Table 1.
Characteristics of included studies that investigated the effect of nuts combined with energy restriction on the obesity treatment.
| Reference | Study Design and Follow-Up | Sample Characteristics | Characteristics of the Intervention | Assessed Cardiometabolic Risk Markers | Main Results |
|---|---|---|---|---|---|
| Studies with Almonds | |||||
| Win et al., 2003 [28] USA |
RCT, controlled 24 wk. 2 wk. run-in period |
Individuals with obesity N: 65 */52 (CG = 33 and IG = 32) ** (F = 37; M = 28) Age: CG = 57 (SD 2) y. IG = 53 (SD 2) y. BMI: CG = 37 (SD 1) kg/m2 IG = 39 (SD 1) kg/m2 |
CG: nut-free CHO-energy-restricted formula-based diet (1015 kcal) IG: energy-restricted diet + 84 g/d of almonds (1012 kcal) |
Anthropometry and body composition Glucose metabolism markers Lipid metabolism markers and blood pressure |
IG: ↓ weight, BMI, WC, FM (kg), SBP, HDL-c vs. CG IG: ↔ FFM (kg), insulin, glucose, HOMA-IR, DBP, TC, TG, LDL-c, LDL-c/HDL-c ratio vs. CG |
| Foster et al., 2012 [36] USA |
RCT, controlled 24 and 72 wk. |
Individuals with overweight and obesity N: 123 */92 (CG = 62 and IG = 61) ** (F = 112; M = 11) Age: 46.8 (SD 12.4) y. BMI: 34.0 (SD 3.6) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 28 g of almonds/day Total energy of diets: 1200–1500 kcal/d for women and 1500–1800 kcal for men) |
Anthropometry and body composition Glucose metabolism markers Lipid metabolism markers and blood pressure |
CG: ↓ weight at 24 wk vs. IG IG: ↓ TC, TG, TC/HDL-c at 24 wk. vs. CG IG: ↔ weight, TG, TC, TC/HDL-c ratio at 72 wk. vs. CG IG: ↔VLDL, LDL-c, HDL-c, SBP, DBP, LM, and FM at 24 and 72 wk. vs. CG |
| Abazarfard; Salehi; Keshavarzi, 2014 [25] Iran |
RCT, controlled 12 wk. |
Premenopausal women with overweight N: 108 */100 (CG = 50 and IG = 50) ** Age: CG= 42.94 (SD 6.82) y. IG = 42.36 (SD 7.30) y. BMI: CG = 29.37 (SD 1.73) kg/m2 IG = 29.91 (SD 1.20) |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 50 g of raw almonds/d Energy-restricted diet for both groups: −1000 kcal |
Anthropometry Glucose metabolism markers Lipid metabolism markers and blood pressure |
IG: ↓ weight, BMI, WC, WHR, TG, TC, TC/HDL-c ratio, glucose, DBP vs. CG CG: ↓ HC, LDL-c, SBP, and ↑ HDL-c vs. IG |
| Abazarfard et al., 2016 [40] Iran |
RCT, controlled 12 wk. |
Premenopausal women with overweight N: 108 */100 (CG = 50 and IG = 50) ** Age: CG = 42.94 (SD 6.82) y. IG = 42.36 (SD 7.30) y. BMI: CG = 29.37 (SD 1.73) kg/m2 IG = 29.91 (SD 1.20) |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 50 g of raw almonds/d Energy-restricted diet for both groups: −1000 kcal |
Liver enzymes | IG: ↓ ALT, AST, and GGT vs. CG IG: ↔ ALP, total bilirubin, albumin, and total protein vs. CG |
| Dhillon; Tan; Mattes, 2016 [26] USA |
RCT, controlled 12 wk. |
Individuals with overweight and obesity N: 86 */79 (CG = 27 and IG = 23) ** (F = 65; M = 21) Age: CG = 34.9 (SD 13.1) y. IG = 33.6 (SD 12.9) y. BMI: CG: 30.6 (SD 3.9) kg/m2 IG: 30.3 (SD 3.2) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 15% of energy from almonds/d Energy-restricted diet for both groups: −500 kcal |
Anthropometry Glucose metabolism markers Lipid metabolism markers and blood pressure |
IG: ↓ DBP, trunk FM (kg and %), FM (%) vs. CG IG: ↑ FFM (%) and truncal FFM (%) vs. CG IG: ↔ weight, VAT, SBP WC, SAD, insulin, glucose, TG, TC, LDL-c, HDL-c, FT (kg), FFM (kg), and truncal FFM (kg) vs. CG |
| Studies with Peanuts | |||||
| Alves et al., 2014 [44] Brazil |
RCT, controlled 4 wk. |
Men with overweight N: 76 */65 (CG = 22, IG1 = 22, and IG2 = 21) ** Age: CG = 27.4 (SEM 1.6) y. IG1 = 28.0 (SEM 1.5) y. IG2 = 26.8 (SEM 1.9) y. BMI: CG = 29.7 (SEM 0.53) kg/m2 IG1 = 29.5 (SEM 0.4) kg/m2 IG2 = 29.9 (SEM 0.6) kg/m2 |
CG: nut-free energy-restricted diet IG1: energy-restricted diet + 56 g of conventional peanuts IG2: energy-restricted diet + 56 g of high-oleic peanuts Energy-restricted diet for all groups: −250 kcal/d |
Anthropometry and body composition |
IG1 and IG2: ↔ weight, BMI, WC, HC, WHR, FM, FFM, LM vs. CG |
| De Oliveira Fialho et al., 2022 [46] Brazil |
RCT, controlled 8 wk. |
Premenopausal women with obesity N: 26 */24 (CG = 8, IG1 = 8, and IG2 = 8) ** Age: 33.1 (SD 8.7) y. BMI: 34.3 (SD 3.7) kg/m2 |
CG: nut-free energy-restricted diet IG1: energy-restricted diet + 56 g of whole roasted peanuts IG2: energy-restricted diet + 56 g of skinless peanuts Energy-restricted diet for all groups: −250 kcal/d |
Anthropometry and body composition Glucose metabolism markers Lipid metabolism markers Liver enzymes |
Week 4 IG1: ↔ weight, WC, WHR, LM (%), FM (%), SBP, DBP, TC, HDL-c, VLDL, LDL-c, LDL-c/HDL-c ratio, TG, glucose, insulin, HOMA-IR, AST, and ALT CG IG1: ↓ BMI vs. CG IG2: ↑ weight, WC, FM (%) vs. CG IG2: ↔ BMI, WHR, SBP, DBP, TC, HDL-c, VLDL, LDL-c, LDL-c/HDL-c ratio, TG, glucose, insulin, HOMA-IR, AST, and ALT vs. CG IG2: ↓ LM (%) vs. CG Week 8 IG1: ↔ weight, WC, WHR, LM (%), FM (%), SBP, DBP, HDL-c, VLDL, LDL-c, LDL-c/HDL-c ratio, TG, glucose, insulin, HOMA-IR, AST, and ALT vs. CG IG1: ↓ BMI, TC vs. CG IG2: ↑ weight, WC, FM (%) vs. CG IG2: ↔ BMI, WHR, SBP, DBP, HDL-c, VLDL, LDL-c, LDL-c/HDL-c ratio, TG, glucose, insulin, HOMA-IR, AST, and ALT vs. CG IG2: ↓ LM (%) and TC vs. CG |
| Petersen et al., 2022 [48] Australia |
RCT, controlled 12 and 24 wk. |
Individuals with overweight or obesity and high risk for T2DM N: 107 */76 (CG = 32 and IG = 44) ** (F = 70; M = 37) Age: 58 (SD 14) y. BMI: 33.1 (SD 5.4) kg/m2 |
CG: nut-free energy-restricted diet and low in fat: energy-restricted diet + 70 g of peanuts Energy restriction in both groups: −1300 and −1700 kcal/d) |
Anthropometry Glucose metabolism markers Blood pressure |
Week 12 IG: ? weight, SBP, DBP, glucose, insulin, HOMA-IR vs. CG IG: ↔ 2-h-glucose vs. CG Week 24 IG: ↔ weight vs. CG IG: ↓ SBP vs. CG IG: ? DBP, glucose, insulin, HOMA-IR vs. CG |
| Caldas et al., 2020 [45] Brazil |
RCT, controlled 4 wk. |
Men with overweight N: 76 */64 ** Age: 27.53 (SD 0.9) y. BMI: 29.76 (SD 0.3) kg/m2 |
CG: nut-free energy-restricted diet IG1: energy-restricted diet + 56 g of conventional peanuts IG2: energy-restricted diet + 56 g of high-oleic peanuts Energy-restricted diet for all groups: −250 kcal/d |
Oxidative stress Inflammation |
CG: ↔ IL-17A, IL-10, IL-6, IL-4, TNF, CRP, GST, ON, and SOD vs. IG1 and IG2 CG: ↓ MDA vs. IG and IG2 |
| Studies with Walnuts | |||||
| Rock et al., 2017 [37] USA |
RCT, controlled 12 and 24 wk. |
Individuals with overweight and obesity without diabetes N: 100 * (CG = 51 and IG = 49) (F = 58; M = 42) Age: CG = 52.2 (SE 1.6) y. IG = 53.3 (SE 1.4) y. BMI: CG = 32.4 (SE 0.4) kg/m2 IG = 32.4 (SE 0.5) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 42 g of walnuts/d for diet ≥ 1500 kcal/d or 28 g for diet < 1500 kcal/d (~15% TEV) Energy-restricted diet for both groups: −500 to −1000 kcal/d |
Anthropometry and body composition Glucose metabolism markers |
IG: ↔ weight, BMI, WC, SBP, DBP, TG, HDL-c, and TC vs. at 12 and 24 wk. CG |
| Fatahi et al., 2019 [41] Iran |
RCT, controlled 12 wk. |
Postmenopausal women with overweight and obesity N: 66 * (CG = 33, IG = 33) Age: 53.5 (SD 1.6) y. BMI: 33.29 (SD 5.63) kg/m2 |
CG: energy-restricted diet + 300 g of fatty fish (salmon or trout)/week IG: energy-restricted diet + 18 units of walnuts/week and avoid fish intake Total energy of diets: ~2000 kcal/d |
Anthropometry Glucose levels Liver enzymes Blood pressure Oxidative stress and inflammation markers |
IG: ↔ weight, WC, MDA, AST, vs. CG IG: ↓ DBP, ↑ HDL-c vs. CG CG: ↓ SBP, glucose, TG, LDL-c, hs-PCR, ALT, TNF, IL-6 vs. IG |
| Studies with Pistachios | |||||
| Li et al., 2010 [38] USA |
RCT, controlled 6 and 12 wk. |
Individuals with overweight and obesity N: 70 */52 ** (CG = 25 and IG = 27) (F = 57; M = 13) Age: CG = 47.30 (SD 2.3) y. IG = 45.40 (SD 2.0) y. BMI: CG = 30.9 (SE 0.4) kg/m2 IG = 30.1 (SE 0.4) kg/m2 |
CG: nut-free energy-restricted diet +56 g of pretzels IG: energy-restricted diet + 53 g of pistachios Energy-restricted diet for all groups: −500 kcal/d |
Anthropometry Glucose metabolism markers Lipid metabolism markers |
IG: ↓ BMI and TG at 6 and 12 wk. vs. CG IG: ↔ weight, TC, LDL-c, HDL-c, glucose, and insulin at 6 and 12 wk. vs. CG |
| Rock et al., 2020 [39] USA |
RCT, controlled 16 wk. |
Individuals with overweight or obesity without diabetes N: 100 */93 ** (CG = 47 and IG = 49) (F = 62; M = 38) Age: CG = 56.2 (SE 1.5) y. IG = 55.0 (SD 1.6) y. BMI: CG = 32.8 (SE 0.5) kg/m2 IG = 32.8 (SD 0.6) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 42 g of pistachios (18% of TEV) Energy-restricted diet for all groups: −500 to −1000 kcal/d |
Anthropometry Glucose metabolism markers Lipid metabolism markers Blood pressure |
IG: ↔ weight, WC, SBP, DBP, TC, TG, HDL-c, LDL-c, insulin, glucose, and HOMA-IR vs. CG |
| Studies with Mixed Nuts | |||||
| Ghanavati et al., 2021 (A) [42] Iran |
RCT, controlled 8 wk. |
Individuals with overweight and obesity and stable coronary artery disease N: 70 */67 ** CG = 32 and IG = 35) (F = 30; M = 37) Age: 58.86 (SD 7.47) y. BMI: 30.9 (SD 3.9) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 20% energy from a mix of nuts (39 to 60 g with equal amounts of pistachios, almonds, and peanuts) Energy-restricted diet for both groups: −25% of RE |
Anthropometry Inflammation |
IG: ↓ ICAM-1 and IL-6 vs. CG IG: ↔ weight, BMI, WC, CRP, IL-10, and MCP-1 vs. CG |
| Ghanavati; Ali-Pour Parsa; Nasrollahzadeh, 2021 (B) [43] Iran |
RCT, controlled 8 wk. |
Individuals with overweight and obesity and stable coronary artery disease N: 70 */67 ** CG = 32 and IG = 35) (F = 30; M = 37) Age: 58.86 (SD 7.47) y. BMI: 30.9 (SD 3.9) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 20% energy from a mix of nuts (39 to 60 g with equal amounts of pistachios, almonds, and peanuts) Energy-restricted diet for both groups: −25% of RE |
Anthropometry and body composition Glucose metabolism markers Lipid metabolism markers Liver enzymes |
IG: ↑ HDL-c and Apo A1 vs. CG IG: ↔ weight, FM (%), MM (kg), TG, TC, LDL-c, sdLDL-c, TC/HDL-c ratio, LDL-c/HDL-c ratio, non-HDL-c, ALT, AST, and uric acid vs. CG IG: ↔ ABCA1 and ABCG1 gene expression vs. CG |
| Caldas et al., 2022 [47] Brazil |
RCT, controlled 8 wk. 7–10 days of run-in |
Women with overweight + at least one marker of metabolic syndrome or obesity regardless of the presence of metabolic syndrome components N: 40 */29 ** (CG = 15 and IG = 14) Age: 31.4 (SD 2.4) y BMI: 33.4 (SD 1.1) kg/m2 |
CG: nut-free energy-restricted diet IG: energy-restricted diet + 45 g of mixed nuts (30 g of cashew nuts + 15 g of Brazil nuts) Energy-restricted diet for all groups: −500 kcal/d |
Anthropometry and body composition Glucose metabolism markers Lipid metabolism markers |
IG: ↓ FM, VCAM-1 vs. CG IG: ↑ LM (%), FFM (%), MMT, TLM, AFM, and blood selenium levels vs. CG IG: ↔ weight, BMI, WC, WHR, HC, NC, WHtR, FM (kg), LM (kg), FFM (KG), TC, TG, LDL-c, HDL-c, VLDL, non-HDL-c, TC/HDL-c ratio, LDL-c/HDL-c ratio, glucose, insulin, TyG index, Apo A1, Apo B, Apo E, ApoB/Apo A, hs-CRP, DBP, SBP, ABI, NO, and ICAM-1 vs. CG |
Legend: * initial n (randomized individuals); ** final n (accounting for losses to follow-up); ↑ increased; ↓ decreased; ↔ unchanged; ? without information; y: years; SD: standard deviation; F: female; M: male; BMI: body mass index; CG, control group; IG intervention group; LCD: low-calorie diet; WC: waist circumference; BF: body fat; TBW: total body water; SBP: systolic blood pressure; FFM: fat-free mass; HOMA-IR: homeostatic model assessment; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride; LDL-c: low-density lipoprotein cholesterol; HDL: high-density lipoprotein cholesterol; RMR: resting metabolic rate; FPG: fasting plasma glucose; AED: almond-enriched diet; NFD: nut-free diet; LM: lean mass; VLD-C: very low-density lipoprotein cholesterol; WHR: waist/hip ratio; RE: energy requirement; CTRL: control; CVP: conventional peanut; HOP: high-oleic peanut; RQ: respiratory quotient; DIT: diet-induced thermogenesis; ALT: alanine aminotransferase; AST: aspartate aminotransferase; GGT: gamma-glutamyl transferase; ALP: alkaline phosphatase; MGT: truncal fat mass; TFFM: truncal fat-free mass; CRP-US: C-reactive protein—ultra sensitive; TNF-α: tumor necrosis factor alpha; IL-6: Interleukin 6; MDA: Malondialdehyde; WP: whole peanut; SP: skinned peanut; NP: no peanut; ox-LDL-c: oxidized low-density lipoprotein; TAC: Total Plasma Antioxidant Capacity; NELCD: nut-enriched low-calorie diet; sdLDL: small dense LDL-c; Apo A1: apolipoprotein A-1; ABCA1: ATP-binding cassette transporter A1; ABCG1: ATP-binding cassette subfamily G member 1; NFLCD: nut-free low-calorie diet; ICAM-1: intercellular adhesion molecule-1; IL-10: Interleukin 10; MCP-1: monocyte chemotactic protein-1; BN: Brazil nut; WHtR: waist-to-height ratio; VCAM-1: Vascular Cell Adhesion Molecule; TLM: Truncal Lean Mass; AFM: Android Fat Mass; HbA1c: Glycated Hemoglobin; ΔAUC: Delta Area Under the Curve; GIP: gastric inhibitory peptide; GLP-1: Glucagon-like Peptide 1.