Pistachio nut consumption modifies systemic hemodynamics, increases heart rate variability, and reduces ambulatory blood pressure in well-controlled type 2 diabetes: a randomized trial

Katherine A Sauder, Cindy E McCrea, Jan S Ulbrecht, Penny M Kris-Etherton, Sheila G West, Katherine A Sauder, Cindy E McCrea, Jan S Ulbrecht, Penny M Kris-Etherton, Sheila G West

Abstract

Background: Managing cardiovascular risk factors is important for reducing vascular complications in type 2 diabetes, even in individuals who have achieved glycemic control. Nut consumption is associated with reduced cardiovascular risk; however, there is mixed evidence about the effect of nuts on blood pressure (BP), and limited research on the underlying hemodynamics. This study assessed the effect of pistachio consumption on BP, systemic hemodynamics, and heart rate variability in adults with well-controlled type 2 diabetes.

Methods and results: We enrolled 30 adults (40 to 74 years) with type 2 diabetes in a randomized, crossover, controlled feeding study. After a 2-week run-in period, participants consumed a low-fat control diet (27% fat) containing low-fat/high-carbohydrate snacks and a moderate-fat diet (33% fat) containing pistachios (20% of total energy) for 4 weeks each, separated by a 2-week washout. Following each diet period, we assessed BP, systemic hemodynamics, and heart rate variability at rest and during acute mental stress, and, in a subset of participants (n=21), 24-hour ambulatory BP. BP at rest and during stress did not differ between treatments. The pistachio diet significantly reduced total peripheral resistance (-3.7±2.9%, P=0.004), increased cardiac output (3.1±2.3%, P=0.002), and improved some measures of heart rate variability (all P<0.05). Systolic ambulatory BP was significantly reduced by 3.5±2.2 mm Hg (P=0.046) following the pistachio diet, with the greatest reduction observed during sleep (-5.7±2.6 mm Hg, P=0.052).

Conclusions: A moderate-fat diet containing pistachios modestly improves some cardiovascular risk factors in adults with well-controlled type 2 diabetes.

Clinical trial registration url: www.clinicaltrials.gov. Unique identifier: NCT00956735.

Keywords: blood pressure; heart rate variability; hemodynamics; nutrition; type 2 diabetes mellitus.

© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1.
Figure 1.
CONSORT diagram of recruitment and study completion. *Of these, 2 developed intolerances to tomatoes and 1 experienced an allergic reaction to pistachios. It was confirmed that this participant reported no history of nut allergies prior to study enrollment, but during questioning that followed the allergic reaction, this participant stated he had not previously eaten pistachios.

References

    1. Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates. J Am Coll Cardiol. 2007; 50:2128-2132.
    1. O'Flaherty M, Ford E, Allender S, Scarborough P, Capewell S. Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults. Heart. 2008; 94:178-181.
    1. Gerstein HC, Miller ME, Byington RP, Goff DC, Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail‐Beigi F, Grimm RH, Jr, Probstfield JL, Simons‐Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358:2545-2559.
    1. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008; 358:2560-2572.
    1. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR, Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009; 360:129-139.
    1. American Diabetes Association. Standards of medical care in diabetes–2014. Diabetes Care. 2014; 37suppl 1:S14-S80.
    1. Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, Chapman MJ, Dodson PM, Fioretto P, Ginsberg HN, Kadowaki T, Lablanche JM, Marx N, Plutzky J, Reiner Z, Rosenson RS, Staels B, Stock JK, Sy R, Wanner C, Zambon A, Zimmet P. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008; 102:1K-34K.
    1. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer‐Davis EJ, Neumiller JJ, Nwankwo R, Verdi CL, Urbanski P, Yancy WS., Jr Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013; 36:3821-3842.
    1. Djousse L, Rudich T, Gaziano JM. Nut consumption and risk of hypertension in US male physicians. Clin Nutr. 2009; 28:10-14.
    1. Weng LC, Steffen LM, Szklo M, Nettleton J, Chambless L, Folsom AR. A diet pattern with more dairy and nuts, but less meat is related to lower risk of developing hypertension in middle‐aged adults: the Atherosclerosis Risk in Communities (ARIC) study. Nutrients. 2013; 5:1719-1733.
    1. Ibarrola‐Jurado N, Bullo M, Guasch‐Ferre M, Ros E, Martinez‐Gonzalez MA, Corella D, Fiol M, Warnberg J, Estruch R, Roman P, Aros F, Vinyoles E, Serra‐Majem L, Pinto X, Covas MI, Basora J, Salas‐Salvado JPREDEIMED Study Investigators. Cross‐sectional assessment of nut consumption and obesity, metabolic syndrome and other cardiometabolic risk factors: the PREDIMED study. PLoS One. 2013; 8:e57367.
    1. O'Neil CE, Keast DR, Nicklas TA, Fulgoni VL., III Nut consumption is associated with decreased health risk factors for cardiovascular disease and metabolic syndrome in U.S. adults: NHANES 1999–2004. J Am Coll Nutr. 2011; 30:502-510.
    1. Casas‐Agustench P, Lopez‐Uriarte P, Ros E, Bullo M, Salas‐Salvado J. Nuts, hypertension and endothelial function. Nutr Metab Cardiovasc Dis. 2011; 21suppl 1:S21-S33.
    1. Estruch R, Martinez‐Gonzalez MA, Corella D, Salas‐Salvado J, Ruiz‐Gutierrez V, Covas MI, Fiol M, Gomez‐Gracia E, Lopez‐Sabater MC, Vinyoles E, Aros F, Conde M, Lahoz C, Lapetra J, Saez G, Ros E. Effects of a Mediterranean‐style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006; 145:1-11.
    1. Salas‐Salvado J, Fernandez‐Ballart J, Ros E, Martinez‐Gonzalez MA, Fito M, Estruch R, Corella D, Fiol M, Gomez‐Gracia E, Aros F, Flores G, Lapetra J, Lamuela‐Raventos R, Ruiz‐Gutierrez V, Bullo M, Basora J, Covas MI. Effect of a Mediterranean diet supplemented with nuts on metabolic syndrome status: one‐year results of the PREDIMED randomized trial. Arch Intern Med. 2008; 168:2449-2458.
    1. West SG, Gebauer SK, Kay CD, Bagshaw DM, Savastano DM, Diefenbach C, Kris‐Etherton PM. Diets containing pistachios reduce systolic blood pressure and peripheral vascular responses to stress in adults with dyslipidemia. Hypertension. 2012; 60:58-63.
    1. Parati G, Bilo G, Ochoa JE. Benefits of tight blood pressure control in diabetic patients with hypertension: importance of early and sustained implementation of effective treatment strategies. Diabetes Care. 2011; 34suppl 2:S297-S303.
    1. Harris JA, Benedict FG. A biometric study of human basal metabolism. Proc Natl Acad Sci USA. 1918; 4:370-373.
    1. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285:2486-2497.
    1. Gronwall DM. Paced auditory serial‐addition task: a measure of recovery from concussion. Percept Mot Skills. 1977; 44:367-373.
    1. Sherwood A, Allen MT, Fahrenberg J, Kelsey RM, Lovallo WR, van Doornen LJ. Methodological guidelines for impedance cardiography. Psychophysiology. 1990; 27:1-23.
    1. Sauder KA, Johnston ER, Skulas‐Ray AC, Campbell TS, West SG. Effect of meal content on heart rate variability and cardiovascular reactivity to mental stress. Psychophysiology. 2012; 49:470-477.
    1. Boardman A, Schlindwein FS, Rocha AP, Leite A. A study on the optimum order of autoregressive models for heart rate variability. Physiol Meas. 2002; 23:325-336.
    1. Berntson GG, Bigger JT, Jr, Eckberg DL, Grossman P, Kaufmann PG, Malik M, Nagaraja HN, Porges SW, Saul JP, Stone PH, van der Molen MW. Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology. 1997; 34:623-648.
    1. Spruill TM, Gerin W, Ogedegbe G, Burg M, Schwartz JE, Pickering TG. Socioeconomic and psychosocial factors mediate race differences in nocturnal blood pressure dipping. Am J Hypertens. 2009; 22:637-642.
    1. Chida Y, Steptoe A. Greater cardiovascular responses to laboratory mental stress are associated with poor subsequent cardiovascular risk status: a meta‐analysis of prospective evidence. Hypertension. 2010; 55:1026-1032.
    1. Beevers G, Lip GY, O'Brien E. ABC of hypertension: the pathophysiology of hypertension. BMJ. 2001; 322:912-916.
    1. Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004; 292:2350-2356.
    1. Schmieder RE, Schlaich MP, Klingbeil AU, Martus P. Update on reversal of left ventricular hypertrophy in essential hypertension (a meta‐analysis of all randomized double‐blind studies until December 1996). Nephrol Dial Transplant. 1998; 13:564-569.
    1. Franklin SS, Gustin W, IV, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age‐related changes in blood pressure. The Framingham Heart Study. Circulation. 1997; 96:308-315.
    1. Verdecchia P, Angeli F, Mazzotta G, Garofoli M, Ramundo E, Gentile G, Ambrosio G, Reboldi G. Day‐night dip and early‐morning surge in blood pressure in hypertension: prognostic implications. Hypertension. 2012; 60:34-42.
    1. Stamler R. Implications of the INTERSALT study. Hypertension. 1991; 17:I16-I20.
    1. Liao D, Cai J, Barnes RW, Tyroler HA, Rautaharju P, Holme I, Heiss G. Association of cardiac autonomic function and the development of hypertension: the ARIC study. Am J Hypertens. 1996; 9:1147-1156.
    1. Liao D, Cai J, Rosamond WD, Barnes RW, Hutchinson RG, Whitsel EA, Rautaharju P, Heiss G. Cardiac autonomic function and incident coronary heart disease: a population‐based case‐cohort study. The ARIC Study. Am J Epidemiol. 1997; 145:696-706.
    1. Tsuji H, Larson MG, Venditti FJ, Jr, Manders ES, Evans JC, Feldman CL, Levy D. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation. 1996; 94:2850-2855.
    1. Liao D, Carnethon M, Evans GW, Cascio WE, Heiss G. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes. 2002; 51:3524-3531.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc. 1995; 57:259-300.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren