title: Nuts as a replacement for carbohydrates in the diabetic diet.
abstract: OBJECTIVE
  Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA(1c) in type 2 diabetes.
  
  
  METHODS
  A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA(1c).
  
  
  RESULTS
  The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA(1c) (-0.21% absolute HbA(1c) units, 95% CI -0.30 to -0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA(1c) (r = -0.20, P = 0.033) and LDL cholesterol (r = -0.24, P = 0.011).
  
  
  CONCLUSIONS
  Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.
authors.affiliation: St. Michael's Hospital Toronto, Toronto,Ontario, Canada.
authors.forename: David J A
authors.initials: DJ
authors.lastname: Jenkins
authors.forename: Cyril W C
authors.initials: CW
authors.lastname: Kendall
authors.forename: Monica S
authors.initials: MS
authors.lastname: Banach
authors.forename: Korbua
authors.initials: K
authors.lastname: Srichaikul
authors.forename: Edward
authors.initials: E
authors.lastname: Vidgen
authors.forename: Sandy
authors.initials: S
authors.lastname: Mitchell
authors.forename: Tina
authors.initials: T
authors.lastname: Parker
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nishi
authors.forename: Balachandran
authors.initials: B
authors.lastname: Bashyam
authors.forename: Russell
authors.initials: R
authors.lastname: de Souza
authors.forename: Christopher
authors.initials: C
authors.lastname: Ireland
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy* / Q000378:metabolism; D003927:Diet, Diabetic; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009754:Nuts
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D004040:Dietary Carbohydrates; D006442:Glycated Hemoglobin