Effects of tree nut and groundnut consumption compared with those of L-arginine supplementation on fasting and postprandial flow-mediated vasodilation: Meta-analysis of human randomized controlled trials

E.T.H.C. Smeets, R.P. Mensink, P.J. Joris*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Introduction: L-arginine supplementation may improve vascular endothelial function. As tree nuts and groundnuts are a source of the amino acid L-arginine, we performed a meta-analysis of human ran-domized controlled trials (RCTs) to compare effects of tree nut and groundnut consumption with those of L-arginine supplementation on fasting and postprandial endothelial function as assessed by flow-mediated vasodilation of the brachial artery (FMD).

Methods: Summary estimates of weighted mean differences (WMDs) in FMD and 95% confidence in-tervals (CIs) were calculated using random-effect meta-analyses.

Results: A total of thirteen RCTs focusing on tree nut and groundnut consumption and nineteen RCTs investigating effects of L-arginine supplementation were included. Longer-term consumption of tree nuts and groundnuts increased fasting FMD by 1.09 %-point (PP) (95% CI: 0.49, 1.69, P < 0.001; I-2: 76.7%, P < 0.001), while L-arginine supplementation (daily range: 3-21 g) increased fasting FMD by 0.53 PP (95% CI: 0.12, 0.93; P = 0.012; I-2: 91.6%, P < 0.001). Effects between treatments were not statistically different (P = 0.31). Tree nut and groundnut consumption did not affect postprandial FMD responses (1.25 PP, 95% CI: -0.31, 2.81, P = 0.12; I-2: 91.4%, P < 0.001), whereas L-arginine supplementation (range: 3-15 g) improved FMD during the postprandial phase by 2.02 PP (95% CI: 0.92, 3.13, P < 0.001; I-2: 99.1%, P < 0.001). However, treatment effects did not differ significantly (P = 0.60). Overall, these results derive from high-quality evidence.

Conclusion: Longer-term consumption of tree nuts and groundnuts, as well as L-arginine supplementa-tion did improve fasting endothelial function, as assessed by FMD. However, the positive effects of tree nuts and groundnuts could not be fully explained by the amount of L-arginine in these nuts. Only L-arginine supplementation did improve postprandial FMD, but effects were not different from those of tree nuts and groundnuts. Future studies should focus on the identifications of the bioactive nutrients in tree nuts and groundnuts and mechanistic pathways behind differences in postprandial and longer-term fasting changes in FMD. (c) 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Original languageEnglish
Pages (from-to)1699-1710
Number of pages12
JournalClinical Nutrition
Issue number4
Publication statusPublished - 1 Apr 2021


  • Meta-analysis
  • Tree nuts
  • Groundnuts
  • L-arginine
  • Flow-mediated vasodilation

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