Daniel Zambón, MD; Joan Sabaté, MD, DrPH; Sonia Muñoz, PhD; Betina Campero, RD; Elena Casals, MD; Manuel Merlos, PhD; Juan C. Laguna, PhD; Emilio Ros, MD
Acknowledgments: The authors thank Nahyr Schinca, RD, and Ana Pérez-Heras, RD, for dietary counseling of the participants in the study. Catherine Bouchet, Antonia Codinach, and Ana Asensio provided skillful technical assistance with the laboratory measurements.
Grant Support: By the California Walnut Commission, Fundació Privada Catalana de Nutrició i Lípids, Fondo de Investigaciónes Sanitarias de la Seguridad Social (FIS 94/0077), and Comisión Interministerial de Ciencia y Tecnología (CICYT, SAF 97/0215, and OLI 96/2132).
Requests for Single Reprints: Emilio Ros, MD, Lipid Clinic, Nutrition & Dietetics Service, Hospital Clínic i Provincial, Villarroel 170, E-08036 Barcelona, Spain.
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Current Author Addresses: Drs. Zambón and Ros and Ms. Campero: Lipid Clinic, Nutrition & Dietetics Service, Hospital Clínic i Provincial, Villarroel 170, E-08036 Barcelona, Spain.
Dr. Sabaté: Department of Nutrition, School of Public Health, Loma Linda University, Loma Linda, CA 92350.
Drs. Muñoz, Merlos, and Laguna: Pharmacology Unit, School of Pharmacy, University of Barcelona, E-08028 Barcelona, Spain.
Dr. Casals: Department of Clinical Biochemistry, Hospital Clínic i Provincial, Villarroel 170, E-08036 Barcelona, Spain.
Author Contributions: Conception and design: D. Zambón, J. Sabaté, E. Ros.
Analysis and interpretation of the data: D. Zambón, J. Sabaté, J.C. Laguna, E. Ros.
Drafting of the article: D. Zambón, J.C. Laguna, E. Ros.
Critical revision of the article for important intellectual content: D. Zambón, J. Sabaté, J.C. Laguna, E. Ros.
Final approval of the article: D. Zambón, J. Sabaté, S. Muñoz, B. Campero, E. Casals, M. Merlos, J.C. Laguna, E. Ros.
Provision of study materials or patients: D. Zambón, B. Campero.
Statistical expertise: D. Zambón, J. Sabaté.
Obtaining of funding: D. Zambón, J. Sabaté, J.C. Laguna, E. Ros.
Administrative, technical, or logistic support: S. Muñoz, E. Casals.
Collection and assembly of data: S. Muñoz, B. Campero, E. Casals, M. Merlos.
It has been reported that walnuts reduce serum cholesterol levels in normal young men.
To assess the acceptability of walnuts and their effects on serum lipid levels and low-density lipoprotein (LDL) oxidizability in free-living hypercholesterolemic persons.
Randomized, crossover feeding trial.
Lipid clinic at a university hospital.
55 men and women (mean age, 56 years) with polygenic hypercholesterolemia.
A cholesterol-lowering Mediterranean diet and a diet of similar energy and fat content in which walnuts replaced approximately 35% of the energy obtained from monounsaturated fat. Patients followed each diet for 6 weeks.
Low-density lipoprotein fatty acids (to assess compliance), serum lipid levels, lipoprotein(a) levels, and LDL resistance to in vitro oxidative stress.
49 persons completed the trial. The walnut diet was well tolerated. Planned and observed diets were closely matched. Compared with the Mediterranean diet, the walnut diet produced mean changes of −4.1% in total cholesterol level, −5.9% in LDL cholesterol level, and −6.2% in lipoprotein(a) level. The mean differences in the changes in serum lipid levels were −0.28 mmol/L (95% CI, −0.43 to −0.12 mmol/L) (−10.8 mg/dL [−16.8 to −4.8 mg/dL]) (P < 0.001) for total cholesterol level, −0.29 mmol/L (CI, −0.41 to −0.15 mmol/L) (−11.2 mg/dL [−16.3 to −6.1 mg/dL]) (P < 0.001) for LDL cholesterol level, and −0.021 g/L (CI, −0.042 to −0.001 g/L) (P = 0.042) for lipoprotein(a) level. Lipid changes were similar in men and women except for lipoprotein(a) levels, which decreased only in men. Low-density lipoprotein particles were enriched with polyunsaturated fatty acids from walnuts, but their resistance to oxidation was preserved.
Substituting walnuts for part of the monounsaturated fat in a cholesterol-lowering Mediterranean diet further reduced total and LDL cholesterol levels in men and women with hypercholesterolemia.
Zambón D, Sabaté J, Muñoz S, Campero B, Casals E, Merlos M, et al. Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women: A Randomized Crossover Trial. Ann Intern Med. ;132:538–546. doi: 10.7326/0003-4819-132-7-200004040-00005
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Published: Ann Intern Med. 2000;132(7):538-546.
Cardiology, Coronary Risk Factors, Dyslipidemia.
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