Background
Although nut
consumption has been associated with a reduced risk of cardiovascular
disease and all-cause mortality, data on less common causes of death
has not been systematically assessed. Previous reviews missed several
studies and additional studies have since been published. We
therefore conducted a systematic review and meta-analysis of nut
consumption and risk of cardiovascular disease, total cancer, and
all-cause and cause-specific mortality.
Methods
PubMed and Embase
were searched for prospective studies of nut consumption and risk of
cardiovascular disease, total cancer, and all-cause and
cause-specific mortality in adult populations published up to July
19, 2016. Summary relative risks (RRs) and 95% confidence intervals
(CIs) were calculated using random-effects models. The burden of
mortality attributable to low nut consumption was calculated for
selected regions.
Results
Twenty studies (29
publications) were included in the meta-analysis. The summary RRs per
28 grams/day increase in nut intake was for coronary heart disease,
0.71 (95% CI: 0.63–0.80, I2 = 47%, n = 11), stroke, 0.93
(95% CI: 0.83–1.05, I2 = 14%, n = 11), cardiovascular
disease, 0.79 (95% CI: 0.70–0.88, I2 = 60%, n = 12), total
cancer, 0.85 (95% CI: 0.76–0.94, I2 = 42%, n = 8),
all-cause mortality, 0.78 (95% CI: 0.72–0.84, I2 = 66%,
n = 15), and for mortality from respiratory disease, 0.48 (95%
CI: 0.26–0.89, I2 = 61%, n = 3), diabetes, 0.61 (95% CI:
0.43–0.88, I2 = 0%, n = 4), neurodegenerative disease, 0.65
(95% CI: 0.40–1.08, I2 = 5.9%, n = 3), infectious disease,
0.25 (95% CI: 0.07–0.85, I2 = 54%, n = 2), and kidney
disease, 0.27 (95% CI: 0.04–1.91, I2 = 61%, n = 2). The
results were similar for tree nuts and peanuts. If the associations
are causal, an estimated 4.4 million premature deaths in the America,
Europe, Southeast Asia, and Western Pacific would be attributable to
a nut intake below 20 grams per day in 2013.
Conclusions
Higher nut intake is
associated with reduced risk of cardiovascular disease, total cancer
and all-cause mortality, and mortality from respiratory disease,
diabetes, and infections.
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