Nut consumption and risk of mortality in the Physicians’ Health Study

Hshieh, Tammy T.; Petrone, Andrew B.; Gaziano, J. Michael; Djoussé, Luc

doi:10.3945/ajcn.114.099846

Cited by 57 publications

(70 citation statements)

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“…One publication was only included in the subgroup analysis of coronary heart disease incidence [17], while another publication was only included in the subgroup analysis of coronary heart disease mortality [15]. The summary RR for high versus low intake was 0.76 (95% CI: 0.69–0.84, I 2 = 42%, P heterogeneity = 0.06) (Additional file 1: Figure S1).…”

Section: Resultsmentioning

confidence: 99%

“…However, whether a high intake of nuts is associated with risk of stroke [13–15, 23–27] or overall cancer risk [13–15, 21, 24, 28] is not clear, as most studies reported no significant association [13–15, 21, 23, 25–27] and only a few reported significant inverse associations [14, 16, 21]. Nevertheless, the possibility that a weak association may have been missed because of low statistical power cannot be excluded.…”

Section: Introductionmentioning

confidence: 99%

“…However, in the latter, the Nurses’ Health Study and the Health Professionals Follow-up Study had been included twice, thus, questions remain with regards to whether there is an association between nut intake and stroke. In addition, several large cohort studies including 47,061 deaths and > 748,000 additional participants were either not included [20, 28] or have been published [14, 15, 22, 34–37] since these reviews, and more detailed and updated analyses have since been published from the Physicians’ Health Study [15] and the Netherlands Cohort Study [16]. Associations between nut consumption and less common causes of death have not been systematically assessed.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies

Aune

Keum

Giovannucci

et al. 2016

BMC Med

347

277

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BackgroundAlthough 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.MethodsPubMed 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.ResultsTwenty 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.ConclusionsHigher nut intake is associated with reduced risk of cardiovascular disease, total cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0730-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies

Aune

Keum

Giovannucci

et al. 2016

BMC Med

347

277

View full text Add to dashboard Cite

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“…Let us take mixed nuts, of the type that many of us eat at cocktail time or add to breakfast cereal. Epidemiologists have investigated this question using large databases on physicians' and nurses' dietary habits and found an association (Bao et al, 2013, Hshieh, Petrone, Gaziano, & Djoussé, 2015. These results have led some writers on nutrition (e.g., Greger, 2015) to conclude there may be a causal relationship, and that a large number of possible confounding variables such as age, exercise, smoking, and alcohol consumption do not appear to contribute significantly.…”

Section: More On Causation Models and Probabilitymentioning

confidence: 99%

Mega‐Review: Causality Books Causal Analytics for Applied Risk Analysis by Louis Anthony Cox, Jr., Douglas A. Popken, and Richard X. Sun. Springer, International Series in Operations Research & Management Science, Vol. 270, 2018, $229, xxii+588.The Book of Why: The New Science of Cause and Effect by Judea Pearl and Dana Mackenzie. New York: Basic Books, 2018, $32, x+419.Causality: Models, Reasoning and Inference by Judea Pearl, Cambridge, UK: Cambridge University Press, 2000

North¹

2019

Risk Analysis

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These three books (which I shall refer to as CA, BW, and C) describe a revolution from traditional thinking in how causality is established and used in science and in decision making. The era of massive computer processing capability to deal with "big data" brings new opportunities and challenges to risk analysis. The conceptual issue of causality in science has a long history. The recent advances discussed in these books should help us to distinguish association from causation, where management choices can reduce risk. Those of us in the field of risk analysis need to be cognizant of this "causal revolution." These three books, written from different perspectives and for different audiences, give both an overview of the change in the analytical thinking, and, for the reader willing to invest the time and effort, detailed instruction in the methodology and computer algorithms.Those readers with a background in statistics would be well advised to read BW before CA and C. While the books have much in common, CA and C will be of greater help to the specialist who wants to learn how to do the analysis, rather than simply seeking understanding of the ideas. But CA and C are densely packed with advanced concepts. Those already familiar with Bayesian nets (BNs) and Bayesian reasoning might go directly to these books, but even they will learn much from BW, especially on why traditional statistics has avoided using both models and what-if (counterfactual) questions about actions that might reduce risks.

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“…The regular consumption of nuts has been shown to be associated with a reduction in total mortality [4,5], with a reduction in the risk of cardiovascular disease (CVD) appearing to be the main driver of this alongside reduced morbidity [3,6,7,8]. Table 1 summarises the evidence for the health effects of nut consumption.…”

Section: Introductionmentioning

confidence: 99%

Perceptions and Knowledge of Nuts amongst Health Professionals in New Zealand

et al. 2017

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Despite their nutritional value, population-level nut consumption remains low. Studies suggest that individuals would eat more nuts on their doctor’s advice, making health professionals potentially important for promoting nut consumption. This cross-sectional study aimed to examine the perceptions and knowledge of nuts and the predictors of nut promotion among health professionals in New Zealand. Dietitians, general practitioners (GPs), and practice nurses were identified from the Electoral Roll and invited to complete a questionnaire (n = 318, 292, and 149 respondents respectively). Over one-fifth of GPs and practice nurses believed that eating nuts could increase blood cholesterol concentrations and cause weight gain. The most common perceptions overall were that nuts are healthy; high in protein, fat, and calories; and are satiating. Nut consumption was recommended for reasons relating to these perceptions and because of nuts’ selenium content. Conversely, reasons for suggesting the consumption of fewer nuts included that they were high in calories and fat, would cause weight gain, and concerns regarding allergies and cost. All groups of health professionals were more likely to promote nut consumption if they perceived nuts to reduce the risk of diabetes (all p ≤ 0.034). Education could improve health professionals’ knowledge regarding the effects of nut consumption on blood cholesterol and body weight, alongside other health benefits, which should improve the advice given to patients and may thereby increase nut consumption.

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Nut consumption and risk of mortality in the Physicians’ Health Study

Abstract: Our data are consistent with an inverse association between nut consumption and the risk of all-cause and cardiovascular disease mortality in US male physicians.

Cited by 57 publications

References 60 publications

Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies

Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies

Perceptions and Knowledge of Nuts amongst Health Professionals in New Zealand

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