Pistachio Nut Effects on the Blood Lipid Profile in Patients With Type II Diabetes Mellitus: A Single-Blind Randomized Crossover Controlled Clinical Trial

Document Type : Original Article


1 Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, IR Iran.

2 Clinical Research Development Center, Qom University of Medical Sciences, Qom, IR Iran.

3 Department of Epidemiology and Biostatistics, School of Medicine, Zanjan University of Medical Sciences, Zanjan, IR Iran.


Introduction: Nuts are known for their health properties, and they play a special role in Mediterranean diets. This study aimed to determine Iranian pistachio effects on serum lipid levels in type II diabetic patients.
Methods: In this randomized crossover single-blind trial, 48 diabetic patients were randomly assigned to 2 groups: one that consumed 50 g of Iranian pistachios and one that followed the usual diet for 12 weeks. After an 8-week washout period, the participants were crossed over to the alternate arm.
Results:Systolic blood pressure was significantly lower in the pistachio phase than the usual diet. Changes in diastolic blood pressure, lipid values (cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein), weight, and body mass index were not significantly different between the 2 intervention phases.
Conclusions: In diabetic patients, an Iranian pistachio intake (50 g daily) improved systolic blood pressure. Additionally, no detrimental effects were caused by pistachio consumption on lipid values. It seems that pistachio consumption at a high dose could change the results. (Iranian Heart Journal 2021; 22(3): 23-32)


  1. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. New England Journal of Medicine. 2010;362(12):1090-101.
  2. Javanbakht M, Baradaran HR, Mashayekhi A, Haghdoost AA, Khamseh ME, Kharazmi E, et al. Cost-of-illness analysis of type 2 diabetes mellitus in Iran. PloS one. 2011;6(10):e26864.
  3. Azimi-Nezhad M, Herbeth B, Siest G, Dadé S, Ndiaye NC, Esmaily H, et al. High prevalence of metabolic syndrome in Iran in comparison with France: what are the components that explain this? Metabolic syndrome and related disorders. 2012;10(3):181-8.
  4. Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, et al. Trends in the Prevalence of Diabetes and Impaired Fasting Glucose in Association with Obesity in Iran: 2005-2011. Diabetes Research and Clinical Practice. 2014;103(2):319-327.
  5. Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. NUt and peanut butter consumption and risk of type 2 diabetes in women. JAMA. 2002;288(20):2554-60.
  6. Sharma M, Ansari MT, Abou-Setta AM, Soares-Weiser K, Ooi TC, Sears M, et al. Systematic Review: Comparative Effectiveness and Harms of Combination Therapy and Monotherapy for Dyslipidemia. Annals of Internal Medicine. 2009;151(9):622-30.
  7. Chehade J, Gladysz M, Mooradian A. Dyslipidemia in Type 2 Diabetes: Prevalence, Pathophysiology, and Management. Drugs. 2013;73(4):327-39.
  8. Kendall CW, Esfahani A, Truan J, Srichaikul K, Jenkins DJ. Health benefits of nuts in prevention and management of diabetes. Asia Pac J Clin Nutr. 2010;19(1):110-6.
  9. Alturfan A, Emekli-Alturfan E, Uslu E. Consumption of pistachio nuts beneficially affected blood lipids and total antioxidant activity in rats fed a high-cholesterol diet. Folia Biologica (Praha). 2009;55(4):132-6.
  10. Ros E, Mataix J. Fatty acid composition of nuts – implications for cardiovascular health. British Journal of Nutrition. 2006;96(SupplementS2):S29-S35.
  11. Kamangar T, Farsam H. Composition of pistachio kernels of various Iranian origins. Journal of Food Science. 1977;42(4):1135-6.
  12. Tomaino A, Martorana M, Arcoraci T, Monteleone D, Giovinazzo C, Saija A. Antioxidant activity and phenolic profile of pistachio (Pistacia vera L., variety Bronte) seeds and skins. Biochimie. 2010;92(9):1115-22.
  13. Rajaei A, Barzegar M, Mobarez AM, Sahari MA, Esfahani ZH. Antioxidant, anti-microbial and antimutagenicity activities of pistachio green hull extract. Food and Chemical Toxicology. 2010;48(1):107-12.
  14. Mandalari G, Bisignano C, Filocamo A, Chessa S, Sarò M, Torre G, et al. Bioaccessibility of pistachio polyphenols, xanthophylls, and tocopherols during simulated human digestion. Nutrition. 2013;29(1):338-44.
  15. Sari I, Baltaci Y, Bagci C, Davutoglu V, Erel O, Celik H, et al. Effect of pistachio diet on lipid parameters, endothelial function, inflammation, and oxidative status: A prospective study. Nutrition. 2010;26(4):399-404.
  16. Sheridan MJ, Cooper JN, Erario M, Cheifetz CE. Pistachio Nut Consumption and Serum Lipid Levels. Journal of the American College of Nutrition. 2007;26(2):141-8.
  17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.
  18. Siahnouri Z, Sadeghian M, Salehisormghi MH, Qomi M. Determination of Iranian Walnut and Pistachio Mineral Contents. Journal of Basic and Applied Scientific Research. 2013; 3(4):217-220.
  19. Kendall CWC, West SG, Augustin LS, Esfahani A, Vidgen E, Bashyam B, et al. Acute effects of pistachio consumption on glucose and insulin, satiety hormones and endothelial function in the metabolic syndrome. Eur J Clin Nutr. 2014;68(3):370-5.
  20. Hernández-Alonso P, Salas-Salvadó J, Baldrich-Mora M, Juanola-Falgarona M, Bulló M. Beneficial Effect of Pistachio Consumption on Glucose Metabolism, Insulin Resistance, Inflammation, and Related Metabolic Risk Markers: a Randomized Clinical Trial. Diabetes Care. 2014. 37(11): 3098-3105.
  21. Parham M, Heidari S, Khorramirad A, Hozoori M, Hosseinzadeh F, Bakhtyari L, et al. Effects of pistachio nut supplementation on blood glucose in patients with type 2 diabetes: a randomized crossover trial. The review of diabetic studies: RDS. 2013;11(2):190-6.
  22. Gulati S, Misra A, Pandey RM, Bhatt SP, Saluja S. Effects of pistachio nuts on body composition, metabolic, inflammatory and oxidative stress parameters in Asian Indians with metabolic syndrome: A 24-wk, randomized control trial. Nutrition. 2014;30(2):192-7.
  23. Anderson AD, Anderson MM, Jacobson JL, Popko MR, Young JR, Limburg PJ, et al. Metabolic Effects of Bedtime Pistachio Consumption for 6 weeks in Overweight Persons. The FASEB Journal. 2013;27:1072.20.
  24. West S, Sauder K, McCrea C, Ulbrecht J, Kris-Etherton P. Daily pistachio consumption benefits multiple cardiovascular risk factors in type 2 diabetes. The FASEB Journal. 2014;28(1 Supplement).
  25. Sauder KA, McCrea CE, Ulbrecht JS, Kris‐Etherton PM, West SG. Pistachio Nut Consumption Modifies Systemic Hemodynamics, Increases Heart Rate Variability, and Reduces Ambulatory Blood Pressure in Well‐Controlled Type 2 Diabetes: a Randomized Trial. Journal of the American Heart Association. 2014;3(4).
  26. Burns-Whitmore B, Hall L, Bushnell A, Towne A, Roy S. Effects of pistachio consumption on body composition and blood lipids in healthy young women . The FASEB Journal. 2014;28(1 Supplement).
  27. Gentile C, Perrone A, Attanzio A, Tesoriere L, Livrea MA. Sicilian pistachio (Pistacia vera L.) nut inhibits expression and release of inflammatory mediators and reverts the increase of paracellular permeability in IL-1β-exposed human intestinal epithelial cells. Eur J Nutr. 2014:1-11.
  28. Ukhanova M, Wang X, Baer DJ, Novotny JA, Fredborg M, Mai V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. British Journal of Nutrition. 2014;111(12):2146-52.