Nut consumption and diseases

1. Nut consumption and diseases 實習生：張瀞文 指導老師：蕭佩珍營養師

2. About nut • low in sodium • contain a variety of nutrients (unsaturated fatty acids, fiber,magnesium and potassium )→ possible beneficial effects onblood pressure, stroke, atrial fibrillation.

3. Association?

4. Nut consumption and risk of hypertension in US male physicians Luc Djousse´ , Tamara Rudich , J. Michael GazianoClinical Nutrition 28 (2009) 10–14

5. Introduction • Lifestyle factors (low sodium intake, DASH diet, weight control, and exercise among other factors) could play an important role in the prevention of hypertension. • Nut consumption has been associated with a lower risk of type 2 diabetes and weight gain.

6. 15,966 participants and free of HTN self-reported, simple abbreviated semi-quantitative FFQ Nut consumption 8423new cases Follw up for 15 years Results

7. simple abbreviated semi-quantitative FFQ • 12 months post-randomization(1983-1985) • Nuts(small packet or 1 oz) • Possible response categories 1/week 1–3/month rarely/never 2–4/week 5–6/week daily 7+/week

8. 8423 new cases of HTN Results Table 1Baseline characteristics of 15,966 US male physicians according to nut consumption.

10. Results Table 2Hazard ratios (95%CI) for hypertension according to nut consumption. Model 2： Additional control for exercise (0, 1, 2–4, 5þ/week), fruit and vegetable intake(<3, 3–4, 5–6, 7–13, 14þ servings/week), breakfast cereal (0, 1, 2–6, and 7þ/week)and type (whole grain vs. refined); red meat (quintiles); fish (quintiles); dairy(quintiles); multivitamin use, treatment assignment, and history of hypercholesterolemia/treatment for hypercholesterolemia. Model 1： Adjusted for age (<45, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75þ y) Bodymass index (<25, 25–29, 30 kg/m2), smoking (never, former, current smoker), alcohol consumption (<1, 1–4, 5–7, 8þ drinks/week), and history of diabetes.

11. Results Table 3Hazard ratios (95% CI) for hypertension according to nut consumption and overweight/obesity.

12. Discussion • We observed v.s • This association was mainly observed among lean subjects. Nut consumption HTN

13. Conclusion Frequent consumption of nuts risk of incident hypertension • limited to lean individuals. lower

14. Nut consumption and risk of atrial fibrillation inthe Physicians’ Health Study Khawaja et al. Nutrition Journal 2012, 11:17

15. Introduction • Atrial Fibrillationis highly prevalent in clinical practice. • Nuts are relatively cheap and widely available and thereby can serve as a cost-effective means to prevent AF.

16. 21,054 participants and free of AF health status, risk factors, dietary, and lifestyle factors by questionnaires. self-reported, simple abbreviated semi-quantitative FFQ Nut consumption 3317 new cases Follw up for 20 years Results

17. AF: based onself-reported • First detected episode of AF (1)Paroxysmal (self terminating usually lasting < 7 days) (2)Persistent (non- self terminating usually lasting > 7 days). (3)Recurrent if two or more episodes of AF and permanent AF if Persistent AF is long lasting.

18. 20 years follow ：3317 new cases Results Table 1Baseline characteristic of 21,054 US male physicians according to nut consumption.

19. Results Table 2Hazard ratios (95% CI) for atrial fibrillation according to nut consumption in Physicians’ Health Study

20. Modle 1: Age (< 45, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ y) BMI (< 25, 25-29.9, and 30+ kg/m2) aspirin, beta-carotene, physical activity(1 or more times per week vs. < 1 per week),smoking(never, past and current smokers) cereal servings per week (≤ 1, 2-6, ≥ 7), fruit/vegetable servings per week (continuous), alcohol consumption (none, monthly, weekly, daily) history of hypertension, hypercholesterolemia, diabetes.

21. Discussion • Our findings: • v.s Nut consumption AF meaningful association

22. Conclusion • Beneficial effects of nuts have been reported on numerous outcomes considered to be important risk factors for developing AF. nut consumption NO significant association risk of incident AF

23. Nut Consumption and Risk of Stroke in US Male Physicians Luc Djoussé J. Michael Gaziano Carlos Kase5, and Tobias Kurth Clin Nutr. 2010 October ; 29(5): 605–609.

24. Introduction • Hypertension is a major risk factor for stroke and can be influenced by modifiable lifestyle factors including diet.

25. 21,078 participants and free of stroke self-reported, simple abbreviated semi-quantitative FFQ Nut consumption 1424new cases Follw up for 21 years Results

26. Ascertainment of stroke Incident stroke was collected through yearly follow-up questionnaires, medical records, ischemic, hemorrhagic and unknown subtypes

27. 21 years follow:1424 incident cases Results Table 1Baseline characteristics of 21,078 US male physicians according to nut consumption.

28. Results Table 2Baseline characteristics of 21,078 US male physicians according to incident stroke

29. Results Table 3Hazard ratios (95% CI) for hemorrhagic, ischemic, and total stroke according to nut consumption The J-shaped

30. Discussion • Our findings: • v.s Nut consumption risk of total or ischemic stroke meaningful association

31. Discussion • The J-shaped relation observed between nut consumption and hemorrhagic stroke merits some comments. • omega-3 fatty acids contained in nuts may be partially responsible for the observed increased risk of hemorrhagic stroke with consumption of nuts or more times per week.

32. Conclusion • There is suggestive J-shaped relation between nut consumption and hemorrhagic stroke. nut consumption NO significant association risk of total or ischemic stroke

33. limitation • male physicians • Nut consumption was assessed only once changed their dietary habits • unable to adjust for total energy intake and other nutrients consumed by study subjects. • types of nuts consumed, preparation • While the number of stroke events is large, the number of stroke subtypes according to nut consumption categories is relatively small.

34. Summary

35. Thank you