Nutrition, Metabolism & Cardiovascular Diseases (2014) xx, 1e7

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Nutrition, Metabolism & Cardiovascular Diseases

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Baru almond improves lipid profile in mildly hypercholesterolemicsubjects: A randomized, controlled, crossover study

A.P.N. Bento a, C. Cominetti a, A. Simões Filho b, M.M.V. Naves a,*a Faculty of Nutrition, Federal University of Goiás (UFG), Goiânia, GO, Brazilb Labex Clinical Laboratory, Goiânia, GO, Brazil

Received 19 February 2014; received in revised form 1 June 2014; accepted 8 July 2014Available online - - -

KEYWORDSNuts;Oxidative stress;Cardiovasculardiseases;Dyslipidemias

Abbreviations: Apo, apolipoprotein; Bdensity lipoprotein cholesterol; LDL-PUFA, polyunsaturated fatty acid; SFAtotal cholesterol; TE, trolox equivalen* Corresponding author. Rua 227, Quad

3209 6273.E-mail addresses: mmvnaves@gmail.c

Please cite this article in press as: Brandomized, controlled, crossoverj.numecd.2014.07.002

http://dx.doi.org/10.1016/j.numecd.2014.07.0020939-4753/ª 2014 Elsevier B.V. All rights rese

Abstract Backgroud and aim: The usual consumption of nuts reduces cardiovascular diseases(CVD) risk by improving serum lipids and oxidation status. Baru almonds (Dipteryxalata Vog.),a native species of Brazilian Savannah, have considerable contents of monounsaturated fattyacids (MUFA), dietary fiber, vitamin E and zinc, which could exert positive effects in serum lipidsand markers of oxidation. However, there is no study about the effect of their consumption onhuman health. Thus, the aim of this study was to evaluate the effect of baru almonds supplemen-tation on lipid profile and oxidation of mildly hypercholesterolemic subjects.Methods and Results: A randomized, crossover, placebo controlled study was performed with 20mildly hypercholesterolemic subjects (total cholesterol (TC) mean �SEM Z 5.8 � 0.2 mmol/L).The assay had 2 periods of 6 weeks each and a 4-week washout period between the treatments.Subjects were randomly allocated in alternated periods receiving the following treatments perperiod: supplementation with 20 g/day of baru almonds or placebo (1 corn starch capsule/day). Compared to placebo, supplementation of baru almonds reduced TC (�8.1 � 2.4%,P Z 0.007), low-density lipoprotein cholesterol (LDL-c) (�9.4 � 2.4%, P Z 0.006) and non-high-density lipoprotein cholesterol (non-HDL-c) (�8.1 � 3.0%, P Z 0.013). There were no signif-icant changes on the oxidation biomarkers evaluated.Conclusion: Dietary supplementation of mildly hypercholesterolemic subjects with baru almondsimproved serum lipid parameters, so that this food might be included in diets for reducing theCVD risk.Clinical Trial registry: Brazilian Registry of Clinical Trials (ReBEC) (website: http://www.ensaiosclinicos.gov.br). Register number: RBR-4zdy9p.ª 2014 Elsevier B.V. All rights reserved.

MI, body mass index; FRAP, Ferric Reducing Antioxidant Total; Hcys, homocysteine; HDL-c, high-c, low-density lipoprotein cholesterol; Hcys, homocysteine; MUFA, monounsaturated fatty acid;, saturated fatty acid; SOD, superoxide dismutase; TBARS, thiobarbituric acid reactive substances; TC,t; TG, triacylglycerol; VLDL, very low-density lipoprotein.ra 68, s/n. Setor Leste Universitário, CEP 74.605-080, Goiânia, GO, Brazil. Tel.: þ55 62 3209 6270; fax: þ55 62

om, anapaulanunes@hotmail.com (M.M.V. Naves).

ento APN, et al., Baru almond improves lipid profile in mildly hypercholesterolemic subjects: Astudy, Nutrition, Metabolism & Cardiovascular Diseases (2014), http://dx.doi.org/10.1016/

rved.

2 A.P.N. Bento et al.

Introduction

Nuts and edible seeds consumption has shown an inverseassociation with CVD risk. Subjects that consumed morethan 3 portions (84 g) of nuts per week presented areduction of 55% in death risk by CVD when they werecompared to those that never or rarely consumed thosefoods [1]. These results are related to the improvementof serum lipid profile and oxidative stress reduction, whichwere evidenced by studies with almonds [2,3], macad-amias [4], pistachios [5], walnuts [6], peanuts [7] andBrazil nuts [8]. The effects on serum lipid and oxidativebalance are attributed to fatty acid and bioactive com-pound contents of the oilseeds.

The fruit of baru tree (Dipteryx alata Vog.), a typicalplant from Brazilian Savanna, is a light brown drupe thatcontains an elliptical dark brown edible seed, commonlynamed almond. This seed has great regional importanceand has attracted recent scientific interest because of itsnutritional composition. Baru almonds have higher con-tents of MUFA (51.1%) and lower contents of saturated fattyacid (SFA) than peanuts (edible seed) and Brazil nuts, truenuts from Brazil which are consumed worldwide [9]. Itshould be highlighted that the u-6:u-3 fatty acid ratio ofbaru almonds (13.6:1) [9] is close to the IOM recommen-dation (5e10:1) [10]. Furthermore, baru almonds presenthigh vitamin E (21.4 mg/100 g) [11], zinc (6.7 mg/100 g)[12], tannin (472.2 mg/100 g) and phytate (1073.6 mg/100 g) [13] contents. Several reports have explored theantioxidant role of these nutrients and bioactive com-pounds and their benefits for the human health [see re-view in [14]].

Experimental studies carried out with rats showedbenefits of baru almonds consumption on serum lipids andoxidation [11,15]. Nevertheless, there are no reports aboutthe effect of baru almonds consumption on human health.Therefore, the aim of this study was to evaluate the effectof baru almonds consumption on serum lipid parametersand oxidation biomarkers of mildly hypercholesterolemicsubjects.

Methods

Study population

Twenty-five individuals aged 21e57 were included in thestudy. Subjects were recruited via flyers distributed on theUniversity campus and emails sent to students and pro-fessors. Subjects were reasonably healthy with no majorcomorbidities. The eligibility criteria were: body massindex (BMI): 18.5e29.99 kg/m2 and TC: 50e95th percen-tile (5.2e7.3 mmol/L) [16], assuming, however, a minimumconcentration of 4.9 mmol/L. Exclusion criteria includedsmoking, history of chronic diseases, participation inweight loss program, use of lipid-lowering medication orother medications known to affect lipid concentrations,history of frequent nut consumption (>2 times per week)and nut aversion or allergy. The Federal University of GoiásResearch Ethics Committee’s approved the study protocol

Please cite this article in press as: Bento APN, et al., Baru almond imrandomized, controlled, crossover study, Nutrition, Metabolismj.numecd.2014.07.002

(reference number 212/2012) and this assay was registeredin the Brazilian Registry of Clinical Trials as RBR-4zdy9p.All participants gave written informed consent.

Study design

A randomized, controlled, 2-period crossover design wasemployed with 2 treatments: 20 g/day of baru almondssupplementation and placebo (one corn starch capsule/day). Subjects were randomly assigned to receive 1 of the 2treatments in alternated periods for 6 weeks each one. A6-week period was chosen because it is considered suffi-cient to stabilize diet-induced lipoprotein changes [17]. A4-week washout period was incorporated between treat-ments in order to eliminate residuals effects (carryover) ofthe first period. All volunteers were informed that theywould receive a supplemental dietary intake composed ofbaru almonds in two forms: capsule and roasted.

Baru almonds, derived from Pirenópolis city, were ob-tained from local commerce in Goiânia city, state of Goiás,Brazil. They were roasted in an electric oven at 140� C for30 min to inactivate anti-nutritional factors [18] and toinvestigate the effect in their usual consumption form.After roasting, portions of baru almonds were weighedand stored in vacuum packs.

The serving of baru almonds (20 g) was determinedbased on portions of seeds, peanuts and Brazil nutsestablished by Jenab et al. [19]. It was recommended thatthe 20 g of baru almonds were consumed as snacks or withmeals, on a daily base. Supplementation compliance wasmonitored weekly by the staff and by reviewing the di-etary records. Table 1 summarizes nutrient composition ofbaru almonds serving used in this assay.

All participants were instructed to maintain their usualdietary intake and level of physical activity and not toconsume other nuts or edible seeds throughout the study.Dietary records, anthropometry and laboratory analysiswere assessed at baseline and after 6 weeks in each period.

Dietary assessment

Participants were asked to complete a 3-day dietary recordin nonconsecutive days, with at least one weekend day. Atrained researcher provided subjects with detailed in-structions on how to fill the dietary records. A researcherreviewed all diet records upon return for accuracy. All di-etary records were analyzed to provide an estimation ofdaily average energy and nutrient intake by using thesoftware Avanutri (Rio de Janeiro, Brazil).

Body composition

All measurements were collected with participants bare-foot and wearing light clothing. Subjects’ height wasmeasured at baseline by using a stadiometer graduated incentimeters (CardioMed�; Curitiba, Brazil). Body weightand composition were assessed by dual-energy x-ray ab-sorptiometry using Lunar DPX-NT (General Electric Medi-cal Systems Lunar; Madison, EUA).

proves lipid profile in mildly hypercholesterolemic subjects: A& Cardiovascular Diseases (2014), http://dx.doi.org/10.1016/

Table 1 Nutrient composition of a serving of baru almonds(20 g)a.

20 g baru almonds

Energy, kcal 109.24Carbohydrate, g 2.45Protein, g 5.98Total fat, g 8.48SFA, g 1.1016:0 0.5018:0 0.4620:0 0.11

MUFA, g 3.8618:1 3.5124:1 0.33

PUFA, g 2.1018:2 2.0718:3 ND

Total fiber, g 1.84Soluble fiber, g 0.41Insoluble fiber, g 1.44

Calcium, mg 22.18Iron, mg 0.71Magnesium, mg 32.96Zinc, mg 0.86Phosphorus, mg 166.56Selenium, mg 0.07Vitamin E, mg 4.28a Data sources: proximal composition and minerals (12),

fatty acids and vitamin E (11). ND, not detected. MUFA,monounsaturated fatty acid; PUFA, polyunsaturated fatty acid;SFA, saturated fatty acid.

Dietary patterns and lipoprotein subclasses 3

Blood analysis

Twelve-hour fasting blood samples were taken at baselineand at the end of each treatment by standard venipunc-ture. Blood was centrifuged at 3000 g for 15 min at 4 �C.Analyses were performed immediately after collection orafter storage in ultra-freezer.

TC, HDL-c, LDL-c and triacylglycerol (TG) weremeasured by enzymatic-colorimetric method using aSelectra E Chemistry Analyzer (Merck-Vitalab; Darmstadt,Germany). Apolipoproteins (Apo) A1 and B were deter-mined by nephelometry using a BN-II, (Siemens; Erlangen,Germany). Total plasma homocysteine was measured bychemiluminescent assay. Superoxide dismutase (SOD) ac-tivity and thiobarbituric acid reactive substances (TBARS)were determined by commercially available kits (BioAssaySystems, California, USA).

Serum antioxidant capacity was determined throughthe ferric reducing antioxidant potential (FRAP) assay, asdescribed by Benzie and Strain [20]. Trolox was used asreference for the standard curve to calculate the FRAPvalue of the samples, which was expressed as troloxequivalents in micromoles per liter.

Statistical analyses

This study was designed to provide an 80% statisticalpower to detect 10% of reduction in LDL-c after a 6-weekperiod of intervention with 20 g/day of baru almonds. Thesignificance level was set at 0.05. It was estimated that a

Please cite this article in press as: Bento APN, et al., Baru almond imrandomized, controlled, crossover study, Nutrition, Metabolismj.numecd.2014.07.002

sample size of 25 subjects would be enough to test theprimary LDL-c hypothesis, already including a 20% dropoutrate.

All statistical analyses were performed with software R2.15.1. ShapiroeWilk test was applied to verifydata normality. In order to describe the relationships be-tween aspects of food intake and biochemical character-istics regardless of energy intake, the density model wasapplied to adjust all nutrient for energy intake. Adjustedvalues were expressed as intake per 1000 kcal (4184 kJ).

The treatment effect (difference between baseline andthe end of each treatment) was evaluated using Student’s ttest or Wilcoxon test for data with normal or non-Gaussiandistribution, respectively.

Carryover significance was determined for all variables.The differences between treatments were verified by t testapplied for crossover.

Results are expressed as means � SEMs. A level lowerthan 5% was considered statistically significant.

Results

Of the 25 subjects that met eligibility criteria, 20 (8 menand 12 women) completed both periods and wereincluded in analysis (Fig. 1). The mean age (�SEM) ofparticipants was 34.9 � 2.7 y and the initial BMI rangedfrom 18.9 to 27.8 kg/m2. Body weight and body fat ofparticipants remained stable throughout the study(P > 0.05) (Table 2).

No carryover effect was evidenced between the twoperiods for all variables. The participants maintainedtheir energy, macronutrient and dietary fiber intakesthroughout the study (P > 0.05). The dietary supple-mentation with baru almonds resulted in a tendency ofincreasing in vitamin E and polyunsaturated fatty acids(PUFA) intakes (51.6 � 19.2%, P Z 0.06; 47.3% � 17.6,P Z 0.07, respectively), and in a slight raise in the MUFAintake (20.8 � 10.1%, P Z 0.14) (Table 3).

Compared to placebo, consumption of baru almondssignificantly reduced serum concentrations of TC(�8.1 � 2.4%, P Z 0.007), non-HDL-c (�8.1 � 3.0%,P Z 0.013), LDL-c (�9.4 � 2.4%, P Z 0.005), but had noeffect on HDL-c (�4.7 � 2.3%, P Z 0.06), TG (�10.4 � 7.0%,P Z 0.08), very low-density lipoprotein (VLDL)(�9.9 � 7.4%, P Z 0.36), Apo B (�7.7 � 2.9%, P Z 0.12), ApoAI (�6.8 � 2.3%, P Z 1.00) and homocysteine (�2.1 � 1.9%,P Z 0.47). TC/HDL-c (�4.9 � 2.0%, P Z 0.36), LDL-c/HDL-c(�5.7 � 2.1%, P Z 0.09) and ApoB/ApoAI (�2.4 � 3.0%,P Z 0.56) ratios also did not change (Table 2).

The consumption of 20 g of baru almonds for 45 dayswas not enough to promote significant changes in theoxidation biomarkers (Table 2): TBARS concentration(�5.2 � 4.3%, P Z 0.82), SOD activity (0.7 � 1.2%, P Z 0.34)and FRAP (13.3 � 6.7%, P Z 0.33).

Discussion

There is a diversity of clinical trials evaluating the effects ofoilseeds on health; however, this is the first study that

proves lipid profile in mildly hypercholesterolemic subjects: A& Cardiovascular Diseases (2014), http://dx.doi.org/10.1016/

Figure 1 Participants flow throughout the study.

4 A.P.N. Bento et al.

investigated the effect of baru almonds in human beings.Our study has shown that, when compared to placebotreatment, the daily inclusion of 20 g of baru almonds inthe diet of mildly hypercholesterolemic individualssignificantly reduced TC, LDL-c and non-HDL-c serumconcentrations.

Two studies investigated the intake of baru almonds inrats. In the one performed by Fernandes [11], animals fedfor two months with high-fat diet and 15% of lipids frombaru almonds presented a reduction in lipid peroxidationand an improvement in serum lipids. In the research ofSiqueira et al. [15], rats were submitted to ironsupplementation-induced oxidative stress and they weregiven diets with 10% of baru almonds for 17 days. Thetreatment was able to protect the animal’s tissues againstdamage induced by oxidation of lipids and proteins.

Despite the relatively high-calorie value of baru almondservings (approximately 110 kcal/day) (Table 1), therewere no changes in participants’ body weight andcomposition. It is possible that high content of fibers andprotein present in the almonds has increased the in-dividuals’ satiety, promoting a reduction in the intake ofother foods and the maintenance of the usual energy

Please cite this article in press as: Bento APN, et al., Baru almond imrandomized, controlled, crossover study, Nutrition, Metabolismj.numecd.2014.07.002

intake and body weight. These results are in agreementwith the review performed by Mattes, Kris-Etherton andFoster [21], in which they suggest that the intake of nutsfor one to six months did not promote body weight gain.

The reduction in LDL-c (�9.4 � 2.4%) promoted by theconsumption of baru almonds represents a decrease of9.4% in the CVD risk, according to an estimate of Gordon[22]. This result was similar to that seen in a study withalmonds (�9.4% � 1.9%) [2]. Other studies, using macad-amias [4] and pistachios [5] showed a higher LDL-c pro-portional reduction (�12.7 and e23.2%, respectively).However, it is noteworthy that the portions offered inthose interventions were much higher from those usuallyconsumed by general population [19]. In addition, theamount of almonds (73 g), macadamias (42.5 g) and pis-tachios (60e100 g) used were two to five times higherthan the serving of baru almonds tested in our study.Nevertheless, in the cited studies, the subjects receiveddietary counseling or had their meals in metabolic units.Taking these results into account and the tendency of adoseeresponse for the effect of oilseeds on the improve-ment of serum lipids [2], it is likely that the intake of ahigher serving of baru almonds might result in an even

proves lipid profile in mildly hypercholesterolemic subjects: A& Cardiovascular Diseases (2014), http://dx.doi.org/10.1016/

Table 2 Participants’ body composition, serum lipids, homocysteine and oxidation biomarkers at baseline and after 6 weeks of treatment withbaru almonds and placebo (n Z 20).a,b

Baru almonds Placebo Pc

Baseline 6 weeks % Change Baseline 6 weeks % Change

Weight, kg 64.0 � 2.4 63.8 � 2.5 �0.4 � 0.4 63.7 � 2.6 63.8 � 2.6 0.1 � 0.5 0.07BMI, kg/m2 23.2 � 0.5 23.2 � 0.6 �0.4 � 0.4 23.1 � 0.5 23.1 � 0.6 0.1 � 0.5 0.06Fat, % 35.7 � 1.7 35.1 � 1.6 �1.4 � 1.0 34.6 � 1.6 34.9 � 1.6 1.1 � 0.9 0.10TC, mmol/L 6.0 � 0.2 0 � 0.1 �8.1 � 2.4 5.6 � 0.2 5.7 � 0.2 1.9 � 2.6 0.007HDL-c, mmol/L 1.4 � 0.1 1.3 � 0.1 �4.7 � 2.3 1.3 � 0.1 1.3 � 0.1 1.6 � 1.6 0.06non-HDL-c, mmol/L 4.6 � 0.2 4.2 � 0.2 �8.1 � 3.0 4.3 � 0.2 4.4 � 0.2 2.4 � 3.3 0.013LDL-c, mmol/L 4.0 � 0.2 3.7 � 0.2 �9.4 � 2.4 3.7 � 0.2 3.8 � 7.8 3.1 � 3.6 0.005VLDL-c, mmol/L 0.7 � 0.1 0.6 � 0.1 �9.9 � 7.4 0.6 � 0.1 0.6 � 0.1 16.9 � 9.4 0.06TG, mmol/L 1.5 � 0.2 1.3 � 0.1 �10.4 � 7.0 1.1 � 0.1 1.2 � 0.2 15.9 � 9.3 0.08TC:HDL ratio 4.5 � 0.3 4.4 � 0.3 �4.9 � 2.0 4.4 � 1.3 4.3 � 1.3 0.7 � 2.2 0.36LDL:HDL ratio 3.0 � 0.3 2.9 � 0.2 �5.7 � 2.1 3.0 � 1.1 2.9 � 1.2 1.5 � 3.6 0.09Apo AI, g/L 1.4 � 1.0 1.3 � 0.1 �6.8 � 2.3 1.3 � 0.1 1.3 � 0.1 �2.2 � 3.0 1.00Apo B, g/L 1.1 � 0.0 1.0 � 0.0 �7.7 � 2.9 1.0 � 0.0 1.0 � 0.0 1.6 � 4.2 0.12ApoB:ApoA1 ratio 0.8 � 0.1 0.8 � 0.0 �2.4 � 3.0 0.8 � 0.0 0.8 � 0.0 5.2 � 4.9 0.56Hcys, mmol/L 13.0 � 0.5 12.7 � 0.5 �2.1 � 1.9 12.6 � 0.4 12.7 � 0.7 1.3 � 2.7 0.47TBARS, nmol/L 3.6 � 0.2 3.4 � 0.1 �1.6 � 5.4 3.3 � 0.1 3.4 � 0.1 1.3 � 3.6 0.82SOD, U/mgHb 5.9 � 0.2 5.9 � 0.2 0.4 � 0.1 5.9 � 0.2 5.7 � 0.2 �1.4 � 0.3 0.34FRAP, mmol TE/mL 701.8 � 33.6 773.6 � 35.0 13.3 � 6.7 719.6 � 56.1 704.2 � 36.2 �2.1 � 5.9 0.33a Values are means � SEMs. Apo, apolipoprotein; BMI, body mass index; FRAP, Ferric Reducing Antioxidant Total; Hcys, homocysteine; HDL-c,

high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; SOD, superoxide dismutase; TBARS, thiobarbituric acid reativesubstances; TC, total cholesterol; TE, trolox equivalent; TG, triacylglycerol; VLDL, very low-density lipoprotein.b Conversion factors: cholesterol, 1 mg/dL Z 0.0259 mmol/L; TG, 1 mg/dL Z 0.0113 mmol/L.c P values represent the differences in the changes of variables between treatments (t test applied for crossover).

Dietary patterns and lipoprotein subclasses 5

greater decrease in LDL-c concentrations, mainly if fol-lowed by specific nutritional counseling.

Despite the reductions observed in TC, LDL-c and non-HDL-c, the TC/HDL-c and LDL-c/HDL-c ratios did not pre-sent a significant decrease when compared to placebo.However, when the baseline and final values of barutreatment were compared (not considering the compari-son with placebo) these ratios presented a significantreduction (P Z 0.029 e 0.043, respectively) [data notshown]. Moreover, it is important to emphasize thatalthough the TC/HDL-c and LDL-c/HDL-c ratios areimportant CV risk markers [23], the National CholesterolEducation Program [16] highlights that the initial goal of

Table 3 Energy and nutrient intake at baseline and after 6 weeks of trea

Baru almond

Baseline 6 weeks

Energy, kcal/day 1791 � 100 1773 � 112Carbohydrate, g/day 131 � 3 129 � 11Protein, g/day 46 � 3 43 � 2Fat, g/day 35 � 3 37 � 4SFA, g/day 9.0 � 0.8 8.9 � 1.2PUFA, g/day 5.2 � 0.7 6.7 � 0.9MUFA, g/day 8.1 � 0.8 9.9 � 1.5Fiber, g/day 9.4 � 1.2 10.0 � 1.4Cholesterol, mg/day 146 � 17 127 � 17Zinc, mg/day 4.6 � 0.4 5.5 � 1.1Vitamin E, mg/day 5.5 � 0.7 7.3 � 0.7a Values are means � SEMs. MUFA, monounsaturated fatty acids; PUFA,b Nutrients were adjusted for energy (density model). Values are expresc P values represent the differences among variables at baseline and afte

test for paired samples or Wilcoxon test).

Please cite this article in press as: Bento APN, et al., Baru almond imrandomized, controlled, crossover study, Nutrition, Metabolismj.numecd.2014.07.002

the therapy for decreasing CVD risks is the reduction inLDL-c concentrations, as this lipoprotein is directlyinvolved in atherosclerosis genesis, contributing greatly toCVD development.

The importance of other lipid parameters, such as non-HDL-c fraction, has been highlighted in CVD risk predic-tion. A meta-analysis performed by Boekholdt et al. [24]has shown that non-HDL-c concentrations had strongerdirect association with CVD risk than LDL-c and Apo B. Inthe present study, baru almonds consumption significantlyreduced non-HDL-c concentrations.

This study’s data suggest that LDL-c, TC, and non-HDL-creduction may be explained by the synergy between the

tment with baru almond and placebo (n Z 20).a,b

Placebo

Pc Baseline 6 weeks Pc

0.44 1766 � 130 1778 � 129 0.840.50 133 � 3 133 � 10 0.680.55 44 � 2 49 � 3 0.080.45 33 � 3 38 � 3 0.180.63 8.6 � 0.9 9.4 � 1.2 0.640.07 5.0 � 0.4 5.7 � 0.3 0.220.14 7.7 � 0.6 8.7 � 1.1 0.290.81 7.8 � 0.5 8.9 � 0.7 0.310.45 128 � 19 145 � 14 0.070.45 4.3 � 0.4 4.3 � 0.5 0.900.06 6.4 � 0.6 5.8 � 0.6 0.37

polyunsaturated fatty acids; SFA, saturated fatty acids.sed as intake per 1000 kcal (4184 kJ).r 6 weeks of treatment with baru almonds and placebo (two-tailed t

proves lipid profile in mildly hypercholesterolemic subjects: A& Cardiovascular Diseases (2014), http://dx.doi.org/10.1016/

6 A.P.N. Bento et al.

increase in unsaturated fatty acids, dietary fibers andbioactive compounds intake (Table 3). Some mechanismswere suggested to explain the serum lipid concentrationsreduction mediated by unsaturated fatty acids, as thereduction of lipogenic enzymes activity, among themcholesterol ester transfer protein (CEPT), lecithin choles-terol acyltransferase (LCAT), lipoprotein lipase and hepaticlipase [25], as well as the increase of lipid oxidation [26].However, more investigation on the topic is still necessary.Oleic acid (C18:1), the predominant fatty acid in baru al-monds (Table 1), has been associated with lower CVDprevalence. It was estimated that the substitution of 5% ofSFA by oleic acid would promote a sufficient LDL-creduction to decrease CVD risks up to 40% [27]. In addi-tion to reducing LDL-c, MUFA-rich diets may decrease thesusceptibility of these particles to oxidation [28]. Dietaryfibers and phytosterols, in turn, may limit intestinal ab-sorption of dietary cholesterol; fibers, due to the formationof gels [29], and phytosterols, for presenting chemicalstructures similar to cholesterol [30].

The oxidative status biomarkers evaluated have notsuffered significant alterations after the consumption of20 g of baru almonds. Some studies have been demon-strating positive effects of oilseeds intake on inflammationand oxidation biomarkers, however, after utilizing servingsat least three times larger than that of our study. A 68 g-ingestion of almonds reduced C-reactive protein (CRP) andE-selectin concentrations in healthy individuals [3]. Con-sumption between 60 and 100 g of pistachios was able toreduce interleukin-6 (IL-6), lipid hydroperoxide and MDAconcentrations, as well as to increase SOD activity [5].

Possible limitations of our study include the size ofbaru almonds serving used, which could be larger, andthe intervention period for daily supplementation.Perhaps, consumption of a larger quantity for a longertime would be able to promote significant alterations andnot only a trend of improvement in the oxidative stressbiomarkers.

Our study endorses scientific evidence that demon-strate beneficial effects of oilseeds consumption on serumlipids, which may contribute to CVD risk reduction. Furtherinvestigations on the effects of baru almonds consumptionare necessary, and will be helpful to substantiate ourfindings, elucidate action mechanisms and the clinical andbiological meaning of discovered alterations. Larger barualmonds servings must be tested in order to evaluatedoseeresponse existence and the impact on otherinflammation and oxidation biomarkers must be explored.

In conclusion, the incorporation of 20 g of baru almondsin mildly hypercholesterolemic individuals’ usual dietpresented meaningful impact on serum lipid parameters,so that baru almonds may integrate the portfolio of rec-ommended oilseeds as part of dietary habits aiming atreducing CVD risks.

Acknowledgements

This project study has been funded by grants from FAPEG(Foundation of Supporting Research in Goiás State e

Please cite this article in press as: Bento APN, et al., Baru almond imrandomized, controlled, crossover study, Nutrition, Metabolismj.numecd.2014.07.002

Fundação deAmparo à Pesquisa do Estado deGoiás; processnumber 201200143070480). The authors would like tothank all the participants, ProfessorMara Reis Silva, PhD, forthe support in research design, and Professor AlexandreSiqueira Guedes Coelho, PhD, for the statistical support.

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