The consumption of nuts was reported to be associated with risk of hypertension and type 2 diabetes mellitus (T2DM), but the results were inconclusive. The aim of this study was to systematically examine longitudinal studies investigating nut intake in relation to risk of hypertension and T2DM.
Methods
A systematic search of the PubMed and EMBASE databases to 31 March 2013 was performed. Reference lists of retrieved articles were also screened. Summary relative risks (SRRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Q and I2 statistics were used to examine between-study heterogeneity.
Results
A total of nine prospective cohort studies (three for hypertension and six for T2DM) were identified. Using random effects models, we found that based on the highest vs lowest analysis, nut consumption were inversely associated with risk of hypertension (SRR = 0.84, 95% CI: 0.76–0.93, pheterogeneity = 0.831, I2 = 0%). Dose-response analyses indicated that nut consumption at more than two servings/wk, but not ne serving/wk, had a preventative role in the hypertension. In addition, nut consumption was not associated with risk of T2DM (SRRs = 0.98, 95% CI: 0.84–1.15; pheterogeneity = 0.008, I2 = 67.7%) on the basis of the highest vs lowest analysis. This null association was also shown in the dose-response analysis.
Conclusion
In our meta-analysis, nut consumption is found to be inversely associated with hypertension risk but is not associated with the risk of T2DM.
ChobanianAVBakrisGLBlackHR, et al.The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA2003; 289: 2560–2572.
2.
WhitworthJA. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens2003; 21: 1983–1992.
3.
ShawJESicreeRAZimmetPZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract2010; 87: 4–14.
4.
PanWHCedresLBLiuK, et al.Relationship of clinical diabetes and asymptomatic hyperglycemia to risk of coronary heart disease mortality in men and women. Am J Epidemiol1986; 123: 504–516.
5.
Stolarz-SkrzypekKBednarskiACzarneckaD, et al.Sodium and potassium and the pathogenesis of hypertension. Curr Hypertens Rep2013; 15: 122–130.
6.
Molmen-HansenHEStolenTTjonnaAE, et al.Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol2012; 19: 151–160.
7.
TsioufisCKasiakogiasATsiachrisD, et al.Metabolic syndrome and exaggerated blood pressure response to exercise in newly diagnosed hypertensive patients. Eur J Prev Cardiol2012; 19: 467–473.
8.
TuomilehtoJLindstromJErikssonJG, et al.Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med2001; 344: 1343–1350.
9.
KnowlerWCBarrett-ConnorEFowlerSE, et al.Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med2002; 346: 393–403.
10.
RahmanKLoweGM. Garlic and cardiovascular disease: A critical review. J Nutr2006; 136: 736S–740S.
11.
PhillipsKMRuggioDMAshraf-KhorassaniM. Phytosterol composition of nuts and seeds commonly consumed in the United States. J Agric Food Chem2005; 53: 9436–9445.
12.
SteffenLMKroenkeCHYuX, et al.Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr2005; 82: 1169–1177; quiz 1363–1164.
13.
DjousseLRudichTGazianoJM. Nut consumption and risk of hypertension in US male physicians. Clin Nutr2009; 28: 10–14.
14.
Martinez-LapiscinaEHPimentaAMBeunzaJJ, et al.Nut consumption and incidence of hypertension: The SUN prospective cohort. Nutr Metab Cardiovasc Dis2010; 20: 359–365.
15.
JiangRMansonJEStampferMJ, et al.Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA2002; 288: 2554–2560.
16.
Parker ED, Harnack LJ and Folsom AR. Nut consumption and risk of type 2 diabetes. JAMA 2003; 290: 38–39; author reply 39–40.
17.
MontonenJJarvinenRHeliovaaraM, et al.Food consumption and the incidence of type II diabetes mellitus. Eur J Clin Nutr2005; 59: 441–448.
18.
VillegasRGaoYTYangG, et al.Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Am J Clin Nutr2008; 87: 162–167.
19.
KocharJGazianoJMDjousseL. Nut consumption and risk of type II diabetes in the Physicians' Health Study. Eur J Clin Nutr2010; 64: 75–79.
20.
StroupDFBerlinJAMortonSC, et al.Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA2000; 283: 2008–2012.
21.
Alvarez LeonEHenriquezPSerra-MajemL. Mediterranean diet and metabolic syndrome: A cross-sectional study in the Canary Islands. Public Health Nutr2006; 9: 1089–1098.
22.
Ibarrola-JuradoNBulloMGuasch-FerreM, et al.Cross-sectional assessment of nut consumption and obesity, metabolic syndrome and other cardiometabolic risk factors: The PREDIMED study. PloS One2013; 8: e57367–e57367.
23.
Wells GA SB, O'Connell D, Peterson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/ oxford..asp (accessed 15 June 2012).
24.
DerSimonianRLairdN. Meta-analysis in clinical trials. Control Clin Trials1986; 7: 177–188.
25.
BeggCBMazumdarM. Operating characteristics of a rank correlation test for publication bias. Biometrics1994; 50: 1088–1101.
26.
HigginsJPThompsonSGDeeksJJ, et al.Measuring inconsistency in meta-analyses. Brit Med J2003; 327: 557–560.
27.
PanASunQMansonJE, et al.Walnut consumption is associated with lower risk of type 2 diabetes in women. J Nutr2013; 143: 512–518.
28.
EstruchRMartinez-GonzalezMACorellaD, et al.Effects of a Mediterranean-style diet on cardiovascular risk factors: A randomized trial. Ann Intern Med2006; 145: 1–11.
29.
KassLWeekesJCarpenterL. Effect of magnesium supplementation on blood pressure: A meta-analysis. Eur J Clin Nutr2012; 66: 411–418.
30.
StreppelMTArendsLRvan 't VeerP, et al.Dietary fiber and blood pressure: A meta-analysis of randomized placebo-controlled trials. Arch Intern Med2005; 165: 150–156.
31.
YeEQChackoSAChouEL, et al.Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr2012; 142: 1304–1313.
32.
LeeCCAdlerAISandhuMS, et al.Association of C-reactive protein with type 2 diabetes: Prospective analysis and meta-analysis. Diabetologia2009; 52: 1040–1047.
33.
JiangRJacobsDRJrMayer-DavisE, et al.Nut and seed consumption and inflammatory markers in the multi-ethnic study of atherosclerosis. Am J Epidemiol2006; 163: 222–231.
34.
SalviniSHunterDJSampsonL, et al.Food-based validation of a dietary questionnaire: The effects of week-to-week variation in food consumption. Int J Epidemiol1989; 18: 858–867.
35.
ColditzGAMartinPStampferMJ, et al.Validation of questionnaire information on risk factors and disease outcomes in a prospective cohort study of women. Am J Epidemiol1986; 123: 894–900.
36.
QinXJacksonRMarshallR, et al.Modelling the potential impact of population-wide and targeted high-risk blood pressure-lowering strategies on cardiovascular disease in China. Eur J Cardiovasc Prev Rehabil2009; 16: 96–101.
37.
Sanchez-VillegasABes-RastrolloMMartinez-GonzalezMA, et al.Adherence to a Mediterranean dietary pattern and weight gain in a follow-up study: The SUN cohort. Int J Obes (Lond)2006; 30: 350–358.
38.
Bes-RastrolloMWedickNMMartinez-GonzalezMA, et al.Prospective study of nut consumption, long-term weight change, and obesity risk in women. Am J Clin Nutr2009; 89: 1913–1919.
39.
TorabianSHaddadERajaramS, et al.Acute effect of nut consumption on plasma total polyphenols, antioxidant capacity and lipid peroxidation. J Hum Nutr Diet2009; 22: 64–71.
40.
CohenAEJohnstonCS. Almond ingestion at mealtime reduces postprandial glycemia and chronic ingestion reduces hemoglobin A(1c) in individuals with well-controlled type 2 diabetes mellitus. Metabolism2011; 60: 1312–1317.
41.
LiSCLiuYHLiuJF, et al.Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism2011; 60: 474–479.
42.
LovejoyJCMostMMLefevreM, et al.Effect of diets enriched in almonds on insulin action and serum lipids in adults with normal glucose tolerance or type 2 diabetes. Am J Clin Nutr2002; 76: 1000–1006.
43.
Altorf-van der KuilWEngberinkMFvan RooijFJ, et al.Dietary protein and risk of hypertension in a Dutch older population: The Rotterdam study. J Hypertens2010; 28: 2394–2400.
