Abstract
Background/Objectives:
Nuts have beneficial effects on coronary heart disease and many cardiovascular risk factors. However, their effect on stroke is less established, and no studies on the topic are available in Northern and Central European populations. Therefore, we aimed at investigating the association between nut consumption and the risk of stroke in a German population.
Subjects/Methods:
We used data from a prospective cohort of 26 285 participants of the European Prospective Investigation into the Cancer and Nutrition Potsdam Study. During a median follow-up time of 8.3 years (interquartile range: 7.5–9.2), 288 incident cases of stroke occurred. Nut consumption (standard portion size of 50 g) was assessed at baseline with a semiquantitative food-frequency questionnaire.
Results:
The median nut intake was 0.82 g per day, interquartile range: 0.41–4.11. In the multivariable model, an increased risk of stroke was observed among participants who never consumed nuts (hazard ratio (HR): 1.56, 95% confidence interval: 1.17–2.08), compared with those consuming <½ portion/week. However, there was no evidence of a dose–response relationship between nut consumption and stroke. Compared with those who consumed <½ portion/week, the multivariable HR for total stroke was 1.06 (0.75–1.52) among those who consumed ½ to 1 portion/week and 1.37 (0.92–2.05) for those who consumed >1 portion/week. Similar nonsignificant associations were observed in stratified analysis for gender, or for fatal and nonfatal stroke.
Conclusions:
We could not observe an association between nut consumption and the risk of developing stroke (fatal/nonfatal) in a population with low habitual nut consumption.
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References
Sabate J, Wien M . Nuts, blood lipids and cardiovascular disease. Asia Pac J Clin Nutr 2010; 19: 131–136.
Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas MI et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Int Med 2006; 145: 1–11.
Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC et al. Association of nut consumption with total and cause-specific mortality. N Engl J Med 2013; 369: 2001–2011.
Sabate J, Ang Y . Nuts and health outcomes: new epidemiologic evidence. Am J Clin Nutr 2009; 89: 1643S–1648S.
Fraser GE, Sabate J, Beeson WL, Strahan TM . A possible protective effect of nut consumption on risk of coronary heart disease. The Adventist Health Study. Arch Int Med 1992; 152: 1416–1424.
Hu FB, Stampfer MJ, Manson JE, Rimm EB, Colditz GA, Rosner BA et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ 1998; 317: 1341–1345.
Kushi LH, Folsom AR, Prineas RJ, Mink PJ, Wu Y, Bostick RM . Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med 1996; 334: 1156–1162.
Albert CM, Gaziano JM, Willett WC, Manson JE . Nut consumption and decreased risk of sudden cardiac death in the Physicians' Health Study. Arch Int Med 2002; 162: 1382–1387.
Djousse L, Gaziano JM, Kase CS, Kurth T . Nut consumption and risk of stroke in US male physicians. Clin Nutr 2010; 29: 605–609.
Yazdekhasti N, Mohammadifard N, Sarrafzadegan N, Mozaffarian D, Nazem M, Taheri M . The relationship between nut consumption and blood pressure in an Iranian adult population: Isfahan Healthy Heart Program. Nutr Metab Cardiovasc Dis 2013; 23: 929–936.
Mercanligil SM, Arslan P, Alasalvar C, Okut E, Akgul E, Pinar A et al. Effects of hazelnut-enriched diet on plasma cholesterol and lipoprotein profiles in hypercholesterolemic adult men. Eur J Clin Nutr 2007; 61: 212–220.
Tey SL, Brown RC, Chisholm AW, Delahunty CM, Gray AR, Williams SM . Effects of different forms of hazelnuts on blood lipids and alpha-tocopherol concentrations in mildly hypercholesterolemic individuals. Eur J Clin Nutr 2011; 65: 117–124.
Hu FB . Plant-based foods and prevention of cardiovascular disease: an overview. Am J Clin Nutr 2003; 78: 544S–551S.
Garcia-Lorda P, Megias Rangil I, Salas-Salvado J . Nut consumption, body weight and insulin resistance. Eur J Clin Nutr 2003; 57: S8–S11.
Bernstein AM, Pan A, Rexrode KM, Stampfer M, Hu FB, Mozaffarian D et al. Dietary protein sources and the risk of stroke in men and women. Stroke 2012; 43: 637–644.
Estruch R, Ros E, Salas-Salvado J, Covas MI, Pharm D, Corella D et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013; 368: 1279–1290.
Zhou D, Yu H, He F, Reilly KH, Zhang J, Li S et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2014; 100: 270–277.
Luo C, Zhang Y, Ding Y, Shan Z, Chen S, Yu M et al. Nut consumption and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis. Am J Clin Nutr 2014; 100: 256–269.
Afshin A, Micha R, Khatibzadeh S, Mozaffarian D . Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr 2014; 100: 278–288.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 2002; 5: 1113–1124.
Riboli E, Kaaks R . The EPIC Project: rationale and study design. European prospective investigation into cancer and nutrition. Int J Epidemiol 1997; 26: S6–S14.
Boeing H, Wahrendorf J, Becker N . EPIC-Germany—a source for studies into diet and risk of chronic diseases. European Investigation into Cancer and Nutrition. Ann Nutr Metab 1999; 43: 195–204.
Bergmann MM, Bussas U, Boeing H . Follow-up procedures in EPIC-Germany—data quality aspects. European Prospective Investigation into Cancer and Nutrition. Ann Nutr Metab 1999; 43: 225–234.
Weikert C, Berger K, Heidemann C, Bergmann MM, Hoffmann K, Klipstein-Grobusch K et al. Joint effects of risk factors for stroke and transient ischemic attack in a German population: the EPIC Potsdam Study. J Neurol 2007; 254: 315–321.
Kroke A, Klipstein-Grobusch K, Voss S, Moseneder J, Thielecke F, Noack R et al. Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr 1999; 70: 439–447.
Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112: 2735–2752.
Weikert C, Stefan N, Schulze MB, Pischon T, Berger K, Joost HG et al. Plasma fetuin-a levels and the risk of myocardial infarction and ischemic stroke. Circulation 2008; 118: 2555–2562.
Ros E . Health benefits of nut consumption. Nutrients 2010; 2: 652–682.
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–2260.
Zazpe I, Sanchez-Tainta A, Estruch R, Lamuela-Raventos RM, Schroder H, Salas-Salvado J et al. A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study. J Am Diet Assoc 2008; 108: 1134–1144.
Djousse L, Petrone A, Gaziano J . Abstract P067: Nut consumption is associated with a lower risk of death among US male physicians. Circulation 2014; 129: AP067.
Rohrmann S, Faeh D . Should we go nuts about nuts?. BMC Med 2013; 11: 165.
Acknowledgements
We are indebted to Ellen Kohlsdorf for data management and Wolfgang Fleischhauer for stroke cases ascertainment.
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di Giuseppe, R., Fjeld, M., Dierkes, J. et al. The association between nut consumption and the risk of total and ischemic stroke in a German cohort study. Eur J Clin Nutr 69, 431–435 (2015). https://doi.org/10.1038/ejcn.2014.212
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DOI: https://doi.org/10.1038/ejcn.2014.212
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