Background / Significance:
T2D affects 5-10 % of the global population, challenging societies, health systems,
economy and quality of life. Dietary treatment may avoid disease burdens, save money and
protect general health resources, but is often limited to unspecific weight loss
recommendations and advise for physical activity. Despite being the common advice, body
weight reduction is faced with inconclusive evidence for its impact on long-term risks
(obesity paradox?), lack of long-term compliance and irresponsive or ineligible subgroups
of patients. The Mediterranean diet provides the ideal dietary composition and reduces
CVD risk, improving every axis of the Metabolic Syndrome, including liver fat. It is
unclear, though, to which extent tree nuts contribute to this effect.
In meta-analyses, almonds improve glycemia and lipids. Benefits on body composition and
inflammation are also expected, these might extend to NAFLD.
n6-PUFAs (typical components of tree nuts) reduce T2D risk and liver fat in humans. This
was shown for sunflower oil, but not yet for nuts. Evidence for NAFLD benefits by almonds
in humans is limited to observational studies, post-hoc analyses of mixed interventions,
and underpowered RCTs.
Aims / Rationale:
Nuts are safe for NAFLD patients. Previous data indicate, that almonds may elicit
benefits on glycemia and liver fat in patients susceptible to this treatment.
Therefore, the investigators' project aims to investigate whole almonds as dietary
treatment for glucose intolerance and NAFLD in patients with this typical combined
phenotype. NAFLD independently predicts T2D progression and late complications.
(Pre)diabetes patients with NAFLD are at higher risk for the entire metabolic syndrome
and for early onset of nephropathy and CVD. On the other hand, prediabetes/T2D patients
with NAFLD are also especially susceptible to lifestyle treatments. The investigators
hypothesize to detect benefits of almonds with respect to glycemia and liver fat, but
also lipid metabolism, body composition and inflammation compared to standard diet.
Treatment period of 16 weeks is longer than earlier almond studies.
The investigators intend to show, that the metabolic improvement is independent from
weight loss and, even in the opposite, supports maintenance of muscle mass. The research
group wants to investigate mechanistic links between the metabolic pathways of visceral
fat accumulation, inflammation, NAFLD, insulin resistance, dyslipidemia and the gut
microbiome. Finally, the investigators aim to assess the lipidome (analysed from the
erythrocyte membranes, full blood and plasma samples), which was recently established as
a novel biomarker to predict disease progression, metabolic response and
treatment-specific improvement.