Almonds vs. carbohydrate snacks in an energy-restricted diet: Weight and cardiometabolic outcomes from a randomized trial

AbstractObjectiveThis study evaluated weight and cardiometabolic outcomes after a 3‐month energy‐restricted diet (−30%) containing almonds (almond‐enriched diet [AED]) or containing carbohydrate‐rich snacks (nut‐free control diet [NFD]) (Phase 1), followed by 6 months of weight maintenance (Phase 2).MethodsParticipants (25–65 years old) with overweight or obesity (BMI 27.5–34.9 kg/m2) were randomly allocated to AED (n = 68) or NFD (n = 72).ResultsBoth groups lost weight during Phase 1 (p < 0.001) (mean [SE], −7.0 [0.5] kg AED vs. −7.0 [0.5] kg NFD, p = 0.858) and Phase 2 (p = 0.009) (−1.1 [0.5] kg AED vs. −1.3 [0.6] NFD, p = 0.756), with improvements in percentage lean mass after Phase 2 (4.8% [0.3%], p < 0.001). Reductions occurred in fasting glucose (−0.2 [0.07] mmol/L, p = 0.003), insulin (−8.1 [4.0] pmol/L, p = 0.036), blood pressure (−4.9 [0.8] mm/Hg systolic, −5.0 [0.5] mm/Hg diastolic, p < 0.001), total cholesterol (−0.3 [0.1] mmol/L), low‐density lipoprotein (LDL) (−0.2 [0.1] mmol/L), very low‐density lipoprotein (−0.1 [0.03] mmol/L), and triglycerides (−0.3 [0.06] mmol/L) (all p < 0.001), and high‐density lipoprotein increased (0.1 [0.02] mmol/L, p = 0.011) by the end of Phase 2 in both groups. There were group by time interactions for lipoprotein particle concentrations: very small triglyceride‐rich (−31.0 [7.7] nmol/L AED vs. −4.8 [7.9] nmol/L NFD, p = 0.007), small LDL (−109.3 [40.5] nmol/L AED vs. −20.7 [41.6] nmol/L NFD, p = 0.017), and medium LDL (−24.4 [43.4] nmol/L AED vs. −130.5 [44.4] nmol/L NFD, p = 0.045).ConclusionsAn energy‐restricted AED resulted in weight loss and weight loss maintenance comparable to an energy‐restricted NFD, and both diets supported cardiometabolic health. The AED resulted in greater improvements in some lipoprotein subfractions, which may enhance reductions in cardiovascular risk.