Nuts as a Replacement for Carbohydrates in the Diabetic Diet

• Published in: Diabetes care Vol. 34; no. 8; pp. 1706 - 1711
• Main Authors: Jenkins, David J.A, Kendall, Cyril W.C, Banach, Monica S, Srichaikul, Korbua, Vidgen, Edward, Mitchell, Sandy, Parker, Tina, Nishi, Stephanie, Bashyam, Balachandran, de Souza, Russell, Ireland, Christopher, Josse, Robert G
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.08.2011
• Subjects: Aged; Biological and medical sciences; Blood cholesterol; Blood Glucose - metabolism; blood lipids; Carbohydrates; Cholesterol, LDL - blood; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes therapy; Diabetes. Impaired glucose tolerance; diabetic diet; Diet; Diet therapy; Diet, Diabetic; Dietary Carbohydrates - administration & dosage; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; energy; Etiopathogenesis. Screening. Investigations. Target tissue resistance; fat intake; Fatty acids; Female; Glycated Hemoglobin A - metabolism; glycemic control; high density lipoprotein cholesterol; Humans; Lipids; low density lipoprotein cholesterol; Male; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; monounsaturated fatty acids; muffins; noninsulin-dependent diabetes mellitus; Nutrition; Nutrition research; Nuts; Original Research; Public health. Hygiene; Public health. Hygiene-occupational medicine; Type 2 diabetes; vegetables; Canada; Ontario; Endocrinopathy; Human; Nuts; Nutrition; Diet; Diabetes mellitus; Metabolic diseases; Carbohydrate; Replacement; Endocrinology; Feeding
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc11-0338

OBJECTIVE: Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA₁c in type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA₁c. RESULTS: The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA₁c (-0.21% absolute HbA₁c units, 95% CI -0.30 to -0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA₁c (r = -0.20, P = 0.033) and LDL cholesterol (r = -0.24, P = 0.011). CONCLUSIONS: Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.