Disclosure

Richard D. Mattes, MPH, PhD, RD

• Affiliations: Purdue University and West Lafayette, IN, USA

• Disclosure: Dr. Mattes has received grants/research support and honorarium from Almond Board of California.

2

Level 1 Epidemiological Evidence

3

Nurses Health Study 4

0

1 23.00

23.50

24.00

24.50

25.00 B

od

y M

ass

Ind

ex (

kg/m

2 )

Never 1-3X/mo to 1X/wk

2-4X/wk >5X/wk

Nut Consumption versus BMI

(Hu et al, BMJ, 1998)

Physicians Health Study (N=21,454) 5

0

5

10

15

20

25

30 B

od

y M

ass

Ind

ex (

kg/m

2

Rarely/Never

1-3X/mo 1X/wk > 2X/wk

)

Average Frequency of Dietary Nut Intake

(Albert et al, Arch Intern Med, 2002)

Level 2 Clinical Evidence

6

7 Nut Subjects Duration (months)

Weight Change

Abby, 1994 Almond/Macadamia 16 0.75 NS

Spiller, 1998 Almond 48 1 NS

Fraser, 2002 Almond 81 6 NS

Hyson, 2002 Almond 22 1.5 NS

Jenkins, 2002 Almond 27 1 L

Lovejoy, 2002 Almond 20 1 +<1Kg

Spiller, 2003 Almond 38 1 NS

Sabate, 2003 Almond 25 1 NS

Wein, 2003 Almond 65 6 L

Hollis, 2007 Almond 20 2.5 NS

Curb, 2000 Macadamia 30 1 NS

Garg, 2003 Macadamia 17 1 L

Kris-Etherton, 1999 Peanut 22 0.75 NS

Alper, 2002 Peanut 15 4.75 NS

Morgan, 2001 Pecan 19 2 NS

Rajaram, 2001 Pecan 23 1 L

Edwards, 1999 Pistachio 10 0.75 NS

Almario, 2001 Walnut 18 1.5 NS

Sabate, 1993 Walnut 19 2 L

Zambon, 2000 Walnut 49 1.5 NS

Iwamoto,2002 Walnut 80 1 L

Sabate, 2005 Walnut 90 6 +0.4Kg

Nu

ts a

nd

Wei

ght C

han

ge

(Wien et al, Int J Obes Relat Metab Discord, 2003)

8

Figure: Weekly change in weight in the two study groups. Data are least-squares means and 95% CL; CHO=carboyhdrate; LCD=low-calorie diet.

(Foster et al, Am J Clin Nutr, 2012)

9

Figure: Mean (±SE) weight change at 6 and 18 mo in a weight-management population after a hypocaloric almond-enriched diet (n=62) or a nut-free diet (n=61). Weight change data were analyzed by using intent-to-treat linear mixed-effects models. These analyses included all observed data on all participants, regardless of attrition.

Level 3 Mechanistic Evidence

10

Mechanisms

• Appetite

• Energy yield

• Energy Expenditure

11

Appetite

12

Appetitive Effects of Nuts

• Suppression of Hunger

─ Eating initiation

• Suppression of Desire to Eat

─ Eating in the absence of hunger

• Enhancement of Fullness

─ Meal size

13

Dietary Compensation

Study Nut % Compensation

Fraser et al., 2002 Almonds 54, 75

LoveJoy et al., 2002 Almonds 63

Hollis & Mattes Almonds 76

Curb et al., 1992 Macadamias 58, 113

Kirkmeyer & Mattes, 2000 Peanuts 104%

Alper & Mattes, 2001 Peanuts 66%

Almario et al., 2001 Walnuts 96%

Abbey et al., 1994 Walnuts 55%

Tey et al., 2011 Hazelnuts 100%

14

Factors Contributing to Satiety

• Energy

• Fatty Acids

• Rheology

• Macronutrient Profile

• Fiber

• Cognition

15

The Satiety value of nuts appears to stem from the

synergy of their components

16

Snacking

17

A Critical Issue for Nutrition & Health

Concerns:

• Positive energy balance

• Diet quality

Opportunities:

• Enhanced nutrient density of diet

• Improved metabolic profile

18

2

2.25

2.5

NHANES I1971-1974

NHANES II1976 - 1980

NHANES III1988 - 1994

NHANES1999 -2002

NHANES2003 - 2006

NHANES2007 - 2010

Men

Women

Mean # Daily Snacks ~2.25

15

17.5

20

22.5

25

NHANES I1971-1974

NHANES II1976 - 1980

NHANES III1988 - 1994

NHANES1999 -2002

NHANES2003 - 2006

NHANES2007 - 2010

% Energy fromsnacks (Men)

% Energy fromsnacks (Women)

75

77.5

80

82.5

85

NHANES I1971-1974

NHANES II1976 - 1980

NHANES III1988 - 1994

NHANES1999 -2002

NHANES2003 - 2006

NHANES2007 - 2010

% Energy frommain meals(Men)

% Energy frommain meals(Women)

% Energy from Snacks increased whereas that from Main Meals decreased.

(Kant and Graubard, J Acad Nutr Diet, 2015)

19

Snacking Increased Among U.S. Adults between 1977 and 2006

N=44,754 adults

≥19 y from four

national surveys

combined.

(Piernas and Popkin, J Nutr, 2010)

20

(Duffey and Popkin, PLoS Med, 2011)

21

0

5

10

15

20

25

30

35

40

Men

Women

Percentages of Selected Nutrients Contributed by Food and Beverages Consumed at Snack Occasions, NHANES 2011–2012

(What We Eat in America, NHANES, 2011-2012)

22

Desirable Properties of Snacks

Palatable/Affordable

Satisfying

Energy neutrality

Nutrient contribution/health promoting

23

• 45 overweight/obese males

• 12 week intervention

(Zaveri and Drummond, J Humn Nutr Dietet, 2009)

24

Healthy Snacks 25

Can the right snack have an impact on satiety and reduce energy intake?

08.25 – 18.00

Subjective ratings of appetite (VAS)

17.30

Ad libitum dinner

Screening Session Day (2 week wash out period between sessions)

12.30

Ad libitum lunch

Health Questionnaires

Eating behaviour questionnaires

BMI

08.30

Breakfast

Training

11.00

Test product

Variable Mean (± SEM) n=32

Age 48.4 ± 1.0 years Gender Female

BMI 22.7 ± 0.26 kg/m2

SCOFF 0.0 ± 0.03

Eating Behaviour score 7.9 ± 0.59

A (28g almonds) B (42g almonds)

©Leatherhead Food Research

(Hull et al, Eur J Nutr, 2014)

26

Dietary Energy Compensation: Meal VS. Snack

(Devitt et al, J Nutr Metab, 2011)

27

Study Design

• Four-week randomized, controlled, parallel-arm

• Healthy adults with increased risk for T2DM

• 18 – 60 y-o, non-diabetic

• Overweight (BMI>25) and/or family history

• Five study groups:

• Control (CL), Meal (BF & LN), Snack (MS & AS)

28

Study Visits

• Acute-feeding sessions (Clinical):

─ Started between 7am and 8am (overnight fasting)

─ Lasted for 515 minutes

─ Standard breakfast (0 min) and lunch (240 min)

29

Almond Consumption and Energy Intake 30

(Tan and Mattes, Eur J Clin Nutr, 2013)

Almond Consumption and Body Weight 31

(Tan and Mattes, Eur J Clin Nutr, 2013)

32

Theoretical Energy Balance

Energy Expenditure

33

Resting Energy Expenditure 34

1000

2000

3000

4000

5000

6000

7000

8000

Before Peanut

Consumption

After Peanut

Consumption

0

kJ/d

a b

(Alper and Mattes, Int J Obes, 2002)

Resting Energy Expenditure 35

Figure: Median REE for lean and overweight participants at baseline and after 8 weeks of peanut oil ingestion. L = lean, O = overweight, M = male, F = female, T = total subjects (male and female). Medians with different letters are significantly different in the same group (p<0.01)

36

Theoretical Energy Balance

Absorption Efficiency

37

Inefficient Absorption 38

0

2

4

6

8

10

12

14

16

18

20

Levine andSilvas, 1980

Haddad andSabate, 2000

Zemaitis andSabate, 2001

Ellis et. al., 2004

% F

ecal fa

t excre

tio

n

Control

Nut Treatment

* *

*

Pecans=31%

dietary fat for

4wk

Almonds= 40%

dietary fat for 4wk

Almonds approx

30-45% dietary

fat for 3 d

Peanuts= 95%

dietary fat for 6 d

Inefficient Absorption

0

10

20

30

40

50

60

Full dose Almonds Half almond/ HalfMuffin

Full dose muffin

Ch

ange

in k

cal e

xcre

ted

(co

ntr

ol -

tr

t)

423kcal / d supplement for 4wks

39

(Kendall et al, FASEB J, 2003)

Inefficient Absorption 40

(Traoret et al, Int J Obes (Lond), 2008)

0

1

2

3

4

5

6

7

8

9

Peanuts Peanut Butter Peanut Oil Peanut Flour

% F

ecal fa

t

Control

Treatment

7-9 day controlled diet with 70 g of peanuts/ peanut butter/ peanut flour/ peanut oil

41

(Ellis et al, Am J Clin Nutr, 2004)

Almond Particle Size after Mastication By Number of Chews

42

(Cassady et al, Am J Clin Nutr, 2009)

Fecal Fat and Energy Lost By Number of Chews

43

(Cassady et al, Am J Clin Nutr, 2009)

Food Forms & Metabolizable Energy Value

•Almonds ~ 80%

•Walnuts ~ 80%

•Pistachios ~ 95%

(Baer et al, Br J Nutr, 2012; Novotny et al, Am J Clin Nutr, 2012)

44

45

Theoretical Energy Balance

Nuts and Energy Balance 46

(Hollis and Mattes, Br J Nutr, 2007)

Component of Energy Balance

% Almond Energy Dissipated

Predicted body weight gain (kg) 3.1

Actual body weight gained (kg) 0

Dietary compensation (KJ) 802 74

Fecal excretion (KJ) 84 7

Energy Expenditure (KJ) REE TEF Physical Activity Total Energy (DLW)

184 13 -79 180

13 .01 -6 14

Total Energy Explained 95

Nuts and Monotony: Change of Palatability

47

0

1

2

3

4

5

6

7

8

9

10

Week 2 Week 4 Week 6 Week 8 Week 10 Week 12

Pal

atab

ility

(0

=did

no

t lik

e a

t al

l, 1

0=l

ike

d e

xtre

me

ly)

Time

Single

Variety

All

N=51

Flavors

Honey

Roasted

Salted

Spicy

Raw

Hedonic Ratings of Almonds Over 12 Weeks of Daily Consumption

0

10

20

30

40

50

60

70

80

90

100

Week 1 Week 12

Hed

on

ic R

atin

g (m

m)

Extremely

Pleasant

48

49

Almonds Baseline

Almonds Post-Diet

Control Baseline

Control Post-Diet

No Oral Stimulation

50

*

Summary

• Epidemiological, clinical and mechanistic data

indicate nuts pose limited threat to positive energy

balance due to:

─Strong satiety properties, precise dietary compensation

especially as a snack

─Limited energy bioaccessibility

─Elevated resting energy expenditure

• Nuts may be a healthful snack as they add nutrients

with limited impact on energy balance

51

Cheryl Forberg RD Chef and Nutritionist for NBC’s The

Biggest Loser, James Beard award-

winning chef, New York Times best-

selling author, Huffington Post Blogger

Disclosure: Cheryl serves as a consultant

to American Pistachio Growers

52

52

53

The Biggest Loser Show

Common Denominators of Cast x 12 years

• calories?

• breakfast

• fruit or vegetables

• lean protein

• whole grains

• too much white stuff; flour; pasta, sugar, rice, simple carbs

• no time to plan ahead so they find themselves grabbing something quick for a meal, which is often consumed in the car or at their desk

• caloric beverages

• water

• exercise

• they prioritize their spouse, partner, children and/or their jobs over their own health and well-being

• Snackwells Paradox

54

Medical Expert Team 55

56

Nutrition Consult

57

Training in Cooking and Nutrition

58

Provide Healthy Food

The Dietary Advice

59

Macronutrient Ratio 60

The 4-3-2-1 Biggest Loser Pyramid 61

Healthy Protein

5 Servings Daily – 3 meals and 2 snack size servings

62

Whole Grains

2 cups maximum

63

White Stuff 64

Vegetables and Fruits

4 cups MINIMUM

65

Good Fats 66

Calorie Budget

1200 calories per day / 4 = 300 cals

• Breakfast 300

• Lunch 300

• Dinner 300

• 300/2 = two 150 calorie snacks (or three 100 calorie snacks)

67

45 % CHO 30% PRO 25% Fat

Daily Calorie Budget 1200

Kcal per meal 300

Kcal per snack 150

Pro kcals q day 360

Pro grams per meal 23

Pro grams per snack 11

Fat grams per day 33

68

Every Meal and Every Snack

Contains balance of CHO, PRO and FAT to

• Promote healthy blood sugar level

• Increase satiety

• Fuel to build lean body mass

69

Sample 1200 cal Menu 70

Breakfast 2 servings Mediterranean Scrambled Eggs (page 131) 1/2 medium banana 8 ounces green tea, ice water or fat-free milk

Mid-Morning Snack 1/2 thin sandwich bun or 1 small whole-wheat pita stuffed with 1/4 cup hummus, 2 slices tomato and 4 slices cucumber

Lunch 1 serving Spinach Salad with Smoked Turkey Pistachios and Currants (page 135) 1 small peach

Mid-Afternoon Snack

1/2 cup fat-free 72.5 g cottage cheese with 1/2 medium apple, chopped, 2 tablespoons chopped walnuts, and 2 tablespoons chopped celery

Dinner 1 serving Best Bison Burger (page 115) 1 serving Chili Ranch Dressing (page 120) 1 cup steamed Swiss chard 8 ounces green tea or water with lemon

Calorie Counter & Diary

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Calorie Counter and Diary

72

The Weight Loss

www.facebook.com/CherylForbergRD www.Instagram.com/CherylForbergRD www.pinterest.com/CherylForbergRD

www.twitter.com/CherylForbergRD www.cherylforbergrd.com

73

Q&A

74

Richard D. Mattes, MPH, PhD, RD

Cheryl Forberg, RD

Credit Claiming

You must complete a brief evaluation of the program in order to download your certificate. The evaluation survey will be available on www.CE.TodaysDietitian.com for 1 year following the live presentation.

RDs should list CPE activity type 175 in their professional development portfolio.

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