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Original Research

Nuts as a Replacement for Carbohydrates in the Diabetic Diet

  1. David J.A. Jenkins, MD1,2,3,4⇑,
  2. Cyril W.C. Kendall, PHD1,3,5,
  3. Monica S. Banach, MSC1,
  4. Korbua Srichaikul, MSC1,3,
  5. Edward Vidgen, BSC1,3,
  6. Sandy Mitchell, RD1,
  7. Tina Parker, RD1,
  8. Stephanie Nishi, BSC1,3,
  9. Balachandran Bashyam, PHD1,3,
  10. Russell de Souza, SD, RD1,3,
  11. Christopher Ireland, BSC1 and
  12. Robert G. Josse, MB, BS1,2,3,4
  1. 1Clinical Nutrition and Risk Factor Modification Center, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
  2. 2Division of Endocrinology and Metabolism, St. Michael’s Hospital Toronto, Toronto, Ontario, Canada
  3. 3Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  1. 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
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    Figure 1

    Mean HbA1c measurements in participants with type 2 diabetes consuming full-nut dose, half-nut dose, or muffins.

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  • Table 1

    Baseline characteristics of study participants

    Number (%) of participantsP
    NutsHalf doseMuffins
    n403839
    Age (years)*63 (9)62 (8)61 (10)0.61†
    Sex
     Male26 (65)26 (68)26 (67)0.97‡
     Female14 (35)12 (32)13 (33)
    Race/ethnicity
     European23 (58)25 (66)18 (46)0.83‡
     Indian10 (25)8 (21)13 (33)
     Far Eastern4 (10)3 (8)3 (8)
     African3 (8)2 (5)3 (8)
     Hispanic0 (0)0 (0)1 (3)
     Native American0 (0)0 (0)1 (3)
    Weight (kg)*80 (15)86 (16)83 (15)0.20†
    BMI (kg/m2)*29 (5)30 (5)29 (4)0.37†
    Current smokers2 (5)4 (11)3 (8)0.57‡
    HbA1c (%)
     <7.020 (50)20 (53)22 (56)0.84‡
     ≥7.020 (50)18 (47)17 (44)
    Duration of diabetes (years)*7 (6)8 (6)8 (6)0.57†
    Medication use
     Hypoglycemic medications40 (100)38 (100)39 (100)1.00‡
     Thiazolidinedione12 (30)11 (29)11 (28)1.00‡
     Biguanide35 (88)36 (95)35 (90)0.62‡
     Sulfonylurea14 (35)13 (34)17 (44)0.64‡
     Meglitinides (nonsulfonylurea)2 (5)3 (8)2 (5)0.79‡
     α-Glucosidase inhibitors0 (0)0 (0)0 (0)1.00
     Dipeptidyl peptidase-4 inhibitor0 (0)0 (0)1 (3)0.66‡
     Cholesterol-lowering medications23 (58)a31 (82)b30 (77)ab0.046‡
     Blood pressure medications23 (58)29 (76)28 (72)0.12‡
    • Data are n (%) or *mean (SD).

    • ↵†P value is for overall F test for between-groups differences using the generalized linear model ANOVA.

    • ↵‡P values for Fisher exact test where appropriate were calculated separately for distribution of each medication, since participants were from multiple nationalities or on multiple medications. A difference in superscript letters signifies a significant difference in percentage changes using the Q statistic.

  • Table 2

    Mean study measurements and significance of treatment differences in the intention-to-treat analysis

    Baseline*End point*Treatment difference†
    Full-nut doseHalf-nut doseMuffinsFull-nut doseHalf-nut doseMuffinsFull-nut dose vs. muffins (P)Full- vs. half-nut dose (P)Half-nut dose vs. muffins (P)
    n403839403839
    Glucose (mmol/L)7.3 (6.9–7.7)7.4 (6.9–7.8)7.1 (6.7–7.5)7.2 (6.7–7.6)7.4 (6.7–8.1)7.2 (6.7–7.7)0.0790.3040.681
    HbA1c (%)7.1 (6.9–7.3)7.1 (6.9–7.3)7.1 (7.0–7.3)6.9 (6.7–7.1)7.0 (6.8–7.3)7.1 (6.9–7.2)0.0010.0040.863
    Lipids (mmol/L)
     Total cholesterol4.4 (4.1–4.8)4.0 (3.8–4.2)4.2 (3.9–4.5)4.2 (3.9–4.6)4.0 (3.8–4.3)4.3 (3.9–4.6)<0.0010.0420.203
     LDL cholesterol2.5 (2.1–2.8)2.2 (2.0–2.4)2.3 (2.0–2.5)2.3 (1.9–2.6)2.1 (1.9–2.4)2.3 (2.1–2.6)<0.0010.1230.048
     HDL cholesterol1.2 (1.1–1.2)1.1 (1.0–1.2)1.2 (1.1–1.3)1.2 (1.1–1.3)1.2 (1.1–1.3)1.2 (1.1–1.3)0.4050.3640.995
     Triglycerides1.8 (1.5–2.0)1.6 (1.3–1.8)1.6 (1.4–1.9)1.7 (1.3–2.0)1.6 (1.3–1.9)1.6 (1.4–1.8)0.1580.0640.970
    Total cholesterol:HDL cholesterol ratio3.9 (3.6–4.3)3.8 (3.3–4.2)3.8 (3.4–4.2)3.6 (3.3–3.9)3.7 (3.2–4.1)3.7 (3.3–4.1)0.0060.1630.047
     LDL cholesterol:HDL cholesterol ratio2.2 (1.9–2.5)2.1 (1.8–2.4)2.1 (1.8–2.4)1.9 (1.7–2.2)1.9 (1.7–2.2)2.0 (1.7–2.3)0.0020.1630.013
     ApoA11.5 (1.4–1.5)1.5 (1.4–1.5)1.5 (1.4–1.5)1.5 (1.4–1.5)1.5 (1.4–1.6)1.5 (1.4–1.6)0.260.2490.976
     ApoB0.85 (0.76–0.93)0.76 (0.70–0.82)0.79 (0.72–0.85)0.80 (0.72–0.88)0.75 (0.69–0.81)0.80 (0.73–0.87)<0.0010.1470.012
     ApoB:apoA10.58 (0.52–0.63)0.54 (0.48–0.60)0.55 (0.49–0.62)0.54 (0.49–0.59)0.52 (0.46–0.58)0.55 (0.49–0.61)0.0040.5370.001
    Serum CRP (nmol/L)1.6 (1.1–2.1)1.8 (0.9–2.7)1.9 (1.1–2.6)2.2 (1.2–3.2)1.5 (1.1–2.0)2.0 (1.2–2.8)0.6820.1860.042
    Blood pressure (mmHg)
     Systolic121 (118–125)123 (119–128)125 (121–129)119 (116–123)124 (120–128)124 (120–128)0.0840.0050.274
     Diastolic70 (67–73)71 (69–74)71 (68–75)69 (66–72)72 (70–74)72 (68–75)0.0240.0210.888
    • Data are means (95% CI). n = 117.

    • ↵*Baseline is an average of weeks −1 and 0 and end point is an average of weeks 8, 10, and 12, except for body weight (week 0).

    • ↵†Mean treatment differences (95% CI) were determined and P values were estimated by CONTRAST using average baseline and the difference from week 8, 10, and 12. Significance by Bonferroni, P < 0.0175.

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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
Diabetes Care Aug 2011, 34 (8) 1706-1711; DOI: 10.2337/dc11-0338

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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
Diabetes Care Aug 2011, 34 (8) 1706-1711; DOI: 10.2337/dc11-0338
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