Nuts and coronary heart disease: an epidemiological perspective

Abstract

The epidemiological evidence for the cardio-protective effect of nut consumption is presented and reviewed. Four large prospective epidemiological studies of primary prevention of coronary heart disease are reviewed and discussed (Adventist Health Study, Iowa Women's Health Study, Nurses' Health Study and the Physicians' Health Study). Other studies of nuts and coronary heart disease risk are addressed. The combined evidence for a cardio-protective effect from nut consumption is summarized and presented graphically. The risk of coronary heart disease is 37 % lower for those consuming nuts more than four times per week compared to those who never or seldom consume nuts, with an average reduction of 8·3 % for each weekly serving of nuts. The evidence for a causal relationship between nut consumption and reduced risk of coronary heart disease is outlined using Hill's criteria for causality and is found to support a causal cardio-protective relationship.

Health Benefits of Nut Consumption

“…A pooled analysis of these studies shows that subjects in the highest intake group for nut consumption had a 37% reduction in multivariable-adjusted risk of fatal CHD [15]. The combined relative risk for total CHD mortality derived from the comparison of rates between the highest and lowest frequency of nut intake in all four studies was 0.63 [95% confidence interval [CI], 0.51 to 0.83].…”

“…The dose-relationship between nut intake and incident CHD translates into an average 8.3 reduction for each weekly serving of nuts [15]. The consistency of findings in all studies points to a causal association between nut consumption and reduced CHD, indicating that nuts possibly are one of the most cardioprotective foods in the habitual diet.…”

“…The scientific evidence behind the proposal of nuts as cardio-protective foods stem from both epidemiological observations suggesting a consistent inverse association between the frequency of nut intake and development of CHD [reviewed in 13,15,16] and numerous short-term clinical trials showing beneficial effects of nut intake on the lipid profile [reviewed in 13,17,18,19, 20] and other intermediate markers of CHD [reviewed in 13,20,21,22]. The mechanism for these salutary effects probably lies in the synergistic interaction of the many bioactive constituents of nuts, which may all favorably influence human physiology.…”

Lifestyle prescriptions for cancer survivors and their communities

“…Physical activity also reduces systemic inflammation, improves endothelial function, facilitates smoking cessation and augments weight loss and weight maintenance [9,10]. Modest consumption of oily fish and intake of whole foods such as fruits, vegetables, whole grains and nuts are consistently associated with significantly lower CVD risk [11][12][13][14]. Lower consumption of industrial trans fats, sodium and starches ⁄ refined carbohydrates also reduces CVD risk.…”

Complementary and alternative medicine: Herbals and supplements: A review for the primary care physician

“…Nut consumption four times a week has been demonstrated to decrease risk for coronary artery disease by 37% based on four large prospective studies [103]. The Nurses' Health Study attributed the decreased risk of diabetes mellitus and coronary artery disease following nut consumption to the large amounts of polyunsaturated fatty acids (PUFA) and monounsaturated fatty acids (MUFA) in nuts [104][105].…”