Increased Nut Consumption and Subsequent Cardiovascular Disease Risk Among U.S. Men and Women: Three Large Prospective Cohort Studies (OR17-08-19).

Objectives: To evaluate the association of changes in total consumption of nuts and in specific type of nuts (e.g., walnuts, other tree nuts, peanuts) and subsequent risk of incident cardiovascular disease (CVD) in three large prospective cohorts of U.S. men and women.

Methods: We included 34,222 men from the Health Professionals Follow-up Study (1986-2012), 77,957 women from the Nurses' Health Study (1986-2012), and 80,756 women from the Nurses' Health Study II (1991-2013). We assessed nut consumption every 4 years using validated food frequency questionnaires. We used multivariable Cox proportional regression models to examine the association between 4-year changes in nut consumption and risk of confirmed CVD endpoints (composite nonfatal myocardial infarction, fatal coronary heart disease [CHD], and nonfatal or fatal stroke) in the subsequent 4 years with a median follow-up of 17.2 years. Models were adjusted for age, sex, race, family history of CVD, intake of nuts at beginning of each-4 year and simultaneous changes of correlated dietary and lifestyle confounders.

Results: During 2818,760 person-years of follow-up, we documented 8478 cases of incident CVD, including 4989 cases of CHD and 3489 cases of stroke. Per 0.5 serving/day (1 serving = 28 g) increase in total consumption of nuts was associated with a lower risk of CVD (RR = 0.92, 95% CI = 0.88-0.96), CHD (0.94, 0.89-0.99), and stroke (0.89, 0.83-0.95) (Figure 1) .For each 0.5 serving increase per day, the RR for CVD in the subsequent 4 years was 0.86 (0.76-0.98) for walnuts, 0.93 (0.86-1.02) for other tree nuts, and 0.92 (0.86-0.99) for peanuts, respectively.We evaluated the joint association of initial and final nut consumption over 4 years with the subsequent risk of CVD, CHD and stroke. Compared with individuals who remained non-consumers, individuals who consistently had a high nut consumption (≥0.5 serving/day) had a significantly lower risk of CVD (0.75, 0.67-0.84), CHD (0.80, 0.69-0.93), and stroke (0.68, 0.57-0.82) ( Figure 2 ).

Conclusions: Increasing intake of total nuts, including walnuts, other tree nuts, or peanuts, was associated with a subsequent lower risk of CVD.

Funding Sources: NIH: UM1 CA186107, UM1 CA176726, UM1 CA167552.Partly funded by The Peanut Institution and the California Walnut Commission.The funders had no role in study design, data collection, analyses, interpretation and publication.