Comparison of the Effect of Milk and Pistachio Snacks on Anthropometric Indices in Overweight or Obese Women: A Randomized Crossover Trial

Leila Sheikhi, Majid Karandish, Seyed Mahmood Latifi, Iran Davoudi


Background: Weight management is the key to prevent and treat the adverse consequences of overweight and obesity. The aim of this study was to compare the effect of consuming milk and pistachio snacks on anthropometric indices in overweight or obese women. Methods: In this randomized crossover trial, 60 overweight or obese women with a mean age of 24 ± 4.2 years were randomly divided into two groups. Women in the milk group received 200 mL/day low‑fat milk while women in the other group received 30 g/day pistachio for 4 weeks. After a 6‑day washout period, the participants received a similar intervention in a crossover manner. Results: Out of the total 60 participants, 52 completed the study. At the end of the study, the weight of women in the milk group significantly decreased (70.8 ± 8.4 vs. 69.9 ± 8.3, P value = 0.001). No statistically significant changes were observed in the weight of participants in the pistachio group (70.3 ± 8.4 vs. 70.6 ± 8.3, P value = 0.06). Further analyses showed a slightly significant beneficial effect on waist circumference (WC) (P‑value =0.068) and body mass index (BMI) in the milk group P value = 0.01). Conclusions: Based on the observed positive effects of milk intake on weight loss in this crossover study, milk consumption may be considered an appropriate snack in weight loss programs in overweight or obese women.


Anthropometric indices; crossover; milk; obesity; overweight; pistachio

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Collaborators GO. Health effects of overweight and obesity in

countries over 25 years. N Engl J Med 2017;377:13‑27.

Onvani S, Haghighatdoost F, Surkan PJ, Azadbakht L. Dairy

products, satiety and food intake: A meta‑analysis of clinical

trials. Clin Nutr 2017;36:389‑98.

snacks M, Movahedi A, Motlagh AD, Abdollahi Z, Djazayery A.

Association of socioeconomic status and food security with

anthropometric indices among 2–5‑year‑old urban children in

eight different cities in Iran. Int J Prev Med 2019;10:173.

Bray G, Kim K, Wilding J, Federation WO. Obesity: A chronic

relapsing progressive disease process. A position statement of the

world obesity federation. Obes Rev 2017;18:715‑23.

Wright SM, Aronne LJ. Causes of obesity. Abdom Radiol


Nair SC, Sheikh SM, Ibrahim H. Higher physician body mass

index is associated with increased weight bias in an Arab country

with high prevalence of obesity. Int J Prev Med 2019;10:93.

Bray GA, Frühbeck G, Ryan DH, Wilding JPH. Management of

obesity. Lancet 2016;387:1947‑56.

Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence

and trends in obesity among US Adults, 1999‑2000. JAMA


Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F,

Sergi G, et al. Predictors of drop‑out in overweight and obese

outpatients. Int J Obesity 2005;29:122‑8.

Kushner RF. Weight loss strategies for treatment of obesity. Prog

Cardiovasc Dis 2014;56:465‑72.

Jackson CL, Hu FB. Long‑term associations of nut

consumption with body weight and obesity. Am J Clin Nutr

;100(Suppl 1):408S‑11S.

Douketis JD, Macie C, Thabane L, Williamson DF. Systematic

review of long‑term weight loss studies in obese adults: Clinical

significance and applicability to clinical practice. Int J Obes


Gregori D, Foltran F, Ghidina M, Berchialla P. Understanding

the influence of the snack definition on the association

between snacking and obesity: A review. Int J Food Sci Nutr


Westerterp KR. Physical activity, food intake, and body weight

regulation: Insights from doubly labeled water studies. Nutr Rev


Mills JP, Perry CD, Reicks M. Eating frequency is associated

with energy intake but not obesity in midlife women. Obesity


Whybrow S, Kirk T. Nutrient intakes and snacking frequency in

female students. J Human Nutr Diet 1997;10:237‑44.

Williams RA, Roe LS, Rolls BJ. Assessment of satiety depends

on the energy density and portion size of the test meal.

Obesity (Silver Spring). 2014;22:318‑24.

Ortinau LC, Hoertel HA, Douglas SM, Leidy HJ. Effects of

high‑protein vs. high‑fat snacks on appetite control, satiety, and

eating initiation in healthy women. Nutr J 2014;13:97.

Njike VY, Smith TM, Shuval O, Shuval K, Edshteyn I,

Kalantari V, et al. Snack food, satiety, and weight. Adv Nutr


Halton TL, Hu FB. The effects of high protein diets on

thermogenesis, satiety and weight loss: A critical review. J Am

Coll Nutr 2004;23:373‑85.

Dougkas A, Minihane AM, Givens DI, Reynolds CK, Yaqoob P.

Differential effects of dairy snacks on appetite, but not overall

energy intake. Br J Nutr 2012;108:2274‑85.

Asghari A, Saed F, Dibajnia P. Psychometric properties of the

depression anxiety stress scales‑21 (DASS‑21) in a non‑clinical

Iranian sample. Int J Psychol 2008;2:82‑102.

Moghaddam MB, Aghdam FB, Jafarabadi MA,

Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian

version of international physical activity questionnaire (IPAQ)

in Iran: Content and construct validity, factor structure,

internal consistency and stability. World Appl Sci J


Halvorsen BL, Carlsen MH, Phillips KM, Bøhn SK, Holte K,

Jacobs Jr DR, et al. Content of redox‑active compounds

(ie, antioxidants) in foods consumed in the United States. Am J

Clin Nutr 2006;84:95‑135.

McCance RA, Widdowson EM. McCance and Widdowson's the

Composition of Foods. 7th ed. UK: Royal Society of Chemistry;

p. 644.

Pal S, Ellis V, Dhaliwal S. Effects of whey protein isolate on

body composition, lipids, insulin and glucose in overweight and

obese individuals. Br J Nutr 2010;104:716‑23.

Bes‑Rastrollo M, Sanchez‑Villegas A, Basterra‑Gortari FJ,

Nunez‑Cordoba JM, Toledo E, Serrano‑Martinez M.

Prospective study of self‑reported usual snacking and weight

gain in a Mediterranean cohort: The SUN project. Clin Nutr


Mela DJ. Determinants of food choice: Relationships with

obesity and weight control. Obes Res 001;9:249S‑55S.

Kong A, Beresford SAA, Alfano CM, Foster‑Schubert KE,

Neuhouser ML, Johnson DB, et al. Associations between

snacking and weight loss and nutrient intake among

postmenopausal overweight to obese women in a dietary

weight‑loss intervention. J Am Diet Assoc 2011;111:1898‑903.

Louie JCY, Flood V, Hector D, Rangan A, Gill T. Dairy

consumption and overweight and obesity: A systematic review of

prospective cohort studies. Obes Rev 2011;12:e582‑e92.

Chen M, Pan A, Malik VS, Hu FB. Effects of dairy intake on

body weight and fat: A meta‑analysis of randomized controlled

trials. Am J Clin Nutr 2012;96:735‑47.

Wang H, Troy LM, Rogers GT, Fox CS, McKeown NM,

Meigs JB, et al. Longitudinal association between dairy

consumption and changes of body weight and waist

circumference: The Framingham heart study. Int J Obes


Gilbert J‑A, Joanisse DR, Chaput J‑P, Miegueu P,

Cianflone K, Alméras N, et al. Milk supplementation

facilitates appetite control in obese women during weight loss:

A randomised, single‑blind, placebo‑controlled trial. Br J Nutr


Faghih S, Abadi A, Hedayati M, Kimiagar S. Comparison of the

effects of cows’ milk, fortified soy milk, and calcium supplement

on weight and fat loss in premenopausal overweight and obese

women. Nutr Metab Cardiovasc Dis 2011;21:499‑503.

Zemel M, Teegarden D, Van Loan M, Schoeller D,

Matkovic V, Lyle R, et al. Dairy‑rich diets augment fat loss

on an energy‑restricted diet: A multicenter trial. Nutrients


Abargouei AS, Janghorbani M, Salehi‑Marzijarani M,

Esmaillzadeh A. Effect of dairy consumption on weight and body

composition in adults: A systematic review and meta‑analysis of

randomized controlled clinical trials. Int J Obes 2012;361485.

doi: 10.1038/ijo. 2011.2.

Dougkas A, Reynolds CK, Givens ID, Elwood PC, Minihane AM.

Associations between dairy consumption and body weight:

A review of the evidence and underlying mechanisms. Nutr Res

Rev 2011;24:72‑95.

Anderson H, Luhovyy B, Akhavan T, Panahi S. Milk proteins in

the regulation of body weight, satiety, food intake and glycemia.

Milk and Milk Products in Human Nutrition. 67: Karger

Publishers; 2011. p. 147‑59.

Bendtsen LQ, Lorenzen JK, Bendsen NT, Rasmussen C,

Astrup A. Effect of dairy proteins on appetite, energy

expenditure, body weight, and composition: A review

of the evidence from controlled clinical trials. Adv Nutr


Hu FB. Protein, body weight, and cardiovascular health. Am J

Clin Nutr 2005;82:242S‑7S.

Mattes RD, Dreher ML. Nuts and healthy body weight

maintenance mechanisms. Asia Pac J Clin Nutr 2010;19:137‑41.

Wilson T. Effect of bedtime pistachio consumption for 6 weeks

on weight, lipid profile and glycemic status in overweight

persons. J Food Nutr Sci 2014;1:1‑4.

Wang X, Li Z, Liu Y, Lv X, Yang W. Effects of pistachios on

body weight in Chinese subjects with metabolic syndrome. Nutr

J 2012;11:20.

Li Z, Song R, Nguyen C, Zerlin A, Karp H, Naowamondhol K,

et al. Pistachio nuts reduce triglycerides and body weight

by comparison to refined carbohydrate snack in obese

subjects on a 12‑week weight loss program. J Am Coll Nutr


Coates AM, Howe PR. Edible nuts and metabolic health. Curr

Opin Lipidol 2007;18:25‑30.

Akkarachiyasit S, Charoenlertkul P, Yibchok‑anun S,

Adisakwattana S. Inhibitory activities of cyanidin and its

glycosides and synergistic effect with acarbose against intestinal

α‑glucosidase and pancreatic α‑amylase. Int J Mol Sci


Laitinen K, Gylling H. Dose‑dependent LDL‑cholesterol

lowering effect by plant stanol ester consumption: Clinical

evidence. Lipids Health Dis 2012;11:140.

Tey SL, Brown R, Gray A, Chisholm A, Delahunty C. Nuts

improve diet quality compared to other energy‑dense snacks

while maintaining body weight. J Nutr Metab 2011;2011:357350.