Including walnuts in a low-fat/modified-faf diet improves HDL cholesterol-to-total cholesterol ratios in patients with type 2 diabetes

OBJECTIVE - The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 ± 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA_1c, total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model. RESULTS - The walnut group achieved a significantly greater increase in HDL cholesterol-to-total cholesterol ratio (P = 0.049) and HDL (P = 0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P = 0.032) and time (P = 0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA_1c levels. The higher dietary polyunsaturated fat-to-saturated fat ratio and intakes of ω-3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake. CONCLUSIONS - Structured "whole of diet" advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes.