Nuts and novel biomarkers of cardiovascular disease

Nuts are energy-dense foods, rich in total fat and unsaturated fatty acids. The favorable fatty acid profile probably contributes to the beneficial effects of nut consumption observed in epidemiologic studies (prevention of coronary heart disease and diabetes) and feeding trials (cholesterol lowering). Besides fat, the complex matrices of nuts contain many bioactive compounds: vegetable protein, fiber, minerals, tocopherols, and phenolic compounds. By virtue of their unique composition, nuts are likely to benefit newer cardiovascular risk biomarkers, such as LDL oxidizability, soluble inflammatory molecules, and endothelial dysfunction. Protection of LDL oxidation by nut intake has been documented in some, but not all, clinical studies. In one study, feeding one daily serving of mixed nuts was associated with lower oxidized LDL concentrations. Regarding inflammation, cross-sectional studies have shown that nut consumption is associated with lower concentrations of circulating inflammatory molecules and higher plasma adiponectin, a potent antiinflammatory adipokine. Clinical studies with nuts have documented reduced inflammatory cytokine concentrations but no consistent changes of C-reactive protein. Only walnuts have been formally tested for effects on endothelial function. After both walnut diets and single walnut meals, favorable vasoreactivity changes have been observed. Walnut consumption also reduced expression of endothelin 1, a potent endothelial activator, in an animal model of accelerated atherosclerosis. Beneficial effects on vascular reactivity may be ascribed to several constituents of walnuts: L-arginine, the precursor of nitric oxide, a-linolenic acid, and phenolic antioxidants. Although more studies are warranted, the emerging picture is that nut consumption beneficially influences cardiovascular risk beyond cholesterol lowering. Am J Clin Nutr 2009; 89(suppl): 1649S-56S.