Intake of partially defatted Brazil nut flour reduces serum cholesterol in hypercholesterolemic patients--a randomized controlled trial

Roberta F Carvalho, Grazielle V B Huguenin, Ronir R Luiz, Annie S B Moreira, Glaucia M M Oliveira, Glorimar Rosa, Roberta F Carvalho, Grazielle V B Huguenin, Ronir R Luiz, Annie S B Moreira, Glaucia M M Oliveira, Glorimar Rosa

Abstract

Objective: Thyroid hormones can lower levels of atherogenic lipoproteins, and selenium is important in thyroid hormone homeostasis. We aimed to investigate the effects of a healthy diet associated with the Brazil nut (Bertholletia excelsa) in dyslipidemic and hypertensive patients.

Methods: This study was a randomized, placebo-controlled, double-blind trial. Seventy-seven dyslipidemic and hypertensive patients already receiving lipid-lowering drugs received either a dietary treatment associated with partially defatted Brazil nut flour (13 g/day providing 227,5 μg of selenium/day),or with dyed cassava flour as a placebo. All patients received a personalized dietary guideline with nutritional recommendations for dyslipidemia and hypertension and were followed for 90 days.

Results: The Brazil nut group showed reductions in total cholesterol (-20.5 ± 61.2 mg/dL, P = 0.02), non HDL-cholesterol (-19.5 ± 61.2 mg/dL, P = 0.02) and Apo A-1 (-10.2 ± 26.7 mg/dL, P = 0.03) without significant alterations in the Apo B/Apo A-1 ratio. The placebo group showed a reduction in FT3 levels (-0.1 ± 0.4, P = 0.03) and increased Lp(a) levels (5.9 ± 18.0 mg/dL, P = 0.02). There were no statistical differences in blood pressure and serum lipids between Brazil nut and placebo group.

Conclusions: Supplementation with Brazil nuts seems to favor the maintenance of FT3 levels and contributes to lipemia reduction in hypercholesterolemic and euthyroid patients.

Trial registration: ClinicalTrials.gov Identifier NCT01990391.

Figures

Fig. 1
Fig. 1
Flowchart of participants in the randomized clinical trial
Fig. 2
Fig. 2
Plasma selenium levels in both groups over 90 days. Values are expressed as means and standard deviations with 95 % CI. n = 77. Values were measured for both groups on days 0, 30, 60 and 90. Excluding baseline levels, values differed significantly within and between groups at every time point
Fig. 3
Fig. 3
Serum total cholesterol levels in both groups over 90 days. Values are expressed as means and standard deviations with 95 % CI, n = 77. Values were measured for both groups on days 0, 30, 60 and 90. Values differed significantly only for the Brazil nut group at the T90

References

    1. WHO . In: Global atlas on cardiovascular disease prevention and control: policies, strategies, and interventions. Mendis S, Puska P, Norrving B, editors. Geneva: World Health Organization; 2011.
    1. Pande RL. Approach to lipid therapy in the patient with atherosclerotic vascular disease. Curr Treat Options Cardiovasc Med. 2012;14:177–83. doi: 10.1007/s11936-012-0167-8.
    1. Berthezene F, Perrot L, De Parscau L, Valentin C, Richard L. Thyroid hormones and the metabolism of lipoproteins. Ann Endocrinol (Paris) 1983;44:73–6.
    1. Sasaki S, Kawai K, Honjo Y, Nakamura H. Thyroid hormones and lipid metabolism. Nihon Rinsho. 2006;64:2323–9.
    1. Josseaume C, Lorcy Y. Thyroid hormone analogs: an important biological supply and new therapeutic possibilities. Ann Endocrinol (Paris) 2008;69(Suppl 1):S33–6. doi: 10.1016/S0003-4266(08)73966-0.
    1. Ladenson PW, Kristensen JD, Ridgway EC, Olsson AG, Carlsson B, Klein I, et al. Use of the thyroid hormone analogue eprotirome in statin-treated dyslipidemia. N Engl J Med. 2010;362:906–16. doi: 10.1056/NEJMoa0905633.
    1. Grover GJ, Mellstrom K, Ye L, Malm J, Li YL, Bladh LG, et al. Selective thyroid hormone receptor-beta activation: a strategy for reduction of weight, cholesterol, and lipoprotein (a) with reduced cardiovascular liability. ProcNatlAcadSci U S A. 2003;100:10067–72. doi: 10.1073/pnas.1633737100.
    1. Morkin E, Ladenson P, Goldman S, Adamson C. Thyroid hormone analogs for treatment of hypercholesterolemia and heart failure: past, present and future prospects. J Mol Cell Cardiol. 2004;37:1137–46.
    1. Park HT, Cho GJ, Ahn KH, Shin JH, Hong SC, Kim T, et al. Thyroid stimulating hormone is associated with metabolic syndrome in euthyroid postmenopausal women. Maturitas. 2009;62:301–5. doi: 10.1016/j.maturitas.2009.01.007.
    1. Köhrle J, Jakob F, Contempré B, Dumont JE. Selenium, thethyroid, and the endocrine system. Endocr Rev. 2005;26:944–84. doi: 10.1210/er.2001-0034.
    1. Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronineselenodeiodinases. Endocr Rev. 2002;23:38–89. doi: 10.1210/edrv.23.1.0455.
    1. Schomburg L. Selenium, selenoproteins and the thyroid gland: interactions in health and disease. Nat Rev Endocrinol. 2011;8:160–71. doi: 10.1038/nrendo.2011.174.
    1. Navarro-Alarcón M, López-Garcia de la Serrana H, Pérez-Valero V, López-Martínez C. Serum and urine selenium concentrations in patients with cardiovascular diseases and relationship to other nutritional indexes. Ann NutrMetab. 1999;43:30–6.
    1. Chang JC, Gutenmann WH, Reid CM, Lisk DJ. Selenium content of Brazil nuts from two geographic locations in Brazil. Chemosphere. 1995;30:801–2. doi: 10.1016/0045-6535(94)00409-N.
    1. Chunhieng T, Pétritis K, Elfakir C, Brochier J, Goli T, Montet D. Study of selenium distribution in the protein fractions of the Brazil nut. Bertholletiaexcelsa J Agric Food Chem. 2004;52:4318–22. doi: 10.1021/jf049643e.
    1. Jones DD, May KE, Geraci SA. Subclinical thyroid disease. Am J Med. 2010;123:502–4. doi: 10.1016/j.amjmed.2009.12.023.
    1. National Kidney Foundation/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.
    1. Millán Adame E, Florea D, Sáez Pérez L, Molina López J, López-González B, Pérez De La Cruz A, et al. Deficient selenium status of a healthy adult Spanish population. Nutr Hosp. 2012;27:524–8.
    1. World Health Organization (WHO) Guidelines for the conduct of tobacco smoking among health professionals. Report WHO. Canadá: Meeting Winnipeg; 1983.
    1. Gomes VB, Siqueira KS, Sichieri R. Physical activity among a random sample of the Rio de Janeiro. Cad SaudePublica. 2001;17:969–76.
    1. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR, Jr, Tudor-Locke C, et al. Compendium of Physical Activities: a second update of codes and MET values. MedSci Sports Exerc. 2011;43:1575–81. doi: 10.1249/MSS.0b013e31821ece12.
    1. TACO . Tabela Brasileira de Composição de alimentos. 4. Campinas, São Paulo, Brazil: NEPA-UNICAMP; 2011.
    1. Agricultural Research Service. 2013. USDA National Nutrient Database for Standard Reference, Release 26. Nutrient Data Laboratory Home Page []
    1. Brazilian Cardiology Society IV Brazilian Guideline for Dyslipidemia and Prevention of Atherosclerosis, Department of Atherosclerosis of Brazilian Cardiology Society. ArqBrasEndocrinolMetabol. 2007;88:1–19.
    1. Brazilian Cardiology Society, Brazilian Society of Hypertension, Brazilian Nephrology Society IV Brazilian Guidelines on Hypertension. Arq Bras Cardiol. 2010;95(1 supl.1):1–51.
    1. Wehmann RE, Rubenstein HA, Pugeat MM, Nisula BC. Extended Clinical Utility of a Sensitive and Reliable Radioimmunoassay of Thyroid-Stimulating Hormone. South Med J. 1983;76:969–76. doi: 10.1097/00007611-198308000-00007.
    1. Ellis SM, Ekins RP. The Radioimmunoassay of Serum Free Triiodothyronine and Thyroxine. In: Pasternak CA, editor. Radioimmunoassay in Clinical Biochemistry. 1975. pp. 187–94.
    1. Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem. 1982;28:2077–80.
    1. Allain CC, Poon LS, Chan CS, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470–5.
    1. Warnick GR, NauckM RN. Evolution of methods for measurement of HDL-cholesterol: from ultracentrifugation to homogeneous assays. Clin Chem. 2001;47:1579–96.
    1. Frost PH, Havel RJ. Rationale for use of non-high-density lipoprotein cholesterol rather than low-density lipoprotein cholesterol as a tool for lipoprotein cholesterol screening and assessment of risk and therapy. Am J Cardiol. 1998;81(4A):26B–31. doi: 10.1016/S0002-9149(98)00034-4.
    1. Friedwald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.
    1. Ledue TB, Collins MF, Ritchie RF. Development of immunoturbidimetric assays for fourteen human serum proteins on the Hitachi 912. ClinChem Lab Med. 2002;40:520–8.
    1. Simó JM, Camps J, Gómez F, Ferré N, Joven J. Evaluation of a fully-automated particle-enhanced turbidimetric immunoassay for the measurement of plasma lipoprotein(a). Population-based reference values in an area with low incidence of cardiovascular disease. Clin Biochem. 2003;36:129–34. doi: 10.1016/S0009-9120(02)00416-2.
    1. Labat L, Dehon B, Lhermitte M. Rapid and simple determination of selenium in blood serum by inductively coupled plasma-mass spectrometry (ICP-MS) Anal Bioanal Chem. 2003;376:270–3.
    1. Rayman MP, Stranges S, Griffin BA, Pastor-Barriuso R, Guallar E. Effect of supplementation with high-selenium yeast on plasma lipids: a randomized trial. Ann Intern Med. 2011;154:656–65. doi: 10.7326/0003-4819-154-10-201105170-00005.
    1. Maranhão PA, Kraemer-Aguiar LG, de Oliveira CL, Kuschnir MC, Vieira YR, Souza MG, et al. Brazil nuts intake improves lipid profile, oxidative stress and microvascular function in obese adolescentes: a randomized controlled trial. NutrMetab (Lond) 2011;8:32. doi: 10.1186/1743-7075-8-32.
    1. Cominetti C, de Bortoli MC, Garrido AB, Jr, Cozzolino SM. Brazilian nut consumption improves selenium status and glutathione peroxidase activity and reduces atherogenic risk in obese women. Nutr Res. 2012;32:403–7. doi: 10.1016/j.nutres.2012.05.005.
    1. Berkenstam A, Kristensen J, Mellström K, Carlsson B, Malm J, Rehnmark S, et al. The thyroid hormone mimetic compound KB2115 lowers plasma LDL cholesterol and stimulates bile acid synthesis without cardiac effects in humans. ProcNatlAcadSci USA. 2008;105:663–7. doi: 10.1073/pnas.0705286104.
    1. Kostner KM, Kostner GM. Factors affecting plasma lipoprotein(a) levels: role of hormones and other nongenetic factors. SeminVasc Med. 2004;4:211–4.
    1. Mathieson RA, Walberg JL, Gwazdauskas FC, Hinkle DE, Gregg JM. The effect of varying carbohydrate content of a very-low-caloric diet on resting metabolic rate and thyroid hormones. Metabolism. 1986;35:394–8. doi: 10.1016/0026-0495(86)90126-5.
    1. Danforth E, Jr, Burger AG, Wimpfheimer C. Nutritionally-induced alterations in thyroid hormone metabolism and thermogenesis. Experientia Suppl. 1978;32:213–7. doi: 10.1007/978-3-0348-5559-4_25.
    1. Combs GF, Jr, Midthune DN, Patterson KY, Canfield WK, Hill AD, Levander OA, et al. Effects of selenomethionine supplementation on selenium status and thyroid hormone in healthy adults. Am J ClinNutr. 2009;89:1808–14.
    1. Balázs C. The effect of selenium therapy on autoimmune thyroiditis. OrvHetil. 2008;149:1227–32.
    1. Thomson CD, McLachlan SK, Grant AM, Paterson E, Lillico AJ. The effect of selenium on thyroid status in a population with marginal selenium and iodine status. Br J Nutr. 2005;94:962–8. doi: 10.1079/BJN20051564.
    1. Berger MM, Reymond MJ, Shenkin A, Rey F, Wardle C, Cayeux C, et al. Influence of selenium supplements on the post-traumatic alterations of the thyroid axis: a placebo-controlled trial. Intensive Care Med. 2001;27:91–100. doi: 10.1007/s001340000757.
    1. Calomme MR, Vanderpas JB, François B, Van Caillie-Bertrand M, Herchuelz A, Vanovervelt N, et al. Thyroid function parameters during a selenium repletion/depletion study in phenylketonuric subjects. Experientia. 1995;51:1208–15. doi: 10.1007/BF01944738.
    1. Ferroni P, Basili S, Davi G. Platelet activation, inflammatory mediators and hypercholesterolemia. CurrVascPharmacol. 2003;1:157–69.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe