Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus
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Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus. / Liu, Gang; Guasch-Ferré, Marta; Hu, Yang; Li, Yanping; Hu, Frank B; Rimm, Eric B; Manson, JoAnn E; Rexrode, Kathryn M; Sun, Qi.
In: Circulation Research, Vol. 124, No. 6, 2019, p. 920-929.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Nut Consumption in Relation to Cardiovascular Disease Incidence and Mortality Among Patients With Diabetes Mellitus
AU - Liu, Gang
AU - Guasch-Ferré, Marta
AU - Hu, Yang
AU - Li, Yanping
AU - Hu, Frank B
AU - Rimm, Eric B
AU - Manson, JoAnn E
AU - Rexrode, Kathryn M
AU - Sun, Qi
PY - 2019
Y1 - 2019
N2 - RATIONALE: The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited.OBJECTIVE: To examine intake of total and specific types of nuts, including tree nuts and peanuts, in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with diabetes mellitus.METHODS AND RESULTS: This prospective analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2014). Nut consumption was assessed using a validated food frequency questionnaire and updated every 2 to 4 years. During 223 682 and 254 923 person-years of follow-up, there were 3336 incident CVD cases and 5682 deaths, respectively. Higher total nut consumption was associated with a lower risk of CVD incidence and mortality. The multivariate-adjusted hazard ratios (95% CIs) for participants who consumed 5 or more servings of total nuts per week (1 serving=28 g), compared with those who consumed <1 serving per month, were 0.83 (0.71-0.98; P trend=0.01) for total CVD incidence, 0.80 (0.67-0.96; P trend=0.005) for coronary heart disease incidence, 0.66 (0.52-0.84; P trend <0.001) for CVD mortality, and 0.69 (0.61-0.77; P trend <0.001) for all-cause mortality. Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality. For specific types of nuts, higher tree nut consumption was associated with lower risk of total CVD, coronary heart disease incidence, and mortality because of CVD, cancer, and all causes, whereas peanut consumption was associated with lower all-cause mortality only (all P trend <0.001). In addition, compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis, participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11% lower risk of CVD, a 15% lower coronary heart disease risk, a 25% lower CVD mortality, and a 27% lower all-cause mortality. The associations persisted in subgroup analyses stratified by sex/cohort, body mass index at diabetes mellitus diagnosis, smoking status, diabetes mellitus duration, nut consumption before diabetes mellitus diagnosis, or diet quality.CONCLUSIONS: Higher consumption of nuts, especially tree nuts, is associated with lower CVD incidence and mortality among participants with diabetes mellitus. These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus.
AB - RATIONALE: The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited.OBJECTIVE: To examine intake of total and specific types of nuts, including tree nuts and peanuts, in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with diabetes mellitus.METHODS AND RESULTS: This prospective analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2014). Nut consumption was assessed using a validated food frequency questionnaire and updated every 2 to 4 years. During 223 682 and 254 923 person-years of follow-up, there were 3336 incident CVD cases and 5682 deaths, respectively. Higher total nut consumption was associated with a lower risk of CVD incidence and mortality. The multivariate-adjusted hazard ratios (95% CIs) for participants who consumed 5 or more servings of total nuts per week (1 serving=28 g), compared with those who consumed <1 serving per month, were 0.83 (0.71-0.98; P trend=0.01) for total CVD incidence, 0.80 (0.67-0.96; P trend=0.005) for coronary heart disease incidence, 0.66 (0.52-0.84; P trend <0.001) for CVD mortality, and 0.69 (0.61-0.77; P trend <0.001) for all-cause mortality. Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality. For specific types of nuts, higher tree nut consumption was associated with lower risk of total CVD, coronary heart disease incidence, and mortality because of CVD, cancer, and all causes, whereas peanut consumption was associated with lower all-cause mortality only (all P trend <0.001). In addition, compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis, participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11% lower risk of CVD, a 15% lower coronary heart disease risk, a 25% lower CVD mortality, and a 27% lower all-cause mortality. The associations persisted in subgroup analyses stratified by sex/cohort, body mass index at diabetes mellitus diagnosis, smoking status, diabetes mellitus duration, nut consumption before diabetes mellitus diagnosis, or diet quality.CONCLUSIONS: Higher consumption of nuts, especially tree nuts, is associated with lower CVD incidence and mortality among participants with diabetes mellitus. These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus.
KW - Adult
KW - Aged
KW - Cardiovascular Diseases/epidemiology
KW - Coronary Disease/epidemiology
KW - Diabetes Complications/epidemiology
KW - Diet
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Neoplasms/epidemiology
KW - Nuts
KW - Prospective Studies
U2 - 10.1161/CIRCRESAHA.118.314316
DO - 10.1161/CIRCRESAHA.118.314316
M3 - Journal article
C2 - 30776978
VL - 124
SP - 920
EP - 929
JO - Circulation Research
JF - Circulation Research
SN - 0009-7330
IS - 6
ER -
ID: 351047862