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Mediterranean diet supplemented with nuts reduces waist circumference and shifts lipoprotein subfractions to a less atherogenic pattern in subjects at high cardiovascular risk

  • Author Footnotes
    1 These authors contributed to this work equally.
    Nagila R.T. Damasceno
    Footnotes
    1 These authors contributed to this work equally.
    Affiliations
    Lipid Clinic, Endocrinology and Nutrition Service, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil
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  • Author Footnotes
    1 These authors contributed to this work equally.
    Aleix Sala-Vila
    Correspondence
    Corresponding author. Clínica de Lípids, Hospital Clínic, Villarroel 170, Edifici Helios, despatx 8, 08036 Barcelona, Spain. Tel.: +34 932275400x2276; fax: +34 934537829.
    Footnotes
    1 These authors contributed to this work equally.
    Affiliations
    Lipid Clinic, Endocrinology and Nutrition Service, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain
    Search for articles by this author
  • Montserrat Cofán
    Affiliations
    Lipid Clinic, Endocrinology and Nutrition Service, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain
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  • Ana M. Pérez-Heras
    Affiliations
    Lipid Clinic, Endocrinology and Nutrition Service, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain
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  • Montserrat Fitó
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Barcelona, Spain
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  • Valentina Ruiz-Gutiérrez
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla, Spain
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  • Miguel-Ángel Martínez-González
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra–Clínica Universidad de Navarra, Pamplona, Spain
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  • Dolores Corella
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Department of Preventive Medicine, University of Valencia, Valencia, Spain
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  • Fernando Arós
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Department of Cardiology, University Hospital of Alava, Vitoria, Spain
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  • Ramon Estruch
    Affiliations
    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

    Department of Internal Medicine, IDIBAPS, Hospital Clínic, Barcelona, Spain
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  • Emilio Ros
    Affiliations
    Lipid Clinic, Endocrinology and Nutrition Service, Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain

    CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed to this work equally.

      Highlights

      • LDL-cholesterol, LDL particle number, and LDL particle size might not be equivalent.
      • 30 g/day of mixed nuts for 1 y decreased LDL particle number and particle size.
      • Nuts induced interrelated changes in waist circumference, fasting triglycerides, and small-dense LDL.
      • Overall results add to the well-known LDL-cholesterol-lowering effect of nuts.
      • We provide mechanistic evidence to the protection against cardiovascular diseases reported in the PREDIMED trial.

      Abstract

      Objective

      The PREDIMED trial showed that Mediterranean diets supplemented with either extra-virgin olive oil or nuts reduced incident cardiovascular events compared to a control diet. Consumption of both supplemental foods has been associated with reduced LDL-cholesterol, but it is unknown whether they can shift lipoprotein subfractions to a less atherogenic pattern. We investigated changes in adiposity and lipoprotein subfractions after consumption of the PREDIMED diets.

      Methods

      In a PREDIMED sub-cohort (n = 169), lipoprotein subclasses (particle concentrations and size) were determined by nuclear magnetic resonance spectroscopy at baseline and after intervention for 1 year.

      Results

      Participants allocated to the Mediterranean diet supplemented with nuts showed significant reductions from baseline of waist circumference (mean [95% CI]; −5 cm [−7; −3]) and concentrations of medium-small (−27 nmol/l [−46; −8]) and very small LDL (−111 nmol/l [−180; −42]); decreased LDL particle number (a nuclear magnetic resonance-specific measurement) (−98 nmol/l [−184; −11]); and an increase of large LDL concentrations (54 nmol/l [18; 90]), with a net increase (0.2 nmol/l [0.1; 0.4]) of LDL size. The Mediterranean diets with olive oil and nuts increased large HDL concentrations (0.6 μM [0.0; 1.1] and 1.0 μM [0.4; 1.5], respectively). Compared to the other two intervention groups, participants in the nut-enriched diet showed significantly reduced waist circumference (p ≤ 0.006, both) and increased LDL size (p < 0.05, both).

      Conclusion

      Lipoprotein subfractions are shifted to a less atherogenic pattern by consumption of Mediterranean diets enriched with nuts. The results contribute mechanistic evidence for the reduction of cardiovascular events observed in the PREDIMED trial.

      Keywords

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