Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial

• Published in: Nutrition Journal 2024, Vol.23 (1)
• Main Authors: Bersch-Ferreira, Ãngela Cristine, Weschenfelder, Camila, Vieira Machado, Rachel Helena, Nakagawa Santos, Renato Hideo, Riley, Terrence M, da Silva, Lucas Ribeiro, Miyada, Debora Harumi Kodama, Sady, Erica Regina Ribeiro, de Abreu-Silva, Erlon Oliveira, Laranjeira, Ligia Nasi, de Quadros, Alexandre Schaan, dos Santos, Júlia Lorenzon, Souza, Gabriela Corrêa, Parahiba, Suena Medeiros, Fayh, Ana Paula Trussardi, Bezerra, Danielle Soares, Carvalho, Ana Paula Perillo Ferreira, Machado, Malaine Morais Alves, Vasconcelos, Sandra Mary Lima, Santos, Mayranne Victórya Rocha, de Figueiredo Neto, José Albuquerque, Dias, Luciana Pereira Pinto, Zaina Nagano, Francisca Eugenia, de Almeida, Cássia Cristina Paes, Moreira, Annie Seixas Bello, de Oliveira, Rodrigo Damasceno, Rogero, Marcelo Macedo, Sampaio, Geni Rodrigues, da Silva Torres, Elizabeth Aparecida Ferraz, Weber, Bernardete, Cavalcanti, Alexandre Biasi, Marcadenti, Aline
• Format: Report
• Language: English
• Subjects: Cardiac patients; Cholesterol, LDL; Control; Diet therapy; Diseases; Health aspects; Heart attack; Nuts; Prevention; Relapse; Risk factors
• ISSN: 1475-2891; 1475-2891
• DOI: 10.1186/s12937-024-01020-5

Nuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction. DICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality. After adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study. Adding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting.