Nuts as a Replacement for Carbohydrates in the Diabetic Diet

David J.A. Jenkins; Cyril W.C. Kendall; Monica S. Banach; Korbua Srichaikul; Edward Vidgen; Sandy Mitchell; Tina Parker; Stephanie Nishi; Balachandran Bashyam; Russell de Souza; Christopher Ireland; Robert G. Josse

doi:10.2337/dc11-0338

Original Research

Nuts as a Replacement for Carbohydrates in the Diabetic Diet

David J.A. Jenkins, MD¹,²,³,⁴ ⇑,
Cyril W.C. Kendall, PHD¹,³,⁵,
Monica S. Banach, MSC¹,
Korbua Srichaikul, MSC¹,³,
Edward Vidgen, BSC¹,³,
Sandy Mitchell, RD¹,
Tina Parker, RD¹,
Stephanie Nishi, BSC¹,³,
Balachandran Bashyam, PHD¹,³,
Russell de Souza, SD, RD¹,³,
Christopher Ireland, BSC¹ and
Robert G. Josse, MB, BS¹,²,³,⁴

¹Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
²Division of Endocrinology and Metabolism, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
³Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
⁴Department of Medicine, University of Toronto, Toronto, Ontario, Canada
⁵College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Corresponding author: David J.A. Jenkins, cyril.kendall{at}utoronto.ca.

Diabetes Care 2011 Aug; 34(8): 1706-1711. https://doi.org/10.2337/dc11-0338

This article has been retracted. Please see:

Statement of Retraction. Nuts as a Replacement for Carbohydrates in the Diabetic Diet. Diabetes Care 2011;34:1706–1711. DOI: 10.2337/dc11-0338 - February 01, 2016

Abstract

OBJECTIVE Fat intake, especially monounsaturated fatty acid (MUFA), has been liberalized in diabetic diets to preserve HDL cholesterol and improve glycemic control, yet the exact sources have not been clearly defined. Therefore, we assessed the effect of mixed nut consumption as a source of vegetable fat on serum lipids and HbA_1c in type 2 diabetes.

RESEARCH DESIGN AND METHODS A total of 117 type 2 diabetic subjects were randomized to one of three treatments for 3 months. Supplements were provided at 475 kcal per 2,000-kcal diet as mixed nuts (75 g/day), muffins, or half portions of both. The primary outcome was change in HbA_1c.

RESULTS The relative increase in MUFAs was 8.7% energy on the full-nut dose compared with muffins. Using an intention-to-treat analysis (n = 117), full-nut dose (mean intake 73 g/day) reduced HbA_1c (−0.21% absolute HbA_1c units, 95% CI −0.30 to −0.11, P < 0.001) with no change after half-nut dose or muffin. Full-nut dose was significantly different from half-nut dose (P = 0.004) and muffin (P = 0.001), but no difference was seen between half-nut dose and muffins. LDL cholesterol also decreased significantly after full-nut dose compared with muffin. The LDL cholesterol reduction after half-nut dose was intermediate and not significantly different from the other treatments. Apolipoprotein (apo) B and the apoB:apoA1 ratio behaved similarly. Nut intake related negatively to changes in HbA_1c (r = −0.20, P = 0.033) and LDL cholesterol (r = −0.24, P = 0.011).

CONCLUSIONS Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes.

Footnotes

Clinical trial reg. no. NCT00410722, clinicaltrials.gov.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-0338/-/DC1.

Received February 18, 2011.
Accepted May 4, 2011.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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