Cardiovascular Disease Clinical Trial
Official title:
A Randomised, Controlled Parallel Dietary Intervention to Investigate the Effect of Almond Snack Consumption on Cardio-metabolic Disease Risk Markers Compared With Isocaloric Snacks, in Adults at Moderate Risk of Cardiovascular Disease
The purpose of this study is to investigate the cardio-metabolic health effects of consuming almond nuts in place of habitual (usual) snack products in adults at moderate risk of developing cardiovascular disease
Tree nuts are recommended in the prevention and management of cardiovascular disease (CVD)
largely based on their LDL (low density lipoprotein) lowering effects, but the CVD risk
reduction observed with tree nut consumption is greater than that predicted by their
hypocholesterolemic effects alone. Other health benefits have also been noted by our group,
such as moderation of postprandial lipemia , as well as by others such as modified
postprandial glycemia , decreased blood pressure (BP) , improvement in oxidant status and
weight loss. Robust evidence for the protective cardio-metabolic effects of nuts from the
PREDIMED study has highlighted the association between nut consumption and decreased risk of
cardiovascular events, obesity, metabolic syndrome and type 2 diabetes (T2DM). However, there
is a paucity of evidence on the effects of almonds on vascular function in humans (BP and
endothelium-dependent vasodilation (EDV)), although there is evidence that almonds promote
nitric oxide (NO) release in animals consuming high-fat diets. Fundamental to vascular health
is a well-functioning liver and there is increasing evidence to demonstrate that the
accumulation of liver fat is a causative factor in the development of cardio-metabolic
disorders. Non-alcoholic fatty liver disease (NAFLD) is now considered the hepatic
manifestation of the metabolic syndrome (MetS); recent data has shown that it is linked to
increased CVD risk via direct effects on vascular function (and EDV) independently of obesity
and MetS . NAFLD is thought to affect 30% of the population in developed countries, and up to
two-thirds of people with obesity and 50% of people with hyperlipidemia. Development of fatty
liver, mainly attributable to obesity and elevated postprandial lipemia, is associated with
increased inflammation, oxidative stress, insulin resistance, dyslipidemia and impaired EDV,
and predicts risk of CVD and T2DM .
Therefore, the long-term goal of this research is to understand the mechanisms underpinning
how dietary change can drive favourable modification of CVD disease risk and to identify
patterns in population food choices, specifically almond consumption, that tend to correlate
with reduced CVD disease risk. The primary aim of this proposal is to investigate, in a
randomised controlled, parallel arm, 6-wk dietary intervention (n=100) whether replacing
snacks based on refined carbohydrates and poor in micronutrients/non-nutrient bioactives
(NNB) with nutrient/NNB-dense, whole almond snacks can influence liver fat content (a key
metabolic driver of insulin resistance and vascular dysfunction, and a hallmark of metabolic
syndrome) and EDV (brachial FMD being an independent predictor of CVD events, in addition to
related biomarkers of cardio-metabolic disease risk. The snacks products provide participants
with 20% of their energy requirements via either whole almonds or as muffins/crackers that
have been designed to mimic the average UK snack.
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