There is evidence that Mediterranean diets with a high proportion of olive oil and nuts can be effective for weight management and prevention of cardiovascular disease. It might be difficult for populations with other eating habits to follow such diets. Therefore, a modified Mediterranean-type diet using fat modification through neutral and butter-flavored canola oil, walnuts and walnut oil with two portion-controlled sweet daily snacks was tested in Germany.
Randomized waiting-list control study with overweight/grade 1 obese subjects: 12-week self-help modified Mediterranean-type diet, 6 weeks of diet plans and 6 weeks of weight loss maintenance training. Trial duration was 12 months. Intervention group (IG) included 100 participants (average age of 52.4 years, weight 85.1 kg and body mass index (BMI) 30.1 kg/m2), waiting-list control group (CG) included 112 participants (52.6 years, 84.1 kg and 30.1 kg/m2).
Per-protocol weight loss after 12 weeks was 5.2 kg in IG vs 0.4 kg in CG (P⩽0.0001), BMI −1.8 vs −0.1 kg/m2 (P⩽0.0001), waist circumference −4.7 vs −0.9 cm (P⩽0.0001). Triglycerides, total cholesterol and LDL cholesterol improved significantly in IG but not in CG. One-year dropouts: 44% in IG and 53% in CG. Weight loss after 12 months: 4.2 kg (pooled data).
A five-meal modified Mediterranean-type diet with two daily portion-controlled sweet snacks was effective for weight management in a self-help setting for overweight and grade 1 obese subjects. Fat modification through canola oil, walnuts and walnut oil improved blood lipids even at 12 months.
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Max-Rubner-Institut, Editor. Nationale Verzehrsstudie II Ergebnisbericht, Teil 1. 2008. Available at http://www.mri.bund.de/fileadmin/Institute/EV/NVS_II_Abschlussbericht_Teil_1_mit_Ergaenzungsbericht.pdf.
Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C . Übergewicht und Adipositas in Deutschland. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt 2013; 56: 786–794.
Ellrott T . Übergewicht und Adipositas. Psychiatr Psychother Up2date 2008; 2: 405–420.
Deutsche Adipositas-Gesellschaft. Evidenzbasierte Leitlinie – Prävention und Therapie der Adipositas – Version 2014. Available at http://www.awmf.org/leitlinien/detail/ll/050-001.html.
Australian Government – National Health and Medical research Council – Department of Health and Ageing. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents, and children in Australia. 2013. Available at http://www.nhmrc.gov.au/guidelines/publications/n57.
Lau DCW, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E et al. Canadian clinical practice guidelines on the management and prevention of obesity in adults and children (summary). CMAJ 2007; 176 (Suppl 8), S1–S13.
Scottish Intercollegiate Guidelines Network (Editor). Management of obesity: a national clinical guideline. 2010.
Esposito K, Kastorini CM, Panagiotakos DB, Giugliano D . Mediterranean diet and weight loss: meta-analysis of randomized controlled trials. Metab Syndr Relat Disord 2011; 9: 1–12.
Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 2008; 359: 229–241.
Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.
Anderson JW, Konz EC, Frederich RC, Wood CL . Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr 2001; 74: 579–584.
Wing RR, Phelan S . Long-term weight loss maintenance. Am J Clin Nutr 2005; 82: 222 S–225 S.
Max-Rubner-Institut, Editor. Nationale Verzehrsstudie II Ergebnisbericht, Teil 2. 2008. Available at http://www.mri.bund.de/fileadmin/Institute/EV/NVSII_Abschlussbericht_Teil_2.pdf.
Mithril C, Dragstedt LO, Meyer C, Blauert E, Holt MC, Astrup A . Guidelines for the New Nordic Diet. Public Helath Nutr 2012; 15: 1941–1947.
Mithril C, Dragstedt LO, Meyer C, Tetens I, Biltoft-Jensen A, Astrup A . Dietary composition and nutrient content of the New Nordic Diet. Public Health Nutr 2013; 16: 775–785.
Fletcher BC, Pine KJ, Woodbridge Z, Nash A . How visual images of chocolate affect the craving and guilt of female dieters. Appetite 2007; 48: 211–217.
Massey A, Hill AJ . Dieting and food craving. A descriptive, quasi-prospective study. Appetite 2012; 58: 781–785.
Stunkard AJ, Messick S . The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 1985; 29: 71–83.
Westenhöfer J, Stunkard A, Pudel V . Validation of the flexible and rigid control dimensions of dietary restraint. Int J Eat Disord 1999; 26: 53–64.
Askari G, Yazdekhasti N, Mohammadifard N, Sarrafzadegan N, Bahonar A, Badiei M et al. The relationship between nut consumption and lipid profile among the Iranian adult population; Isfahan Healthy Heart Program. Eur J Clin Nutr 2013; 67: 385–389.
Banel DK, Hu FB . Effects of walnut consumption on blood lipids and other cardiovascular risk factors: a meta-analysis and systematic review. Am J Clin Nutr 2009; 90: 56–63.
Lin L, Allemekinders H, Dansby A, Campbell L, Durance-Tod S, Berger A et al. Evidence of health benefits of canola oil. Nutr Rev 2013; 71: 370–385.
Saris WH, Astrup A, Prentice AM, Zunft HJ, Formiguera X, Verboeket-van de Venne WP et al. The carbohydrate ratio management in European National diets. Int J Obes Relat Metab Disord 2000; 24: 1310–1318.
Drewnowski A, Bellisle F . Liquid calories, sugar, and body weight. Am J Clin Nutr 2007; 85: 651–661.
Heymsfield SB1, van Mierlo CA, van der Knaap HC, Heo M, Frier HI . Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord 2003; 27: 537–549.
Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J et al. The Look AHEAD Study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006; 14: 737–752.
Bischoff SC, Damms-Machado A, Betz C, Herpertz S, Legenbauer T, Löw T et al. Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life - a prospective study. Int J Obes (Lond) 2012; 36: 614–624.
Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B, Dansinger ML et al. Ultra-processed products are becoming dominant in the global food system. Obes Rev 2013; 14: 21–28.
Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ . Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 2005; 293: 43–53.
Goodpaster BH, Delany JP, Otto AD, Kuller L, Vockley J, South-Paul JE et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304: 1795–1802.
Claessens M, van Baak MA, Monsheimer S, Saris WH . The effect of a low-fat, high-protein or high-carbohydrate ad libitum diet on weight loss maintenance and metabolic risk factors. Int J Obes (Lond) 2009; 33: 296–304.
Hönemann I, Ranke C, Austel A, Jarzemski S, Deeken I, Pleyer I et al. Changes of cardiovascular risk factors while following one of three currently discussed dietetic weight-reducing strategies. Aktuel Ernahrungsmed 2010; 35: 227–235.
Rajaram S, Haddad EH, Mejia A, Sabaté J . Walnuts and fatty fish influence different serum lipid fractions in normal to mildly hyperlipidemic individuals: a randomized controlled study. Am J Clin Nutr 2009; 89: 1657–1663.
Zambón D, Sabaté J, Muñoz S, Campero B, Casals E, Merlos M et al. Substituting walnuts for monounsaturated fat improves the serum lipid profile of hypercholesterolemic men and women. Ann Intern Med 2000; 132: 538–546.
Iwamoto M, Imaizumi K, Sato M, Hirooka Y, Sakai K, Takeshita A et al. Serum lipid profiles in Japanese women and men during consumption of walnuts. Eur J Clin Nutr 2002; 56: 629–637.
Byrne S, Cooper Z, Fairburn C . Weight maintenance and relapse in obesity: a qualitative study. Int J Obes Relat Metab Disord 2003; 27: 955–962.
Westenhöfer J, Engel D, Holst C, Lorenz J, Peacock M, Stubbs J et al. Cognitive and weight-related correlates of flexible and rigid restrained eating behavior. Eat Behav 2013; 14: 69–72.
Teixeira PJ, Silva MN, Coutinho SR, Palmeira AL, Mata J, Vieira PN et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity (Silver Spring) 2010; 18: 725–735.
Blomquist KK, Grilo KM . Predictive significance of changes in dietary restraint in obese patients with binge eating disorder during treatment. Int J Eat Disord 2011; 44: 515–523.
This research was funded by Taste of Sweden Deutschland (Oerlinghausen, Germany), a manufacturer of flavored canola oil, and by the California walnut commission (Folsom, California, USA). Alba oil (flavored canola oil) was donated by Taste of Sweden, walnuts and walnut oil were donated by the California Walnut Commission.
None of the sponsors had any role in the trial design, data analysis or reporting of the results.
The authors declare no conflict of interest.
Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website
About this article
Walnut consumption in a weight reduction intervention: effects on body weight, biological measures, blood pressure and satiety
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