1. Nuts as a replacement for carbohydrates in the diabetic diet: a reanalysis of a randomised controlled trial
- Author
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Monica S. Banach, John L. Sievenpiper, Christopher Ireland, Joseph Beyene, Balachandran Bashyam, David J.A. Jenkins, Korbua Srichaikul, Cyril W.C. Kendall, Benoît Lamarche, Edward Vidgen, Stephanie K. Nishi, Tina Parker, Robert G. Josse, Russell J. de Souza, Sathish C. Pichika, and Sandy Mitchell
- Subjects
Nut ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Blood lipids ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Animal science ,Glycaemic control ,Internal Medicine ,medicine ,Clotting factors ,Nuts ,2. Zero hunger ,Clotting factor ,Cholesterol ,business.industry ,Unsaturated fat ,digestive, oral, and skin physiology ,Repeated measures design ,medicine.disease ,3. Good health ,Diabetic diet ,chemistry ,business - Abstract
Aims/hypothesis In line with current advice, we assessed the effect of replacing carbohydrate consumption with mixed nut consumption, as a source of unsaturated fat, on cardiovascular risk factors and HbA1c in type 2 diabetes. The data presented here are from a paper that was retracted at the authors’ request (10.2337/dc16-rt02) owing to lack of adjustment for repeated measures in the same individual. Our aim, therefore, was to fix the error and add new complementary data of interest, including information on clotting factors and LDL particle size. Methods A total of 117 men and postmenopausal women with type 2 diabetes who were taking oral glucose-lowering agents and with HbA1c between 47.5 and 63.9 mmol/mol (6.5–8.0%) were randomised after stratification by sex and baseline HbA1c in a parallel design to one of three diets for 3 months: (1) ‘full-dose nut diet’ (n = 40): a diet with 2.0 MJ (477 kcal) per 8.4 MJ (2000 kcal) energy provided as mixed nuts (75 g/day); (2) ‘full-dose muffin diet’ (n = 39): a diet with 1.97 MJ (471 kcal) per 8.4 MJ (2000 kcal) energy provided as three whole-wheat muffins (188 g/day), with a similar protein content to the nuts, and the same carbohydrate-derived energy content as the monounsaturated fatty acid-derived energy content in the nuts; or (3) ‘half-dose nut diet’ (n = 38): a diet with 1.98 MJ (474 kcal) per 8.4 MJ (2000 kcal) energy provided as half portions of both the nuts and muffins. The primary outcome was change in HbA1c. The study was carried out in a hospital clinical research centre and concluded in 2008. Only the statistician, study physicians and analytical technicians could be blinded to the group assessment. Results A total of 108 participants had post-intervention data available for analysis (full-dose nut group, n = 40; full-dose muffin group, n = 35; half-dose nut group, n = 33). Compared with the full-dose muffin diet, the full-dose nut diet provided 9.2% (95% CI 7.1, 11.3) greater total energy intake from monounsaturated fat. The full-dose nut diet (median intake, 75 g/day) also reduced HbA1c compared with the full-dose muffin diet by −2.0 mmol/mol (95% CI −3.8, −0.3 mmol/mol) (−0.19% [95% CI −0.35%, −0.02%]), (p = 0.026). Estimated cholesterol levels in LDL particles with a diameter
- Published
- 2018