Journal of the American College of Nutrition, Vol. 23, No. 6, 660-668 (2004)
Published by the American College of Nutrition
Improved Diet Quality with Peanut Consumption
Amy E. Griel, MEd,
Brenda Eissenstat, MS, RD,
Vijaya Juturu, PhD,
Gloria Hsieh and
Penny M. Kris-Etherton, PhD, RD
Department of Nutritional Sciences (A.E.G., B.E., P.M.K.)
The Prevention Research Center (G.H.)
The Pennsylvania State University, University Park, Pennsylvania, Nutrition 21, Purchase, New York (V.J.)
Address correspondence to: Penny M. Kris-Etherton PhD, RD, 126-S Henderson Bldg., Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802. E-mail: pmk3{at}psu.edu
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ABSTRACT
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Objective: To evaluate the diet quality of free-living men, women, and children choosing peanuts and peanut products.
Design: Using data reported in the Continuing Survey of Food Intake by Individuals and Diet and Health Knowledge Survey (CSFII/DHKS) from 1994–1996, food codes were used to sort respondents by use or nonuse of peanuts.
Subjects: A nationally representative sample of 4,751 men, 4,572 women, and 4,939 children (boys and girls, 2–19 yrs) who completed 2-day intake records.
Measures of Outcome: The two-sample t test was used to analyze differences between peanut users and nonusers for energy, nutrient intakes, Health Eating Index (HEI) scores, and body mass index (BMI).
Results: Peanut users (24% of CSFII/DHKS) had higher intakes (p < 0.001) of protein, total fat, polyunsaturated fat (PUFA), monounsaturated fat, (MUFA) (p < 0.01), fiber, vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron. Percent of energy from saturated fat was not significantly different for men, women or girls and was slightly lower (p < 0.01) for boys. Dietary cholesterol of peanut users was lower for all population groups; this decrease was significant for both men (p < 0.01) and children (p < 0.001). The HEI was calculated as a measure of overall nutrient profile of the diets and was significantly greater for peanut users (men 61.4, women, 65.1, children 66.8) compared to nonusers (men 59.9, women 64.1, children 64.7) for men (p = 0.0074) and children (p < 0.001). Energy intake was significantly higher in all population groups of peanut users (p < 0.001; boys: p < 0.01); however mean BMI for peanut users was lower for all gender/age categories (women: p < 0.05; children: p < 0.001).
Conclusions: These results demonstrate improved diet quality of peanut users, indicated by the higher intake of the micronutrients vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron and dietary fiber, and by the lower intake of saturated fat and cholesterol. Despite a higher energy intake over a two-day period, peanut consumption was not associated with a higher BMI.
Key words: nuts, peanuts, peanut butter, peanut products, diet quality, Healthy Eating Index (HEI), CSFII
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INTRODUCTION
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A large body of evidence consistently shows that consumption of tree nuts and peanuts is associated with a reduced risk of coronary heart disease (CHD). To date, five large epidemiologic studies (the Adventist Health Study [1–4], the Iowa Women’s Health Study [5–6], the Nurses’ Health Study [7], the Physicians’ Health Study [8] and the Cholesterol and Recurrent Events (CARE) Study [9]) have reported an inverse association between nut consumption and the risk of CHD [10]. The Nurses’ Health Study reported that the substitution of the fat from one ounce of nuts for the equivalent energy from carbohydrate and saturated fat reduced CHD risk 30% and 45%, respectively [10]. In addition, results from the Adventist Health Study demonstrated that the consumption of nuts 5 times per week reduced the risk of death from CHD by 39% [3]. Numerous clinical studies have demonstrated that tree nuts and peanuts beneficially affect plasma lipids and lipoproteins (reduced total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and triglycerides without reducing high density lipoprotein (HDL) cholesterol) [11]. A meta-analysis by Fulgoni et al. [12] showed that the consumption of almonds significantly reduced both TC (3.6%) and LDL-C (4.7%), with significantly greater responses in those individuals with baseline TC values greater than 5.2 mmol/L. Beyond CHD, the Nurses’ Health Study [13] has shown that the consumption of peanuts and peanut butter 5 times a week (equivalent to 
140-g of peanuts/week) was associated with a 27% and 21% reduction in risk of type 2 diabetes, respectively.
The health benefits associated with nuts are thought to reflect their nutritional profile including their nutrient density, fatty acid profile and presence of bioactive compounds. While peanuts are botanically classified as a legume, they frequently are grouped with the tree nuts because their nutritional profile is similar (Table 1). For example, peanuts are a rich source of B-vitamins, vitamin E, magnesium, copper and phosphorus. In addition, they are a source of plant protein (including arginine), dietary fiber, and unsaturated fatty acids. Numerous bioactive substances (i.e., flavonoids, resveratrol and plant sterols) also are present in peanuts. Resveratrol and ß-sitosterol found in peanuts have been associated with decreased risk of CHD and reduced cancer risk [14–15]. Thus, it stands to reason that tree nut and peanut consumption would be associated with a favorable nutrient intake.
Despite their unique nutritional profile, some individuals avoid tree nuts and peanuts because they are an energy dense food. Accordingly, because of the high caloric density of tree nuts, peanuts and peanut products, inclusion in the diet might increase energy intake leading to weight gain and an increase in Body Mass Index (BMI). Although they did not report data on BMI, an analysis of data from the 1992–94 Market Research Corporation of America reported that individuals including nuts in their diet had a significantly higher energy intake (
10%) than did non-nut users [16]. Of note however, is that a recent review of epidemiologic, controlled-feeding and free-living studies reported that the incorporation of nuts into a self-selected diet does not result in a higher body mass index or a tendency to gain weight [17]. In fact, the research conducted to date has shown that nut eaters have a lower BMI than do non-nut eaters. Hu et al. [7] reported that an increase in nut and peanut consumption in the Nurses’ Health Study did not result in a higher BMI, but rather a decrease in BMI with every quartile increase in nut consumption, when controlled for total energy intake. The possibility does exist that individuals who already have a higher BMI avoid tree nuts and peanuts altogether due to their high energy density. This may be one possible explanation for the lower BMI among nut consumers. Alternatively, tree nut and peanut consumers could include tree nuts, peanuts and peanut products in a healthy eating pattern that achieves calorie control, resulting in a lower BMI.
Until recently, low-fat, and often very low-fat high-carbohydrate diets had been widely accepted as the recommended diet of choice for good health. Current dietary guidance now embraces a moderate-fat diet for reducing risk of chronic disease. In addition to its health benefits, a moderate-fat diet, that incorporates tree nuts and peanuts, may promote long-term healthy dietary practices. For example, a recent study by McManus et al. [18] found that individuals who followed a moderate-fat (35% total energy from fat), Mediterranean style diet for 18 months, had better adherence with a weight loss program and maintained their weight loss for a longer period of time compared to individuals instructed to follow a very low-fat diet (20% total energy from fat). The recognition that a moderate-fat diet (that is low in saturated fatty acids and cholesterol) confers health benefits is important because it provides flexibility in diet planning. This is important because diet guidance can be individualized to enhance dietary adherence.
The purpose of the present study was to use data reported in the Continuing Survey of Food Intake by Individuals (CSFII) from 1994–1996 to clarify whether individuals in a free-living population who consume peanuts and peanut products exhibit an overall healthier eating pattern compared with non-peanut eaters. Moreover, we assessed whether the inclusion of peanuts and peanut products in a diet was associated with a higher BMI compared with individuals who did not consume peanuts or peanut products.
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MATERIALS AND METHODS
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The CSFII 1994–96 was conducted by Westat, Inc (Rockville, MD) under contract to USDA’s Food Surveys Research Group, Agricultural Research Service. The Diet and Health Knowledge Survey (DHKS) was a follow-up telephone survey to the CSFII. Together, they are popularly referred to as the "What We Eat in America" survey. The CSFII survey is part of a continuing effort to monitor changes over time in the food choices Americans make and the adequacy of their diet [19]. In each of the three survey years, a nationally representative sample of noninstitutionalized individuals of all ages, provided through in-person interviews, a 1-day dietary recall on 2 nonconsecutive days (3 to 10 days apart). A multi-pass dietary recall strategy was used by the interviewers to maximize the accuracy and amount of information collected [20–21]. The survey included over sampling of low income individuals to yield a national sample of the low-income population. Records of men, women and children (ages 2–19 years) were used in our analysis. A complete list of the foods and nutrients analyzed to date can be found at: http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm
Food codes were used to sort respondents by use of peanuts and peanut products. Type of peanut consumed was identified as peanut butter, peanuts as part of a savory snack, peanuts as part of a sweet snack, roasted/boiled peanuts, or peanuts as part of a meal (including peanut oil and peanut butter identified as ingredients in an entrée).
Analysis of 2-day mean intakes included energy, sugar, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, fiber, cholesterol, carbohydrate, vitamin A (retinol equivalents), vitamin E, vitamin C, thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, calcium, phosphorus, magnesium, iron, zinc, sodium, and potassium. Although reported in other studies, vitamin D, selenium, manganese, and copper were not evaluated in this study because they were excluded from the CSFII 1994–96 database. In addition, alcohol was not included.
Percentage RDAs [22] were assessed for energy, protein, vitamin A, vitamin E, vitamin C, thiamin, riboflavin, niacin, vitamin B-6, folate, vitamin B-12, calcium, phosphorus, magnesium, iron, and zinc. Percentage RDAs were truncated at 100 to account for the dilution effect of individuals with higher intakes. If the extreme values (>100%) were not truncated then it would be possible for those values to elevate individuals who may be at a marginal or low level of intake when looking at mean data [23]. Since the time of the CSFII 1994–96 Survey, new Dietary Reference Intake (DRI) values have been established for many vitamins and minerals by the Food and Nutrition Board of the National Academy of Sciences/National Academies [23–27]. Adequacy of several nutrients with marginal intakes is evaluated relative to these new standards.
The Healthy Eating Index (HEI) was calculated as a measure of diet quality. The HEI includes 10 components, with the score for each component ranging from 0 to 10. The components are defined in Table 2. Components 1–5 measure the degree to which an individual’s diet matches the serving recommendations of the USDA Food Guide Pyramid for the five major food groups: grains, vegetables, fruits, milk products, and meat products, respectively. HEI scores were calculated for 200-calorie increments between 1200 and 3000 calories, to account for the differences in serving size recommendations associated with the USDA Food Guide Pyramid. This calorie range was selected based on the 1994–1995 mean food energy intakes of 1,633 kcal for women and 2,470 kcal for men [19]. Components 6 and 7 are based on overall fat and saturated fat consumption, respectively, as a percentage of total food energy intake. Component 8 is based on cholesterol intake and component 9 is based on sodium intake. For components 6–9 a perfect score of 10 is assigned to the recommended daily intake, with a score of 0 assigned to extreme values. Components are then scored proportionally between 0 and 10, based on the recommended values. See Table 2 for specific values. Values above the high limits were also assigned a 0. A measure of variety in the diet (component 10) was not assessed in the present study, thus the HEI scores reported here have a maximum score of 90.
The two-sample t test was used to statistically analyze (Statistical Analysis System, SAS 8.1, 1999–2000, Cary, NC) differences between peanut users and nonusers in terms of energy, nutrient intake, HEI and BMI. Analysis of Variance was used to detect differences among peanut users for the different quartiles of peanut intake. If significant differences were detected among the quartiles of peanut intake, Tukey post-hoc analyses were used to determine which quartiles were different from one another. A p-value of .05 was used to determine statistical significance.
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RESULTS
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14,262 individuals (4,752 men, 4,572 women, and 4,939 children) completed 2-day diet records in the 1994–96 CSFII/DHKS. 24% of respondents consumed peanuts or peanut products. 13% consumed peanut butter, 9% consumed peanuts as part of a sweet snack, 3% consumed peanuts as part of a savory snack, 1.7% consumed peanuts, and 0.7% consumed peanuts, peanut butter or peanut oil as ingredients in a meal. The HEI index was calculated for a subset of individuals who were consuming between 1200 and 3000 calories (n = 10,632; 3,508 men, 3,315 women, and 3,809 children).
The demographic profile of the individuals is listed in Table 3. Our sample contained 51% men and 49% women, representative of the proportion determined in the U.S. Census Bureau’s Census 2000 (49% men, 51% women) [28]. When men, women and children were combined, our sample included 78.0% Whites, 12.7% Blacks, 2.4% Asians, 0.7% American Indians and 6.1% Other. This sample is representative of the US population: 75.1% Whites, 12.3% Blacks, 3.6% Asians, and 0.9% [28]. The data indicate a slight gender difference between peanut use of adult men (20.6%) and women (18.2%), but use by children was highest (32.9%). While peanut users were more likely to be white across men, women and children, the highest peanut consumption was seen in the small sample of Native American men (n = 30) and children (n = 42) (23% and 38%, respectively).
Respondents of the CSFII/DHKS tended to have generally good diets (Table 4). The average HEI of all respondents exceeded 60 (maximum score of 90), and many of the RDA 1989 values exceeded 100%. The HEI of individuals consuming peanuts was significantly higher than that of nonusers for both men (p < 0.01) and children (p < 0.001). All nutrients with marginal intakes in nonusers were significantly higher in peanut users (p < 0.001). Nutrients of concern for adult men and women were vitamin A, vitamin E, and zinc. In addition, female nonusers had lower intakes of calcium and magnesium (p < 0.001). Vitamin E intake was low for all children (ranging from 68.7 ± 23.8 to 82.8 ± 19.6% RDA) while calcium and zinc intake was lower for female children, when compared to male children. Beginning in 1998, Dietary Reference Intakes (DRI) were established for many nutrients. If nutrient intake during this study is compared to recent DRIs, magnesium intake also would be low for men; folate and iron become nutrients of concern for women (Table 5).
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Table 4. Healthy Eating Index (HEI)a and Selected Nutrient Intakes as Percentages of 1989 Recommended Dietary Allowances (RDAs) Truncated at 100 for Peanut Users and Nonusers
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Energy intake of peanut users was significantly higher (p < 0.001) in men, women, girls and boys (p < 0.01) compared to that of nonusers (Table 6). Interestingly, despite the higher energy intake, BMI was lower in peanut users compared to nonusers for all population groups. The lower BMI was significant in adult women (p < 0.05) and highly significant in children (p < 0.001) but not in men. Percent of energy from total fat was higher in peanut users compared to nonusers; the higher intake was only significant for men and women (p < 0.001). Percent of energy from MUFA also was significantly higher in peanut users compared to nonusers for men (p < 0.01), women (p < 0.001), and children (p < 0.05). However, percent of energy from saturated fat was comparable, and was actually lower for male children (p < 0.01) and female children (p < 0.05) peanut users when compared to nonusers. Percent of energy from protein was significantly lower in peanut users compared to nonusers for all population groups (p < 0.001). In addition, dietary cholesterol was significantly lower in peanut users compared to nonusers for men (p < 0.01) and children (p < 0.001). Fiber was significantly higher in peanut users versus nonusers in all age/gender groups (p < 0.001).
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Table 6. BMIa, Mean Total Energy, Percent Energy Intake from Carbohydrate, Protein, Fat, Saturated Fat, Monounsaturated Fat, Polyunsaturated Fat, Cholesterol, and Fiber for Peanut Users and Nonusersb
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Macronutrient characteristics also were examined for adults and children consuming varying amounts of peanuts or peanut butter. 533 men, 446 women, and 1095 children reported consuming peanuts or peanut butter in varying quantities (Table 7). Intake was subdivided into four categories, 1.01–28.35 g, 28.36–56.70 g, 56.71–85.05 g, and >85.05 g. For men, women, and children, total energy increased with increasing levels of peanut or peanut butter consumption. The percent of energy from total fat and from MUFA also increased with each increasing level of peanut or peanut butter consumption (1 oz/level), with the exception of women consuming 56.71–85.05 g. Likewise, there was a step-wise increase in the percent of energy from SFA in men. The percent of energy from SFA for women was variable among quartiles, ranging from 9.6% to 11.2%, and was not different in children (11.3–11.9%). Fiber intake also increased with each increasing level of peanut consumption, with the exception of the men who consumed 56.71–85.05 g. Despite increases in energy and fat consumption, there was no significant difference in BMI for adults or children consuming small versus large quantities of peanuts or peanut butter.
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Table 7. BMIa,b, Mean Total Energyb, Percent Energy Intake from Total Fat, Saturated Fat, Monounsaturated Fat, and Fiberb for Various Levels of Peanut/Peanut Butter Consumption
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DISCUSSION
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Our results indicate that individuals who included peanuts in their diet had a significantly higher diet quality as measured by the HEI, and had significantly higher quantities of all marginal nutrients. One might expect improved diet quality with the additional energy consumption from a nutrient dense food such as peanuts and, in fact, including peanuts and peanut butter in their diet also led to an increase in the nutrient density (intake/1000 kcal) for vitamin E, folate and magnesium. Nutrient density for calcium also was greater for men using peanuts relative to nonusers. Although peanuts are not a significant source of calcium, these individuals may be choosing high calcium foods, such as milk, to accompany their peanut and peanut butter food choices (e.g. a peanut butter sandwich and a glass of milk). This may also reflect the possibility that peanut consumers in general make healthy food choices and follow a well-balanced nutrient dense diet.
Vitamin E is a nutrient that is often low in U.S. and Canadian diets. Diets containing fewer than 30% kcal from fat, such as the NCEP Step 1 and Step 2 diets result in even lower intakes of vitamin E [29]. Epidemiologic studies demonstrated the importance of vitamin E in maintaining heart health. Postmenopausal women who ate foods rich in vitamin E reduced their risk for stroke (59%) and heart disease (62%) when comparing women in the highest quintile versus those in the lowest quintile of intake [6,30]. In addition, Rimm reported an inverse correlation between vitamin E and heart disease in men [31]. The Food and Nutrition Board recently revised the RDA for vitamin E to 15 mg daily (approximately 50% higher than the 1989 RDA) [25]. Vitamin E intake in this study (male users 11.7 mg, nonusers 8.8 mg; female users 7.9 mg, nonusers 6.5 mg) fell far below the new RDA. In addition, it may be possible that the higher levels of vitamin E intake in peanut users is an artifact of including gamma tocopherol in the calculation of vitamin E equivalents since peanuts are a rich source of gamma tocopherol. Encouraging use of foods high in vitamin E (i.e., nuts or peanuts) should continue to be a target of nutrition education efforts.
The 1989 RDA for folate was 200 µg for men, and 180 µg for women. By these standards, the percentage RDA (truncated at 100%) for folate in the present study was relatively good (male users 92%, nonusers 89%; female users 88%, nonusers 83%). Since that time however, the importance of folate in the U.S. diet has assumed renewed prominence. The role of folate in preventing neural tube defects led the FDA to mandate the fortification of all grain products beginning in 1998. Folate also is important in the breakdown of the amino acid homocysteine, which in excess, is implicated in arterial wall damage and higher risk of heart attack [32]. The 1998 RDA is 400 µg/day for men and women [25]. Intake by individuals in this study fell far below the new RDA (male users 328 µg, nonusers 278 µg; female users 237 µg, nonusers 210 µg). However, male peanut users did have a significantly higher intake of folate (p < 0.001). A one-ounce serving of roasted peanuts provides approximately 35 µg of folate [33]. The results from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 indicate a mean folate intake of 405 µg for men and 319 µg for women [34]. This increase may represent the impact of the recent folate fortification of grains. From a practical perspective, a peanut butter sandwich, 2 tablespoons of peanut butter on 2 slices of a folate-fortified grain product would be a good food vehicle for folate (total: 86 µg).
Magnesium is critical to heart health. Low magnesium status can contribute to dysrhythmias, myocardial infarction, and possibly hypertension. Both experimental [35] and epidemiologic [36] evidence indicate that dietary magnesium may attenuate insulin resistance and the development of type 2 diabetes. The percentage of the 1989 RDA (truncated at 100) for magnesium was significantly higher for men, women and male children choosing peanuts compared to nonusers (p < 0.001). Adequacy of magnesium in the diet of adult women not choosing peanuts was marginal (female users 81%, nonusers 73%). All legumes, including peanuts, are excellent sources of magnesium. One ounce of roasted peanuts provides approximately 52 mg of magnesium [33]. The revised 1998 RDI for magnesium increased 15–20 percent compared to the 1989 RDA [23]. Relative to these standards, magnesium intake appears to be a nutrient of concern for men (71% RDA) and women (68% RDA) not choosing peanuts.
Vitamin A intake was marginal for all adults (male users 78% vs. nonusers 71%; female users 76% vs. nonusers 72%) in this study. The Food and Nutrition Board recently released new information regarding vitamin A and the provitamin A carotenoids indicating that earlier methods of measuring retinol equivalents significantly overestimated the amount available from carotenoids [26]. The new RDA for vitamin A is slightly lower than the 1989 recommendations, but the CSFII nutrient database used the older conversion factors for beta-carotene and the other carotenoids, making comparisons between intake in this study and the 2001 RDA difficult. Nonetheless, it is possible that the Vitamin A intake in this study was adequate, based on the 2001 RDA, given the fact that the older conversion factors were used.
Percentage energy from total fat was significantly higher for adult peanut users versus nonusers, however the total fat intake for both groups was within the Acceptable Macronutrient Distribution Range (AMDR) of 20–35% of calories, set by the Dietary Reference Intake (DRI) for macronutrients guidelines [37]. This fat difference was primarily due to increases in MUFA and PUFA, as there was no significant difference in percentage of energy from saturated fat between peanut consumers and non-consumers. The favorable fatty acid profile of peanuts has been shown repeatedly to provide substantial cholesterol-lowering effects without decreasing HDL cholesterol [38]. Moreover, individuals with elevated triglycerides and type 2 diabetes mellitus have benefited from an improved glycemic profile and reduced triglycerides when consuming a moderate fat diet high in MUFA compared to a high-carbohydrate, low-fat diet [39].
Percent of energy from protein was lower in peanut users relative to nonusers. The lower intake of cholesterol for men, women and children, implies a lower intake of animal protein sources. Choosing plant rather than animal protein sources could improve fiber intake, depending on the foods selected. The fiber intake of men, women and children was significantly higher in peanut users vs. nonusers (p < 0.001). However, fiber intake for low-moderate peanut users was still less than what is currently recommended (25–35 g/d). Men and women consuming 56.71–85.05 g/d of peanut/peanut butter had a mean fiber intake of 21.7 g and 21.9 g, respectively (Table 7). Peanuts provide 2.6 g fiber/1 oz serving, of which 25% is soluble fiber. Soluble fiber has been shown to reduce total- and LDL-cholesterol concentrations and improve glycemic control [40]. Peanuts also provide a substantial amount of arginine. Arginine is a precursor of nitric oxide, a potent vasodilator that inhibits platelet adhesion and aggregation producing anti-atherogenic effects [41].
There is a concern that consumption of peanuts (or other nuts), a high fat, but nutrient dense food, may increase the risk of weight gain. Results of this study indicate that despite the higher energy intake over the 2-day period assessed, free living men, women and children consuming peanuts did not have a higher BMI than nonusers. While the lower mean BMI for women including peanuts was significantly different (p < 0.05) relative to nonusers (25.7 vs. 26.2), this difference was not significant for men (male users 26.3, nonusers 26.6). However, the lower mean BMI for male and female children including peanuts was highly significant (p < 0.001) relative to that of nonusers. These results indicate that the additional energy intake observed in free-living adults and children including peanuts in their diet in a 2-day period, even at a high level (> 85.05 g/day) was not associated with a higher BMI. Therefore, our results suggest that heavy peanut use over a 2-day period is associated either with increased physical activity or reduced calorie intake at another time in order to maintain a lower BMI. In the present study, since data were assessed over a 2-day period, it was not possible to determine whether one or both of these likely explain our results.
There are other lifestyle factors that may influence the diet quality associated with peanut consumption. It is evident that the effects of the incorporation of peanuts into a diet plan as a replacement for a particular food will vary greatly based on the foods that peanuts replace. In addition, it is possible that individuals who, in general, make unhealthy food choices avoid peanuts, a high-energy and nutrient dense food, so that they are able to consume other low nutrient dense foods instead. It will be important to gain a better understanding of food choice behaviors to answer these and other related questions.
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CONCLUSIONS
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In summary, the results of the present study have shown that peanuts and peanut products enhance the nutrient profile of the diet. Moreover, inclusion of this energy dense food can be done in a manner that does not result in weight gain provided that energy intake does not exceed energy expended over time. This can be achieved with appropriate food substitution strategies and/or increases in physical activity. Consumer awareness about the energy content and nutrient value of peanuts and how they can be incorporated in the diet as a strategy for substituting unsaturated fats for saturated fat can improve the nutrient, especially micronutrient, profile of the diet. Encouraging the use of peanuts and peanut butter, both popular and familiar foods, gives additional options that may promote adherence to a healthy diet that reduces risk of chronic disease.
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FOOTNOTES
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At the time of this study, Dr. Juturu was a postdoctoral fellow in the Department of Nutritional Sciences at The Pennsylvania State University.
Received December 5, 2003.
Accepted July 5, 2004.
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ABSTRACT
INTRODUCTION
