Effect of walnut consumption on markers of endothelial function in adults: A systematic review and meta-analysis of randomized controlled trials

<jats:title>Abstract</jats:title><jats:p>Findings on the effect of walnut consumption on endothelial function are conflicting. Therefore, the present systematic review and meta-analysis summarized available trials in this regard. A systematic search was performed in online databases including PubMed-Medline, Scopus, and ISI Web of Science up to October 2023. Articles that reported the effect of walnut intake on flow-mediated dilation (FMD), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and stimulus-adjusted response measure (SARM) were included. Random effects models for a weighted mean difference (WMD) or standardized mean difference (SMD) were used to test for the overall effect. Six eligible trials were analyzed (250 participants). Walnut intake significantly increased FMD (WMD: 0.94%, 95% CI: 0.12 to 1.75; <jats:italic>p</jats:italic> = 0.02). However, meta-analysis could not show any beneficial effect of walnut intake on ICAM-1 (SMD: −0.23, 95% CI: −0.68 to 0.22; <jats:italic>p</jats:italic> = 0.31), VCAM-1 (SMD: −0.02, 95% CI: −1.38 to 1.34; <jats:italic>p</jats:italic> = 0.97), and SARM (WMD: 0.01%, 95% CI: −0.01 to 0.04; <jats:italic>p</jats:italic> = 0.28). In conclusion, the present meta-analysis suggests that walnuts may reduce cardiovascular disease risk by improving FMD. However, further studies should be performed on adults to determine the effect of walnut intake on endothelial function.</jats:p>