Chapter 17 - Contribution of Nuts to the Mediterranean Diet

Abstract

Like all tree nuts, Mediterranean nuts (almonds, hazelnuts, pine nuts, pistachios, and walnuts) are nutrient-dense foods rich in unsaturated fatty acids, protein, fiber, healthy minerals, tocopherols, phytosterols, and polyphenols. By virtue of their unique composition, nuts beneficially affect health outcomes. Epidemiologic studies have associated nut consumption with a reduced incidence of coronary heart disease (in both sexes) and diabetes (only in women). Randomized clinical trials demonstrate that nut intake has a cholesterol-lowering effect regardless of the background diet, and there is emerging evidence of beneficial effects on insulin sensitivity, oxidative stress, inflammation, and vascular reactivity. The large 5-year PREDIMED trial tested a nut-enriched Mediterranean diet against a control diet for cardiovascular health outcomes in older participants at high risk. Results to date have shown protection from cardiovascular diseases, particularly stroke, diabetes, and the metabolic syndrome. A beneficial effect on intermediate markers such as blood pressure, lipids, insulin resistance, oxidation, and inflammation also has been uncovered in the PREDIMED study. Also, chronic nut intake does not promote weight gain. In conclusion, the evidence is convincing that nuts, an integral component of the Mediterranean diet, are nutrient-rich foods with wide-ranging cardiometabolic benefits.