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Effects of Mediterranean Diet supplemented with almonds

on adipose tissue biology

Josep Vidal

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The health benefits of Mediterranean Diet

Reduced cardiovascular risk ¹
Reduced incidence of type 2 diabetes ¹
Improved lipid profile ¹
Improved blood pressure ¹
Improved systemic inflammation ¹
Healthier obese phenotype ²

1. Estruch R et al, N Eng J Med 2018. 2. Konieczna J et al, Clin Nutr 2020. 3. Estruch R et al, Ann Int Med 2006

The consumption of a MedDiet supplemented with nuts (walnuts, hazelnuts, and almonds) or EV olive oiI, resulted in improved blood pressure, glucose, and colesterol at 3 monhts follow up ³.

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The health benefits of Mediterranean Diet

Adaptated from Perdomo CM et al; Rev End Meta Dis 2023

Consisting of:

Altered adipocytes (size, number)
Inflammation
Insufficient angioenesis
Dysregulated autophagy
Inapropriated ECM remodelling

Adipose tissue dysfunction and metabolic dysfunction in obesity

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The health benefits of Mediterranean Diet

Aim of the study:

In women with obesity that were bariatric surgery (BS) candidates, To investigate the short-term effects of an MD-based intervention supplemented with almonds (MDSA) on:

the main features of WAT dysfunction, and
the association between tissue variables of WAT dysfunction and systemic markers of metabolic health

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Female sex
Age 18-68 y
BMI 40-50 kg/m2
+ 2 comp MetSd
Weight stability ≥ 3 mo
No nut allergy
No T2D
No drugs influencing BW
Normal Thyroid function

N=35

Med Diet + almonds (30 g/d)

Usual diet

Dietitian every 2 weeks

Diet estabilization
Estimation of daily kcal consumption

Isocaloric to taht during the weight stability phase

Adipose tissue biopsy

SCAT

VAT

Blood samples

Fasting

MMTT

Fasting

MMTT

Baseline

3 months

Body composition

DEXA

Study design

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Charactestics of the study population at baseline

	MDSA group (n=19)	Control group (n=15)	p
Age (years)	48.9 ± 11.0	45.3 ± 11.8	ns
BMI (kg/m²)	43.8 ± 4.0	45.7 ± 3.0	ns
Weight (kg)	110.0 ± 11.3	110.3 ± 11.0	ns
Fat mass (%)	52.8 ± 4.3	55.1 ± 3.0	ns
eVAT (gr)	2351 ± 912	2396 ± 953	ns
Fasting plasma glucose (mg/dl)	106.0 ± 14.0	100.0 ± 10.6	ns
Triglycerides (mg/dl)	124.2 ± 47.0	144 ± 42.4	ns
Cholesterol: total/HDL/LDL (mg/dl)	187/46.3/120	200/48.2/125	ns
Systolic/Diastolic BP (mmHg)	(135 ± 15)/(86 ± 9)	(133 ± 16)/(90 ± 13)	ns
HOMA-IR	5.3 ± 2.1	6.2 ± 4.0	ns
Adiponectin (ug/ml)	19.3 ± 10.5	25.1 ± 13.5	ns
Hs-CRP (mg/dl)	0.8 ± 0.7	0.8 ± 0.6	ns

Osorio-Conles O et al. Nutrients 2022

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Adherence to the dietary intervention

Mediterranean Diet Adherence Screener

(MEDAS – 14 items)

No significant difference @ baseline

Relative content of α–Linolenic acid

in red blood cell membranes

Osorio-Conles O et al. Nutrients 2022

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Changes in adipose tissue morphology with the intervention

Adipocyte size and distribution

No change in adipocyte size in SCAT or VAT in both groups
Favourable changes in adipocyte size distribution associated with MDSA

Subcutaneous AT- pre vs post

Control group

MDSA group

Visceral AT post

MDSA associated with a shift towards smaller (healthier) adipocytes

Osorio-Conles O et al. Nutrients 2022

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Changes in adipose tissue morphology with the intervention

Adipose tissue fibrosis

(Sirius red staining)

Subcutaneous AT- pre vs post

Visceral AT post

MDSA not associated with changes in fibrosis in the adipose tissue

Osorio-Conles O et al. Nutrients 2022

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Changes in adipose tissue morphology with the intervention

Changes in subcutaneous adipose tissue gene expression

Adipokines

Autophagy and senescence

MDSA associated with favourable, yet limited, changes in subcutaneous adipose tissue gene expression

Angiogenesis

No changes in SCAT expression of genes associated with inflammation, adipogenesis, fatty acid metabolism, beiging, or glucose metabolism

Osorio-Conles O et al. Nutrients 2022

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Changes in adipose tissue morphology with the intervention

Changes in visceral adipose tissue gene expression

Inflammation

In the MDSA, higher expression of favourable genes in visceral adipose tissue post-intervention

Differences in VAT expression of some genes associated with autophagy and senescence, fatty acid metabolism, and mitochondrial function, also found.

No differences in genes associated with glucose metabolism.

Angiogenesis

Adipogenesis

Beiging

Osorio-Conles O et al. Nutrients 2022

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Changes in clinical characteristics with the intervention

	MDSA group PRE (n=19)	MDSA group POST (n=19)	Control group PRE (n=15)	Control group POST (n=15)	Time*group interaction p
Age (years)	48.9 ± 11.0	---	45.3 ± 11.8	---	ns
BMI (kg/m²)	43.8 ± 4.0	44.0 ± 3.8	45.7 ± 3.0	45.8 ± 3.8	ns
Weight (kg)	110.0 ± 11.3	111.0 ± 11.7	110.3 ± 11.0	110.0 ± 11.9	ns
Fat mass (%)	52.8 ± 4.3	53.1 ± 3.2	55.1 ± 3.0	54.9 ± 3.0	ns
eVAT (gr)	2351 ± 912	2540 ± 1010	2396 ± 953	2398 ± 703	ns
Fasting plasma glucose (mg/dl)	106.0 ± 14.0	106.0 ± 12.4	100.0 ± 10.6	100.0 ± 15.1	ns
Triglycerides (mg/dl)	124.2 ± 47.0	124.0 ± 30.0	144.0 ± 42.4	151.7 ± 61.0	ns
Cholesterol: total/HDL/LDL (mg/dl)	187/46.3/120	176/46.6/105	200/48.2/125	207/49.7/132	<0.05/ns/<0.05
Systolic/Diastolic BP (mmHg)	(135 ± 15)/(86 ± 9)	(132 ± 18)/(83 ± 10)	(133 ± 16)/(90 ± 13)	(135 ± 15)/(83 ± 8)	ns
HOMA-IR	5.3 ± 2.1	5.4 ± 2.0	6.2 ± 4.0	6.2 ± 4.1	ns
Adiponectin (ug/ml)	19.3 ± 10.5	20.4 ± 10.1	25.1 ± 13.5	24.3 ± 15.9	ns
Hs-CRP (mg/dl)	0.8 ± 0.7	0.7 ± 0.6	0.8 ± 0.6	1.2 ± 1.3	ns

Osorio-Conles O et al. Nutrients 2022

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Changes in clinical characteristics with the intervention

	MDSA group PRE (n=19)	MDSA group POST (n=19)	Control group PRE (n=15)	Control group POST (n=15)	Time*group interaction p
GM-CSF (pg/ml)	26.6 ± 21.0	14.9 ± 7.7	15.8 ± 9.9	17.7 ± 13.7	0.018
IFN-gamma ( pg/ml)	5.7 ±54.0	3.2 ± 1.7	3.6 ± 3.0	4.3 ± 4.1	0.014
IL-6 (pg/ml)	2.1 ± 1.4	1.5 ± 1.0	1.2 ± 0.5	1.2 ± 0.8	ns
TNF-alfa (pg/ml)	4.2 ± 2.4	3.1 ± 1.2	3.6 ± 1.6	3.8 ± 1.9	ns
Selectin (pg/ml)	87.2 ± 40.5	85.9 ± 45.3	86.8 ± 36.3	83.9 ± 27.2	ns
sICAM-1 (ng/ml)	176 ± 110	163 ± 80	178 ± 91	170 ± 87	ns
sVCAM-1 (ng/ml)	679 ± 162	633 ± 148	683 ± 141	666 ± 115	ns
SAA (ug/ml)	26.9 ± 26.3	38.7 ± 42.7	62.3 ± 68.6	60.6 ± 62.0	ns

In our study:

MDSA associated with limited metabolic benefit

Improvement in some, yet not all, serum inflammatory markers

Osorio-Conles O et al. Nutrients 2022

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Association with adherence to the Med Diet irrespective of the group allocation

	Upper tertile of Med Diet adherence (MEDAS ≥11) (n=12)	Lower tertile of Med Diet adherence (MEDAS ≤ 6) (n=11)
IL6	better	worse
IL1-beta	better	worse
INF-gamma	better	worse
GM-CSF	better	worse
TNF-alfa	better	worse
Adiponectin	comparable	comparable
sICAM-1	comparable	comparable
sVCAM-1	comparable	comparable
SAA	comparable	comparable

Changes in clinical characteristics with the intervention

In our study:

Improvement in some, yet not all, serum inflammatory markers

Osorio-Conles O et al. Nutrients 2022

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Summary

In our short-term, exploratory study, a Mediterranean Diet supplemented with almonds:

Resulted in beneficial changes in adipose tissue morphology and gene expression in SCAT
Was associated beneficial changes adipose tissue morphology and gene expression in VAT
Resulted in improved, yet limited, improved metabolic and inflammatory profile

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Summary

Benefit

Med Diet

CV Disease

Improved

AT function

Improved factors

involved in CVD

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Acknowledgements

Oscar Osorio-Conles

Ana de Hollanda

Romina Olbeyra

Ainize Ibarzabal

Violeta Moizé

Amanda Jiménez

Lílliam Flores, Anna Curell, Judit Molero, Alba Andreu

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Thank you for your attention