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. 2019 Aug 12;8(8):302. doi: 10.3390/antiox8080302

Table 1.

Nut consumption and cardiometabolic morbidity and mortality.

Author, Year, Country [Ref] Design Subjects (F:M)
Mean Age (Range)
Length of Study Comparison Group Intake of Nuts Findings
Salas-Salvadó et al., 2011,2018 Spain [13] RCT 418 (293:125)
67 (55–80) y
4 y Control (low-fat diet *) MD + 30 g/d nuts (15 g W, 7.5 g H, 7.5 g A) ↓ diabetes incidence, HR 0.47 (95% CI: 0.23–0.98)
(vs. control)
Estruch et al., 2018, Spain [20] RCT,
Parallel, multicenter
2454 (1326:1128)
66.7 ± 6.1
4.8 y Control (nut free diet) MD + 30 g/d mixed nuts (15 g W, 7.5 g A, 7.5 g H) ↓ incidence of CV events (myocardial infarction, stroke, death from CV causes) (vs. control)
HR 0.64 (95% CI: 0.47–0.88)
Pan et al., 2013, USA [14] Prospective (NHS) 58,063 F
52–77 y
22 y Tree nuts and peanuts
(1) Never/rarely
(2) <1 serving/wk
(3) 1 serving/wk
(4) 2–4 servings/wk
(5) ≥5 servings/wk
↓ T2DM risk (p-trend < 0.001) for tree nuts and peanuts
HR 0.80 (95% CI: 0.71–0.90) for (2) to (4) vs. (1)
HR 0.74 (95% CI: 0.65–0.84) for (5) vs. (1)
↓ T2DM risk (p-trend = 0.002) for walnuts
HR 0.76 (95% CI: 0.62–0.94) for (4),(5) vs. (1)
Ibarrola-Jurado et al., 2013, Spain [15] Cross-sectional (PREDIMED) 7210 (4143:3067) 67
(55–80) y
Tree nuts and peanuts
(1) <1 serving/wk
(2) 1–3 servings/wk
(3) >3 servings/wk
↓ prevalence of diabetes (3) vs. (1):
OR 0.87 (95% CI: 0.78–0.99), p-trend = 0.043
↓ prevalence of MS (3) vs. (1):
OR 0.74 (95% CI: 0.65–0.85), p-trend < 0.001
↓ prevalence of obesity (3) vs. (1):
OR 0.61 (95% CI: 0.54–0.68), p-trend < 0.001
Guasch-Ferré et al., 2013, Spain [16] Prospective
(PREDIMED)
7216 (4145:3071)
67 y
4.8 y Tree nuts and peanuts
(1) none
(2) 1–3 servings/wk
(3) >3 servings/wk
↓ CV mortality (3) vs. (1) for walnuts
HR 0.53 (95% CI: 0.29–0.98), p-trend = 0.047
↓ CV mortality (3) vs. (1) for tree nuts (no walnuts) and peanuts
HR 0.42 (95% CI: 0.20–0.89), p-trend = 0.031
↓ total mortality risk (3) vs. (1) for tree nuts (walnuts included) and peanuts
HR 0.61 (95% CI: 0.45–0.83), p-trend = 0.01
Hshieh et al., 2015, USA [17] Prospective 20,742 M
67 y
9.6 y Tree nuts and peanuts
(1) <1 serving/mo
(2) 1–3 servings/mo
(3) 1 serving/wk
(4) 2–4 servings/wk
(5) ≥5 servings/wk
↓ CVD deaths (5) vs. (1)
HR 0.74 (95% CI: 0.55–1.02), p-trend = 0.015
Guasch-Ferré et al., 2017, USA [18] Prospective (a) NHS
(b) NHS II
(c) HPFS
(a) 76,364 F
(b) 92,946 F
(c) 41,526 M
56 y
28.7 y
21.5 y
22.5 y
Tree nuts and peanuts
(1) Never/almost never
(2) <1 time/wk
(3) 1 time/wk
(4) 2–4 times/wk
(5) ≥5 times/wk
(5) vs. (1) for tree nuts and peanuts
↓ CVD-HR 0.86 (95% CI: 0.79–0.93, p-trend < 0.001)
↓ CHD-HR 0.80 (95% CI: 0.72–0.89, p-trend < 0.001)
≥2 times/wk tree nuts and peanuts
↓ 13–19% CVD risk
↓ 15–23% CHD risk
Larsson et al., 2018, Sweden [19] Prospective 61,364 (28,453:32,911)
58 (45–83) y
17 y Tree nuts and peanuts
(1) none
(2) 1–3 times/mo
(3) 1–2 times/wk
(4) ≥3 times/wk
↓ risk of atrial fibrillation for (4) vs. (1) (linear association)
HR 0.82 (95% CI: 0.68–0.99), p-trend = 0.004
↓ risk of heart failure for (3) vs. (1) (non-linear association)
HR 0.80 (95% CI: 0.67–0.97), p-trend = 0.003
(fully adjusted models)
Liu et al., 2019, USA [21] Prospective (NHS, HPFS) 16,217 (12,006:4211)
64.7–69.4 y
34 y
28 y
Tree nuts and peanuts
(1) <1 serving/mo
(2) <1 serving/wk
(3) 1 serving/wk
(4) 2–4 servings/wk
(5) ≥5 servings/wk
(5) vs. (1) HRs
↓ CVD incidence, 0.83 (0.71–0.98), p-trend = 0.01
↓ CHD incidence, 0.80 (0.67–0.96), p-trend = 0.005
↓ CVD mortality, 0.66 (0.52–0.84), p-trend < 0.001
↓ all-cause mortality 0.69 (0.61–0.77), p-trend < 0.001

* low-fat diet—all types of fat, from both animal and vegetable sources, reduced, but no fat-free foods. A—almonds; CHD—coronary heart disease; CI—confidence interval; CV—cardiovascular; CVD—cardiovascular diseases; F—women; H—hazelnuts; HR—hazard ratio; HPFS—Health Professionals Follow-Up Study; M—men; MD—Mediterranean diet; MS—metabolic syndrome; NHS—Nurses’ Health Study; OR—odds ratio; RCT—randomized controlled trial; RR—risk ratio; T2DM—type 2 diabetes mellitus; W—walnuts.