Approximately 30% of patients experience "Long-COVID" syndrome presenting with symptoms such as cognitive difficulties ('brain fog'), fatigue, dyspnea, autonomic dysfunction, depression and anxiety, lasting beyond 12 weeks causing significant disability, and threaten health and wellbeing of millions around the world. At the current time, there is no effective treatment for long-COVID. Walnuts contain a mixture of nutrients and phytochemicals include monounsaturated fatty acids (MUFA), polyunsaturated fatty acids (PUFA), and alpha-linolenic acid (ALA). Walnut consumption was directly associated with cognitive function. The investigators have shown pomegranate that share the same phytonutrient ellagitannins as walnut and mixed nuts including walnuts could increase blood microbiome metabolites of tryptophan metabolite indole propionate and serotonin levels via change of gut microbiota and therefore play an essential role in gut-brain axis including cognitive function. The proposed pilot study will include 76 adults (ages \>40 years) with diagnosis of SARS-CoV2 infection presenting with long-COVID symptoms lasting longer than 12 weeks. They will be randomized 1:1 to usual care vs. an intervention group that will include 2 oz (57g) of walnuts daily into their habitual diet for 12 weeks. The investigators will compare the improvement in symptoms of cognitive complains of "brain fog", fatigue and depression of the active intervention group vs. usual care. The outcome of the investigation of the benefit of walnut consumption will provide important novel information on using dietary sources of polyunsaturated fatty acids and phytochemicals to mitigate the common symptoms of long-COVID. This application was submitted in response to the California Walnut Commission's commodity board topic.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
31
Participants randomized to the intervention group will consume (2 oz ) of whole walnuts daily, incorporated into their diet for 12 weeks. Walnuts were provided to participants, and adherence was monitored using dietary records.
UCLA Center for Human Nutrition
Los Angeles, California, United States
Episodic Memory - RAVLT-Revised Long-Delay Free Recall (number of words recalled)
Change in long-delay free recall score (number of words correctly recalled) on the RAVLT-Revised from baseline to week 12.
Time frame: Baseline to Week 12
Executive Function
Digit Vigilance Test Score Description: Total completion time (seconds) and/or number of errors on the Digit Vigilance Test, assessing sustained attention and processing speed.
Time frame: Baseline to Week 12
Trail Making Test Part A Completion Time
Description: Time to completion (seconds) for Trail Making Test Part A, assessing processing speed.
Time frame: baseline and 12 weeks
Fatigue
Patient-Reported Outcomes Measurement Information System (PROMIS®) Fatigue Short Form - 8 Item. Fatigue will be assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS®) Fatigue Short Form (8 items). Raw scores range from 8 to 40, with higher scores indicating greater fatigue (worse outcome). Scores may also be converted to standardized T-scores (mean = 50, SD = 10), where higher T-scores indicate greater fatigue.
Time frame: Baseline and 12
Mood
PROMIS® Depression Short Form (8 items)
Time frame: baseline and 12 weeks
NIH Toolbox Cognitive Battery (NIHTB-CB) - Fluid Intelligence Composite
Fluid cognitive function will be assessed using the Fluid Intelligence Composite score from the NIH Toolbox Cognitive Battery. The composite is a standardized score (mean = 100, SD = 15), with higher scores indicating better cognitive performance.
Time frame: Baseline to Week 12
Quality of Life
SF-36 Health Survey
Time frame: Baseline and 12
Blood Pressure
Seated systolic and diastolic blood pressure Systolic and diastolic blood pressure will be measured in millimeters of mercury (mmHg) using an automated calibrated sphygmomanometer after 5 minutes of seated rest. Higher values indicate higher blood pressure.
Time frame: Baseline and Week 12
Dietary Intake
24-hour dietary recall (ASA24™)
Time frame: Baseline and 12
Blood and Urine Biomarkers
Measures: metabolic markers and inflammatory Blood fatty acid profile Plasma ellagic acid Urinary urolithin metabolites (LC-MS/MS)
Time frame: Baseline, 12 Weeks
WAIS-IV Symbol Search Score
Total correct responses (scaled score) on the WAIS-IV Symbol Search subtest, assessing processing speed.
Time frame: Baseline and 12 weeks
Heart Rate
Resting heart rate Description: Resting heart rate will be measured in beats per minute (bpm) using an automated blood pressure monitor after 5 minutes of seated rest.
Time frame: Baseline and Week 12
Body Weight
Measure: Body weight in kilograms Description: Body weight will be measured in kilograms (kg) using a calibrated digital scale with participants wearing light clothing and no shoes.
Time frame: baseline and week 12
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