Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study

BMJ 1998;317:1341-1345 ( 14 November )

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Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study

Editorial by Tunstall-Pedoe

Frank B Hu, research associate, ^a Meir J Stampfer, professor, ^a JoAnn E Manson, associate professor, ^c Eric B Rimm, associate professor, ^a Graham A Colditz, professor, ^b Bernard A Rosner, professor, ^b Frank E Speizer, professor, ^b Charles H Hennekens, professor, ^c Walter C Willett, professor. ^a

^a Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA, ^b Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA, ^c Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital

Correspondence to: Dr Hu Frank.Hu{at}channing.harvard.edu

Objective: To examine the relation between nut consumptionand risk of coronary heart disease in a cohort of women from theNurses' HealthStudy.
Design: Prospective cohortstudy.
Setting: Nurses' HealthStudy.
Subjects: 86 016 women from 34 to 59 years of age withoutpreviously diagnosed coronary heart disease, stroke, or cancerat baseline in1980.
Main outcome measures: Major coronary heart disease including non-fatalmyocardial infarction and fatal coronary heart disease.
Results: 1255 major coronary disease events (861 casesof non-fatal myocardial infarction and 394 cases of fatal coronaryheart disease) occurred during 14 years of follow up. After adjustingfor age, smoking, and other known risk factors for coronary heartdisease, women who ate more than five units of nuts (one unitequivalent to 1 oz of nuts) a week (frequent consumption) hada significantly lower risk of total coronary heart disease (relativerisk 0.65, 95% confidence interval 0.47 to 0.89, P for trend=0.0009)than women who never ate nuts or who ate less than one unit amonth (rare consumption). The magnitude of risk reduction wassimilar for both fatal coronary heart disease (0.61, 0.35 to 1.05,P for trend=0.007) and non-fatal myocardial infarction (0.68,0.47 to 1.00, P for trend=0.04). Further adjustment for intakesof dietary fats, fibre, vegetables, and fruits did not alter theseresults. The inverse association persisted in subgroups stratifiedby levels of smoking, use of alcohol, use of multivitamin andvitamin E supplements, body mass index, exercise, and intake ofvegetables orfruits.
Conclusions: Frequent nut consumption was associated witha reduced risk of both fatal coronary heart disease and non-fatalmyocardial infarction. These data, and those from other epidemiologicaland clinical studies, support a role for nuts in reducing therisk of coronary heartdisease.

Key messages

Nuts are high in fat, but most of the fatty acids are unsaturated
This study suggests that frequent consumption of nuts, including peanuts, may reduce the risk of coronary heart disease
This protective effect may be partly mediated through serum lipids because unsaturated fats have benefical effects on serum lipids. Other potentially protective constituents include vegetable protein, magnesium, vitamin E, fibre, and potassium
Nuts can be included as part of a healthy diet

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