Nutrition Research and Managing Diabetes – in a nutshell · Kris-etherton et al 1999 . In this study high CHO diets recommended by the AHA were compared against an energy match

Nutrition Research and Managing Diabetes – in a nutshell

Alison Coates, PhD, RNutr

Nuts for life

Almost 1 in 4 Australians aged over 25 years has either diabetes or pre-diabetes

56% 44%

Magliano DJ, et al. Diabetes Care 2008; 31(2):267–272; Australian Institute of Health and Welfare, Diabetes prevalence in Australia, July 2011

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The worldwide prevalence of the metabolic syndrome and type 2 diabetes is increasing Approximately 787,500 Australians had been diagnosed with Type 2 diabetes based on self-reports in the 2007–08 NHS. About 444,300 were males (56%) and 343,200 were females (44%). Around 92% of people with Type 2 diabetes were 45 years old or more and 45% were 65 years or older (Figure 7, Table A8).

Food choices to help manage diabetes

Raidl et al. The Healthy Diabetes Plate. Prev Chronic Dis. 2007 Jan;4(1):A12.

high fibre / low GI carbohydrate

lean protein vegetables / salad www.foodpolitics.com

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For those people with pre diabetes or diabetes good nutritional advice is essential and it can be difficult to know what are good choices

Secrets of the Mediterranean diet • Olive oil • Oily fish • Fruit and vegetables • Wine in moderation •Nuts

www.msccruisesusa.com

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Traditional Mediterranean diet (non-calorie-restricted) decreased the incidence of diabetes after a median follow up of 4.0 years by 52% when med diet + 30g nuts eaten cf low fat diet

NUTS • Nuts have a wide variety of nutritional benefits

• Tree nuts include

• Peanuts, a legume grown in the ground also share these good nutritional properties

Almonds Hazelnuts Pistachios

Brazil Nuts Macadamias Walnuts

Cashews Pecans

Chestnuts Pine Nuts

www.find-me-a-gift.co.uk

• Nuts are energy dense foods ~2200-3000 kJ/100g

• Nuts are nutrient-rich foods – High in protein, MUFA and PUFA

• Nuts are low GI – Rich in fibre

• Nuts contain antioxidants – Vit E, polyphenols

• Nuts have healthy electrolytes – Low in Na+, Rich in K+ and Mg2+

What makes nuts so good?

Coates AM, et al. Edible nuts and metabolic health. Curr Opin Lipidol. 2007; 18(1):25–30.

Nuts for life

Just 30g can make all the difference

Pictures from thenutfactory.com

In Australian diets, nuts contribute • only 1% of total energy intake • 2% of total fat intake

– 3% of MUFA intake – 4% of PUFA intake

• 1.5% of fibre intake

National Nutrition Survey Australia, 1995

Australians on average consume 1 serve (~30g) per week

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Heart Health Benefits

Prospective cohort studies of diet and cardiovascular disease Epidemiological evidence of heart health benefits

Hu FB & Willett WC JAMA 2002;281:2569

http://fruitvegies.com.au/wp-content/uploads/2013/04/bg1.jpg

http://www.freegreatpicture.com/food-seasoning/whole-grains-10109

http://miracleskinnydrops.com/wp-content/uploads/2010/03/mixed_nuts.jpg

Physicians Health Study

21,454 men 40-84 years began 1982 - diet questionnaire in 1983 17 year follow-up - 201 sudden deaths

Albert CM. Arch Intern Med 2002;162:1382-1387

Frequency of nut consumption

Relative Risk

<1/mth 1-3/mth 1/wk >2/wk

Coronary Heart Disease

1.0 0.89 (0.9-1.2)

0.90 (0. 9-1.0)

0.7 (0.5-0.9)

Sudden Death 1.0 0.98 (0.7-1.4)

0.85 (0.6-1.3)

0.64 (0.4-1.0)

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Eating nuts at least twice a week reduced the risk of heart disease by 30-40% in both males

Nurses Health Study 86,016 women aged 34-59 years

began 1976 - diet Questionnaire in 1980 14 year follow-up - 1255 major CHD events

Frequency of nut consumption

Hu FB. BMJ 1999;317:1341-1345

Relative Risk

Almost never

1-3/mth to 1/wk

2-4/wk >5/wk

Coronary Heart Disease

1.0 0.91 (0.8-1.0)

0.78 (0.6-0.9)

0.66 (0.47-0.93)

Fatal Coronary Heart Disease

1.0 0.76 (0.6-0.9)

0.60 (0.4-0.96)

0.60 (0.3-1.1)

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And also in females

The Good Oil

http://www.vitafit.si/wp-content/uploads/2013/06/Orehovo-olje.jpg

Nuts are a good source of Monounsaturated Fatty Acids

Mukuddem-Petersen J et al, J. Nutr. 2005;135:2082–2089

0%

20%

40%

60%

80%

100%

Pistachio

s

Brazil

nuts

Waln

uts

Hazeln

uts

Pecans

Almonds

Macadam

ias

Cashews

Peanuts

n-6 PUFA n-3 PUFA MUFA SFA

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As I showed you in the table earlier each of the nuts different fatty acid profiles and here is you focus on the green bars you will see the proportion of MUFA in each nuts

Source: IOM (Institutes of Medicine). Dietary Reference Intakes: Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academies Press, 2002.

More monounsaturated fat associated with a healthier cholesterol profile

Dietary MUFA (% energy) 5 10 15 20 25 30 35 0

Perc

ent

Chan

ge in

TC/H

DL

Chol

-25

-20

-15

-10

-5

0

10

5

15

20

25

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As MUFA intake increase in the change on cholesterol towards a healthy profile so there is a reduction overall and there is more of the good HDL cholesterol in this mix

-35

-25

-15

-5

5

15

T-Chol LDL-C HDL-C TGs

% C

hang

e fro

m b

asel

ine

pecans (72g/d) 4 wks almonds(66g/d) 6 wks almond oil (35g/d)hazelnuts(40g/d) 4 wks walnuts (56g/d) 6 wks macadamia (40-90g/d) 4 wkspistachio(20% calories) 3wks

Overall improvement of blood lipid profiles with regular consumption of tree nuts

Rajaram et al J Nutr. 2001,131(9):2275-9; Hyson et al. J Nutr. 2002, 132(4):703-7; Mercanligil et al. Eur J Clin Nutr. 2007, 61(2):212-20; Zambon et al Ann Intern Med. 2000, 4;132(7):538-46; Garg et al. J Nutr. 2003,133(4):1060-3; Edwards et al J Am Coll Nutr. 1999 Jun;18(3):229-32.

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(mercanligil et al 2007).This study is comparable to those reported for other tree nuts such as almond (Hyson et al., 2002), macadamia (Garg et al 2004), pecan (Rajaram et al., 2001), pistachio (Edwards et al., 1999) and walnut (Zambon et al., 2000), despite the fact that inclusion of hazelnut into the human diet in our study was less than half of those reported for other nuts. You need to keep in mind that subjects started with different starting levels of cholesterol. Nut oils have alos been found to reduce cholesterol levels effectively. Almonds and almond oil have been found to be equally effective

What about peanuts?

Hazel handed in her notice, because she was tired of working for peanuts. . . . . . . .

www2.printshop.co.uk

Peanuts are better than approved low fat diets (Step 1 and 2) for improving blood lipid profiles

LDL HDL Triglycerides

% change

-20

-15

-10

-5

0

5

10

15 Step 1 Step 2 Olive Oil Peanut Oil Peanuts & peanut butter

Kris-etherton et al 1999

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In this study high CHO diets recommended by the AHA were compared against an energy match diet that was instead high in fat. The fat was in the diet predominantly in the from of olive oil , peanut oil or in a more solid form as peanuts or peanut butter Can see that while all diets were effective in lowering LDL cholsterol the additional benefits from the high fat diet were the preservation of HDL cholesterol and the reduction in TGs

But doesn’t eating high fat foods cause weight gain?

The good news....nut-eaters weigh less.

Nuts for life

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The Nurses’ Health Study found a decrease in BMI with every quartile increase in nut consumption, when controlled for total energy intake. 1

8865 Men aged 23-54 years began 1999 - diet Questionnaire in 2005

Frequency of nut consumption (50g serve)

Bes-Rastrollo et al, Obesity 2007;15:107-116.

Almost never

1-3/mth to 1/mth

1/wk >2/wk P for trend

nut consumption (g/d)

<3.3 3.3-7.0 7.1- 21.3

21.4

number/group 1,847 4,097 1,772 1,149

number who gained weight

214 444 194 85

Relative risk 1.00 0.93 0.94 0.61 <0.001

adjusting for age, gender, smoking, leisure time physical activity

Low nut consumption linked to greater weight gain

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Over 10% gained >5kg in 6yrs Lowest nut eaters gained ~1/2 kg more

+ almonds

– almonds

Week

Weight (kg)

Nuts can enhance weight loss in people with insulin resistance or diabetes on a low calorie diet (LCD)

Wien et al. Int J Obes Relat Metab Disord. 2003;27(11):1365-72

Both diets reduced insulin resistance Almond-LCD:-66% CHO-LCD:-35% (P<0.0001)

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Wien et al (2003) reported after 24 weeks on a low calorie diet (LCD) ± almonds, the almond-LCD group experienced a: 62% greater reduction in weight, 50% greater reduction in waist circumference and 56% greater reduction in fat mass than the CHO-LCD intervention Th To evaluate the effect of an almond-enriched (high monounsaturated fat, MUFA) or complex carbohydrate-enriched (high carbohydrate) formula-based low-calorie diet (LCD) on anthropometric, body composition and metabolic parameters in a weight reduction programey also showed greater improvements in glucose homeostasis

Nurses Health Study 83,818 women aged 34-59 years

began 1976 - diet questionnaire in 1980 16 year follow-up - 3206 new cases of type 2 diabetes

Jiang R et al JAMA 2002;288:2554

Almost never <1/wk 1-4/wk >5/wk

P for trend

RR 1.0 0.82 (0.76-0.89)

0.69 (0.63-0.76)

0.55 (0.45-0.66)

<0.001

Risk of Type 2 Diabetes reduced as frequency of nut consumption increased

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Josse et al (2007) Metabolism Clinical and Experimental 56, 400– 404

Addition of nuts improves blood glucose response

• Similar effects also seen with mixed nuts and pistachios

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Acute feeding studies indicate that nuts have minimal effects on rising postprandial blood glucose levels when eaten alone, and diminish the postprandial glycaemic response when consumed with high-glycaemic index carbohydrate foods in both normoglycaemic and type 2 diabetic individuals Josse et al 2007 assessed the effects of varying amounts of almonds on the postprandial blood glucose response to a carbohydrate meal. The addition of almonds to white bread resulted in a progressive reduction in the glycemic index of the composite meal in a dose-dependent manner for the 30-g (105.8 F 23.3), 60-g (63.0 F 9.0), and 90-g (45.2 F 5.8) doses of almonds (r = 0.524, n = 36, P = .001).

Replacing Carbohydrate with nuts improves HbA1C

• 3 month parallel study in 117 people with type 2 diabetes • Supplements provided ~2000 KJ

75g (mixed nuts)

Jenkins et al (2011) Diabetes Care;34(8):1706-11

38g (mixed nuts) + ½ muffin

-0.21% absolute

HbA1c units

FDA considers >0.3%

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The full nut dose reduced HBA1c by 2/3 the reduction recognised as clinically meaningful by FDA >0.3% absolute Hba1c units) when considering antihyperglycemic drugs Tapsell et al. (2004) (Gillen et al., 2004) conducted a 6-month RCT where 30 g of walnuts were supplemented into the diet of patients with type II diabetes in comparison with two low-fat dietary regimes. Although no improvements occurred in blood-glucose control (as indicated by HbA1c levels) or body composition, the walnut group achieved a significantly greater increase in the HDL–C-to-TC ratio (P = 0.049) and HDL (P = 0.046) than low-fat diets, one which was rich in fish.

Circulatory function is altered in diabetes endothelium

Reyes-Soffer et al (2010) Metabolism Clinical and Experimental 59 :1365–1371

preventing-a-heart-attack.com

heart.org

Arginine is important for maintaining healthy blood vessels

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higher serum HbA1c levels in non-diabetic subjects are inversely associated with FMD

Arginine Content of Nuts (g/100g)

0

0.5

1

1.5

2

2.5

3

3.5

Beef

Peanuts

Almonds

Waln

uts

Brazil

s

Hazeln

uts

Cashews

Pistachio

s

Macadamia

s

Pecans

mg

Ros et al Circulation 2004;109:1609

Blood vessel function improves after 4 weeks of consuming walnuts

Can peanuts improve endothelial function and does

this impact on cognition? Cognitive decline Depression Neuro-degenerative disorders

impaired blood flow

+ heart.org

Why Nuts?

• great source of healthy nutrients • favourably influence blood lipids • help to reduce or control body weight

• help to control blood glucose • should be part of your daily diet

but avoid the salt!!!

http://echolife.files.wordpress.com/2010/07/macadamia_nuts.jpg

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Add soemthing about diabeetes

Nutritional Physiology Research Centre

http://www.unisa.edu.au/nutritional.physiology/

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I would just like to acknowledge the people who have contributed to this work The team at the Nutritional Physiology Research Centre, especially the students who have contributed to the data collection, Kade Davison, Rachel Wong and Matt Robinson And the companies that have sponsored this research.

Documents

Nutrition Research and Managing Diabetes – in a nutshell · Kris-etherton et al 1999 . In this study high CHO diets recommended by the AHA were compared against an energy match