Markers of Cardiovascular Risk in Postmenopausal Women with Type 2 Diabetes Are Improved by the Daily Consumption of Almonds or Sunflower Kernels: A Feeding Study

Dietary guidelines for the treatment of type 2 diabetes advocate the regular consumption of nuts and seeds. Key lipid abnormalities associated with diabetes include raised LDL-C, VLDL-C, and TAG concentrations and decreased concentrations of HDL-C. The fatty acid profiles of nuts and seeds differ and may potentially influence lipid outcomes in people with diabetes differently. To examine the effects of nut or seed consumption on lipid and lipoprotein markers of cardiovascular disease (CVD), we added almonds (AD) or sunflower kernels (SKD) to a recommended diet in a randomised crossover feeding study. Twenty-two postmenopausal women with type 2 diabetes consumed personalised diets, with the addition of 30？g/d of either almonds or sunflower kernels. All food was supplied for two periods of three weeks, separated by a four-week washout. There was a significant reduction in high-density lipoprotein cholesterol (HDL-C), triacylglycerol (TAG), and apolipoprotein (apo) A1 and B100 on the SKD compared to the AD. Total (TC) and low density lipoprotein cholesterol (LDL-C) decreased significantly on both diets from baseline, with no difference between diets. A diet with the addition of either almonds or sunflower kernels has clinically beneficial effects on lipid- and lipoprotein-mediated CVD risk. 1. Introduction Type 2 diabetes is a major independent risk factor for CVD, and this increased risk is partly attributed to abnormalities in lipid and lipoprotein metabolism as a consequence of hyperglycaemia and insulin resistance [1–4]. People with diabetes have a greater than twofold increase in the risk of CVD [5], and this risk is even greater in women who have an estimated fivefold higher cardiovascular mortality compared to women without diabetes [6]. Additionally, this risk is higher after menopause [7, 8], and with an ageing population the burden of diabetes is likely to increase. The key lipid abnormalities associated with diabetes include raised LDL-C, VLDL-C, and TAG concentrations and decreased concentrations of HDL-C [1, 3, 4, 9]. Dietary intervention plays a major role in the treatment of both type 2 diabetes and dyslipidaemia with particular emphasis on the fatty acid composition of the diet as a determinant of CVD risk [9, 10]. Nuts and seeds are rich sources of cis-unsaturated fatty acids, and their inclusion into the diets of people with diabetes is recommended in dietary guidelines [11, 12]. There is strong evidence from both epidemiological and intervention studies for the benefits of incorporating nuts into the diet for CVD prevention and treatment