gabrielle sherer cardiovascular risk reduction jeff luckring ms, rd
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Association of Nut Consumption with Total and Cause-Specific Mortality
Gabrielle ShererCardiovascular Risk Reduction
Jeff Luckring MS, RD
Bao Y, Han J, Hu F, et al. Association of Nut
Consumption with Total and Cause-Specific Mortality. N Engl J Med. 2013; 369:2001-2011
Citation
Background
Reductions in: Blood cholesterol Oxidative stress Inflammation Visceral adiposity Hyperglycemia Insulin resistance Endothelial
dysfunction
Reduced risks of: CHD DM2 Metabolic syndrome Colon cancer HTN Gallstone disease Diverticulitis Death from
inflammatory diseases
Unknown: relationship btw nut consumption and
total mortality
Examine the association of nut consumption with total and cause specific mortality in two large, independent cohort studies of nurses and other health professionals.
Objective
Prospective cohort study Repeated measures of diet
separate data on peanuts and tree nuts Adj confounding variables 30 years of f/u data on 27,000+ deaths
Design
Nurses’ Health Study
121,700 female nurses n= 76,464 from 11 U.S. states enrolled in 1976
Health Professionals Follow-up Study 51,529 male health professionals n= 42,498 from all 50 states enrolled in 1986
Exclusion: h/o Cancer, CHD, CVA, DM, smoking 40<BMI<18.5
Participants & Setting
F/U questionnaire every other yr Baseline: year of first validated food frequency
questionnaire How often was a 1 oz serving of nuts consumed?
Subsequent questionnaires split reporting of nut consumption into peanuts and other nuts.
Systematic searches of vital records of states and National Death Index
Blinded Physician-COD using International Classification of Diseases
Methods
Primary Endpoint: death from any cause Nut consumption :
never or almost never one to three times a month once a week two to four times a week five or six times a week once a day two or three times a day four to six times a day more than six times a day
Outcome Measures
Cumulative average of nut consumption Suspended updating of dietary variables when
participants reported dx of CVA, CHD, angina, DM, or cancer
Cox proportional-hazards models adj for predictors of death hazard ratios and 95% confidence intervals
Wald test P values for trend
Restricted-cubic-spline regression model the association
Controlled for intake of Na and oil
Statistical Analysis
More frequent nut consumption- leaner, less
likely to smoke, more likely to exercise, more likely to use multivit/min, ate more fruit/veg, drank more etoh
Significant inverse association btw frequency of nut consumption and total mortality among women and men
Results
Consume nuts 7+ times per week – 20% lower
death rate Consistent with smaller studies Strengths: large sample, repeated measures
of intake over 30yrs, measures to min confounding factors and reverse causality
Limitations: self reporting of intake (avg), nut preparation not considered, cohort of health professionals (metabolic processes unlikely to differ from gen pop).
Conclusions