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.

Russell J de Souza
Mahshid Dehghan
Andrew Mente
Shrikant I Bangdiwala
Suad Hashim Ahmed
Khalid F Alhabib
Yuksel Altuntas
Alicja Basiak-Rasała
Gilles-R Dagenais
Rafael Diaz
Leela Itty Amma
Roya Kelishadi
Rasha Khatib, Advocate Aurora Health
Scott A Lear
Patricio Lopez-Jaramillo
Viswanathan Mohan
Paul Poirier
Sumathy Rangarajan
Annika Rosengren
Rosnah Ismail
Sumathi Swaminathan
Edelweiss Wentzel-Viljoen
Karen Yeates
Rita Yusuf
Koon K Teo
Sonia S Anand
Salim Yusuf

Advocate Research Institute, Advocate Health Care


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 withmo) 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

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