Nov;80(5):1207-14.
manage diabetes, and the body of research suggests that Cohen, A.E.; Johnston, C.S. (2011). Almond ingestion at mealtime
eating almonds may be a satisfying way to help maintain reduces postprandial glycemia and chronic ingestion reduces
healthy blood sugar levels. hemoglobin A(1c) in individuals with well-controlled type 2
diabetes mellitus. Metabolism 60 (9):1312-1317.
Jenkins, D.J.A.; Kendall, C.W.C.; Josse, A.R.; Salvatore, S.;
Brighenti, F.; Augustin, L.S.A.; Ellis, P.R.; Vidgen, E.; & Rao, A.V.
(2006). Almonds decrease postprandial glycemia, insulinemia,
and oxidative damage in healthy individuals. J. Nutr. 136
(12):2987-2992.
Jenkins, D.J.A.; Kendall, C.W.C.; Marchie, A.; Josse, A.R.; Nguyen,
T.H.; Faulkner, D.A.; Lapsley, K.G.; & Singer, W. (2008). Effect of
almonds on insulin secretion and insulin resistance in nondiabetic
hyperlipidemic subjects: a randomized controlled crossover trial.
Metabolism 57 (7):882-887.
Josse, A.R.; Kendall, C.W.C.; Augustin, L.S.A.; Ellis, P.R.; & Jenkins,
D.J.A. (2007). Almonds and postprandial glycemia--a dose-
response study. Metabolism 56 (3):400-404.
Li, S.C.; Liu, Y.H.; Liu, J.F.; Chang, W.H.; Chen, C.M.; Chen, C.Y.
(2011). Almond consumption improved glycemic control and lipid
profiles in patients with type 2 diabetes mellitus. Metabolism.
2011 Apr;60(4):474-9.
Lovejoy, J.C.; Most, M.M.; Lefevre, M.; Greenway, F.L.; & Rood, J.C.
(2002). Effect of diets enriched in almonds on insulin action and
serum lipids in adults with normal glucose tolerance or type 2
diabetes. Am. J. Clin. Nutr. 76 (5):1000-1006.
Mori, A.M.; Considine, R.V.; & Mattes, R.D. (2011). Acute and
second-meal effects of almond form in impaired glucose tolerant
adults: a randomized crossover trial. Nutr. Metab. (Lond.) 8:6.
Sabate, J.; Haddad, E.; Tanzman, J.S.; Jambazian, P.; & Rajaram,
S. (2003). Serum lipid response to the graduated enrichment of
a Step I diet with almonds: a randomized feeding trial American
journal of clinical nutrition (American journal of clinical nutrition)
77 (6):1379-1384.
Wien, M.; Bleich, D.; Raghuwanshi, M.; Gould-Forgerite, S.; Gomes,
J.; Monahan-Couc, H.L.; & Oda, K. (2010). Almond consumption
and cardiovascular risk factors in adults with prediabetes. J. Am.
Coll. Nutr. 29 (3):189-197.
Wien, M.A.; Sabate, J.M.; Ikle, D.N.; Cole, S.E.; & Kandeel, F.R.
(2003). Almonds vs complex carbohydrates in a weight reduction
program. Int. J. Obes. Relat. Metab. Disord. 27 (11):1365-1372.
6
Almond Nutrition Research: State of the Science Weight ManageMent
effectS of almondS on outcomeS to those who did not consume almonds. Despite consuming
Related to WeiGht manaGement, approximately 250 calories from almonds every day for 4 weeks,
participants did not increase their daily total calorie intake or
body comPoSition and aPPetite
experience any change in weight over the course of the study.
Although the study was of short duration, these findings suggest
The prevalence of overweight and obesity in the U.S. and almonds may be a satisfying snack option to help maintain a
Canada continues to be a major public health issue. In the U.S., healthy weight.
more than 78 million (35.7%) adults and 12.5 million (17%)
children and adolescents are obese. It is estimated that obesity overweight or obese Subjects
is associated with an annual medical cost of $147 billion. Weight A total of seven randomized controlled studies investigating the
management is of critical importance from a preventative health effects of almonds on measures related to body composition
standpoint, as being overweight or obese is a risk factor for have been conducted in overweight or obese adults (i.e., BMI
heart disease, stroke, type 2 diabetes, and some cancers. The ≥25 kg/m2) with or without other diet-related diseases, such as
nutrients in almonds, including monounsaturated fat (13 grams/ pre-diabetes or type 2 diabetes; two were post-meal studies
ounce),1 protein (6 grams/ounce) and fiber (4 grams/ounce), are (Burton-Freeman et al., 2004; Mori et al., 2011), and the study
associated with improved satiety, suggesting they would be an durations of the other five studies ranged from 10 weeks to 18
ideal snack for those concerns about weight management. months (Wien et al., 2003, 2010; Hollis and Mattes, 2007; Cohen
and Johnston, 2011; Foster et al., 2012). In one post-meal study,
Many randomized controlled studies have been conducted to
overweight women who consumed a meal containing 1 oz (28 g)
examine the effects of almonds, consumed as part of a sensible
of almonds reported feeling more hungry, less full, more desire
eating plan, on outcomes related to satiety (e.g., hunger, fullness,
to eat, with a greater food consumption later in the day relative
desire to eat, prospective food consumption, etc.) and/or body
to when they consumed a control meal containing a mixture
composition [e.g., body weight, body mass index (BMI), body
of safflower and corn oils; in contrast, differences in satiety
fat, waist circumference, etc.]. These studies were conducted
ratings were not observed in overweight men (Burton-Freeman
in different population groups, including people with normal
et al., 2004). In the other post-meal study conducted in obese
body weight, as well as overweight or obese people. An overall
adults, the consumption of a meal containing 1.5 oz (42.5 g) of
summary of these studies is presented below, and additional
almonds resulted in significant increases in fullness ratings in the
details about the design and results can be found in the Weight
afternoon and throughout the day relative to the consumption of
Management reference table on page 15 of this brochure.
a control meal without almonds, which was lower in total dietary
normal Weight Subjects energy but provided the same amount of available carbohydrate
(Mori et al., 2011).
Two randomized controlled studies investigating the effects of
almonds on measures related to satiety have been conducted
The five remaining long-term studies cumulatively suggest that
in healthy adults with a normal body weight (i.e., BMI between
almonds have no detrimental effects on body composition in
18 and 25 kg/m2); both were post-meal studies (Kirkmeyer and
overweight or obese subjects (Wien et al., 2003, 2010; Hollis and
Mattes, 2000; Lokko et al., 2004). In these two studies, the daily
Mattes, 2007; Cohen and Johnston, 2011; Foster et al., 2012).
consumption of 2.8 oz (80.4 g) of almonds reduced subjective
In fact, improvements in body composition were observed in two
ratings of hunger in one study (Kirkmeyer and Mattes, 2000) and
studies (Wien et al., 2003; Cohen and Johnston, 2011). In obese
increased salivary flow rate in the other study (Lokko et al., 2004).
adults with type 2 diabetes, the consumption of 1 oz (28 g) of
Although the primary outcomes of the two studies were related
almonds, 5 days per week, for 12 weeks resulted in a significant
to post-prandial satiety, both studies had limitations, namely that
decrease in BMI relative to no almond consumption (Cohen
calorie intake was significantly different during the almond and
and Johnston, 2011). Furthermore, overweight and obese
control periods because the subjects were not given any food
subjects who consumed 3 oz (84 g) of almonds daily for 24
during the control period, and between-group comparisons for the
weeks had significantly greater reductions in body weight, BMI,
other endpoints related to appetite and hunger (e.g., fullness, desire
waist circumference, fat mass, and total body water compared
to eat, prospective food consumption, etc.) were not reported.
to subjects who did not consume almonds (Wien et al., 2003).
The most recent investigations on the effects of almond These findings are remarkable, given that subjects consumed the
consumption on body weight and appetite are a 4-week almonds as part of a healthy low-calorie diet (Wien et al., 2003).
randomized, controlled clinical study with an 8-hour feeding study Other strengths of the long-term studies include sufficient study
component in which participants were given 1.5 ounces (43 g) of duration to discern the effects on body weight, the adequate
almonds as a snack or with meals (Tan and Mattes, 2013). In the control of the total energy intake between the control and almond
8-hour feeding study, there were significantly greater reductions diets, and a primary study outcome that was related to body
in the daylong ratings of hunger and desire to eat in subjects who composition. Overall, the studies are limited by inadequate
consumed almonds either as a snack or as part of a meal relative control of the confounding effects of physical activity.
1 u.s. Dietary Guidelines recommend that the majority of your fat in-
take be unsaturated. One serving of almonds (28g) has 13g of unsat-
urated fat and only 1g of saturated fat. scientific evidence suggests,
but does not prove, that eating 1.5 oz of most nuts, such as almonds,
as part of a diet low in saturated fat and cholesterol may reduce the
risk of heart disease.
7
Almond Nutrition Research: State of the Science Weight ManageMent
concluSionS RefeRences
Almonds are tree nuts that are very nutrient-rich; Burton-Freeman B, Davis PA, Schneeman BO (2004). Interaction of
however, because of their caloric content, some people fat availability and sex on postprandial satiety and cholecystokinin
after mixed-food meals. Am J Clin Nutr 80:1207-1214.
shy away from consuming almonds for fear that they will
gain weight. Based on the totality of scientific evidence Cohen AE, Johnston CS (2011). Almond ingestion at mealtime
reduces postprandial glycemia and chronic ingestion reduces
from randomized controlled studies, almonds, when
hemoglobin A1c in individuals with well-controlled type 2 diabetes
incorporated into a sensible eating plan do not harm and mellitus. Metabolism 60:1312-1317.
may even have beneficial effects on body composition,
Foster GD, Shantz KL, Vander Veur SS, Oliver TL, Lent MR, Virus
especially in overweight or obese adults. Additionally, a A et al. (2012). A randomized trial of the effects of an almond-
recent study (Novotny et al, 2012) measuring digestibility enriched, hypocaloric diet in the treatment of obesity. Am J Clin
Nutr 96(2):249-254.
found that whole almonds contain 20% fewer calories
than the Nutrition Facts Panel states, suggesting that Hollis J, Mattes R (2007). Effect of chronic consumption of almonds
because of their rigid cell structure, not all calories are on body weight in healthy humans. Br J Nutr 98(3):651
available for absorption. Further research is needed Kirkmeyer SV, Mattes RD (2000). Effects of food attributes on hunger
to better understand how this technique for calculating and food intake. Int J Obes Relat Metab Disord 24(9):1167
calories could potentially affect the calorie count of other Lokko P, Kirkmeyer S, Mattes RD (2004). A cross-cultural comparison
foods. of appetitive and dietary responses to food challenges. Food Qual
Prefer 15(2):129-136.
Dietary changes are essential for successful weight
Mori AM, Considine RV, Mattes RD (2011). Acute and second-meal
management, and the body of research suggests that effects of almond form in impaired glucose tolerant adults:
eating almonds may be a satisfying way to help maintain a randomized crossover trial. Nutr Metab (Lond) 8(1):6. doi:
a healthy body weight. 10.1186/1743-7075-8-6.
Novotny JA, Gebauer SK, Baer DJ (2012). Discrepancy between
the Atwater factor predicted and empirically measured energy
values of almonds in human diets. American Journal of Clinical
Nutrition 96(2):296-301.
Tan YT, Mattes RD (2013). Appetitive, dietary and health effects of
almonds consumed with meals or as snacks: a randomised,
controlled trial. European Journal of Clinical Nutrition,
doi:10.1038/ejcn.2013.184
Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR (2003). Almonds
vs complex carbohydrates in a weight reduction program. Int J
Obes Relat Metab Disord 27(11):1365-1372.
Wien M, Bleich D, Raghuwanshi M, Gould-Forgerite S, Gomes J,
Monahan-Couch L, Oda K (2010). Almond consumption and
cardiovascular risk factors in adults and prediabetes. J Am Coll
Nutr 29(3):189-197.
8
Heart HealtH Reference Table
StudieS of the effectS of AlmondS on Blood lipidS
Reference Study design Study population daily Amount outcome measurements Related to Blood Study Strengths and limitations
of Almonds lipids
consumed and
country1
Study duration Assessed in Study2 SS differences vs.
control at eot
Subjects with normal Blood lipid levels
Sabaté et al. • Randomized 3-arm CO study, 2-wk • Healthy adults (n=25; 14M, 11F) • 1.2 oz (34 g) • Total CH • ↓Total CH for high WA Strengths
(2003) run-in (Western diet with 34% energy • Mean age=41±13 y • 2.4 oz (68 g) • LDL-CH • ↓LDL-CH for high WA • Study was of a sufficient duration to discern effects
from fat), no WO period • BMI <30 kg/m2 • 4 wks • HDL-CH • ↓ LDL-CH:HDL-CH for on blood lipids
• NCEP Step I diets (provided) plus: • LDL-CH:HDL-CH high WA • Diets were isoenergetic and had similar protein
• No WA (C) • United States • TG • ↓ApoB for high WA contents3
• Low WA (10% total energy) • ApoA • ↓ ApoB:ApoA for high • Primary study outcome was related to blood lipids
• High WA (20% total energy) • ApoB WA Limitations
• ApoB:ApoA • Test meals were provided to participants for the
entire study duration (limited generalizability to free-
• Lp(a)
living conditions)
Jia et al. (2006) • Randomized 3-arm parallel study • Healthy adult smokers5 • 3 oz (84 g) • Total CH • None Strengths
• Diets (provided4) included: (n=30M) • 6 oz (168 g) • TG • Study was of a sufficient duration to discern effects
• No almonds (C) • Mean age=22.1 y (age range on blood lipids
• Half-dose powdered almonds of 18 to 25 y) • 4 wks Limitations
• Full-dose powdered almonds • Mean BMI: NR • Dietary intakes were not reported
• Primary study outcomes were related to oxidative
damage and oxidative stress
• China
• Limited generalizability because:
• Study participation was limited to male smokers
• Test meals were provided to participants for the
entire study duration
Kurlandsky et • Randomized 4-arm parallel study, • Healthy women (n=47)7 • 2.1 oz (60 g) • Total CH • None Strengths
al. (2006) 4-wk run-in (NCEP ATP III TLC diet) • Mean age=43.7 y • LDL-CH • Study was of a sufficient duration to discern effects
• NprCeEpaPr eAdT6P) pIIlIu TsL:C diets (self- • Mean BMI=25.6 kg/m2 • 6 wks • HDL-CH on blood lipids
• No WA, no chocolate (C) • TG • Primary study outcome was related to blood lipids
Limitations
• Chocolate (C) • United States
• WA diet provided more energy than the C diet
• WA (8,089 vs. 5,958 kJ, respectively)
• WA + chocolate • Limited generalizability because study was
conducted in women only
• Two subjects received stable HRT, which may have
independent effects on blood lipids
9
Heart HealtH Reference Table
StudieS of the effectS of AlmondS on Blood lipidS
Reference Study design Study population daily Amount outcome measurements Related to Blood Study Strengths and limitations
of Almonds lipids
consumed and
country1
Study duration Assessed in Study2 SS differences vs.
control at eot
Subjects with elevated Blood lipids
Spiller et al. • Randomized 3-arm parallel study, • Non-medicated • 3.5 oz (100 g) • Total CH • ↓Total CH Strengths
(1998) 1-wk run-in (diet NR) hypercholesterolemic adults • LDL-CH • ↓LDL-CH • Study was of a sufficient duration to discern effects
• Diets (partially provided8) included9: (n=30; gender distribution NR) • 4 wks • HDL-CH on blood lipids
• Cheddar cheese + butter + rye • Mean age=53±10 y • Total CH:HDL-CH • Diets were similar in total energy, protein, and total
crackers (C) • Mean BMI: NR fat
• TG
• Almonds (whole or ground) • Primary study outcome was related to blood lipids
• United States Limitations
• Test meals were partially provided to participants for
the entire study duration (limited generalizability to
free-living conditions)
Easwaran et al. • Randomized 7-arm parallel study • Non-medicated hyperlipidemic • 0.16 oz (4.5 g) • Total CH • None Strengths
(2002) • Diets (self-prepared10) included11: men (n=24) • LDL-CH • Total CH NR (C vs. WA)
• Control (C) • Mean age=NR (age range of 35 • 4 wks • HDL-CH • HDL-CH NR (C vs. WA) • Study was of a sufficient duration to discern effects
• Orange juice (C) to 60 y) • VLDL-CH • Outcomes for orange on blood lipids
• WA • Mweeraen c BlaMssI= IN oRr I(I7 o6b%es oef) subjects • TG jjuuiiccee vgsro. uWpAs +N Rorange •L iPmriitmataioryn sstudy outcome was related to blood lipids
• WA + orange juice
• India
• Small sample size
• Between-group comparison of macronutrient
intakes was not reported
• Limited generalizability because study was
conducted in men only
Jenkins et al. • Randomized 3-arm CO study, ≥2-wk • Hyperlipidemic adults (n=27; • 1.3 oz (≈37 g) • Total CH Half-dose WA vs. C : Strengths
(2002) WO period b/w treatment periods 15M, 12 postmenopausal F)13 • 2.6 oz (≈73 g) • LDL-CH • ↓Total CH • Study was of a sufficient duration to discern effects
• NCEP Step II diets (self-prepared12) • Mean age=64±9 y • HDL-CH • ↓Total CH:HDL-CH on blood lipids
pl•u sM:uffins (C) • Mean BMI=25.7±3.0 kg/m2 • 4 wks • Total CH:HDL-CH Full-dose WA vs. C: • Daniedt sP hUaFdA ssimilar total energy, protein, fibre, SFAs,
• LDL-CH:HDL-CH • ↓Total CH
• Half-dose WA + half-dose muffins • Canada • TG • ↓LDL-CH • Primary study outcome was related to blood lipids
• Full-dose WA • ApoA-1 • ↓HDL-CH • The 2 subjects who were taking statins responded
similarly to the rest of the group.
• ApoB • ↓Total CH:HDL-CH
Limitations
• ApoB:ApoA-1 • ↓LDL-CH:HDL-CH
• Eight subjects (including the 2 subjects who
• Lp(a) • ↓ApoB consumed statins) also consumed medications
• ↓ApoB:ApoA-1 for hypertension and/or HRT, which may have
• ↓Lp(a) independent effects on blood lipid levels
• Study had 43 subjects who were enrolled; but, 16
did not complete the study (37% attrition rate)
10