title: Inclusion of walnut in the diets of adults at risk for type 2 diabetes and their dietary pattern changes: a randomized, controlled, cross-over trial.
abstract: BACKGROUND
  In our recently published study, including walnuts in the diets of adults with prediabetes led to overall improvement in diet quality. This report adds to those study findings by examining the food groups displaced during walnut inclusion in the diets of those adults with prediabetes.
  
  
  METHODS
  Randomized, controlled, modified Latin square parallel design with 2 treatment arms. The 112 participants (31 men, 81 women) were randomly assigned to a diet with or without dietary counseling to regulate calorie intake in a 1:1 ratio. Within each treatment arm, participants were further randomized to 1 of 2 sequence permutations to receive a walnut-included diet with 56 g (366 kcal) of walnuts per day and a walnut-excluded diet. Participants in the calorie-regulated arm received advice from a dietitian to preserve an isocaloric condition while including walnuts. We analyzed the 12 components of the 2010 Healthy Eating Index to examine dietary pattern changes of study participants.
  
  
  RESULTS
  Seafood and plant protein foods intake significantly increased with walnut inclusion, compared with their exclusion (2.14±2.06 vs -0.49±2.33; p=0.003). The ingestion of healthful fatty acids also significantly increased with walnut inclusion, compared with their exclusion (1.43±4.53 vs -1.76±4.80; p=0.02). Dairy ingestion increased with walnut inclusion in the calorie-regulated phase, compared with walnut inclusion without calorie regulation (1.06±4.42 vs -2.15±3.64; p=0.02).
  
  
  CONCLUSIONS
  Our data suggest that walnut inclusion in the diets of adults at risk for diabetes led to an increase in intake of other healthful foods.
  
  
  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: Griffin Hospital-Derby , Derby, Connecticut , USA.
authors.forename: Niloufarsadat
authors.initials: N
authors.lastname: Yarandi
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: Rockiy G
authors.initials: RG
authors.lastname: Ayettey
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: A1C; Nutrition; Nuts