Review – Nut consumption and risk of cardiovascular disease events and all-cause mortality: A systematic review and dose-response meta-analysis of prospective cohort studies

Mengna Liu, Mengmeng Wang, Xueru Fu, Xinxin He, Mengdi Wang, Yijia Su, Ge Liu, Fulan Hu, Ming Zhang, Yang Zhao, Dongsheng Hu

Background: Evidence for the effects of nut consumption on cardiovascular disease (CVD) events and all-cause mortality has been reported inconsistently.

Aims: To assess the associations between nut consumption and CVD events and all-cause mortality.

Methods: We searched the Web of Science, Embase and PubMed up until 24 October 2023. In order to compute relative risks (RRs) and 95% confidence intervals (CIs), random-effects models were employed. Restricted cubic splines were performed to explore potential linear or non-linear associations. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2-statistic). NutriGrade assessed the certainty of the evidence.
Results: Thirty-three publications (63 studies) were included. Comparisons between individuals with the highest versus lowest intake of nuts resulted in RRs (95% CIs) for coronary heart disease (CHD), stroke, CVD, CVD mortality and all-cause mortality of 0.81 (0.75–0.87), 0.91 (0.84–0.99), 0.86 (0.82–0.91),0.74 (0.70–0.78) and 0.77 (0.73–0.81), respectively. With per 28-g increases in weekly nut intake, the RRs (95% CIs) for CHD, stroke, CVD, CVD mortality and all-cause mortality were 0.96 (0.95–0.97), 0.99(0.97–1.01), 0.98 (0.97–0.99), 0.90 (0.86–0.94) and 0.92 (0.90–0.94), respectively. Nut intake was linearly associated with incidence of stroke (Pnon-linearity= 0.691), CVD (Pnon-linearity= 0.101) and CVD mortality (Pnon-linearity= 0.069) and non-linearly associated with CHD (Pnon-linearity< 0.05) and all-cause mortality (Pnon-linearity< 0.001).

Conclusions: This systematic review and meta-analysis revealed an association between nut consumption and reduced risk of CVD and all-cause mortality. It highlighted the importance of nuts as a dietary supplement in the primary prevention of CVD and all-cause mortality.

• Nut consumption
• All-cause mortality
• Cardiovascular disease
• Dose-response

1. Abbreviations
2. Background
3. Methods
4. Results
5. Discussion
6. Conclusions

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