Both groups received dietary consultation to limit energy intake and were evaluated at baseline, 3 months and 6 months. Overweight and obesity remain a global public health issue.

sean compiled Medical Nutrition MNT 022-08-05 08:58 published in Beijing

https://doi.org/10.3390/nu14142986

Release time: July 21, 2022 Daily

abstract

The purpose of this study was to examine the effect of eating 35 grams of peanuts before two main meals a day on weight and blood sugar control indicators, as well as the blood pressure of adults at risk of 2 diabetes within 6 months as part of the weight loss diet.

researchers conducted a two-arm randomized controlled trial . BMI 26 kg/m 2 adults (age 18 years) and patients at risk of type 2 diabetes were randomly assigned to the peanut group or the traditional low-fat diet group (control group).

recommended that the peanut group eat 35 grams of micro-salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. Both groups received dietary consultation to limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d) and were evaluated at baseline, 3 months and 6 months. A total of 107 participants were randomly assigned (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m2, waist circumference 109 ± 13 cm, AUSDRISK score 15 ± 5 points), and 76 participants completed the study. No inter-group difference in body weight (main results) was observed at 6 months (mean difference, -0.12 kg; 95% CI, -2.42, 2.18; p=0.92). The mean weight loss at 6 months in the cohort was 6.7 ± 5.1 kg (visit p 0.001). HbA1c, fasting blood glucose , fasting insulin, 2-hour glucose , and HOMA-IR did not differ between the groups.

At 6 months, the peanut group had a greater reduction in systolic blood pressure compared with the control group (-5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). In the case of energy-restricted diet, 35 grams of peanuts were consumed before two main meals a day, which was comparable to a traditional low-fat weight loss diet without preload. After peanut ingestion, the systolic blood pressure is reduced more, which may reduce the risk of cardiovascular disease.

Keywords: weight loss; peanuts; overweight; obesity; Pre-diabetes

1. Introduction

overweight and obesity are still a problem with global public health significance. In the United States, approximately 74% of adults aged 20 are overweight or obese [1 ]. Similarly, in Australia, 67% of adults were overweight or obese in 2017/2018, up from 63.4% in 2014/2015 [ 2 ]. Among young Australian adults (ages 18-24 years), overweight and obesity increased from 38.9% in 2014/2015 to 46.0% in 2017/2018. Overweight and obesity significantly increase the risk of type 2 diabetes and cardiovascular disease (CVD) [3, 4]. Dietary methods that help overweight and obese adults achieve continuous weight loss are essential to reduce the risk of type 2 diabetes and CVD.

First-line intervention in the treatment of overweight and obesity is the energy-restricted diet [5]; however, there are many obstacles in adopting and maintaining an energy-restricted diet. A key challenge is hunger, as many weight loss diets have lower fullness. A high-protein diet has a higher sense of fullness and is a dietary method recommended for weight loss [5]. Another strategy that promotes fullness and helps reduce energy intake is to consume preload before the main meal. A recent randomized trial showed that taking an energy-restricted diet (-500 kcal/d) and ingestion of high-protein, fiber-based shakes (17 g protein, 6 g fiber) 30 minutes before breakfast and lunch can reduce body weight to a greater extent than isocal-low protein fiber shakes (1 g protein, 3 g fiber) after 84 days (-3.3 kg vs. -1.8 kg, p 0.05) [ 6 ].In addition to feeling fullness, the preload of protein reduces postprandial glucose fluctuations by delaying gastric emptying, slowing glucose absorption and/or stimulating insulin secretion before the main glucose load in the meal [7, 8, 9]. The oil-containing preload is similar to the postprandial effects of protein-containing preload [10]. Importantly, post-meal blood sugar levels in are the main factor leading to overall hyperglycemia in patients with non-type 2 diabetes. In a group of adults without diabetes (hemoglobin A1c (HbA1c) 5.1–5.5%), postprandial blood glucose levels accounted for approximately 81% of overall relative hyperglycemia [11]. Therefore, preloads containing fat, protein, and fiber before the main meal may be a strategy to promote satiety and reduce post-prandial hyperglycemia, which is expected to promote weight loss and reduce the risk of type 2 diabetes.

a large amount of evidence suggests that nuts are associated with reduced risk of CVD and type 2 diabetes [12]. These findings are supported by randomized controlled trials that show that nuts can improve risk factors for cardiovascular disease [13, 14, 15] and blood sugar control markers [16, 17]. In addition, nuts have a high sense of fullness. Human feeding experiments have shown that nut intake can regulate appetite after meals [18]. It is worth noting that nuts, including peanuts, have been shown to suppress hunger and appetite and increase fullness after intake. However, nuts are energy-intensive and are often excluded from the weight loss diet. Evidence to date shows that in studies on weight maintenance, nut intake does not promote weight gain [19]. However, few studies have evaluated the effects of nut intake in the context of an energy-restricted diet. The purpose of this trial was to evaluate the effect of 35 grams of peanuts before two main meals per day, HbA1c, 2 hours of blood sugar and blood pressure in overweight or obese adults at moderate or high risk of type 2 diabetes as part of a traditional low-fat weight loss diet as part of an energy-restricted weight loss diet. It is speculated that adding peanuts to a weight loss diet will increase weight loss and improve blood sugar control compared to the traditional low-fat weight loss diet.

2. Materials and Methods

2.1. Study Planning

A 6-month 2-arm parallel randomized controlled trial was conducted at the University of South Australia in Adelaide, Australia to examine the effects of energy-restricted diets including 70 g/tallion peanuts on weight loss, blood pressure and blood sugar results compared with a low-fat weight loss diet. It is recommended that the peanut group eat 35 grams of salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. It is recommended that two dietary groups limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d). Using a computer-generated scheme (randomization.com), participants were randomly assigned at baseline in a one-to-one ratio. The study was approved by the Human Research Ethics Committee of the University of South Australia and obtained written informed consent from participants (Ethics Agreement “Long-term Effects of Peanuts on Weight and Diabetes Prevention and Control Markers”; Application ID: 203354; Approved October 23, 2020). The study was conducted according to the Declaration of Helsinki of .

2.2. Participants

Participants were recruited from Adelaide, Australia from January 2021 to May 2021 to use printing, social media and radio advertising. Eligible individuals were 18 years old, with body mass index (BMI) 26 kg/m2 and at moderate or high risk of type 2 diabetes in the Australian type 2 diabetes assessment (score 6 points) (Risk Assessment Tool (AUSDRISK)) [ 20]. In addition, eligible individuals have no health status that is likely to affect the study results, nor have peanuts allergies to food /intoler tolerant.People who have had previous bariatric surgery, systolic blood pressure of 160 mmHg, are currently receiving medication for acute illness, participate in another ongoing clinical trial, current diet for weight loss, and are reluctant to eat peanuts, take medications for diabetes or obesity. Women who are allowed to use hypertensive medications, are pregnant or plan to get pregnant or who are breastfed are not eligible.

2.3. Dietary Intervention

Peanut Group and the control group both received nutrition education from certified practicing nutritionist to follow the energy-restricted diet. Participants in both groups met with dietitians monthly throughout the study. According to previous research, it is recommended that women and men limit their energy intake to 5500 and 7000 kJ, respectively [ 21, 22 ], respectively. Participants in both groups were asked to keep their exercise patterns unchanged throughout the study.

During the entire 6-month study period, participants in the peanut group were educated to eat 35 grams of peanuts 30 minutes before two meals (i.e. 70 grams per day). Micro-salted dried roasted peanuts (Fisher Nuts: 1890 kJ/70 g, fat, 35 g/70 g; MUFA, 18.3 g/70 g; sodium, 188 mg/70 g; carbohydrate , 12.5 g/70 g; protein, 17.5 g/70 g provided during the study period). The intake of peanuts provided was assessed through a daily checklist filled out by the participants. Participants in the control group were educated on a low-fat diet and asked to avoid peanuts and peanut butter during the study period. Dietary education following an energy-restricted diet reflects standard care for overweight and obesity management [23]. Participants in the control group received food stamps of the same value as those provided to the peanuts group. Participants in both groups were asked to weigh at home every week between clinic visits.

2.4. Results

Participants attended the research center 7 times ( Table 1). At baseline, 3- and 6-month blood samples were collected for measurement of HbA1c, fasting blood glucose, and insulin, and a 2-hour oral glucose tolerance test was performed. Throughout the study, body weight was measured monthly and blood pressure was measured every 3 months. Prior to each visit, participants were asked to start fasting from 12:00 the night before, and only water was allowed. After taking off your shoes, measure your weight and height in light clothes, and use an automatic blood pressure monitor to measure your blood pressure in triplicate after 5 minutes of rest. Blood samples were collected at collection points in an accredited clinical laboratory (Clinpath Pathology, Adelaide) for measurement of HbA1c, fasting blood glucose, and insulin. Calculate the homeostatic model evaluation of insulin resistance (HOMA-IR) according to the following formula: [24]. A 2-hour oral glucose tolerance test was conducted at the research center. Blood samples were collected 120 minutes after drinking a 75g glucose beverage on an empty stomach. Blood samples were analyzed by commercial laboratories (Clinpath Pathology, Adelaide).

Table 1. Results evaluation timetable for the study period

Results evaluation

Time (month)

0

0

html l01

2

3

3

4

4

5

6

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

height

X

blood pressure

X

X

X

X

X

24 hours dietary memories

X

X

X

X

X

X

X

X

X

X

X

X

X

Glycosified hemoglobin

Xhtml l9

X

X

Fasting blood sugar and insulin

X

X

X

X

2-hour glucose tolerance test

X

X

X

X

HbA1c, hemoglobin A1c.

uses an automated managed 24-hour recall (ASA-24) system (Australia 2016 edition) to collect a single non-random 24-hour recall at baseline, 3 months, and 6 months. It is recommended to complete a 24-hour recall at each time point to evaluate changes in average normal intake after the intervention [25 ]. Participants were asked to recall intakes from midnight to midnight the day before. Since all reported energy intakes were considered reasonable, no exclusion was made based on energy intake. Follow the National Cancer Institute's Guide to Review and Cleaning ASA-24 Data [26].

2.5. Statistical analysis

sample size calculation shows that the completion of each group of 50 participants will provide 80% of the efficacy to detect the difference between 1.7 kg (standard deviation 3.0 kg) between groups (p 0.05) [ 21 ]. Weight loss is the main result. All other results are secondary.

All statistical analyses were performed using SAS (version 9.4; SAS Institute, Cary, NC, USA). All available data from random participants were included in the data analysis that conformed to the intention-to-treat principle. Data from participants who exited the study were obtained when endpoint measurements were obtained. The hybrid model process does not perform list deletion, thus retaining degrees of freedom; therefore, this analysis method allows participants containing ≥1 missing data points. Normality of the residual was evaluated by using univariate analysis (PROC UNIVARIATE) to quantitatively evaluate skewness and visually examine the distribution and normal probability (Q-Q) plots.

Mixed Model Program (PROC MIXED) was used to check the effect of diet on each result. Access is modeled as repetitive effects to interpret repeated measurement designs. Diet was modeled as a fixed effect, with baseline values ​​included as covariate . When the main effects of diet, visits, or successive diets were detected, post hoc pairwise comparisons were performed and multiple comparisons were adjusted using the Tukey-Kramer method; data from the post hoc test were expressed as pairwise difference and 95% CI and Tukey-Kramer adjusted p-values. Gender effects and gender-diet interactions were also evaluated.The statistical significance was set to p 0.05.

3. Results

3.1. Participant

There are a total of 107 participants randomly assigned. Among the random participants, one exited during the baseline test and two were considered unqualified at baseline. At 3 months, 47 participants randomly assigned to the peanut group and 33 participants randomly assigned to the control group participated in the follow-up. Six months later, 44 participants in the peanut group and 32 participants in the control group participated in the follow-up ( Figure 1). At baseline, the two groups were very similar. The mean age of this cohort was 58 years (range 19-79 years), with an average BMI of 33.1 ± 5.4 kg/m 2 and a waist circumference of 109 ± 12.9 cm ( Table 2). The Peanuts group reported that the peanuts provided were consumed on 93% of the study days.

Figure 1. CONSORT flow chart.

Table 2. Baseline characteristics of all random participants

		Total (n = 107)	Peanuts (n = 57)	Control (n = 50)
	age, age	58±14	59±14	58±15
female, n (%)	70 (65)	41 (72)	29 (58)
	weight, kg	92.2±17.2	91.6±17.6	92.9 ± 16.9
body weight index, kg/m2	33.1±5.4	33.1±5.4	33.1±5.4	33.1± 4.9	33.0±6.0
waist circumference, centimeter	109±12.9	108±13.4	109±12.5
systolic blood pressure, mmHg		128±16	126±15	129±17
diastolic blood pressure , mmHg	81±10	81±10	81±10	81±10	81±10
AUSDRISK Rating	15.3±4.7	15.0±4.7	15.6±4.7
fasting blood sugar, mmol/L	5.1±0.7	5.1±0.6 1	5.2 ±0.8 2
Fasted insulin, u/mL	11.1±6.7	10.6±6.9	11.8±6.3 2
	saccharified hemoglobin, %	5.6±0.4	5.6±0.3	5.6±0.3	5.6±0.6 ±0.6 3
2 hours glucose, mmol/L	5.9±2.3	5.7±1.8 1	6.2 ± 2.9 2
Prescription antihypertensive drugs, n (%)	14 (13)	5 (9)	9 (18)

Unless otherwise stated, the data are expressed as the mean ± standard deviation; 1 n = 56; 2 n = 44; 3 n = 45. AUSDRISK, Australia Type 2 diabetes risk assessment tool; BMI, body mass index; HbA1c, hemoglobin A1c.

3.2. Weight

The main access effect of body weight was observed (p 0.001); no dietary effect (p = 0.94) or dietary interactions (p = 0.98) were observed ( Figure 2).Compared with baseline, the peanut group lost 6.72 kg (95% CI, -8.21, -5.23) at 6 months and the control group lost 6.60 kg (95% CI, -8.35, -4.85); at 6 months, there was no difference in weight loss between the peanut group and the control group (mean difference, -0.12; 95% CI, -2.42, 2.18; p = 0.92). No gender influence or gender-diet interaction was observed. Only 3 participants in each group did not lose weight at 6 months compared to baseline.

Figure 2. The weight of each study group changed from baseline during the 6-month study period. The mean value of the data expressed in least squares ± the standard error of the mean. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on weight changes from baseline was examined by modeling access as repetitive effects and baseline weight as covariates.

3.3.Blood pressure

For systolic blood pressure, the main effects of diet (p=0.007) and medical treatment (p0.001) were observed; the interaction of diet each visit (p=0.063) was close to statistical significance ( Table 3). Compared with baseline, the peanut group (-9.46 mmHg, 95% CI, -11.96, -6.95; p 0.001) and the control group (-4.13 mmHg; 95% CI, -7.11, -1.14; p = 0.007) were 6 months later. The 6-month reduction in systolic blood pressure observed in the peanut group was significantly greater than the corresponding changes observed in the control group (mean difference between groups, -5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). No gender influence of systolic blood pressure or gender-diet interaction was observed.

Table 3. Study the effect of diet on blood pressure.

Peanut group

Control group htt ml3

p value

time (month)

0 ( n = 57)

3 (n = 47)

6 (n = 44)

0 (n = 44)

0 (n = 50)

3 (n = 33)

6 (n = 33)

6 (n = 31)

Diet

Access

Diet x Visit

systolic blood pressure, mmHg

127±0.9

119±1.0

117±1.1

117±1.1

127±1.0

html ml0122±1.2

122±1.3

0.007

0.001

0.063

0.063

diastolic blood pressure, mmHg

81±0.6

77±0.7

75±0.7

81±0.7

81±0.7

77±0.8

76±0.8

0.52

0.001

0.70

0 the data mean ± standard error of the mean value expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. SBP, systolic blood pressure; DBP, diastolic blood pressure.

For diastolic blood pressure, no dietary effects or interaction between diet and visit was observed. The diastolic blood pressure in this cohort decreased at month 3 (-3.92 mmHg; 95% CI, -5.52, -2.32; p 0.001) and 6 (-4.76 mmHg; 95% CI, -6.40, -3.13; p 0.001) compared with baseline. No differences in diastolic blood pressure were observed between 3 and 6 months. No gender influence or gender-diet interaction was observed.

3.4. Blood glucose results

For fasting blood glucose, fasting insulin, 2-hour glucose, HbA1c or HOMA-IR, no dietary effects or interactions of diets per visit were observed ( Table 4). Fasting blood glucose decreased in the cohort over time (visit p 0.001). Fasting blood glucose was in the cohort at 3 months (-0.14 mmol/L; 95% CI, -0.24, -0.04; p = 0.004) and 6 months (-0.18 mmol/L; 95% CI, -0.28, -0.08; p 0.001). No gender effect or diet-sex interaction was observed in fasting blood glucose. For 2-hour glucose, no major effects of visits, gender, or dietary gender were observed.

Table 4. Effect of research results on blood sugar results

Peanut group

Control group

p value

time (month)

0 ( n = 57)

3 (n = 46)

6 (n = 43)

0 (n = 43)

0 (n = 44)

3 (n = 35)

6 (n = 35)

6 (n = 32)

Diet

Access

Diet x Access

Diet x Access

fasting blood sugar, mmol/L

5.12 ± 0.04 1

5.01 ± 0.05

4.99±0.05

5.13±0.05

4.96 ± 0.05 4

4.90 ± 0.06 5

0.37

0.001

0.46

Fasted insulin, u/mL

10.89±0.52

8.95±0.58

8.14±0.59 3

11.42±0.59

8.15±0.67

7.33±0.70

0.50

0.001

0.41

2 hours glucose, mmol/L

5.84 ± 0.17 1

5.93 ± 0.19 2

6.06±0.19

5.89 ± 0.19

6.30 ± 0.21 4

6.41 ± 0.22 5

0.18

0.09

0.58

Glycoated hemoglobin, %

5.61±0.02

5.50±0.02

5.48±0.02

5.61±0.02

5.61±0. 0.02 2

5.55±0.02

5.49±0.02

0.21

0.001

0.32

0.32

HOMA-IR

2.49 ±0.12 1

2.09 ± 0.14

1.88±0.14

2.66±0.14

1.83 ± 0.16 4

1.60 ± 0.17 5

0.35

0.001

0.17

The data mean ± the standard error of the mean expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined, access was modeled as a repetitive effect, and baseline values ​​were included as covariates; 1 n = 56; 2 n = 45; 3 n = 44; 4 n = 34; 5 n = 31. HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model evaluation of insulin resistance.

Insulin in the entire cohort decreased over time (visit p 0.001). Insulin levels were lower at 3 months (-2.62 u/mL; 95% CI, -4.06, -1.19; p 0.01) and 6 months (-3.38 u/mL; 95% CI, -4.85, -1.91) compared with baseline; p 0.001). No gender effect of insulin or diet-sex interaction was observed. HOMA-IR also declined over time throughout the queue (p 0.001). Compared with baseline, HOMA-IR was at 3 months (-0.61; 95% CI, -0.93, -0.30; p 0001) and 6 months (-0.84; 95% CI, -1.16, -0.51; p 0.001). No gender effects or diet-sex interaction was observed in HOMA-IR.

HbA1c in this queue declines over time (visit p 0.001). Compared with baseline, HbA1c was 3 months (-0.08%; 95% CI, -0.12, -0.04; p 0.001) and 6 months (-0.13%; 95% CI, -0.17%, -0.09; p 0.001) in the entire cohort. HbA1c was also lower at 6 months compared to 3 months (-0.05%; 95% CI, -0.09, -0.003; p = 0.03). Gender effects were observed ( p = 0.03), i.e., higher HbA1c was found in women than men; however, no diet-gender interaction was observed.

3.5. Dietary intake

The main effects of diet, medical treatment and successive diet on energy intake, total fat (g and % kJ), MUFA (% kJ), and carbohydrates (% kJ) were observed ( Table 5). Post hoc tests showed that compared with the peanut group, the control group had a significant reduction in energy intake at 6 months (-1731 kJ; 95% CI, -3231, -231; p = 0.01); no differences between groups were observed at 3 months. The percentage of total fat energy in the peanut group was significantly higher than that in the control group at 3 months (11%; 95% CI, 6, 17; p 0.001) and 6 months (12%; 95% CI, 6). The reason for the higher fat intake in the peanut group is the higher MUFA intake in the peanuts provided. Compared with the control group, the peanut group was at 3 months (10%; 95% CI, 7, 13; p 0.001) and 6 months (11%; 95% CI, 7, 14; p 0.001). The percentage of carbohydrate energy in the peanut group was significantly lower than that in the control group CI, -16, -5; p 0.001) and 6 months (-10%; 95%). These data confirm high compliance levels in both groups, as the differences reflect intakes of high-fat foods (i.e., peanuts) versus low-fat diets (higher carbohydrates).

Table 5. Effects of peanut-containing weight loss diet on diet intake compared with traditional low-fat weight loss diets through self-managed 24-hour memory assessment.

sean compiled Medical Nutrition MNT 022-08-05 08:58 published in Beijing

https://doi.org/10.3390/nu14142986

Release time: July 21, 2022 Daily

abstract

The purpose of this study was to examine the effect of eating 35 grams of peanuts before two main meals a day on weight and blood sugar control indicators, as well as the blood pressure of adults at risk of 2 diabetes within 6 months as part of the weight loss diet.

researchers conducted a two-arm randomized controlled trial . BMI 26 kg/m 2 adults (age 18 years) and patients at risk of type 2 diabetes were randomly assigned to the peanut group or the traditional low-fat diet group (control group).

recommended that the peanut group eat 35 grams of micro-salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. Both groups received dietary consultation to limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d) and were evaluated at baseline, 3 months and 6 months. A total of 107 participants were randomly assigned (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m2, waist circumference 109 ± 13 cm, AUSDRISK score 15 ± 5 points), and 76 participants completed the study. No inter-group difference in body weight (main results) was observed at 6 months (mean difference, -0.12 kg; 95% CI, -2.42, 2.18; p=0.92). The mean weight loss at 6 months in the cohort was 6.7 ± 5.1 kg (visit p 0.001). HbA1c, fasting blood glucose , fasting insulin, 2-hour glucose , and HOMA-IR did not differ between the groups.

At 6 months, the peanut group had a greater reduction in systolic blood pressure compared with the control group (-5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). In the case of energy-restricted diet, 35 grams of peanuts were consumed before two main meals a day, which was comparable to a traditional low-fat weight loss diet without preload. After peanut ingestion, the systolic blood pressure is reduced more, which may reduce the risk of cardiovascular disease.

Keywords: weight loss; peanuts; overweight; obesity; Pre-diabetes

1. Introduction

overweight and obesity are still a problem with global public health significance. In the United States, approximately 74% of adults aged 20 are overweight or obese [1 ]. Similarly, in Australia, 67% of adults were overweight or obese in 2017/2018, up from 63.4% in 2014/2015 [ 2 ]. Among young Australian adults (ages 18-24 years), overweight and obesity increased from 38.9% in 2014/2015 to 46.0% in 2017/2018. Overweight and obesity significantly increase the risk of type 2 diabetes and cardiovascular disease (CVD) [3, 4]. Dietary methods that help overweight and obese adults achieve continuous weight loss are essential to reduce the risk of type 2 diabetes and CVD.

First-line intervention in the treatment of overweight and obesity is the energy-restricted diet [5]; however, there are many obstacles in adopting and maintaining an energy-restricted diet. A key challenge is hunger, as many weight loss diets have lower fullness. A high-protein diet has a higher sense of fullness and is a dietary method recommended for weight loss [5]. Another strategy that promotes fullness and helps reduce energy intake is to consume preload before the main meal. A recent randomized trial showed that taking an energy-restricted diet (-500 kcal/d) and ingestion of high-protein, fiber-based shakes (17 g protein, 6 g fiber) 30 minutes before breakfast and lunch can reduce body weight to a greater extent than isocal-low protein fiber shakes (1 g protein, 3 g fiber) after 84 days (-3.3 kg vs. -1.8 kg, p 0.05) [ 6 ].In addition to feeling fullness, the preload of protein reduces postprandial glucose fluctuations by delaying gastric emptying, slowing glucose absorption and/or stimulating insulin secretion before the main glucose load in the meal [7, 8, 9]. The oil-containing preload is similar to the postprandial effects of protein-containing preload [10]. Importantly, post-meal blood sugar levels in are the main factor leading to overall hyperglycemia in patients with non-type 2 diabetes. In a group of adults without diabetes (hemoglobin A1c (HbA1c) 5.1–5.5%), postprandial blood glucose levels accounted for approximately 81% of overall relative hyperglycemia [11]. Therefore, preloads containing fat, protein, and fiber before the main meal may be a strategy to promote satiety and reduce post-prandial hyperglycemia, which is expected to promote weight loss and reduce the risk of type 2 diabetes.

a large amount of evidence suggests that nuts are associated with reduced risk of CVD and type 2 diabetes [12]. These findings are supported by randomized controlled trials that show that nuts can improve risk factors for cardiovascular disease [13, 14, 15] and blood sugar control markers [16, 17]. In addition, nuts have a high sense of fullness. Human feeding experiments have shown that nut intake can regulate appetite after meals [18]. It is worth noting that nuts, including peanuts, have been shown to suppress hunger and appetite and increase fullness after intake. However, nuts are energy-intensive and are often excluded from the weight loss diet. Evidence to date shows that in studies on weight maintenance, nut intake does not promote weight gain [19]. However, few studies have evaluated the effects of nut intake in the context of an energy-restricted diet. The purpose of this trial was to evaluate the effect of 35 grams of peanuts before two main meals per day, HbA1c, 2 hours of blood sugar and blood pressure in overweight or obese adults at moderate or high risk of type 2 diabetes as part of a traditional low-fat weight loss diet as part of an energy-restricted weight loss diet. It is speculated that adding peanuts to a weight loss diet will increase weight loss and improve blood sugar control compared to the traditional low-fat weight loss diet.

2. Materials and Methods

2.1. Study Planning

A 6-month 2-arm parallel randomized controlled trial was conducted at the University of South Australia in Adelaide, Australia to examine the effects of energy-restricted diets including 70 g/tallion peanuts on weight loss, blood pressure and blood sugar results compared with a low-fat weight loss diet. It is recommended that the peanut group eat 35 grams of salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. It is recommended that two dietary groups limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d). Using a computer-generated scheme (randomization.com), participants were randomly assigned at baseline in a one-to-one ratio. The study was approved by the Human Research Ethics Committee of the University of South Australia and obtained written informed consent from participants (Ethics Agreement “Long-term Effects of Peanuts on Weight and Diabetes Prevention and Control Markers”; Application ID: 203354; Approved October 23, 2020). The study was conducted according to the Declaration of Helsinki of .

2.2. Participants

Participants were recruited from Adelaide, Australia from January 2021 to May 2021 to use printing, social media and radio advertising. Eligible individuals were 18 years old, with body mass index (BMI) 26 kg/m2 and at moderate or high risk of type 2 diabetes in the Australian type 2 diabetes assessment (score 6 points) (Risk Assessment Tool (AUSDRISK)) [ 20]. In addition, eligible individuals have no health status that is likely to affect the study results, nor have peanuts allergies to food /intoler tolerant.People who have had previous bariatric surgery, systolic blood pressure of 160 mmHg, are currently receiving medication for acute illness, participate in another ongoing clinical trial, current diet for weight loss, and are reluctant to eat peanuts, take medications for diabetes or obesity. Women who are allowed to use hypertensive medications, are pregnant or plan to get pregnant or who are breastfed are not eligible.

2.3. Dietary Intervention

Peanut Group and the control group both received nutrition education from certified practicing nutritionist to follow the energy-restricted diet. Participants in both groups met with dietitians monthly throughout the study. According to previous research, it is recommended that women and men limit their energy intake to 5500 and 7000 kJ, respectively [ 21, 22 ], respectively. Participants in both groups were asked to keep their exercise patterns unchanged throughout the study.

During the entire 6-month study period, participants in the peanut group were educated to eat 35 grams of peanuts 30 minutes before two meals (i.e. 70 grams per day). Micro-salted dried roasted peanuts (Fisher Nuts: 1890 kJ/70 g, fat, 35 g/70 g; MUFA, 18.3 g/70 g; sodium, 188 mg/70 g; carbohydrate , 12.5 g/70 g; protein, 17.5 g/70 g provided during the study period). The intake of peanuts provided was assessed through a daily checklist filled out by the participants. Participants in the control group were educated on a low-fat diet and asked to avoid peanuts and peanut butter during the study period. Dietary education following an energy-restricted diet reflects standard care for overweight and obesity management [23]. Participants in the control group received food stamps of the same value as those provided to the peanuts group. Participants in both groups were asked to weigh at home every week between clinic visits.

2.4. Results

Participants attended the research center 7 times ( Table 1). At baseline, 3- and 6-month blood samples were collected for measurement of HbA1c, fasting blood glucose, and insulin, and a 2-hour oral glucose tolerance test was performed. Throughout the study, body weight was measured monthly and blood pressure was measured every 3 months. Prior to each visit, participants were asked to start fasting from 12:00 the night before, and only water was allowed. After taking off your shoes, measure your weight and height in light clothes, and use an automatic blood pressure monitor to measure your blood pressure in triplicate after 5 minutes of rest. Blood samples were collected at collection points in an accredited clinical laboratory (Clinpath Pathology, Adelaide) for measurement of HbA1c, fasting blood glucose, and insulin. Calculate the homeostatic model evaluation of insulin resistance (HOMA-IR) according to the following formula: [24]. A 2-hour oral glucose tolerance test was conducted at the research center. Blood samples were collected 120 minutes after drinking a 75g glucose beverage on an empty stomach. Blood samples were analyzed by commercial laboratories (Clinpath Pathology, Adelaide).

Table 1. Results evaluation timetable for the study period

Results evaluation

Time (month)

0

0

html l01

2

3

3

4

4

5

6

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

height

X

blood pressure

X

X

X

X

X

24 hours dietary memories

X

X

X

X

X

X

X

X

X

X

X

X

X

Glycosified hemoglobin

Xhtml l9

X

X

Fasting blood sugar and insulin

X

X

X

X

2-hour glucose tolerance test

X

X

X

X

HbA1c, hemoglobin A1c.

uses an automated managed 24-hour recall (ASA-24) system (Australia 2016 edition) to collect a single non-random 24-hour recall at baseline, 3 months, and 6 months. It is recommended to complete a 24-hour recall at each time point to evaluate changes in average normal intake after the intervention [25 ]. Participants were asked to recall intakes from midnight to midnight the day before. Since all reported energy intakes were considered reasonable, no exclusion was made based on energy intake. Follow the National Cancer Institute's Guide to Review and Cleaning ASA-24 Data [26].

2.5. Statistical analysis

sample size calculation shows that the completion of each group of 50 participants will provide 80% of the efficacy to detect the difference between 1.7 kg (standard deviation 3.0 kg) between groups (p 0.05) [ 21 ]. Weight loss is the main result. All other results are secondary.

All statistical analyses were performed using SAS (version 9.4; SAS Institute, Cary, NC, USA). All available data from random participants were included in the data analysis that conformed to the intention-to-treat principle. Data from participants who exited the study were obtained when endpoint measurements were obtained. The hybrid model process does not perform list deletion, thus retaining degrees of freedom; therefore, this analysis method allows participants containing ≥1 missing data points. Normality of the residual was evaluated by using univariate analysis (PROC UNIVARIATE) to quantitatively evaluate skewness and visually examine the distribution and normal probability (Q-Q) plots.

Mixed Model Program (PROC MIXED) was used to check the effect of diet on each result. Access is modeled as repetitive effects to interpret repeated measurement designs. Diet was modeled as a fixed effect, with baseline values ​​included as covariate . When the main effects of diet, visits, or successive diets were detected, post hoc pairwise comparisons were performed and multiple comparisons were adjusted using the Tukey-Kramer method; data from the post hoc test were expressed as pairwise difference and 95% CI and Tukey-Kramer adjusted p-values. Gender effects and gender-diet interactions were also evaluated.The statistical significance was set to p 0.05.

3. Results

3.1. Participant

There are a total of 107 participants randomly assigned. Among the random participants, one exited during the baseline test and two were considered unqualified at baseline. At 3 months, 47 participants randomly assigned to the peanut group and 33 participants randomly assigned to the control group participated in the follow-up. Six months later, 44 participants in the peanut group and 32 participants in the control group participated in the follow-up ( Figure 1). At baseline, the two groups were very similar. The mean age of this cohort was 58 years (range 19-79 years), with an average BMI of 33.1 ± 5.4 kg/m 2 and a waist circumference of 109 ± 12.9 cm ( Table 2). The Peanuts group reported that the peanuts provided were consumed on 93% of the study days.

Figure 1. CONSORT flow chart.

Table 2. Baseline characteristics of all random participants

		Total (n = 107)	Peanuts (n = 57)	Control (n = 50)
	age, age	58±14	59±14	58±15
female, n (%)	70 (65)	41 (72)	29 (58)
	weight, kg	92.2±17.2	91.6±17.6	92.9 ± 16.9
body weight index, kg/m2	33.1±5.4	33.1±5.4	33.1±5.4	33.1± 4.9	33.0±6.0
waist circumference, centimeter	109±12.9	108±13.4	109±12.5
systolic blood pressure, mmHg		128±16	126±15	129±17
diastolic blood pressure , mmHg	81±10	81±10	81±10	81±10	81±10
AUSDRISK Rating	15.3±4.7	15.0±4.7	15.6±4.7
fasting blood sugar, mmol/L	5.1±0.7	5.1±0.6 1	5.2 ±0.8 2
Fasted insulin, u/mL	11.1±6.7	10.6±6.9	11.8±6.3 2
	saccharified hemoglobin, %	5.6±0.4	5.6±0.3	5.6±0.3	5.6±0.6 ±0.6 3
2 hours glucose, mmol/L	5.9±2.3	5.7±1.8 1	6.2 ± 2.9 2
Prescription antihypertensive drugs, n (%)	14 (13)	5 (9)	9 (18)

Unless otherwise stated, the data are expressed as the mean ± standard deviation; 1 n = 56; 2 n = 44; 3 n = 45. AUSDRISK, Australia Type 2 diabetes risk assessment tool; BMI, body mass index; HbA1c, hemoglobin A1c.

3.2. Weight

The main access effect of body weight was observed (p 0.001); no dietary effect (p = 0.94) or dietary interactions (p = 0.98) were observed ( Figure 2).Compared with baseline, the peanut group lost 6.72 kg (95% CI, -8.21, -5.23) at 6 months and the control group lost 6.60 kg (95% CI, -8.35, -4.85); at 6 months, there was no difference in weight loss between the peanut group and the control group (mean difference, -0.12; 95% CI, -2.42, 2.18; p = 0.92). No gender influence or gender-diet interaction was observed. Only 3 participants in each group did not lose weight at 6 months compared to baseline.

Figure 2. The weight of each study group changed from baseline during the 6-month study period. The mean value of the data expressed in least squares ± the standard error of the mean. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on weight changes from baseline was examined by modeling access as repetitive effects and baseline weight as covariates.

3.3.Blood pressure

For systolic blood pressure, the main effects of diet (p=0.007) and medical treatment (p0.001) were observed; the interaction of diet each visit (p=0.063) was close to statistical significance ( Table 3). Compared with baseline, the peanut group (-9.46 mmHg, 95% CI, -11.96, -6.95; p 0.001) and the control group (-4.13 mmHg; 95% CI, -7.11, -1.14; p = 0.007) were 6 months later. The 6-month reduction in systolic blood pressure observed in the peanut group was significantly greater than the corresponding changes observed in the control group (mean difference between groups, -5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). No gender influence of systolic blood pressure or gender-diet interaction was observed.

Table 3. Study the effect of diet on blood pressure.

Peanut group

Control group htt ml3

p value

time (month)

0 ( n = 57)

3 (n = 47)

6 (n = 44)

0 (n = 44)

0 (n = 50)

3 (n = 33)

6 (n = 33)

6 (n = 31)

Diet

Access

Diet x Visit

systolic blood pressure, mmHg

127±0.9

119±1.0

117±1.1

117±1.1

127±1.0

html ml0122±1.2

122±1.3

0.007

0.001

0.063

0.063

diastolic blood pressure, mmHg

81±0.6

77±0.7

75±0.7

81±0.7

81±0.7

77±0.8

76±0.8

0.52

0.001

0.70

0 the data mean ± standard error of the mean value expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. SBP, systolic blood pressure; DBP, diastolic blood pressure.

For diastolic blood pressure, no dietary effects or interaction between diet and visit was observed. The diastolic blood pressure in this cohort decreased at month 3 (-3.92 mmHg; 95% CI, -5.52, -2.32; p 0.001) and 6 (-4.76 mmHg; 95% CI, -6.40, -3.13; p 0.001) compared with baseline. No differences in diastolic blood pressure were observed between 3 and 6 months. No gender influence or gender-diet interaction was observed.

3.4. Blood glucose results

For fasting blood glucose, fasting insulin, 2-hour glucose, HbA1c or HOMA-IR, no dietary effects or interactions of diets per visit were observed ( Table 4). Fasting blood glucose decreased in the cohort over time (visit p 0.001). Fasting blood glucose was in the cohort at 3 months (-0.14 mmol/L; 95% CI, -0.24, -0.04; p = 0.004) and 6 months (-0.18 mmol/L; 95% CI, -0.28, -0.08; p 0.001). No gender effect or diet-sex interaction was observed in fasting blood glucose. For 2-hour glucose, no major effects of visits, gender, or dietary gender were observed.

Table 4. Effect of research results on blood sugar results

Peanut group

Control group

p value

time (month)

0 ( n = 57)

3 (n = 46)

6 (n = 43)

0 (n = 43)

0 (n = 44)

3 (n = 35)

6 (n = 35)

6 (n = 32)

Diet

Access

Diet x Access

Diet x Access

fasting blood sugar, mmol/L

5.12 ± 0.04 1

5.01 ± 0.05

4.99±0.05

5.13±0.05

4.96 ± 0.05 4

4.90 ± 0.06 5

0.37

0.001

0.46

Fasted insulin, u/mL

10.89±0.52

8.95±0.58

8.14±0.59 3

11.42±0.59

8.15±0.67

7.33±0.70

0.50

0.001

0.41

2 hours glucose, mmol/L

5.84 ± 0.17 1

5.93 ± 0.19 2

6.06±0.19

5.89 ± 0.19

6.30 ± 0.21 4

6.41 ± 0.22 5

0.18

0.09

0.58

Glycoated hemoglobin, %

5.61±0.02

5.50±0.02

5.48±0.02

5.61±0.02

5.61±0. 0.02 2

5.55±0.02

5.49±0.02

0.21

0.001

0.32

0.32

HOMA-IR

2.49 ±0.12 1

2.09 ± 0.14

1.88±0.14

2.66±0.14

1.83 ± 0.16 4

1.60 ± 0.17 5

0.35

0.001

0.17

The data mean ± the standard error of the mean expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined, access was modeled as a repetitive effect, and baseline values ​​were included as covariates; 1 n = 56; 2 n = 45; 3 n = 44; 4 n = 34; 5 n = 31. HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model evaluation of insulin resistance.

Insulin in the entire cohort decreased over time (visit p 0.001). Insulin levels were lower at 3 months (-2.62 u/mL; 95% CI, -4.06, -1.19; p 0.01) and 6 months (-3.38 u/mL; 95% CI, -4.85, -1.91) compared with baseline; p 0.001). No gender effect of insulin or diet-sex interaction was observed. HOMA-IR also declined over time throughout the queue (p 0.001). Compared with baseline, HOMA-IR was at 3 months (-0.61; 95% CI, -0.93, -0.30; p 0001) and 6 months (-0.84; 95% CI, -1.16, -0.51; p 0.001). No gender effects or diet-sex interaction was observed in HOMA-IR.

HbA1c in this queue declines over time (visit p 0.001). Compared with baseline, HbA1c was 3 months (-0.08%; 95% CI, -0.12, -0.04; p 0.001) and 6 months (-0.13%; 95% CI, -0.17%, -0.09; p 0.001) in the entire cohort. HbA1c was also lower at 6 months compared to 3 months (-0.05%; 95% CI, -0.09, -0.003; p = 0.03). Gender effects were observed ( p = 0.03), i.e., higher HbA1c was found in women than men; however, no diet-gender interaction was observed.

3.5. Dietary intake

The main effects of diet, medical treatment and successive diet on energy intake, total fat (g and % kJ), MUFA (% kJ), and carbohydrates (% kJ) were observed ( Table 5). Post hoc tests showed that compared with the peanut group, the control group had a significant reduction in energy intake at 6 months (-1731 kJ; 95% CI, -3231, -231; p = 0.01); no differences between groups were observed at 3 months. The percentage of total fat energy in the peanut group was significantly higher than that in the control group at 3 months (11%; 95% CI, 6, 17; p 0.001) and 6 months (12%; 95% CI, 6). The reason for the higher fat intake in the peanut group is the higher MUFA intake in the peanuts provided. Compared with the control group, the peanut group was at 3 months (10%; 95% CI, 7, 13; p 0.001) and 6 months (11%; 95% CI, 7, 14; p 0.001). The percentage of carbohydrate energy in the peanut group was significantly lower than that in the control group CI, -16, -5; p 0.001) and 6 months (-10%; 95%). These data confirm high compliance levels in both groups, as the differences reflect intakes of high-fat foods (i.e., peanuts) versus low-fat diets (higher carbohydrates).

Table 5. Effects of peanut-containing weight loss diet on diet intake compared with traditional low-fat weight loss diets through self-managed 24-hour memory assessment.

0

9±1.0

Peanut group

Control group

p value

time (month)

0 ( n = 57)

3 ( n = 48)

6 ( n = 44)

0 ( n = 47)

3 ( n = 34)

6 ( n = 32)

Diet

Access

Access

Diet x Access

Energy (kJ)

8340±295

7011±322

7657±336

8770±325

6126±382

5926±394

0.01

0.001

0.005

protein (g)

91± 3.6

87±4.0

97±4.1

91±4.0

72±4.7

79±4.9

0.005

0.02

0.02

0.055

Protein (% kJ)

19±0.6

21±0.6

21±0.6

21±0.7

18±0.7

20±0.8

22±0.8

0.52

0.001

0.27

Total fat (g)

80±4.0

75±4.4

88±4.6

83±4.4

50±5. 2

52±5.4

0.001

0.001

0.001

0.001

Total fat (% kJ)

36±1.1

40±1.2

44±1.2

44±1.2

35±1.2

29±1.4

32±1.4

0.001

0.03

0.001

0.001

Saturated fat (g)

29±1.5

21±1.7

24±1.7

24±1.7

30±1.7

18±2 .0

18±2.0

0.07

0.001

0.001

0.17

saturated fat (% kJ)

13±0.5

11±0.5

12±0.5

12±0.5

12±0.5

12±0.5

10±0.6

11±0. 6

0.25

0.005

0.88

Monounsaturated fatty acids (g)

32±1.9

38±2.1

45±2.1

34±2.1

34±2.1

18±2.4

20±2.5

0.001

0.09

0.09

0.001

monounsaturated fatty acids (% kJ)

14±0.7

21±0.7

23±0.7

14±0.7

14±0.7

11±0.8

12±0. 9

0.001

0.001

0.001

polyunsaturated fatty acids (g)

13±0.7

10±0.8

12±0.8

13±0.8

13±0.8

8±1.0

0.03

0.001

0.22

polyunsaturated fatty acids (% kJ)

5.8±0.3

5.1±0.3

5.7±0.3

5.5±0.3

5.5±0.3

4.8±0.4

5. 4±0.4

0.24

0.08

0.99

carbohydrate (g)

192±7.5

138±8.1

140±8.5

201±8.2

167±9.7

144±10

0.055

0.001

0.33

carbohydrate (% kJ)

39±1.1

33±1.2

30±1.2

30±1.2

39±1.2

46±1.4

40±1.5

0.001

0.001

0.003

0.001

0.003

0.001

0.001

Total sugar (g)

81±3.8

66±4.1

66±4.3

66±4.3

86±4.2

86±4.2

70±4.9

70±5 .1

0.21

0.001

0.99

Total fiber (g)

25±1.2

29±1.3

29±1.3

29±1.3

26±1.3

27±1.5

23±1.6

0.18

0.13

0.13

0.03

sodium (mg)

2319±118

1950 ± 129

1968 ± 135

2380±131

2098 ± 153

1850±158

0.81

0.002

0.61

Potassium (mg)

3287±137

3352±149

3619±156

3442±150

2877 ± 177

2973 ± 183

0.02

0.24

0.02

0.02

The data mean ± standard error of the mean expressed by least squares.Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid. Access effects of saturated fat were observed with post hoc tests, and post hoc tests showed lower intake at 3 months compared to baseline for the entire cohort (-1.8%; 95% CI, -3.0, -0.5; p=0.004). Access effects were also observed with sodium. In the entire cohort, sodium intake was not observed at 3 months (-325 mg; 95% CI, -625, -26; p = 0.03) and 6 months (-440 mg; 95% CI, -747, -134; p = 0.002) compared with baseline; no dietary effects or diet-visit interactions were observed. The main effects of diet and diet per-time on potassium were observed. Throughout the study, potassium intake was higher in the peanut group than in the control group. Post hoc test showed that there was no significant difference in potassium intake in each group at each time point (p 0.05 all). Sequential dietary interactions of fiber were observed; post hoc tests showed no significant difference in fiber intake between groups at each time point (all p 0.05).

4. Discussion

This randomized trial showed that a peanut-rich weight loss diet was similar to the traditional low-fat weight loss diet. However, at 6 months, the peanut-containing weight loss diet decreased a greater systolic blood pressure compared to the traditional diet. Both diets improved fasting blood glucose and insulin, HOMA-IR, and HbA1c. Overall, the results of this trial show that 70 g/day peanuts can be included in an energy-limited weight loss diet without losing weight within 6 months.

Peanuts are energy-intensive (24.6 kJ/g or 5.9 kcal/g), and people are concerned that habitual intake of nuts may promote weight gain [27]. For this reason, people who have a weight loss diet often avoid eating nuts. In this trial, participants in the peanut group consumed 70 g/d (1890 kJ/450 kcal) of peanuts before two main meals per day. In the context of dietary consultation to follow an energy-restricted diet, participants did achieve energy deficits consistent with clinically significant weight loss (-7.5% of initial weight), which was no different from the control group who gave dietary consultation to follow an energy-restricted diet at 6 months. Differences in the composition of macronutrients in each group of diets were observed; however, these differences were consistent with the nutrient content and portion size of the peanuts provided. These results are consistent with data showing weight loss comparable to low-fat diets ([5]. However, the effect of low-fat, high-carbohydrate diets on blood pressure is not quite consistent compared to high-fat, low-carbohydrate diets [5]. In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28] [28 In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28 ]. In overweight or obese individuals, it is recommended to control blood pressure by weight loss [29], although the blood pressure reduction effect of weight loss varies in the study [30, 31]. Metare regression of randomized controlled trial data showed that weight loss by 1 kg reduced systolic blood pressure by 0.36 mmHg [30]. However, early analysis showed that for every 1 kg of weight loss, systolic blood pressure decreased by 1.05 mmHg [ 31]. Since weight loss in the peanut group and the control group was comparable, diet-related differences may explain the observed systolic blood pressure reduction in the peanut group. A meta-analysis of

versus 21 randomized controlled trials showed that intake of nuts reduced systolic blood pressure in non-type 2 diabetes patients (mean difference, -1.29 mmHg; 95% CI, -2.35, -0.22); however, only two included studies examined peanuts, and no effect on systolic blood pressure was observed in both studies [32]. A recent meta-analysis of six randomized controlled trials showed that peanuts had no effect on systolic blood pressure [32 ]. 33].Although the results of this study differ from previous evidence, it should be noted that relatively few studies examined the effects of peanuts on blood pressure, and limited studies evaluated people at high risk for type 2 diabetes with weight loss.

The higher MUFA/lower carbohydrate intake in the peanut group may lead to the observed reduction in systolic blood pressure. A systematic review and meta-analysis of a randomized controlled trial including patients with type 2 diabetes showed a high-carbohydrate diet [34]. However, a meta-analysis of 14 randomized controlled trials showed that a low-saturated fat, high-MUFA diet did not affect the blood pressure diet compared to low-saturated fat and high carbohydrate [35]. Therefore, the effect of a higher MUFA diet on systolic blood pressure remains unclear. However, the dietary source of MUFA may explain some inconsistencies. In the meta-analysis of Qian et al., all studies included plant sources of MUFA [34]. Overall, this evidence suggests that diets with high plant-derived MUFAs may have a lowering effect.

In both groups, sodium intake decreased over the 6-month period, which may lead to the observed reduction in systolic blood pressure over time. However, based on meta regression showing that 0.042 mmHg decreases in systolic blood pressure is expected to decrease 1 mmHg for every 1 mmol reduction in sodium excretion [36 ]. On average, potassium intake was higher in the peanut group than in the control group (322 mg), although the increase in potassium intake only moderately reduced systolic blood pressure (1 mmHg) [36]. Therefore, changes in sodium and potassium intake may have contributed little to the observed overall systolic blood pressure reduction.

In this study, we did not observe between groups of fasting blood glucose or insulin, HOMA-IR, 2-hour blood glucose, or HbA1c. A meta-analysis of a randomized controlled feeding study showed that replacing 5% carbohydrate energy with MUFA had no effect on fasting blood glucose, 2-hour glucose, or fasting insulin [37]. However, HbA1c (-0.09%; 95% CI, -0.12, -0.05), 2-h insulin (-20 pmol/L; 95% CI, -32.2, -8.4), and HOMA-IR (-2.4%; 95% CI, -4.6, -0.3) were observed. Therefore, replacing carbohydrates with MUFA may have the insulin sensitization effect that we did not detect in this study, as only HOMA-IR was evaluated, which mainly reflects hepatic insulin sensitivity. In individuals with impaired fasting blood glucose, the level of insulin in the fasting state is low and is not sufficient to maintain normal blood glucose, which is not considered in the HOMA-IR calculation [ 38 ].

Also reasonable is that no hypothetical improvement in blood sugar control was observed because MUFA consumed as part of the peanut matrix has limited intestinal bioavailability and therefore does not delay gastric emptying, reduce carbohydrate absorption and/or stimulate insulin secretion Pre-meal intake of MUFA-rich oil can reduce post-meal glucose fluctuations [10 ]. Given that postprandial blood sugar levels are the main determinant of overall blood sugar control in individuals with impaired blood sugar control [11], it may be necessary to intake a peanut with higher intestinal bioavailability to reduce postprandial hyperglycemia and thus improve overall blood sugar control. A random crossover study showed that adding 42.5 grams of peanut butter to breakfast reduced blood sugar levels by 15 and 45 minutes compared to control or peanut butter breakfast; a diet containing 42.5 grams of whole peanuts did not affect glucose [ 39 ]. In addition, the blood sugar response of the peanut butter-containing breakfast significantly decreased for the second meal compared to the control breakfast. Reis et al. Compared with the control meal, lower levels of non-esterified fatty acids (NEFA) after peanut butter meals were also observed [39]. The authors believe that the improvement in blood sugar response caused by peanut butter is due to the increased sensitivity of insulin due to reduced NEFA circulation concentrations. Increased fatty acid concentrations are known to impair insulin signaling and lead to insulin resistance. Therefore, if peanut butter is used instead of the whole peanut, we may observe different effects.Future studies should investigate whether habitual intake of peanut butter during meal times can improve long-term blood sugar control.

This study has several advantages, including a randomized controlled design, a 6-month follow-up period, and nutritional consultation provided by the dietician. However, this study was limited by the lack of assessment of 2-hour insulin concentration and measurement of insulin sensitivity. Characteristics of changes in insulin sensitivity will help to gain insight into the effects of diet on reversing insulin resistance and delaying type 2 diabetes. Furthermore, we did not evaluate the loss of waist circumference or lean body weight and fat-free weight after a weight loss diet. The control group in this study received dietary education to follow an energy-restricted diet, which reflects standard care for overweight and obesity management. However, since the control group did not consume pretension, it was impossible to infer the superiority of peanut pretension over other pretension forces. Finally, the loss in the control group was greater than that in the peanut group, which may have affected our ability to detect statistically significant differences in the main results among the groups. However, based on the observed effects and 95% CI (mean difference, -0.12 kg; 95% CI, -2.42, 2.18), it is unlikely that there will be clinically significant differences between the two groups.

5. Conclusion

In summary, in the context of a weight loss diet, 35 grams of micro-salted dried roasted peanuts before two main meals per day have a weight loss effect on high-risk adults similar to the traditional low-fat weight loss diet type 2 diabetes 6 months later. No differences in HbA1c, fasting glucose, fasting insulin, or 2-hour glucose were observed between the two weight loss diets. A peanut-containing weight loss diet can significantly reduce systolic blood pressure, which may reduce the risk of cardiovascular disease.

References

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23. 20.Australian Government Department of Health. The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Available online: https://www.health.gov.au/resources/apps-and-tools/the-australian-type-2-diabetes-risk-assessment-tool-ausdrisk (accessed on 26 February 2022).
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31. 28.Rahimi, K.; Bidel, Z.; Nazarzadeh, M.; Copland, E.; Canoy, D.; Ramakrishnan, R.; Pinho-Gomes, A.-C.; Woodward, M.; Adler, A.; Agodoa, L. Pharmacological Blood Pressure Lowering for Primary and Secondary Prevention of Cardiovascular Disease across Different Levels of Blood Pressure: An Individual Participant-Level Data Meta-Analysis. Lancet 2021, 397, 1625–1636.
32. 29.Whelton, P.K.; Carey, R.M.; Aronow, W.S.; Casey, D.E.; Collins, K.J.; Himmelfarb, C.D.; DePalma, S.M.; Gidding, S.; Jameson, K.A.; Jones, D.W. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. J. Am. Coll. Cardiol. 2018, 71, e127–e248.
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35. 32.Mohammadifard, N.; Salehi-Abargouei, A.; Salas-Salvadó, J.; Guasch-Ferré, M.; Humphries, K.; Sarrafzadegan, N. The Effect of Tree Nut, Peanut, and Soy Nut Consumption on Blood Pressure: A Systemic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Am. J. Clin. Nutr. 2015, 101, 966–982.
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37. 34.Qian, F.; Korat, A.A.; Malik, V.; Hu, F.B. Metabolic Effects of Monounsaturated Fatty Acid–Enriched Diets Compared with Carbohydrate or Polyunsaturated Fatty Acid–Enriched Diets in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diabetes Care 2016, 39, 1448–1457.
38. 35.Jovanovski, E.; de Castro Ruiz Marques, A.; Li, D.; Ho, H.V.T.; Blanco Mejia, S.; Sievenpiper, J.L.; Zurbau, A.; Komishon, A.; Duvnjak, L.; Bazotte, R.B. Effect of High-Carbohydrate or High-monounsaturated Fatty Acid Diets on Blood Pressure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. Nutr. Rev. 2019, 77, 19–31.
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42. 39.Reis, C.E.G.; Ribeiro, D.N.; Costa, N.M.B.; Bressan, J.; Alfenas, R.C.G.; Mattes, R.D. Acute and Second-Meal Effects of Peanuts on Glycaemic Response and Appetite in Obese Women with High Type 2 Diabetes Risk: A Randomised Cross-over Clinical Trial. Br. J. Nutr. 2013, 109, 2015–2023.
Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid. Access effects of saturated fat were observed with post hoc tests, and post hoc tests showed lower intake at 3 months compared to baseline for the entire cohort (-1.8%; 95% CI, -3.0, -0.5; p=0.004). Access effects were also observed with sodium. In the entire cohort, sodium intake was not observed at 3 months (-325 mg; 95% CI, -625, -26; p = 0.03) and 6 months (-440 mg; 95% CI, -747, -134; p = 0.002) compared with baseline; no dietary effects or diet-visit interactions were observed. The main effects of diet and diet per-time on potassium were observed. Throughout the study, potassium intake was higher in the peanut group than in the control group. Post hoc test showed that there was no significant difference in potassium intake in each group at each time point (p 0.05 all). Sequential dietary interactions of fiber were observed; post hoc tests showed no significant difference in fiber intake between groups at each time point (all p 0.05).

4. Discussion

This randomized trial showed that a peanut-rich weight loss diet was similar to the traditional low-fat weight loss diet. However, at 6 months, the peanut-containing weight loss diet decreased a greater systolic blood pressure compared to the traditional diet. Both diets improved fasting blood glucose and insulin, HOMA-IR, and HbA1c. Overall, the results of this trial show that 70 g/day peanuts can be included in an energy-limited weight loss diet without losing weight within 6 months.

Peanuts are energy-intensive (24.6 kJ/g or 5.9 kcal/g), and people are concerned that habitual intake of nuts may promote weight gain [27]. For this reason, people who have a weight loss diet often avoid eating nuts. In this trial, participants in the peanut group consumed 70 g/d (1890 kJ/450 kcal) of peanuts before two main meals per day. In the context of dietary consultation to follow an energy-restricted diet, participants did achieve energy deficits consistent with clinically significant weight loss (-7.5% of initial weight), which was no different from the control group who gave dietary consultation to follow an energy-restricted diet at 6 months. Differences in the composition of macronutrients in each group of diets were observed; however, these differences were consistent with the nutrient content and portion size of the peanuts provided. These results are consistent with data showing weight loss comparable to low-fat diets ([5]. However, the effect of low-fat, high-carbohydrate diets on blood pressure is not quite consistent compared to high-fat, low-carbohydrate diets [5]. In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28] [28 In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28 ]. In overweight or obese individuals, it is recommended to control blood pressure by weight loss [29], although the blood pressure reduction effect of weight loss varies in the study [30, 31]. Metare regression of randomized controlled trial data showed that weight loss by 1 kg reduced systolic blood pressure by 0.36 mmHg [30]. However, early analysis showed that for every 1 kg of weight loss, systolic blood pressure decreased by 1.05 mmHg [ 31]. Since weight loss in the peanut group and the control group was comparable, diet-related differences may explain the observed systolic blood pressure reduction in the peanut group. A meta-analysis of

versus 21 randomized controlled trials showed that intake of nuts reduced systolic blood pressure in non-type 2 diabetes patients (mean difference, -1.29 mmHg; 95% CI, -2.35, -0.22); however, only two included studies examined peanuts, and no effect on systolic blood pressure was observed in both studies [32]. A recent meta-analysis of six randomized controlled trials showed that peanuts had no effect on systolic blood pressure [32 ]. 33].Although the results of this study differ from previous evidence, it should be noted that relatively few studies examined the effects of peanuts on blood pressure, and limited studies evaluated people at high risk for type 2 diabetes with weight loss.

The higher MUFA/lower carbohydrate intake in the peanut group may lead to the observed reduction in systolic blood pressure. A systematic review and meta-analysis of a randomized controlled trial including patients with type 2 diabetes showed a high-carbohydrate diet [34]. However, a meta-analysis of 14 randomized controlled trials showed that a low-saturated fat, high-MUFA diet did not affect the blood pressure diet compared to low-saturated fat and high carbohydrate [35]. Therefore, the effect of a higher MUFA diet on systolic blood pressure remains unclear. However, the dietary source of MUFA may explain some inconsistencies. In the meta-analysis of Qian et al., all studies included plant sources of MUFA [34]. Overall, this evidence suggests that diets with high plant-derived MUFAs may have a lowering effect.

In both groups, sodium intake decreased over the 6-month period, which may lead to the observed reduction in systolic blood pressure over time. However, based on meta regression showing that 0.042 mmHg decreases in systolic blood pressure is expected to decrease 1 mmHg for every 1 mmol reduction in sodium excretion [36 ]. On average, potassium intake was higher in the peanut group than in the control group (322 mg), although the increase in potassium intake only moderately reduced systolic blood pressure (1 mmHg) [36]. Therefore, changes in sodium and potassium intake may have contributed little to the observed overall systolic blood pressure reduction.

In this study, we did not observe between groups of fasting blood glucose or insulin, HOMA-IR, 2-hour blood glucose, or HbA1c. A meta-analysis of a randomized controlled feeding study showed that replacing 5% carbohydrate energy with MUFA had no effect on fasting blood glucose, 2-hour glucose, or fasting insulin [37]. However, HbA1c (-0.09%; 95% CI, -0.12, -0.05), 2-h insulin (-20 pmol/L; 95% CI, -32.2, -8.4), and HOMA-IR (-2.4%; 95% CI, -4.6, -0.3) were observed. Therefore, replacing carbohydrates with MUFA may have the insulin sensitization effect that we did not detect in this study, as only HOMA-IR was evaluated, which mainly reflects hepatic insulin sensitivity. In individuals with impaired fasting blood glucose, the level of insulin in the fasting state is low and is not sufficient to maintain normal blood glucose, which is not considered in the HOMA-IR calculation [ 38 ].

Also reasonable is that no hypothetical improvement in blood sugar control was observed because MUFA consumed as part of the peanut matrix has limited intestinal bioavailability and therefore does not delay gastric emptying, reduce carbohydrate absorption and/or stimulate insulin secretion Pre-meal intake of MUFA-rich oil can reduce post-meal glucose fluctuations [10 ]. Given that postprandial blood sugar levels are the main determinant of overall blood sugar control in individuals with impaired blood sugar control [11], it may be necessary to intake a peanut with higher intestinal bioavailability to reduce postprandial hyperglycemia and thus improve overall blood sugar control. A random crossover study showed that adding 42.5 grams of peanut butter to breakfast reduced blood sugar levels by 15 and 45 minutes compared to control or peanut butter breakfast; a diet containing 42.5 grams of whole peanuts did not affect glucose [ 39 ]. In addition, the blood sugar response of the peanut butter-containing breakfast significantly decreased for the second meal compared to the control breakfast. Reis et al. Compared with the control meal, lower levels of non-esterified fatty acids (NEFA) after peanut butter meals were also observed [39]. The authors believe that the improvement in blood sugar response caused by peanut butter is due to the increased sensitivity of insulin due to reduced NEFA circulation concentrations. Increased fatty acid concentrations are known to impair insulin signaling and lead to insulin resistance. Therefore, if peanut butter is used instead of the whole peanut, we may observe different effects.Future studies should investigate whether habitual intake of peanut butter during meal times can improve long-term blood sugar control.

This study has several advantages, including a randomized controlled design, a 6-month follow-up period, and nutritional consultation provided by the dietician. However, this study was limited by the lack of assessment of 2-hour insulin concentration and measurement of insulin sensitivity. Characteristics of changes in insulin sensitivity will help to gain insight into the effects of diet on reversing insulin resistance and delaying type 2 diabetes. Furthermore, we did not evaluate the loss of waist circumference or lean body weight and fat-free weight after a weight loss diet. The control group in this study received dietary education to follow an energy-restricted diet, which reflects standard care for overweight and obesity management. However, since the control group did not consume pretension, it was impossible to infer the superiority of peanut pretension over other pretension forces. Finally, the loss in the control group was greater than that in the peanut group, which may have affected our ability to detect statistically significant differences in the main results among the groups. However, based on the observed effects and 95% CI (mean difference, -0.12 kg; 95% CI, -2.42, 2.18), it is unlikely that there will be clinically significant differences between the two groups.

5. Conclusion

In summary, in the context of a weight loss diet, 35 grams of micro-salted dried roasted peanuts before two main meals per day have a weight loss effect on high-risk adults similar to the traditional low-fat weight loss diet type 2 diabetes 6 months later. No differences in HbA1c, fasting glucose, fasting insulin, or 2-hour glucose were observed between the two weight loss diets. A peanut-containing weight loss diet can significantly reduce systolic blood pressure, which may reduce the risk of cardiovascular disease.

sean compiled Medical Nutrition MNT 022-08-05 08:58 published in Beijing



https://doi.org/10.3390/nu14142986

Release time: July 21, 2022 Daily





abstract

The purpose of this study was to examine the effect of eating 35 grams of peanuts before two main meals a day on weight and blood sugar control indicators, as well as the blood pressure of adults at risk of 2 diabetes within 6 months as part of the weight loss diet.

researchers conducted a two-arm randomized controlled trial . BMI 26 kg/m 2 adults (age 18 years) and patients at risk of type 2 diabetes were randomly assigned to the peanut group or the traditional low-fat diet group (control group).

recommended that the peanut group eat 35 grams of micro-salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. Both groups received dietary consultation to limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d) and were evaluated at baseline, 3 months and 6 months. A total of 107 participants were randomly assigned (65% female; mean age 58 ± 14 years, BMI 33 ± 5.4 kg/m2, waist circumference 109 ± 13 cm, AUSDRISK score 15 ± 5 points), and 76 participants completed the study. No inter-group difference in body weight (main results) was observed at 6 months (mean difference, -0.12 kg; 95% CI, -2.42, 2.18; p=0.92). The mean weight loss at 6 months in the cohort was 6.7 ± 5.1 kg (visit p 0.001). HbA1c, fasting blood glucose , fasting insulin, 2-hour glucose , and HOMA-IR did not differ between the groups.

At 6 months, the peanut group had a greater reduction in systolic blood pressure compared with the control group (-5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). In the case of energy-restricted diet, 35 grams of peanuts were consumed before two main meals a day, which was comparable to a traditional low-fat weight loss diet without preload. After peanut ingestion, the systolic blood pressure is reduced more, which may reduce the risk of cardiovascular disease.

Keywords: weight loss; peanuts; overweight; obesity; Pre-diabetes





1. Introduction

overweight and obesity are still a problem with global public health significance. In the United States, approximately 74% of adults aged 20 are overweight or obese [1 ]. Similarly, in Australia, 67% of adults were overweight or obese in 2017/2018, up from 63.4% in 2014/2015 [ 2 ]. Among young Australian adults (ages 18-24 years), overweight and obesity increased from 38.9% in 2014/2015 to 46.0% in 2017/2018. Overweight and obesity significantly increase the risk of type 2 diabetes and cardiovascular disease (CVD) [3, 4]. Dietary methods that help overweight and obese adults achieve continuous weight loss are essential to reduce the risk of type 2 diabetes and CVD.

First-line intervention in the treatment of overweight and obesity is the energy-restricted diet [5]; however, there are many obstacles in adopting and maintaining an energy-restricted diet. A key challenge is hunger, as many weight loss diets have lower fullness. A high-protein diet has a higher sense of fullness and is a dietary method recommended for weight loss [5]. Another strategy that promotes fullness and helps reduce energy intake is to consume preload before the main meal. A recent randomized trial showed that taking an energy-restricted diet (-500 kcal/d) and ingestion of high-protein, fiber-based shakes (17 g protein, 6 g fiber) 30 minutes before breakfast and lunch can reduce body weight to a greater extent than isocal-low protein fiber shakes (1 g protein, 3 g fiber) after 84 days (-3.3 kg vs. -1.8 kg, p 0.05) [ 6 ].In addition to feeling fullness, the preload of protein reduces postprandial glucose fluctuations by delaying gastric emptying, slowing glucose absorption and/or stimulating insulin secretion before the main glucose load in the meal [7, 8, 9]. The oil-containing preload is similar to the postprandial effects of protein-containing preload [10]. Importantly, post-meal blood sugar levels in are the main factor leading to overall hyperglycemia in patients with non-type 2 diabetes. In a group of adults without diabetes (hemoglobin A1c (HbA1c) 5.1–5.5%), postprandial blood glucose levels accounted for approximately 81% of overall relative hyperglycemia [11]. Therefore, preloads containing fat, protein, and fiber before the main meal may be a strategy to promote satiety and reduce post-prandial hyperglycemia, which is expected to promote weight loss and reduce the risk of type 2 diabetes.

a large amount of evidence suggests that nuts are associated with reduced risk of CVD and type 2 diabetes [12]. These findings are supported by randomized controlled trials that show that nuts can improve risk factors for cardiovascular disease [13, 14, 15] and blood sugar control markers [16, 17]. In addition, nuts have a high sense of fullness. Human feeding experiments have shown that nut intake can regulate appetite after meals [18]. It is worth noting that nuts, including peanuts, have been shown to suppress hunger and appetite and increase fullness after intake. However, nuts are energy-intensive and are often excluded from the weight loss diet. Evidence to date shows that in studies on weight maintenance, nut intake does not promote weight gain [19]. However, few studies have evaluated the effects of nut intake in the context of an energy-restricted diet. The purpose of this trial was to evaluate the effect of 35 grams of peanuts before two main meals per day, HbA1c, 2 hours of blood sugar and blood pressure in overweight or obese adults at moderate or high risk of type 2 diabetes as part of a traditional low-fat weight loss diet as part of an energy-restricted weight loss diet. It is speculated that adding peanuts to a weight loss diet will increase weight loss and improve blood sugar control compared to the traditional low-fat weight loss diet.

2. Materials and Methods

2.1. Study Planning

A 6-month 2-arm parallel randomized controlled trial was conducted at the University of South Australia in Adelaide, Australia to examine the effects of energy-restricted diets including 70 g/tallion peanuts on weight loss, blood pressure and blood sugar results compared with a low-fat weight loss diet. It is recommended that the peanut group eat 35 grams of salted dried roasted peanuts before two main meals a day. Participants in the control group were educated on a low-fat diet. It is recommended that two dietary groups limit energy intake (female: 5500 kJ/1300 kcal/d; male: 7000 kJ/1700 kcal/d). Using a computer-generated scheme (randomization.com), participants were randomly assigned at baseline in a one-to-one ratio. The study was approved by the Human Research Ethics Committee of the University of South Australia and obtained written informed consent from participants (Ethics Agreement “Long-term Effects of Peanuts on Weight and Diabetes Prevention and Control Markers”; Application ID: 203354; Approved October 23, 2020). The study was conducted according to the Declaration of Helsinki of .

2.2. Participants

Participants were recruited from Adelaide, Australia from January 2021 to May 2021 to use printing, social media and radio advertising. Eligible individuals were 18 years old, with body mass index (BMI) 26 kg/m2 and at moderate or high risk of type 2 diabetes in the Australian type 2 diabetes assessment (score 6 points) (Risk Assessment Tool (AUSDRISK)) [ 20]. In addition, eligible individuals have no health status that is likely to affect the study results, nor have peanuts allergies to food /intoler tolerant.People who have had previous bariatric surgery, systolic blood pressure of 160 mmHg, are currently receiving medication for acute illness, participate in another ongoing clinical trial, current diet for weight loss, and are reluctant to eat peanuts, take medications for diabetes or obesity. Women who are allowed to use hypertensive medications, are pregnant or plan to get pregnant or who are breastfed are not eligible.

2.3. Dietary Intervention

Peanut Group and the control group both received nutrition education from certified practicing nutritionist to follow the energy-restricted diet. Participants in both groups met with dietitians monthly throughout the study. According to previous research, it is recommended that women and men limit their energy intake to 5500 and 7000 kJ, respectively [ 21, 22 ], respectively. Participants in both groups were asked to keep their exercise patterns unchanged throughout the study.

During the entire 6-month study period, participants in the peanut group were educated to eat 35 grams of peanuts 30 minutes before two meals (i.e. 70 grams per day). Micro-salted dried roasted peanuts (Fisher Nuts: 1890 kJ/70 g, fat, 35 g/70 g; MUFA, 18.3 g/70 g; sodium, 188 mg/70 g; carbohydrate , 12.5 g/70 g; protein, 17.5 g/70 g provided during the study period). The intake of peanuts provided was assessed through a daily checklist filled out by the participants. Participants in the control group were educated on a low-fat diet and asked to avoid peanuts and peanut butter during the study period. Dietary education following an energy-restricted diet reflects standard care for overweight and obesity management [23]. Participants in the control group received food stamps of the same value as those provided to the peanuts group. Participants in both groups were asked to weigh at home every week between clinic visits.

2.4. Results

Participants attended the research center 7 times ( Table 1). At baseline, 3- and 6-month blood samples were collected for measurement of HbA1c, fasting blood glucose, and insulin, and a 2-hour oral glucose tolerance test was performed. Throughout the study, body weight was measured monthly and blood pressure was measured every 3 months. Prior to each visit, participants were asked to start fasting from 12:00 the night before, and only water was allowed. After taking off your shoes, measure your weight and height in light clothes, and use an automatic blood pressure monitor to measure your blood pressure in triplicate after 5 minutes of rest. Blood samples were collected at collection points in an accredited clinical laboratory (Clinpath Pathology, Adelaide) for measurement of HbA1c, fasting blood glucose, and insulin. Calculate the homeostatic model evaluation of insulin resistance (HOMA-IR) according to the following formula: [24]. A 2-hour oral glucose tolerance test was conducted at the research center. Blood samples were collected 120 minutes after drinking a 75g glucose beverage on an empty stomach. Blood samples were analyzed by commercial laboratories (Clinpath Pathology, Adelaide).

Table 1. Results evaluation timetable for the study period

Results evaluation

Time (month)

0

0

html l01

2

3

3

4

4

5

6

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

height

X

blood pressure

X

X

X

X

X

24 hours dietary memories

X

X

X

X

X

X

X

X

X

X

X

X

X

Glycosified hemoglobin

Xhtml l9

X

X

Fasting blood sugar and insulin

X

X

X

X

2-hour glucose tolerance test

X

X

X

X

HbA1c, hemoglobin A1c.

uses an automated managed 24-hour recall (ASA-24) system (Australia 2016 edition) to collect a single non-random 24-hour recall at baseline, 3 months, and 6 months. It is recommended to complete a 24-hour recall at each time point to evaluate changes in average normal intake after the intervention [25 ]. Participants were asked to recall intakes from midnight to midnight the day before. Since all reported energy intakes were considered reasonable, no exclusion was made based on energy intake. Follow the National Cancer Institute's Guide to Review and Cleaning ASA-24 Data [26].

2.5. Statistical analysis

sample size calculation shows that the completion of each group of 50 participants will provide 80% of the efficacy to detect the difference between 1.7 kg (standard deviation 3.0 kg) between groups (p 0.05) [ 21 ]. Weight loss is the main result. All other results are secondary.

All statistical analyses were performed using SAS (version 9.4; SAS Institute, Cary, NC, USA). All available data from random participants were included in the data analysis that conformed to the intention-to-treat principle. Data from participants who exited the study were obtained when endpoint measurements were obtained. The hybrid model process does not perform list deletion, thus retaining degrees of freedom; therefore, this analysis method allows participants containing ≥1 missing data points. Normality of the residual was evaluated by using univariate analysis (PROC UNIVARIATE) to quantitatively evaluate skewness and visually examine the distribution and normal probability (Q-Q) plots.

Mixed Model Program (PROC MIXED) was used to check the effect of diet on each result. Access is modeled as repetitive effects to interpret repeated measurement designs. Diet was modeled as a fixed effect, with baseline values ​​included as covariate . When the main effects of diet, visits, or successive diets were detected, post hoc pairwise comparisons were performed and multiple comparisons were adjusted using the Tukey-Kramer method; data from the post hoc test were expressed as pairwise difference and 95% CI and Tukey-Kramer adjusted p-values. Gender effects and gender-diet interactions were also evaluated.The statistical significance was set to p 0.05.

3. Results

3.1. Participant

There are a total of 107 participants randomly assigned. Among the random participants, one exited during the baseline test and two were considered unqualified at baseline. At 3 months, 47 participants randomly assigned to the peanut group and 33 participants randomly assigned to the control group participated in the follow-up. Six months later, 44 participants in the peanut group and 32 participants in the control group participated in the follow-up ( Figure 1). At baseline, the two groups were very similar. The mean age of this cohort was 58 years (range 19-79 years), with an average BMI of 33.1 ± 5.4 kg/m 2 and a waist circumference of 109 ± 12.9 cm ( Table 2). The Peanuts group reported that the peanuts provided were consumed on 93% of the study days.



Figure 1. CONSORT flow chart.

Table 2. Baseline characteristics of all random participants

		Total (n = 107)	Peanuts (n = 57)	Control (n = 50)
	age, age	58±14	59±14	58±15
female, n (%)	70 (65)	41 (72)	29 (58)
	weight, kg	92.2±17.2	91.6±17.6	92.9 ± 16.9
body weight index, kg/m2	33.1±5.4	33.1±5.4	33.1±5.4	33.1± 4.9	33.0±6.0
waist circumference, centimeter	109±12.9	108±13.4	109±12.5
systolic blood pressure, mmHg		128±16	126±15	129±17
diastolic blood pressure , mmHg	81±10	81±10	81±10	81±10	81±10
AUSDRISK Rating	15.3±4.7	15.0±4.7	15.6±4.7
fasting blood sugar, mmol/L	5.1±0.7	5.1±0.6 1	5.2 ±0.8 2
Fasted insulin, u/mL	11.1±6.7	10.6±6.9	11.8±6.3 2
	saccharified hemoglobin, %	5.6±0.4	5.6±0.3	5.6±0.3	5.6±0.6 ±0.6 3
2 hours glucose, mmol/L	5.9±2.3	5.7±1.8 1	6.2 ± 2.9 2
Prescription antihypertensive drugs, n (%)	14 (13)	5 (9)	9 (18)

Unless otherwise stated, the data are expressed as the mean ± standard deviation; 1 n = 56; 2 n = 44; 3 n = 45. AUSDRISK, Australia Type 2 diabetes risk assessment tool; BMI, body mass index; HbA1c, hemoglobin A1c.

3.2. Weight

The main access effect of body weight was observed (p 0.001); no dietary effect (p = 0.94) or dietary interactions (p = 0.98) were observed ( Figure 2).Compared with baseline, the peanut group lost 6.72 kg (95% CI, -8.21, -5.23) at 6 months and the control group lost 6.60 kg (95% CI, -8.35, -4.85); at 6 months, there was no difference in weight loss between the peanut group and the control group (mean difference, -0.12; 95% CI, -2.42, 2.18; p = 0.92). No gender influence or gender-diet interaction was observed. Only 3 participants in each group did not lose weight at 6 months compared to baseline.



Figure 2. The weight of each study group changed from baseline during the 6-month study period. The mean value of the data expressed in least squares ± the standard error of the mean. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on weight changes from baseline was examined by modeling access as repetitive effects and baseline weight as covariates.

3.3.Blood pressure

For systolic blood pressure, the main effects of diet (p=0.007) and medical treatment (p0.001) were observed; the interaction of diet each visit (p=0.063) was close to statistical significance ( Table 3). Compared with baseline, the peanut group (-9.46 mmHg, 95% CI, -11.96, -6.95; p 0.001) and the control group (-4.13 mmHg; 95% CI, -7.11, -1.14; p = 0.007) were 6 months later. The 6-month reduction in systolic blood pressure observed in the peanut group was significantly greater than the corresponding changes observed in the control group (mean difference between groups, -5.33 mmHg; 95% CI, -9.23, -1.43; p= 0.008). No gender influence of systolic blood pressure or gender-diet interaction was observed.

Table 3. Study the effect of diet on blood pressure.

Peanut group

Control group htt ml3

p value

time (month)

0 ( n = 57)

3 (n = 47)

6 (n = 44)

0 (n = 44)

0 (n = 50)

3 (n = 33)

6 (n = 33)

6 (n = 31)

Diet

Access

Diet x Visit

systolic blood pressure, mmHg

127±0.9

119±1.0

117±1.1

117±1.1

127±1.0

html ml0122±1.2

122±1.3

0.007

0.001

0.063

0.063

diastolic blood pressure, mmHg

81±0.6

77±0.7

75±0.7

81±0.7

81±0.7

77±0.8

76±0.8

0.52

0.001

0.70

0 the data mean ± standard error of the mean value expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. SBP, systolic blood pressure; DBP, diastolic blood pressure.

For diastolic blood pressure, no dietary effects or interaction between diet and visit was observed. The diastolic blood pressure in this cohort decreased at month 3 (-3.92 mmHg; 95% CI, -5.52, -2.32; p 0.001) and 6 (-4.76 mmHg; 95% CI, -6.40, -3.13; p 0.001) compared with baseline. No differences in diastolic blood pressure were observed between 3 and 6 months. No gender influence or gender-diet interaction was observed.

3.4. Blood glucose results

For fasting blood glucose, fasting insulin, 2-hour glucose, HbA1c or HOMA-IR, no dietary effects or interactions of diets per visit were observed ( Table 4). Fasting blood glucose decreased in the cohort over time (visit p 0.001). Fasting blood glucose was in the cohort at 3 months (-0.14 mmol/L; 95% CI, -0.24, -0.04; p = 0.004) and 6 months (-0.18 mmol/L; 95% CI, -0.28, -0.08; p 0.001). No gender effect or diet-sex interaction was observed in fasting blood glucose. For 2-hour glucose, no major effects of visits, gender, or dietary gender were observed.

Table 4. Effect of research results on blood sugar results

Peanut group

Control group

p value

time (month)

0 ( n = 57)

3 (n = 46)

6 (n = 43)

0 (n = 43)

0 (n = 44)

3 (n = 35)

6 (n = 35)

6 (n = 32)

Diet

Access

Diet x Access

Diet x Access

fasting blood sugar, mmol/L

5.12 ± 0.04 1

5.01 ± 0.05

4.99±0.05

5.13±0.05

4.96 ± 0.05 4

4.90 ± 0.06 5

0.37

0.001

0.46

Fasted insulin, u/mL

10.89±0.52

8.95±0.58

8.14±0.59 3

11.42±0.59

8.15±0.67

7.33±0.70

0.50

0.001

0.41

2 hours glucose, mmol/L

5.84 ± 0.17 1

5.93 ± 0.19 2

6.06±0.19

5.89 ± 0.19

6.30 ± 0.21 4

6.41 ± 0.22 5

0.18

0.09

0.58

Glycoated hemoglobin, %

5.61±0.02

5.50±0.02

5.48±0.02

5.61±0.02

5.61±0. 0.02 2

5.55±0.02

5.49±0.02

0.21

0.001

0.32

0.32

HOMA-IR

2.49 ±0.12 1

2.09 ± 0.14

1.88±0.14

2.66±0.14

1.83 ± 0.16 4

1.60 ± 0.17 5

0.35

0.001

0.17

The data mean ± the standard error of the mean expressed by least squares. Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined, access was modeled as a repetitive effect, and baseline values ​​were included as covariates; 1 n = 56; 2 n = 45; 3 n = 44; 4 n = 34; 5 n = 31. HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model evaluation of insulin resistance.

Insulin in the entire cohort decreased over time (visit p 0.001). Insulin levels were lower at 3 months (-2.62 u/mL; 95% CI, -4.06, -1.19; p 0.01) and 6 months (-3.38 u/mL; 95% CI, -4.85, -1.91) compared with baseline; p 0.001). No gender effect of insulin or diet-sex interaction was observed. HOMA-IR also declined over time throughout the queue (p 0.001). Compared with baseline, HOMA-IR was at 3 months (-0.61; 95% CI, -0.93, -0.30; p 0001) and 6 months (-0.84; 95% CI, -1.16, -0.51; p 0.001). No gender effects or diet-sex interaction was observed in HOMA-IR.

HbA1c in this queue declines over time (visit p 0.001). Compared with baseline, HbA1c was 3 months (-0.08%; 95% CI, -0.12, -0.04; p 0.001) and 6 months (-0.13%; 95% CI, -0.17%, -0.09; p 0.001) in the entire cohort. HbA1c was also lower at 6 months compared to 3 months (-0.05%; 95% CI, -0.09, -0.003; p = 0.03). Gender effects were observed ( p = 0.03), i.e., higher HbA1c was found in women than men; however, no diet-gender interaction was observed.

3.5. Dietary intake

The main effects of diet, medical treatment and successive diet on energy intake, total fat (g and % kJ), MUFA (% kJ), and carbohydrates (% kJ) were observed ( Table 5). Post hoc tests showed that compared with the peanut group, the control group had a significant reduction in energy intake at 6 months (-1731 kJ; 95% CI, -3231, -231; p = 0.01); no differences between groups were observed at 3 months. The percentage of total fat energy in the peanut group was significantly higher than that in the control group at 3 months (11%; 95% CI, 6, 17; p 0.001) and 6 months (12%; 95% CI, 6). The reason for the higher fat intake in the peanut group is the higher MUFA intake in the peanuts provided. Compared with the control group, the peanut group was at 3 months (10%; 95% CI, 7, 13; p 0.001) and 6 months (11%; 95% CI, 7, 14; p 0.001). The percentage of carbohydrate energy in the peanut group was significantly lower than that in the control group CI, -16, -5; p 0.001) and 6 months (-10%; 95%). These data confirm high compliance levels in both groups, as the differences reflect intakes of high-fat foods (i.e., peanuts) versus low-fat diets (higher carbohydrates).

Table 5. Effects of peanut-containing weight loss diet on diet intake compared with traditional low-fat weight loss diets through self-managed 24-hour memory assessment.

0

9±1.0

Peanut group

Control group

p value

time (month)

0 ( n = 57)

3 ( n = 48)

6 ( n = 44)

0 ( n = 47)

3 ( n = 34)

6 ( n = 32)

Diet

Access

Access

Diet x Access

Energy (kJ)

8340±295

7011±322

7657±336

8770±325

6126±382

5926±394

0.01

0.001

0.005

protein (g)

91± 3.6

87±4.0

97±4.1

91±4.0

72±4.7

79±4.9

0.005

0.02

0.02

0.055

Protein (% kJ)

19±0.6

21±0.6

21±0.6

21±0.7

18±0.7

20±0.8

22±0.8

0.52

0.001

0.27

Total fat (g)

80±4.0

75±4.4

88±4.6

83±4.4

50±5. 2

52±5.4

0.001

0.001

0.001

0.001

Total fat (% kJ)

36±1.1

40±1.2

44±1.2

44±1.2

35±1.2

29±1.4

32±1.4

0.001

0.03

0.001

0.001

Saturated fat (g)

29±1.5

21±1.7

24±1.7

24±1.7

30±1.7

18±2 .0

18±2.0

0.07

0.001

0.001

0.17

saturated fat (% kJ)

13±0.5

11±0.5

12±0.5

12±0.5

12±0.5

12±0.5

10±0.6

11±0. 6

0.25

0.005

0.88

Monounsaturated fatty acids (g)

32±1.9

38±2.1

45±2.1

34±2.1

34±2.1

18±2.4

20±2.5

0.001

0.09

0.09

0.001

monounsaturated fatty acids (% kJ)

14±0.7

21±0.7

23±0.7

14±0.7

14±0.7

11±0.8

12±0. 9

0.001

0.001

0.001

polyunsaturated fatty acids (g)

13±0.7

10±0.8

12±0.8

13±0.8

13±0.8

8±1.0

0.03

0.001

0.22

polyunsaturated fatty acids (% kJ)

5.8±0.3

5.1±0.3

5.7±0.3

5.5±0.3

5.5±0.3

4.8±0.4

5. 4±0.4

0.24

0.08

0.99

carbohydrate (g)

192±7.5

138±8.1

140±8.5

201±8.2

167±9.7

144±10

0.055

0.001

0.33

carbohydrate (% kJ)

39±1.1

33±1.2

30±1.2

30±1.2

39±1.2

46±1.4

40±1.5

0.001

0.001

0.003

0.001

0.003

0.001

0.001

Total sugar (g)

81±3.8

66±4.1

66±4.3

66±4.3

86±4.2

86±4.2

70±4.9

70±5 .1

0.21

0.001

0.99

Total fiber (g)

25±1.2

29±1.3

29±1.3

29±1.3

26±1.3

27±1.5

23±1.6

0.18

0.13

0.13

0.03

sodium (mg)

2319±118

1950 ± 129

1968 ± 135

2380±131

2098 ± 153

1850±158

0.81

0.002

0.61

Potassium (mg)

3287±137

3352±149

3619±156

3442±150

2877 ± 177

2973 ± 183

0.02

0.24

0.02

0.02

The data mean ± standard error of the mean expressed by least squares.Data were analyzed using a linear hybrid model (PROC MIXED; SAS version 9.4). The effect of diet on each outcome was examined by accessing modeling as repetitive effects and baseline values ​​as covariates. MUFA, monounsaturated fatty acid; PUFA, polyunsaturated fatty acid. Access effects of saturated fat were observed with post hoc tests, and post hoc tests showed lower intake at 3 months compared to baseline for the entire cohort (-1.8%; 95% CI, -3.0, -0.5; p=0.004). Access effects were also observed with sodium. In the entire cohort, sodium intake was not observed at 3 months (-325 mg; 95% CI, -625, -26; p = 0.03) and 6 months (-440 mg; 95% CI, -747, -134; p = 0.002) compared with baseline; no dietary effects or diet-visit interactions were observed. The main effects of diet and diet per-time on potassium were observed. Throughout the study, potassium intake was higher in the peanut group than in the control group. Post hoc test showed that there was no significant difference in potassium intake in each group at each time point (p 0.05 all). Sequential dietary interactions of fiber were observed; post hoc tests showed no significant difference in fiber intake between groups at each time point (all p 0.05).

4. Discussion

This randomized trial showed that a peanut-rich weight loss diet was similar to the traditional low-fat weight loss diet. However, at 6 months, the peanut-containing weight loss diet decreased a greater systolic blood pressure compared to the traditional diet. Both diets improved fasting blood glucose and insulin, HOMA-IR, and HbA1c. Overall, the results of this trial show that 70 g/day peanuts can be included in an energy-limited weight loss diet without losing weight within 6 months.

Peanuts are energy-intensive (24.6 kJ/g or 5.9 kcal/g), and people are concerned that habitual intake of nuts may promote weight gain [27]. For this reason, people who have a weight loss diet often avoid eating nuts. In this trial, participants in the peanut group consumed 70 g/d (1890 kJ/450 kcal) of peanuts before two main meals per day. In the context of dietary consultation to follow an energy-restricted diet, participants did achieve energy deficits consistent with clinically significant weight loss (-7.5% of initial weight), which was no different from the control group who gave dietary consultation to follow an energy-restricted diet at 6 months. Differences in the composition of macronutrients in each group of diets were observed; however, these differences were consistent with the nutrient content and portion size of the peanuts provided. These results are consistent with data showing weight loss comparable to low-fat diets ([5]. However, the effect of low-fat, high-carbohydrate diets on blood pressure is not quite consistent compared to high-fat, low-carbohydrate diets [5]. In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28] [28 In this study, we observed a greater reduction in systolic blood pressure (-5 mmHg) in the peanut group at 6 months compared to the control group. According to a recent meta-analysis, a systolic blood pressure reduction of 5 mmHg is expected to reduce the risk of major cardiovascular events by 10% [28 ]. In overweight or obese individuals, it is recommended to control blood pressure by weight loss [29], although the blood pressure reduction effect of weight loss varies in the study [30, 31]. Metare regression of randomized controlled trial data showed that weight loss by 1 kg reduced systolic blood pressure by 0.36 mmHg [30]. However, early analysis showed that for every 1 kg of weight loss, systolic blood pressure decreased by 1.05 mmHg [ 31]. Since weight loss in the peanut group and the control group was comparable, diet-related differences may explain the observed systolic blood pressure reduction in the peanut group. A meta-analysis of

versus 21 randomized controlled trials showed that intake of nuts reduced systolic blood pressure in non-type 2 diabetes patients (mean difference, -1.29 mmHg; 95% CI, -2.35, -0.22); however, only two included studies examined peanuts, and no effect on systolic blood pressure was observed in both studies [32]. A recent meta-analysis of six randomized controlled trials showed that peanuts had no effect on systolic blood pressure [32 ]. 33].Although the results of this study differ from previous evidence, it should be noted that relatively few studies examined the effects of peanuts on blood pressure, and limited studies evaluated people at high risk for type 2 diabetes with weight loss.

The higher MUFA/lower carbohydrate intake in the peanut group may lead to the observed reduction in systolic blood pressure. A systematic review and meta-analysis of a randomized controlled trial including patients with type 2 diabetes showed a high-carbohydrate diet [34]. However, a meta-analysis of 14 randomized controlled trials showed that a low-saturated fat, high-MUFA diet did not affect the blood pressure diet compared to low-saturated fat and high carbohydrate [35]. Therefore, the effect of a higher MUFA diet on systolic blood pressure remains unclear. However, the dietary source of MUFA may explain some inconsistencies. In the meta-analysis of Qian et al., all studies included plant sources of MUFA [34]. Overall, this evidence suggests that diets with high plant-derived MUFAs may have a lowering effect.

In both groups, sodium intake decreased over the 6-month period, which may lead to the observed reduction in systolic blood pressure over time. However, based on meta regression showing that 0.042 mmHg decreases in systolic blood pressure is expected to decrease 1 mmHg for every 1 mmol reduction in sodium excretion [36 ]. On average, potassium intake was higher in the peanut group than in the control group (322 mg), although the increase in potassium intake only moderately reduced systolic blood pressure (1 mmHg) [36]. Therefore, changes in sodium and potassium intake may have contributed little to the observed overall systolic blood pressure reduction.

In this study, we did not observe between groups of fasting blood glucose or insulin, HOMA-IR, 2-hour blood glucose, or HbA1c. A meta-analysis of a randomized controlled feeding study showed that replacing 5% carbohydrate energy with MUFA had no effect on fasting blood glucose, 2-hour glucose, or fasting insulin [37]. However, HbA1c (-0.09%; 95% CI, -0.12, -0.05), 2-h insulin (-20 pmol/L; 95% CI, -32.2, -8.4), and HOMA-IR (-2.4%; 95% CI, -4.6, -0.3) were observed. Therefore, replacing carbohydrates with MUFA may have the insulin sensitization effect that we did not detect in this study, as only HOMA-IR was evaluated, which mainly reflects hepatic insulin sensitivity. In individuals with impaired fasting blood glucose, the level of insulin in the fasting state is low and is not sufficient to maintain normal blood glucose, which is not considered in the HOMA-IR calculation [ 38 ].

Also reasonable is that no hypothetical improvement in blood sugar control was observed because MUFA consumed as part of the peanut matrix has limited intestinal bioavailability and therefore does not delay gastric emptying, reduce carbohydrate absorption and/or stimulate insulin secretion Pre-meal intake of MUFA-rich oil can reduce post-meal glucose fluctuations [10 ]. Given that postprandial blood sugar levels are the main determinant of overall blood sugar control in individuals with impaired blood sugar control [11], it may be necessary to intake a peanut with higher intestinal bioavailability to reduce postprandial hyperglycemia and thus improve overall blood sugar control. A random crossover study showed that adding 42.5 grams of peanut butter to breakfast reduced blood sugar levels by 15 and 45 minutes compared to control or peanut butter breakfast; a diet containing 42.5 grams of whole peanuts did not affect glucose [ 39 ]. In addition, the blood sugar response of the peanut butter-containing breakfast significantly decreased for the second meal compared to the control breakfast. Reis et al. Compared with the control meal, lower levels of non-esterified fatty acids (NEFA) after peanut butter meals were also observed [39]. The authors believe that the improvement in blood sugar response caused by peanut butter is due to the increased sensitivity of insulin due to reduced NEFA circulation concentrations. Increased fatty acid concentrations are known to impair insulin signaling and lead to insulin resistance. Therefore, if peanut butter is used instead of the whole peanut, we may observe different effects.Future studies should investigate whether habitual intake of peanut butter during meal times can improve long-term blood sugar control.

This study has several advantages, including a randomized controlled design, a 6-month follow-up period, and nutritional consultation provided by the dietician. However, this study was limited by the lack of assessment of 2-hour insulin concentration and measurement of insulin sensitivity. Characteristics of changes in insulin sensitivity will help to gain insight into the effects of diet on reversing insulin resistance and delaying type 2 diabetes. Furthermore, we did not evaluate the loss of waist circumference or lean body weight and fat-free weight after a weight loss diet. The control group in this study received dietary education to follow an energy-restricted diet, which reflects standard care for overweight and obesity management. However, since the control group did not consume pretension, it was impossible to infer the superiority of peanut pretension over other pretension forces. Finally, the loss in the control group was greater than that in the peanut group, which may have affected our ability to detect statistically significant differences in the main results among the groups. However, based on the observed effects and 95% CI (mean difference, -0.12 kg; 95% CI, -2.42, 2.18), it is unlikely that there will be clinically significant differences between the two groups.

5. Conclusion

In summary, in the context of a weight loss diet, 35 grams of micro-salted dried roasted peanuts before two main meals per day have a weight loss effect on high-risk adults similar to the traditional low-fat weight loss diet type 2 diabetes 6 months later. No differences in HbA1c, fasting glucose, fasting insulin, or 2-hour glucose were observed between the two weight loss diets. A peanut-containing weight loss diet can significantly reduce systolic blood pressure, which may reduce the risk of cardiovascular disease.

References

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