Insulin resistance is central for the aetiology of the metabolic syndrome cluster of disease: blood lipid disorders, hypertension, propensity for thrombus formation, abdominal obesity and Type II (insulin-dependent) diabetes mellitus [1]. Although genetic predisposition is a factor, the prevalence of obesity and diabetes is increasing rapidly in both developed and developing countries [2] arguing that lifestyle factors such as dietary and physical activity patterns, which are amenable to change, modulate insulin action and hence disease development.Experimental and clinical data suggest that the amount and quality of fat in the diet could be important for the development of insulin resistance and related metabolic disorders [3]. A high proportion of Diabetologia (2001) AbstractAims/hypothesis. The amount and quality of fat in the diet could be of importance for development of insulin resistance and related metabolic disorders. Our aim was to determine whether a change in dietary fat quality alone could alter insulin action in humans. Methods. The KANWU study included 162 healthy

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Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research that reflects different study designs, with inherent strengths and limitations. We propose a systematic approach for the review of evidence that begins with research on dietary patterns. This research will identify the combinations of foods that best protect, or appear deleterious to, health. Next, we suggest that evidence be sought from research that focuses on the effects of individual foods. Finally, nutrient-based research should be considered to explain the mechanisms by which these foods and dietary patterns exert their effects, take into account the effects of ingredients added to the food supply, and enable assessments of dietary sufficiency. The consideration of individual nutrients and food components (e.g., upper limits for saturated fat, added sugar, and sodium) provides important benchmarks for evaluating overall diet quality. The concepts of core and discretionary foods (nutrient-rich and nutrient-poor foods, respectively) enable distinctions between foods, and this has implications for the relation between food policy and food manufacturing. In summary, evidence supporting healthy dietary patterns provides the foundation for the development of dietary guidelines. Further reference to individual foods and nutrients follows from the foundation of healthy dietary patterns.

Research and practice in nutrition relate to food and its constituents, often as supplements. In food, however, the biological constituents are coordinated. We propose that "thinking food first"' results in more effective nutrition research and policy. The concept of food synergy provides the necessary theoretical underpinning. The evidence for health benefit appears stronger when put together in a synergistic dietary pattern than for individual foods or food constituents. A review of dietary supplementation suggests that although supplements may be beneficial in states of insufficiency, the safe middle ground for consumption likely is food. Also, food provides a buffer during absorption. Constituents delivered by foods taken directly from their biological environment may have different effects from those formulated through technologic processing, but either way health benefits are likely to be determined by the total diet. The concept of food synergy is based on the proposition that the interrelations between constituents in foods are significant. This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level. Many examples are provided of superior effects of whole foods over their isolated constituents. The food synergy concept supports the idea of dietary variety and of selecting nutrient-rich foods. The more we understand about our own biology and that of plants and animals, the better we will be able to discern the combinations of foods, rather than supplements, which best promote health.

OBJECTIVE -The aim of this study was to examine the effect of a moderate-fat diet inclusive of walnuts on blood lipid profiles in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -This was a parallel randomized controlled trial comparing three dietary advice groups each with 30% energy as fat: low fat, modified low fat, and modified low fat inclusive of 30 g of walnuts per day. Fifty-eight men and women, mean age 59.3 Ϯ 8.1 years, started the trial. Dietary advice was given at baseline with monthly follow-up and fortnightly phone calls for support. Body weight, percent body fat, blood lipids, HbA 1c , total antioxidant capacity, and erythrocyte fatty acid levels were measured at 0, 3, and 6 months. Data were assessed by repeated-measures ANOVA with an intention-to-treat model. RESULTS -The walnut group achieved a significantly greater increase in HDL cholesterolto-total cholesterol ratio (P ϭ 0.049) and HDL (P ϭ 0.046) than the two other treatment groups. A 10% reduction in LDL cholesterol was also achieved in the walnut group, reflecting a significant effect by group (P ϭ 0.032) and time (P ϭ 0.036). There were no significant differences between groups for changes in body weight, percent body fat, total antioxidant capacity, or HbA 1c levels. The higher dietary polyunsaturated fat-to-saturated fat ratio and intakes of -3 fatty acids in the walnut group were confirmed by erythrocyte biomarkers of dietary intake.CONCLUSIONS -Structured "whole of diet" advice that included 30 g of walnuts/day delivering substantial amounts of polyunsaturated fatty acid improved the lipid profile of patients with type 2 diabetes. The literature on recommendations varies to a minor degree, and cultural differences may have an influence (9), but a total fat level of Յ30% energy (10) and Ͻ10% saturated fat is reasonably well accepted (11,12). There is some concern that PUFAs are more susceptible to oxidation and therefore may be more atherogenic (11), so a level of Ͻ10% energy for PUFAs is seen with greater flexibility in the proportions of carbohydrate and MUFA (13). Within the PUFA fraction of the diet, the ratio of -6 to -3 fatty acids is also considered (9) with daily recommendations for a 2,000-kcal diet of 0.65 g for the long-chain -3s (EPA ϩ DHA) and 2.22 g for ALA (14) and the -6 -to--3 ratio reduced to substantially Ͻ10 (14a). Diabetes CareFish are the major source of EPA ϩ DHA, but fish oil supplements produce a decreased oxidative stability of plasma LDL (15,16). In contrast, consumption of fish itself may be protective against type 2 diabetes (17). Nuts provide substantial amounts of dietary PUFA, and nut consumption is inversely associated with the risk of type 2 diabetes in women (18). There is no net effect on glucose homeostasis from nut supplementation, but more interestingly, no net weight gain when nuts were used as a replacement food (19). In subjects with dyslipidemia (total cholesterol Ͼ5.17; LDL Ͼ3.36; triglycerides Ͼ2.26 mmol/l), a low-fat diet supplemented with walnuts was found to reduce total choles...

Hypertension is a major risk factor for developing cardiovascular disease, stroke, and kidney disease. To lower blood pressure (BP), several lifestyle changes are recommended such as weight loss, exercise, and following a healthy diet. Investigating the effect of single nutrients may have positive results, but food is consumed as part of a whole diet, resulting in nutrient interactions. The aim of this systematic review and meta-analysis was to assess the effect of dietary patterns on BP in adults. Studies that were published between January 1999 and June 2014 were retrieved using Scopus, Web of Science, and the MEDLINE database. Seventeen randomized controlled trials were included in the meta-analysis. The results suggest that healthy dietary patterns such as the Dietary Approaches to Stop Hypertension diet, Nordic diet, and Mediterranean diet significantly lowered systolic BP and diastolic BP by 4.26 mm Hg and 2.38 mm Hg, respectively. These diets are rich in fruit, vegetables, whole grains, legumes, seeds, nuts, fish, and dairy and low in meat, sweets, and alcohol. Lifestyle factors such as exercise and weight loss in combination with dietary changes may also reduce BP. Further research is needed to establish the effect of dietary patterns on BP in different cultures other than those identified in this review. The review was registered on PROSPERO (International prospective register of systematic reviews) as CRD42015016272.

Dietary fibre has been consumed for centuries with known health benefits, but defining dietary fibre is a real challenge. From a functional perspective, dietary fibre is described as supporting laxation, attenuating blood glucose responses and assisting with cholesterol lowering. The problem is different types of dietary fibre have different effects, and new effects are increasingly observed, such as the influence on gut microbiota. Thus, a single definition may need to be described in more generic terms. Rather than being bound by a few functional definitions, we may need to embrace the possibilities of new horizons, and derive a working definition of dietary fibre based on a set of conceptual principles, rather than the limited definitions we have to date. To begin this process, a review of individual fibre types and their physiological effects would be helpful. Dietary fibre is a complex group of substances, and there is a growing interest in specific effects linked to fibre type. Different fractions of dietary fibre have different physiological properties, yet there is a paucity of literature covering the effects of all fibres. This paper describes a range of individual fibre types and identifies gaps in the literature which may expose new directions for a working definition of dietary fibre.

Background/Objectives: Most dietary interventions have metabolic effects in the short term, but long-term effects may require dietary fat changes to influence body composition and insulin action. This study assessed the effect of sustained high polyunsaturated fatty acids (PUFA) intake through walnut consumption on metabolic outcomes in type II diabetes. Subjects/Methods: Fifty overweight adults with non-insulin-treated diabetes (mean age 54±8.7 years) were randomized to receive low-fat dietary advice ± 30 g per day walnuts targeting weight maintenance (around 2000 kcal, 30% fat) for 1 year. Differences between groups were assessed by changes in anthropometric values (body weight, body fat, visceral adipose tissue) and clinical indicators of diabetes over treatment time using the general linear model. Results: The walnut group consumed significantly more PUFA than the control (P ¼ 0.035), an outcome attributed to walnut consumption (contributing 67% dietary PUFA at 12 months). Most of the effects were seen in the first 3 months. Despite being on weight maintenance diets, both groups sustained a 1-2 kg weight loss, with no difference between groups (P ¼ 0.680). Both groups showed improvements in all clinical parameters with significant time effects (Po0.004), bar triacylglycerol levels, but these were just above normal to begin with. The walnut group produced significantly greater reductions in fasting insulin levels (P ¼ 0.046), an effect seen largely in the first 3 months. Conclusions: Dietary fat can be manipulated with whole foods such as walnuts, producing reductions in fasting insulin levels. Long-term effects are also apparent but subject to fluctuations in dietary intake if not of the disease process.