Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study

de Souza RJ 1 , Dehghan M 2 , Mente A 1 , Bangdiwala SI 1 , Ahmed SH 3 , Alhabib KF 4 Show all authors , Altuntas Y 5 , Basiak-Rasała A 6 , Dagenais GR 7 , Diaz R 8 , Amma LI 9 , Kelishadi R 10 , Khatib R 11 , Lear SA 2 , Lopez-Jaramillo P 12 , Mohan V 13 , Poirier P 14 , Rangarajan S 2 , Rosengren A 15 , Ismail R 16 , Swaminathan S 17 , Wentzel-Viljoen E 18 , Yeates K 19 , Yusuf R 20 , Teo KK 2 , Anand SS 1 , Yusuf S 2 , PURE study investigators

Affiliations 

  • 1 Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
  • 2 Population Health Research Institute, Hamilton, ON, Canada
  • 3 Dubai Health Authority, Dubai, UAE
  • 4 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  • 5 Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Teaching and Research Hospital , Istanbul, Turkey
  • 6 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  • 7 Université Laval, Quebec, Canada
  • 8 Estudios Clinicos Latinoamerica (ECLA), Rosario, Santa Fe, Argentina
  • 9 Health Action by People/Amrita Institute of Medical Sciences, Kerala, India
  • 10 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  • 11 Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
  • 12 Instituto Masira, Medical School, Facultad de Ciencias de la Salud, Universidad de Santander (UDES) and Fundacion Oftalmologica de Santander (FOSCAL), Bucaramanga, Colombia
  • 13 Madras Diabetes Research Foundation, Chennai, India
  • 14 Institut universitaire de cardiologie et de pneumologie de Québec, Quebec, Canada
  • 15 Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 16 Community Health Department, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
  • 17 St John's Research Institute, Koramangala, Bangalore, India
  • 18 Centre of Excellence for Nutrition, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
  • 19 Department of Medicine, Division of Nephrology, Queens University, Ontario, Canada
  • 20 School of Life Sciences, Independent University, Dhaka, Bangladesh
Am J Clin Nutr, 2020 07 01;112(1):208-219.
PMID: 32433740 DOI: 10.1093/ajcn/nqaa108

Abstract

BACKGROUND: The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries.

OBJECTIVE: To assess the association of nuts with mortality and cardiovascular disease (CVD).

METHODS: The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35-70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure].

RESULTS: We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with <30 g per mo) was associated with a lower risk of the primary composite outcome of mortality or major cardiovascular event [multivariate HR (mvHR): 0.88; 95% CI: 0.80, 0.96; P-trend = 0.0048]. Significant reductions in total (mvHR: 0.77; 95% CI: 0.69, 0.87; P-trend <0.0001), cardiovascular (mvHR: 0.72; 95% CI: 0.56, 0.92; P-trend = 0.048), and noncardiovascular mortality (mvHR: 0.82; 95% CI: 0.70, 0.96; P-trend = 0.0046) with a trend to reduced cancer mortality (mvHR: 0.81; 95% CI: 0.65, 1.00; P-trend = 0.081) were observed. No significant associations of nuts were seen with major CVD (mvHR: 0.91; 95% CI: 0.81, 1.02; P-trend = 0.14), stroke (mvHR: 0.98; 95% CI: 0.84, 1.14; P-trend = 0.76), or MI (mvHR: 0.86; 95% CI: 0.72, 1.04; P-trend = 0.29).

CONCLUSIONS: Higher nut intake was associated with lower mortality risk from both cardiovascular and noncardiovascular causes in low-, middle-, and high-income countries.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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