title: Walnut ingestion in adults at risk for diabetes: effects on body composition, diet quality, and cardiac risk measures.
abstract: BACKGROUND
  Despite their energy density, walnuts can be included in the diet without adverse effects on weight or body composition. The effect of habitual walnut intake on total calorie intake is not well studied. Effects on overall diet quality have not been reported.
  
  
  METHODS
  Randomized, controlled, modified Latin square parallel design study with 2 treatment arms. The 112 participants were randomly assigned to a diet with or without dietary counseling to adjust calorie intake. Within each treatment arm, participants were further randomized to 1 of the 2 possible sequence permutations to receive a walnut-included diet with 56 g (providing 366 kcal) of walnuts per day and a walnut-excluded diet. Participants were assessed for diet quality, body composition, and cardiac risk measures.
  
  
  RESULTS
  When compared with a walnut-excluded diet, a walnut-included diet for 6 months, with or without dietary counseling to adjust caloric intake, significantly improved diet quality as measured by the Healthy Eating Index 2010 (9.14±17.71 vs 0.40±15.13; p=0.02 and 7.02±15.89 vs -5.92±21.84; p=0.001, respectively). Endothelial function, total and low-density lipoprotein (LDL) cholesterol improved significantly from baseline in the walnut-included diet. Body mass index, percent body fat, visceral fat, fasting glucose, glycated hemoglobin, and blood pressure did not change significantly.
  
  
  CONCLUSIONS
  The inclusion of walnuts in an ad libitum diet for 6 months, with or without dietary counseling to adjust calorie intake, significantly improved diet quality, endothelial function, total and LDL cholesterol, but had no effects on anthropometric measures, blood glucose level, and blood pressure.
  
  
  BACKGROUND
  NCT02330848.
authors.affiliation: Yale University Prevention Research Center , Derby, Connecticut , USA ; Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: Valentine Yanchou
authors.initials: VY
authors.lastname: Njike
authors.affiliation: Yale University Prevention Research Center , Derby, Connecticut , USA ; Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: Rockiy
authors.initials: R
authors.lastname: Ayettey
authors.affiliation: Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Petraro
authors.affiliation: Yale University Prevention Research Center , Derby, Connecticut , USA ; Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Treu
authors.affiliation: Yale University Prevention Research Center , Derby, Connecticut , USA ; Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Katz
keywords: BMI; Body Composition; Body Fat Distribution