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Snacking on whole almonds for 6 weeks improves endothelial function and lowers LDL cholesterol but does not affect liver fat and other cardiometabolic risk factors in healthy adults: the ATTIS study, a randomized controlled trial.

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Vita Dikariyanto, Leanne Smith, Lucy Francis, May Robertson, Eslem Kusaslan, Molly Callaghan-Latham, Camille Palanche, Maria D'Annibale, Dimitra Christodoulou, Nicolas Basty, Brandon Whitcher, Haris Shuaib, Geoffrey Charles-Edwards, Philip Chowienczyk, Peter Ellis, Sarah Berry, Wendy Hall

Original languageEnglish
JournalAmerican Journal of Clinical Nutrition
Publication statusPublished - 15 May 2020

King's Authors


Background: There is convincing evidence that daily whole almond consumption lowers blood LDL-cholesterol concentrations, but effects on other cardiometabolic risk factors such as endothelial function and liver fat are still to be determined.
Objective: We aimed to investigate whether isoenergetic substitution of whole almonds for control snacks with the macronutrient profile of average snack intakes, had any impact on markers of cardiometabolic health in adults aged 30-70 y at above average risk of cardiovascular disease.
Design: The study was a 6-week randomized controlled, parallel-arm trial. Following a 2-week run-in period consuming control snacks (mini-muffins), participants consumed either whole roasted almonds (n = 51) or control snacks (n = 56), providing 20% of daily estimated energy requirements. Endothelial function (flow mediated dilation), liver fat (magnetic resonance imaging (MRI)/spectroscopy (MRS)), and secondary outcomes as markers of cardiometabolic disease risk were assessed at baseline and endpoint.
Results: Almonds, compared with control, increased endothelium-dependent vasodilation (mean difference 4.1 % units of measurement, 95% CI 2.2, 5.9), but there were no differences in liver fat between groups. Plasma LDL-cholesterol concentrations decreased in the almond group relative to control (mean difference -0.25 mmol/L, 95% CI -0.45, -0.04), but there were no group differences in triglycerides, HDL-cholesterol, glucose, insulin, insulin resistance, leptin, adiponectin, resistin, liver function enzymes, fetuin-A, body composition, pancreatic fat, intramyocellular lipids, fecal short chain fatty acids, blood pressure or 24 h heart rate variability. However, the long-phase heart rate variability parameter, very low-frequency power, was increased during night-time following the almond treatment compared to control (mean difference 337 ms2, 95% CI 12, 661), indicating greater parasympathetic regulation.
Conclusions: Whole almonds consumed as snacks markedly improve endothelial function, in addition to lowering LDL-cholesterol, in adults with above average risk of cardiovascular disease. This trial was registered at as NCT02907684.

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