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Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women: A Randomized Crossover Trial

Daniel Zambón, MD; Joan Sabaté, MD, DrPH; Sonia Muñoz, PhD; Betina Campero, RD; Elena Casals, MD; Manuel Merlos, PhD; Juan C. Laguna, PhD; and Emilio Ros, MD
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From Hospital Clínic and School of Pharmacy, University of Barcelona, Barcelona, Spain; and Loma Linda University, Loma Linda, California.

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.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

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.

Ann Intern Med. 2000;132(7):538-546. doi:10.7326/0003-4819-132-7-200004040-00005
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Lifestyle modification is the cornerstone of population-based strategies for prevention of coronary heart disease and is the first line of therapy in patients with hypercholesterolemia. Diets low in saturated fatty acids and cholesterol have long been recommended to decrease low-density lipoprotein (LDL) cholesterol levels and reduce cardiovascular risk (1). Ample evidence suggests that polyunsaturated fatty acids and monounsaturated fatty acids have a similar cholesterol-lowering effect when substituted for saturated fatty acids (24). However, most studies of fatty acids and blood lipids have been done with fats and oils, rarely with whole fatty foods. Because people usually buy and consume whole food products, it is desirable to know the effects of specific foods on risk factors for coronary heart disease.

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Figure 2.
Changes from baseline values in levels of serum lipids, lipoproteins, and apolipoproteins in all patients who completed the study. Top.Bottom.tPP

Mean changes from baseline in serum lipid levels. Mean changes from baseline in levels of apolipoprotein A-I, apolipoprotein B, and lipoprotein(a). White bars indicate the control diet; striped bars indicate the walnut diet. HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; TC = total cholesterol; TG = triglyceride; VLDL-C = very-low-density lipoprotein cholesterol. Error bars represent 95% CIs. To convert triglyceride values to mg/dL, divide by 0.01129; to convert high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, and very-low-density lipoprotein cholesterol values to mg/dL, divide by 0.02586. Asterisks indicate significant differences from baseline by the two-tailed -test. * < 0.001; ** < 0.05.

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Summary for Patients

Eating Walnuts Lowers Cholesterol Levels in People with High Cholesterol

The summary below is from the full report titled “Substituting Walnuts for Monounsaturated Fat Improves the Serum Lipid Profile of Hypercholesterolemic Men and Women. A Randomized Crossover Trial.”. It is in the 4 April 2000 issue of Annals of Internal Medicine (volume 132, pages 538-546). The authors are D. Zambón, J. Sabaté, S. Muñoz, B. Campero, E. Casals, M. Merlos, J.C. Laguna, and E. Ros.


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