|
 
 |
| REVIEW ARTICLE |
|
| Year : 2023 | Volume
: 15
| Issue : 1 | Page : 1-10 |
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The Effects of Consuming Almonds and Almond Oil on Blood Lipids: A Systematic Review
Muhamed T Osman1, Redhwan Ahmed Al-Naggar2
1 Department of Pathology, Faculty of Medicine and Health Sciences, UCSI Hospital, Port Dickson, Negeri Sembilan, Malaysia
2 Department of Community Medicine, Faculty of Medicine, AlJeel AlJadeed University, Yemen
| Date of Submission | 14-Oct-2022 |
| Date of Decision | 17-Jan-2023 |
| Date of Acceptance | 08-Feb-2023 |
| Date of Web Publication | 31-Mar-2023 |
Correspondence Address:
Redhwan Ahmed Al-Naggar
Department of Community Medicine, Faculty of Medicine, AlJeel AlJadeed University
Yemen
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ajprhc.ajprhc_90_22
Introduction: Pharmacological approaches to hyperlipidemia are used in practice to lower lipids, but the benefits in lowering lipid levels also lead to some adverse effects. Therefore, the aim of this systematic review is to find out how almonds and almond oil affect blood lipids. Methodology: The studies in this systematic review were chosen systematically by searching Cochrane, PubMed, Scopus, Web of Science, and Embase from the earliest date to March 2021. Two authors independently screened titles and abstracts, followed by screening. Search strategy was conducted using the following keywords: Almond, Prunus, Prunus dulcis, amygdalus, oleum amygdalae, P. amygdalus, Prunus dulcis, Prunus amygdalus dulcis, and P. dulcis; human, person, subject, people, patient, participant, individual, volunteer, elder, senior, geriatric, women, men, adult, woman, and man; and LDL, Lipid, Lipid Profile, blood profile, HDL, Low Density Lipoprotein, TAG, Triglyceride, Triacylglycerol, High Density Lipoprotein, Cholesterol, Lipid regulation, TG Lipid Distribution, Total Cholesterol, Cholesterol, TC Lipid Distribution, cholesterol, total cholesterol, HDL-C, LDL, LDL-C, lipoprotein, hyperlipidaemia, hypercholesterolaemia, and hyperlipaemia. Results: Overall, the studies demonstrate a significant outcome of almond or almond oil on lowering blood lipid levels, except in three studies. We included 40 clinical trials. In all studies, the average daily intake of almonds was between 10 and 100 g/day. For almond oil, it was 500 ml of almond oil daily. The duration of almond consumption ranged from 3 to 30 weeks. Sample sizes in all strata ranged from 12 to 128 participants. In the 17 strata, subjects were described as generally healthy and in 5 strata as overweight or obese. Conclusions: Consuming almonds or almond oil has a significant effect on lowering lipids.
Keywords: Almond oil, almond, human, lipid reduction, systematic review
How to cite this article:
Osman MT, Al-Naggar RA. The Effects of Consuming Almonds and Almond Oil on Blood Lipids: A Systematic Review. Asian J Pharm Res Health Care 2023;15:1-10 |
How to cite this URL:
Osman MT, Al-Naggar RA. The Effects of Consuming Almonds and Almond Oil on Blood Lipids: A Systematic Review. Asian J Pharm Res Health Care [serial online] 2023 [cited 2023 Jun 8];15:1-10. Available from: http://www.ajprhc.com/text.asp?2023/15/1/1/373380 |
| Introduction | |  |
Cardiovascular disease is the major cause of death worldwide.[1] Cardiovascular disease is estimated to have killed 17.3 million people worldwide in 2008, accounting for 30% of all causes of death, and by 2030, 23.3 million people are expected to die from cardiovascular disease.[2] Cardiovascular disease also places a significant economic burden on society. The mortality rate associated with cardiovascular disease in the Middle East is one of the highest in the world.[3]
The major causes of the increase in cardiovascular deaths include diabetes mellitus, smoking, obesity, hypertension, and hyperlipidemia.[4] Hyperlipidemia is a leading risk factor for cardiovascular disease progression. Blood lipid levels must be reduced in order to minimize the risk of heart disease.[5] The onset and progression of coronary atherosclerosis are correlated with levels of triglycerides (TGs), total cholesterol (TC), and low-density lipoprotein (LDL)-cholesterol.
Although pharmacological approaches are used in practice, lifestyle changes such as diet, increase physical activities, and smoking cessation are among the most effective preventive measures. Whether or not a person has high cholesterol, lifestyle changes to improve lipoprotein concentrations are critical (national cholestrol education program [NCEP], 2008). Despite the role of statins in lowering cholesterol levels in dyslipidemia, this class of medication also has some adverse effects such as myalgia.[6]
One of the most important changes is to increase the consumption of nuts, which can cut down the risk of cardiovascular disease by 25% to 40%.[7] Nuts are high in monounsaturated and polyunsaturated fatty acids, soluble fiber, plant sterols, and flavonoids, and they have clinical benefits through antihyperlipidemic effects.[8],[9],[10] There is evidence that consumption of tree nuts may be a protective factor against coronary heart disease (CHD).[11],[12],[13],[14],[15],[16] One study showed that eating about 42.5 g of nuts per week reduced the risk of CHD death by 37%.[17] Reduced sugars, salts, and saturated fats have the potential to aid people in the prevention and management of lifestyle diseases such as CHD; thus, dietary interventions play a critical role in this effort. The almond is one of the most important nuts for lowering human blood lipids.
Almond effects on lipid concentration have been widely studied. A serving of 35 almonds (42.5 g) is full of 246 calories and also contains a high nutrient density with fiber, protein, carbohydrate, and fat.[18] Numerous nutrients and phytochemicals found in almonds have each been associated with positive effects on the cardiovascular system.
Consuming 100 g of almonds daily for 4 weeks resulted in a notable reduction in LDL-cholesterol (LDL-C) and TC.[19] According to another study, eating 20 g of almonds daily significantly reduced levels of LDL, TC, and nonhigh-density lipoprotein-cholesterol (HDL-C).[20] For a period of 6 weeks, swapping a high-carb snack for almonds could be an efficient dietary approach to halt the onset of cardiovascular disease.[21] Daily consumption of almonds, representing 20% of total calories, over a 4-week period significantly decreased LDL/HDL-C ratio, TC, and LDL-C.[22] Replacing fat diet with almonds for 4 weeks significantly decreased LDL-C/HDL-C, TC, and LDL-C.[23]
There are some systematic reviews that show that regular consumption of almonds reduces blood lipids significantly. The first systematic review showed that almonds were associated with a reduction in TC and LDL-C.[24] The results of the second systematic review revealed a correlation between eating almonds and significantly lower levels of both TC and LDL-C.[25]
Low consumption of seeds and nuts is a risk factor for cardiovascular disease according to another systematic review.[26] The fourth systematic review showed that almonds are ideal for maintaining healthy blood lipid levels.[27] However, there was no previous systematic review that combined both almonds and their oil. Therefore, the aim of this systematic review is to find out whether both almonds and almond oil both lower blood lipid levels in humans.
| Methodology | | |
Study design
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to prepare and structure this study to investigate the role of almonds and almond oil on lipid parameters. A systematic review of clinical studies was conducted. The population was defined as individuals who have or are at risk of having elevated levels of any of “TC, TG, LDL-C, and HDL-C,” the intervention being solely the consumption of almonds for lipid lowering, subjects: sufficient data to allow a comparison of pre- and postintervention levels in terms of HDL-C, TC, LDL-C, and TG. The outcome is the effect of almonds on lipids.
Inclusion criteria
We included studies with the following criteria: (1) English-language studies; (2) almond intervention studies in adults aged 18 and up who were either healthy or had dyslipidemia at baseline; (3) controls were no almond consumption or a replacement diet that did not contain almonds; (4) the minimum study period was 3 weeks; (5) only human randomized controlled trials; and (6) TGs, TC, high-density lipoprotein (HDL), LDL-C, and crossover and parallel trials were included.
Exclusion criteria
We excluded studies with the following criteria: (1) studies on pregnant women children or animals, (2) review studies, (3) studies that used statins in both the intervention and control groups, and (4) lack of information on diet.
Outcomes were as follows: (1) TGs, (2) LDL-C, (3) TC, and (4) HDL-cholesterol.
Data source and search strategy
A systematic search of Scopus, PubMed, Embase, Google Scholar, Web of Science, and Cochrane from the earliest date to March 2022. In addition, to identify relevant studies, a manual search for references from primary or review articles was conducted.
For almond, a search strategy was conducted using the following keywords: Almond, Prunus, Prunus dulcis, amygdalus, oleum amygdalae, Prunus dulcis, P. amygdalus, P. dulcis, and Prunus amygdalus dulcis.
For the search for subjects, we used the following keywords: Human, person, subject, people, patient, participant, individual, volunteer, elder, senior, geriatric, women, men, adult, woman, and man.
For lipid keywords, we have used the following: LDL, Lipid, Lipid Profile, blood profile, HDL, Low Density Lipoprotein, TAG, Triglyceride, Triacylglycerol, High Density Lipoprotein, Cholesterol, Lipid regulation, TG Lipid Distribution, Total Cholesterol, Cholesterol, TC Lipid Distribution, cholesterol, total cholesterol, HDL-C, LDL, LDL-C, lipoprotein, hyperlipidaemia, hypercholesterolaemia, and hyperlipaemia.
Study selection
Screening of titles and abstracts and then screening of full texts were conducted independently by the two authors. Disagreements about eligibility were discussed and solved by consensus. If an article met the inclusion criteria, it was included [Table 1].
| Results | | |
This systematic review included 40 clinical trials. Most clinical trials were conducted in the United States (22 trials), followed by Canada (five trials), Iran (four trials), and Brazil (three trials). Each country conducted two clinical trials: the United Kingdom, Spain, and New Zealand. Each of the following countries conducted one clinical trial: China, Korea, India, Taiwan, Pakistan, and Australia. The almond consumption ranged from 3 to 30 weeks. The sample size in all strata ranged from 12 to 128 patients. The age of the participants ranged from 18 to 86 years.[28] The majority of strata included both male and female subjects, six studies included only females,[29],[30],[31],[32] and two studies included only males.[33],[34]
Almond interventions
In all studies, the average daily consumption of almonds was between 10 and 100 g/day. For almond oil, participants consumed 40 ml of almond oil daily in one study[35] and 500 ml of almond oil daily in another study.[36] Almonds had to be consumed daily in all studies, except in one study were to be consumed 5 to 7 times a week.[37]
The almonds type
In seven studies, whole, raw, unblanched, unsalted almonds were consumed.[17],[23],[30],[37],[38],[39],[40] In strata,[41],[42] two strata were about the almond oil[35],[36] (500 ml almond oil). In other studies, almonds were consumed as a snack or incorporated into meals and snacks.[22],[39],[43],[44]
Control diets
Control diets were not specific in some trials but defined in others, although all trials were randomized and controlled. Nuts were not allowed to be eaten by participants in the control group or during the control phase. The control food muffin was reported in some strata.[17],[21],[43],[45] The control diet was an educational intervention reported in two strata.[36],[38] The following strata used olive oil/walnut oil/mineral oil/canola oil as a control diet.[19],[35],[44] Other strata used biscuits or snacks as control food.[28],[46],[47],[48] Other strata used cocoa powder and dark chocolate,[49] peanuts,[50] sunflower,[31] maize starch,[20] hazelnuts,[51] and maltodextrin.[29]
Most studies demonstrated a significant reduction in lipids when consuming almond or almond oil [Table 2]
Effects of almond on lipid profile
Overall, studies showed a significant effect of eating almonds or almond oil in lowering lipids, except in three studies. The overall findings of the studies revealed a significant decrease in TG. The pooled mean difference revealed a significant reduction in TC when consuming almond. Almond consumption overall significantly reduced LDL-C and significantly increased HDL-C levels.
| Discussion | | |
When consumed in small or large amounts, almonds may benefit human health. Several clinical studies suggested a potential effect of almond on glycemic control and lipid metabolism by lowering postprandial blood glucose levels and insulin resistance and improving HDL concentrations.[29],[43],[47],[49] Human health benefits of almond consumption include reduced cardiovascular risk, benefits for diabetics, hyperlipidemics and obese individuals, and reduced biomarkers of lipid peroxidation.[28],[29],[43],[47],[52] Almonds may even be a helpful food for people who do not want to or cannot take a higher dose of statins.[49] In addition, eating almonds may help control feelings of fullness.[43],[49]
Almond consumption was found to significantly lower cholesterol levels.[30] Almonds have been shown in several well-conducted studies to lower LDL-C.[37],[48] Another systematic review found that eating almonds significantly lower TG, LDL-C, and TC. HDL-C levels are not significant, though.[43]
A study from India reported that almonds lower LDL, TG, and lower body weight in diabetic patients with type 2.[40]
One of the paradoxes of lifestyle interventions, such as reducing saturated fat, is dietary strategies to lower LDL and cholesterol.[53]
Another study in Pakistan screened 1489 patients with CHD and found that almonds increased HDL-C levels by 14% in 6 weeks. After a 6-week intervention period, a study that looked at the effect of nuts such as almonds and hazelnuts on HDL levels showed a significant decline in LDL levels and an increase in HDL levels.[19],[53]
In addition, almond oil has drawn a lot of interest. According to one study, consuming almond oil for 2 months reduced serum TG levels while having no effect on TC, LDL, or HDL-cholesterol.[32] For 1 month, adding 10 ml of almond oil twice a day to the diet had a noticeable impact on lowering TC and LDL, but not TG or HDL.[53]
Almonds' nutrients are most likely a factor in the mechanisms underlying the observed LDL reduction with consumption. By increasing bile acid and cholesterol excretion, decreasing cholesterol and bile acid uptake, and increasing LDL receptor activity, these naturally biologically active nutrients lower LDL levels. Nutrients in almonds have the ability to control the enzymes that produce bile acid and new cholesterol. Along with other special cardioprotective nutrients, almonds also contain α-tocopherol, arginine, magnesium, copper, manganese, calcium, and potassium.
Almonds are also high in nutrients and bioactive components such as vitamins, monounsaturated, minerals, polyunsaturated fatty acids, plant sterols, polyphenolic compounds, and antioxidants.[33] In addition, almonds contained catechin, protocatechuic acid, and chlorogenic acid, which are crucial polyphenols.[33] Almond also contained hydrolysable tannins, proanthocyanidins, phenolic acids and aldehydes, flavonoids, stilbenes, isoflavones, and lignans.[51]
Almonds are a good source of fiber and have the highest fiber content of any nut. Almonds contain cellulose, lignin, and hemicellulose that are viscous and insoluble and pectin that is viscous and insoluble.[54],[55] According to a meta-analysis study, eating 2–10 g of soluble fiber per day was associated with a significant reduction in cholesterol.[8]
| Conclusions | | |
Almonds primarily have a positive impact on LDL-C and TC. The studies conducted have shown a significant effect on lipid parameters in hypercholesterolemic individuals. The suggestion to include almonds in a healthy diet may help to improve the lipid profile. Future research is likely to uncover additional bioactive substances in almond that will provide health benefits in addition to those already known.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017;70:1-25.  |
| 2. | Myers L, Mendis S. Cardiovascular disease research output in WHO priority areas between 2002 and 2011. J Epidemiol Glob Health 2014;4:23-8. |
| 3. | Ramahi TM. Cardiovascular disease in the Asia middle east region: Global trends and local implications. Asia Pac J Public Health 2010;22:83S-89S. |
| 4. | Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, et al. Priority actions for the non-communicable disease crisis. Lancet 2011;377:1438-47. |
| 5. | Jain KS, Kathiravan MK, Somani RS, Shishoo CJ. The biology and chemistry of hyperlipidemia. Bioorg Med Chem 2007;15:4674-99. |
| 6. | Bruckert E, Hayem G, Dejager S, Yau C, Bégaud B. Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients – The PRIMO study. Cardiovasc Drugs Ther 2005;19:403-14. |
| 7. | Kelly JH Jr., Sabaté J. Nuts and coronary heart disease: An epidemiological perspective. Br J Nutr 2006;96 Suppl 2:S61-7. |
| 8. | Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: A meta-analysis. Am J Clin Nutr 1999;69:30-42. |
| 9. | Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R, et al. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003;78:965-78. |
| 10. | Taku K, Umegaki K, Sato Y, Taki Y, Endoh K, Watanabe S. Soy isoflavones lower serum total and LDL cholesterol in humans: A meta-analysis of 11 randomized controlled trials. Am J Clin Nutr 2007;85:1148-56. |
| 11. | US FDA. Qualified Health Claims, Letter of Enforcement Discretion Nuts and Coronary Heart Disease (Docket no 02P-0505). Rockville (MD): US FDA; 2003. p. 1-4. |
| 12. | Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA, et al. Frequent nut consumption and risk of coronary heart disease in women: Prospective cohort study. BMJ 1998;317:1341-5. |
| 13. | Albert CM, Gaziano JM, Willett WC, Manson JE. Nut consumption and decreased risk of sudden cardiac death in the Physicians' health study. Arch Intern Med 2002;162:1382-7. |
| 14. | Fraser GE, Sabaté J, Beeson WL, Strahan TM. A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist health study. Arch Intern Med 1992;152:1416-24. |
| 15. | Ellsworth JL, Kushi LH, Folsom AR. Frequent nut intake and risk of death from coronary heart disease and all causes in postmenopausal women: The Iowa women's health study. Nutr Metab Cardiovasc Dis 2001;11:372-7. |
| 16. | Sabaté J, Ang Y. Nuts and health outcomes: New epidemiologic evidence. Am J Clin Nutr 2009;89:1643S-8S. |
| 17. | Jenkins DJ, Kendall CW, Marchie A, Josse AR, Nguyen TH, Faulkner DA, et al. Almonds reduce biomarkers of lipid peroxidation in older hyperlipidemic subjects. J Nutr 2008;138:908-13. |
| 18. | USDA Nutrient Database for Standard Reference. Release 17, U.S. Department of Agriculture, Agricultural Research Service. Available from: http://www.nal. usda.gov/fnic/foodcomp. [Last accessed 2022 Sep 09]. |
| 19. | Spiller GA, Jenkins DA, Bosello O, Gates JE, Cragen LN, Bruce B. Nuts and plasma lipids: An almond-based diet lowers LDL-C while preserving HDL-C. J Am Coll Nutr 1998;17:285-90. |
| 20. | Bento AP, Cominetti C, Simões Filho A, Naves MM. Baru almond improves lipid profile in mildly hypercholesterolemic subjects: A randomized, controlled, crossover study. Nutr Metab Cardiovasc Dis 2014;24:1330-6. |
| 21. | Berryman CE, West SG, Fleming JA, Bordi PL, Kris-Etherton PM. Effects of daily almond consumption on cardiometabolic risk and abdominal adiposity in healthy adults with elevated LDL-cholesterol: A randomized controlled trial. J Am Heart Assoc 2015;4:e000993. |
| 22. | Li SC, Liu YH, Liu JF, Chang WH, Chen CM, Chen CY. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism 2011;60:474-9. |
| 23. | Damasceno NR, Pérez-Heras A, Serra M, Cofán M, Sala-Vila A, Salas-Salvadó J, et al. Crossover study of diets enriched with virgin olive oil, walnuts or almonds. Effects on lipids and other cardiovascular risk markers. Nutr Metab Cardiovasc Dis 2011;21 Suppl 1:S14-20. |
| 24. | Mukuddem-Petersen J, Oosthuizen W, Jerling JC. A systematic review of the effects of nuts on blood lipid profiles in humans. J Nutr 2005;135:2082-9. |
| 25. | Phung OJ, Makanji SS, White CM, Coleman CI. Almonds have a neutral effect on serum lipid profiles: A meta-analysis of randomized trials. J Am Diet Assoc 2009;109:865-73. |
| 26. | Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2224-60. |
| 27. | Musa-Veloso K, Paulionis L, Poon T, Lee HY. The effects of almond consumption on fasting blood lipid levels: A systematic review and meta-analysis of randomised controlled trials. J Nutr Sci 2016;5:e34. |
| 28. | Dhillon J, Tan SY, Mattes RD. Almond consumption during energy restriction lowers truncal fat and blood pressure in compliant overweight or obese adults. Nutr J 2016;146:2513-9. |
| 29. | Souza RG, Gomes AC, Naves MM, Mota JF. Nuts and legume seeds for cardiovascular risk reduction: Scientific evidence and mechanisms of action. Nutr Rev 2015;73:335-47. |
| 30. | Abazarfard Z, Salehi M, Keshavarzi S. The effect of almonds on anthropometric measurements and lipid profile in overweight and obese females in a weight reduction program: A randomized controlled clinical trial. J Res Med Sci 2014;19:457-64. |
| 31. | Richmond K, Williams S, Mann J, Brown R, Chisholm A. Markers of cardiovascular risk in postmenopausal women with type 2 diabetes are improved by the daily consumption of almonds or sunflower kernels: A feeding study. ISRN Nutr 2013;2013:626414. |
| 32. | Hollis J, Mattes R. Effect of chronic consumption of almonds on body weight in healthy humans. Br J Nutr 2007;98:651-6. |
| 33. | Choudhury K, Clark J, Griffiths HR. An almond-enriched diet increases plasma α-tocopherol and improves vascular function but does not affect oxidative stress markers or lipid levels. Free Radic Res 2014;48:599-606. |
| 34. | Beatrice DA, Shivaji G. Effect of almond supplementation on the anthropometric measurements, biochemical parameters and blood pressure levels of men with metabolic syndrome. Indian J Nutr Diet 2015;52:184-91. |
| 35. | Schincaglia RM, Cuppari L, Neri HF, Cintra DE, Sant'Ana MR, Mota JF. Effects of baru almond oil (Dipteryx alata Vog.) supplementation on body composition, inflammation, oxidative stress, lipid profile, and plasma fatty acids of hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial. Complement Ther Med 2020;52:102479. |
| 36. | Chen CY, Holbrook M, Duess MA, Dohadwala MM, Hamburg NM, Asztalos BF, et al. Effect of almond consumption on vascular function in patients with coronary artery disease: A randomized, controlled, cross-over trial. Nutr J 2015;14:61. |
| 37. | |
| 38. | Ruisinger JF, Gibson CA, Backes JM, Smith BK, Sullivan DK, Moriarty PM, et al. Statins and almonds to lower lipoproteins (the STALL Study). J Clin Lipidol 2015;9:58-64. |
| 39. | Sabaté J, Haddad E, Tanzman JS, Jambazian P, Rajaram S. Serum lipid response to the graduated enrichment of a Step I diet with almonds: A randomized feeding trial. Am J Clin Nutr 2003;77:1379-84. |
| 40. | Wien MA, Sabaté JM, Iklé DN, Cole SE, Kandeel FR. Almonds versus complex carbohydrates in a weight reduction program. Int J Obes Relat Metab Disord 2003;27:1365-72. |
| 41. | Burns AM, Zitt MA, Rowe CC, Langkamp-Henken B, Mai V, Nieves C Jr., et al. Diet quality improves for parents and children when almonds are incorporated into their daily diet: A randomized, crossover study. Nutr Res 2016;36:80-9. |
| 42. | Gulati S, Misra A, Pandey RM. Effect of almond supplementation on glycemia and cardiovascular risk factors in Asian Indians in North India with type 2 diabetes mellitus: A 24-week study. Metab Syndr Relat Disord 2017;15:98-105. |
| 43. | Berryman CE, West SG, Bordi PL, Fleming JA, Kris-Etherton PM. Daily inclusion of almonds (1.5 ounces) in a cholesterol-lowering diet maintains HDL-cholesterol and HDL subclasses in mildly hypercholesterolemic adults. Poster presentation at the IUNS 20 th International Congress of Nutrition. Ann Nutr Metab Ann Nutr Metab 2013;63:1338. |
| 44. | Lovejoy JC, Most MM, Lefevre M, Greenway FL, Rood JC. Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes. Am J Clin Nutr 2002;76:1000-6. |
| 45. | Nishi S, Kendall CW, Gascoyne AM, Bazinet RP, Bashyam B, Lapsley KG, et al. Effect of almond consumption on the serum fatty acid profile: A dose-response study. Br J Nutr 2014;112:1137-46. |
| 46. | Dikariyanto V, Smith L, Chowienczyk PJ, Berry SE, Hall WL. Snacking on whole almonds for six weeks increases heart rate variability during mental stress in healthy adults: A randomized controlled trial. Nutrients 2020;12:1828. |
| 47. | Jung H, Chen CO, Blumberg JB, Kwak HK. The effect of almonds on vitamin E status and cardiovascular risk factors in Korean adults: A randomized clinical trial. Eur J Nutr 2018;57:2069-79. |
| 48. | |
| 49. | Lee Y, Berryman CE, West SG, Chen CO, Blumberg JB, Lapsley KG, et al. Effects of dark chocolate and almonds on cardiovascular risk factors in overweight and obese individuals: A randomized controlled-feeding trial. J Am Heart Assoc 2017;6:e005162. |
| 50. | Hou YY, Ojo O, Wang LL, Wang Q, Jiang Q, Shao XY, et al. A randomized controlled trial to compare the effect of peanuts and almonds on the cardio-metabolic and inflammatory parameters in patients with type 2 diabetes mellitus. Nutrients 2018;10:1565. |
| 51. | Tey SL, Delahunty C, Gray A, Chisholm A, Brown RC. Effects of regular consumption of different forms of almonds and hazelnuts on acceptance and blood lipids. Eur J Nutr 2015;54:483-7. |
| 52. | Jamshed H, Sultan FA, Iqbal R, Gilani AH. Dietary almonds increase serum HDL cholesterol in coronary artery disease patients in a randomized controlled trial. J Nutr 2015;145:2287-92. |
| 53. | Lamarche B, Desroches S, Jenkins DJ, Kendall CW, Marchie A, Faulkner D, et al. Combined effects of a dietary portfolio of plant sterols, vegetable protein, viscous fibre and almonds on LDL particle size. Br J Nutr 2004;92:657-63. |
| 54. | Schakel SF, Pettit J, Himes JH. Dietary fifiber values for common foods. In: Spiller GA, editor. The CRC Handbook of Dietary Fiber in Human Nutrition. 3 rd ed. London: CRC Press; 2001. |
| 55. | Marlett JA. Content and composition of dietary fiber in 117 frequently consumed foods. J Am Diet Assoc 1992;92:175-86. |
[Table 1], [Table 2]
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