Nut consumption and diseases

實習生：張瀞文指導老師：蕭佩珍營養師

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About nut• low in sodium • contain a variety of nutrients (unsaturated fatty acids, fiber,magnesium

and potassium )→ possible beneficial effects on blood pressure, stroke, atrial fibrillation.

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Association?3

Nut consumption and risk of hypertension in US male physiciansLuc Djousse´ , Tamara Rudich , J. Michael Gaziano Clinical Nutrition 28 (2009) 10–14

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Introduction• Lifestyle factors (low sodium intake, DASH

diet, weight control, and exercise among other factors) could play an important role in the prevention of hypertension.

• Nut consumption has been associated with a lower risk of type 2 diabetes and weight gain.

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15,966 participants and free of HTN

15,966 participants and free of HTN

Nut consumption Nut consumption

ResultsResults

Follw up for 15 yearsFollw up for 15 years

self-reported, simple abbreviated semi-quantitative

FFQ

self-reported, simple abbreviated semi-quantitative

FFQ

8423 new cases8423 new cases

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simple abbreviated semi-quantitative FFQ• 12 months post-randomization(1983-1985)• Nuts (small packet or 1 oz) • Possible response categories

rarely/neverrarely/never 1–3/month1–3/month 1/week1/week

2–4/week2–4/week 5–6/week5–6/week dailydaily 7+/week7+/week

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Results Table 1Baseline characteristics of 15,966 US male physicians according to nut consumption.

8423 new cases of HTN8

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Results Table 2Hazard ratios (95%CI) for hypertension according to nut consumption.

Model 1：Adjusted for age (<45, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75þ y) Body mass index (<25, 25–29, 30 kg/m2), smoking (never, former, current smoker),alcohol consumption (<1, 1–4, 5–7, 8þ drinks/week), and history of diabetes.

Model 2：Additional control for exercise (0, 1, 2–4, 5þ/week), fruit and vegetable intake(<3, 3–4, 5–6, 7–13, 14þ servings/week), breakfast cereal (0, 1, 2–6, and 7þ/week)and type (whole grain vs. refined); red meat (quintiles); fish (quintiles); dairy(quintiles); multivitamin use, treatment assignment, and history of hypercholesterolemia/treatment for hypercholesterolemia.

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Results Table 3Hazard ratios (95% CI) for hypertension according to nut consumption and overweight/obesity.

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Discussion• We observed

v.s

• This association was mainly observed among lean subjects.

Nut consumptionNut consumption HTNHTN

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Conclusion

• limited to lean individuals.

Frequent consumption of nuts

Frequent consumption of nuts

lowerlower risk of incident hypertension risk of incident hypertension

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Nut consumption and risk of atrial fibrillation in

the Physicians’ Health StudyKhawaja et al. Nutrition Journal 2012, 11:17

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Introduction• Atrial Fibrillation is highly prevalent in clinical

practice.• Nuts are relatively cheap and widely available and

thereby can serve as a cost-effective means to prevent AF.

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21,054 participants and free of AF

21,054 participants and free of AF

Nut consumption Nut consumption

ResultsResults

Follw up for 20 yearsFollw up for 20 years

self-reported, simple abbreviated semi-quantitative

FFQ

self-reported, simple abbreviated semi-quantitative

FFQ

3317 new cases3317 new cases

health status, risk factors, dietary, and lifestyle factors by questionnaires.

health status, risk factors, dietary, and lifestyle factors by questionnaires.

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AF:based on self-reported

•First detected episode of AF (1)Paroxysmal(self terminating usually lasting < 7 days) (2)Persistent (non- self terminating usually lasting > 7 days).(3)Recurrent if two or more episodes of AF and permanent AF if Persistent AF is long lasting.

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Results Table 1Baseline characteristic of 21,054 US male physicians according to nut consumption.

20 years follow ： 3317 new cases18

Results Table 2Hazard ratios (95% CI) for atrial fibrillation according to nut consumption in Physicians’ Health Study

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Modle 1:Age (< 45, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ y) BMI (< 25, 25-29.9, and 30+ kg/m2) aspirin, beta-carotene, physical activity (1 or more times per week vs. < 1 per week),smoking (never, past and current smokers) cereal servings per week (≤ 1, 2-6, ≥ 7), fruit/vegetable servings per week (continuous), alcohol consumption (none, monthly, weekly, daily)history of hypertension, hypercholesterolemia, diabetes.

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Discussion• Our findings:

• v.sAFAF Nut consumptionNut consumption

meaningful association meaningful association

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Conclusion

• Beneficial effects of nuts have been reported on numerous outcomes considered to be important risk factors for developing AF.

nut consumptionnut consumption risk of incident AFrisk of incident AFNO significant

association

NO significant

association

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Nut Consumption and Risk of Stroke in US Male Physicians

Luc Djoussé J. Michael Gaziano Carlos Kase5, and Tobias KurthClin Nutr. 2010 October ; 29(5): 605–609.

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Introduction• Hypertension is a major risk factor for stroke and

can be influenced by modifiable lifestyle factors including diet.

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21,078 participants and free of stroke

21,078 participants and free of stroke

Nut consumption Nut consumption

ResultsResults

Follw up for 21 yearsFollw up for 21 years

self-reported, simple abbreviated semi-quantitative

FFQ

self-reported, simple abbreviated semi-quantitative

FFQ

1424 new cases1424 new cases

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Ascertainment of strokeIncident stroke was collected through yearly follow-up questionnaires, medical records, ischemic, hemorrhagic and unknown subtypes

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Results Table 1Baseline characteristics of 21,078 US male physicians according to nut consumption.

21 years follow : 1424 incident cases 27

Results Table 2Baseline characteristics of 21,078 US male physicians according to incident stroke

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Results Table 3Hazard ratios (95% CI) for hemorrhagic, ischemic, and total stroke according to nut consumption

The J-shaped The J-shaped

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Discussion• Our findings:

• v.srisk of total or ischemic strokerisk of total or

ischemic strokeNut consumptionNut consumption

meaningful association meaningful association

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Discussion• The J-shaped relation observed between

nut consumption and hemorrhagic stroke merits some comments.

• omega-3 fatty acids contained in nuts may be partially responsible for the observed increased risk of hemorrhagic stroke with consumption of nuts or more times per week.

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Conclusion

• There is suggestive J-shaped relation between nut consumption and hemorrhagic stroke.

nut consumptionnut consumptionrisk of total or

ischemic strokerisk of total or

ischemic strokeNO

significant association

NO significant

association

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limitation• male physicians• Nut consumption was assessed only oncechanged their dietary habits• unable to adjust for total energy intake and

other nutrients consumed by study subjects.• types of nuts consumed, preparation• While the number of stroke events is large,

the number of stroke subtypes according to nut consumption categories is relatively small.

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Summary34

Thank youThank you

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