Nuts and your health Dr. Peter Pribis 2014. Adventist Health Study Fraser GE, Sabate J, Beeson WL & Strahan MT. A possible protective effect of nut consumption

Nuts and your health

Dr. Peter Pribis

2014

Adventist Health Study

Fraser GE, Sabate J, Beeson WL & Strahan MT. A possible protective effect of nut consumption on risk of coronary heart disease: the Adventist Health StudyArch Inter Med 1992; 152:1416-1424

Adventist Health StudyAll participants (%)

Man Woman

Nuts: < 1/week 35.8 37.6

Nuts: 1-4/week 41.4 39.7

Nuts: > 5 week 22.8 22.7

Adventist Health StudyVegetarian participants (%)

Men Women

Nuts: < 1/week 20.2 23.7

Nuts: 1-4/week 44.9 42.6

Nuts: > 5 week 34.9 33.7

Nuts consumption and risk of MI

Adjusted for age, gender, smoking, exercise, weight, hypertension, consumption of whole wheat bread and beef

*p<0.005; ** p<0.0001

Non-fatal MI Fatal MI0

20

40

60

80

100100 100

78 76

49 52

< 1 week 1-4 week > 5 week

% r

isk o

f M

I

* **

Nuts consumption and risk of MI

Adjusted for age*p<0.001; § p<0.001 for Trend

Man Woman0

20

40

60

80

100100 100

82

58

4054


% r

isk o

f M

I

*§

§*

Nuts consumption and risk of MIAdjusted for age and gender

*p<0.001; **p<0.05; § p<0.001 for Trend; † p<0.05 for Trend

Vegetarians Omnivore0

20

40

60

80

100100 100

59

98

42 50


% r

isk o

f M

I

**§ †*


*p<0.001; § p<0.001 for Trend

Age < 80 Years Age > 80 Years0

20

40

60

80

100100 100

89

5648 45


% r

isk o

f M

I

*§*

§


*p<0.001; **p<0.01; § p<0.01 for Trend; † p<0.001 for Trend

BMI < 24 BMI > 240

20

40

60

80

100100 100

59

79

44 50


% r

isk o

f M

I

*** §†

Nuts and cancer

• Adventist with the highest nut consumption have the lowest mortality

• Nuts consumption promotes longevity

Fraser GE, Sabaté J, Beeson WL. Nuts, nuts good for your heart...? Arch Intern Med 1992;152: 2507-8.

Walnuts and serum lipid levels

Sabaté J, Fraser GE, Burke K, Knutsen SF, Bennett H & Lindsted KD. Effects of walnuts on serum lipid levels and blood pressure in normal men. N Engl J Med 1993;328: 603-7

The Walnuts StudyStudy Design

• 18 Men

• Age 21 - 43 years (mean 30 years)

• BMI 18.7 - 30.6 ( mean 23.8)

• Cholesterol (range) 137 - 250 mg/dl (3.54-6.47 mmol/l)

• Blood pressure (mean) 109 / 72 mm Hg

5 days 4 weeks 4 weeks

Introduction First period Second period

Meal Plan

Energy: 2500 - 2600 Kcal/Day

Fatty acids:Saturated: 6-9 g/DayMono: 7-8 g/DayPoly: 9-16 g/Day

ReferenceWalnuts

0

25

50

75

100

5654

1414

3032

Total cholesterol (mg/dl)

Run-in First period Second period140

154

168

182

196

210202

180 185198

160158

Reference Walnuts

LDL-Cholesterol (mg/dl)


100105110115120

112

94

95

115

Walnuts Reference

HDL-Cholesterol (mg/dl)


28

36

44

52

60

48 47

4541

Walnuts Reference

• Nurses Health Study

• Health Professionals Follow Up Study

• Iowa Women’s Health Study

• Cholesterol and Recurrent Event Study

The story of statins reversed

Adventist Health StudyMultivariate estimates of effects of high- vs. low-risk values of individual behavioral risk factors

Fraser GE & Shavlik DJ Ten years of life? Does it matter. Arch Intern Med 2001;161:1645-52

Contrasts Difference in Life Expectancy (95% CI)

Men Women

Vegetarian : Non-vegetarian 1.53 (0.41-2.65) 1.51 (0.53-2.50)

High exercise : Low exercise 2.73 (1.41-4.06) 1.88 (0.86-2.90)

Nuts > 5/ Week : Nuts < 1/Week 2.74 (1.60-3.88) 1.87 (0.72-3.02)

Medium tertile BMI : High tertile BMI 1.41 (0.34-2.49) 2.25 (1.27-3.23)

Never smoker : Past smoker 1.25 (0.44-2.07) 1.80 (0.56-3.04)

HRT ever : HRT never 1.06 (0.27-1.86)

Nut Consumption and Total and Cause-Specific

Mortality Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC & Fuchs CS. Association of Nuts Consunption with Total and Cause-Specific Mortality. N Engl J Med 2013;369: 2001-11

Methods

• Cohort studies

• Nurses Health Study (76,464 nurses)

• Health Professionals Follow-up Study (42,498 physicians, dentist, pharmacist, veterinarians)

• Nuts intake updated every 2 to 4 years

Selected Characteristics of Participants According to Frequency if Nuts

Consumption

Characterictics Never < 1 Week 1/Week 2-4/

Week 5-6/Week 7>/Week

Age (yr) 57.4 ±11.4

60.1 ±10.9

60.8 ±10.9

62.0 ±10.8

62.7 ±11.1

61.8 ±11.5

Physical activity (MET/wk)

19.2 ±28.9

20.4 ±27.5

25.2 ±32.5

28.5 ±34.9

31.3 ±38.4

34.3 ±42.3

BMI 26.0 ±5.1

26.1 ±5.0

25.9 ±4.6

25.6 ±4.4

25.2 ±4.2

24.9 ±4.1

Fruit intake (servings/day)

2.1 ±1.4

2.1 ±1.2

2.3 ±1.3

2.5 ±1.4 2.8 ±1.6 2.9

±1.7Vegetable intake (servings/day)

2.4 ±1.4

2.6 ±1.3

2.9 ±1.4

3.2 ±1.5 3.4 ±1.6 3.4

±1.8

Never < Once/week Once/week 2 to 4/week 5 to 6/week 7/week

0.7

0.8

0.9

0.9

1.01.00

0.94

0.88

0.850.88

0.79

Total Mortality According to Frequency of Nut Consumption in Woman

(p<0.001)


0.7

0.8

0.9

0.9

1.01.00

0.91 0.91

0.89

0.83

0.80

Total Mortality According to Frequency of Nut Consumption in Man

(p<0.001)


0.7

0.8

0.9

0.9

1.01.00

0.93

0.89

0.87

0.85

0.80

Total Mortality According to Frequency of Nut Consumption(Pooled)

(p<0.001)

Walnuts and Cognition Pribis P, Bailey RN, Russell AA, Kilsby MA, Hernandez M, Craig WJ, Grahales T, Shavlik DJ & Sabate J. Effects of Walnuts consumption on cognitive performance in yong adults

Br J Nutr 2012; 107(9): 1393-1401

Experimental groupWalnuts8 weeks

Control groupPlacebo8 weeks

Environmental control groupNo dietary intervention

8 weeks

Control groupWalnuts8 weeks

Experimental groupPlacebo8 weeks

Environmental control groupNo dietary intervention

8 weeks

Washout period6 weeks

Category n (%)

Males 39 (41)33 (43)

Females 57 (59)44 (57)

Gender distribution

Experimental Placebo Environmental p

Age (years) 20.6 ± 2.0 20.7 ± 2.1 20.0 ± 1.9 0.362

Hours of sleep (h/day) 7.2 ± 1.3 7.0 ± 0.7 7.0 ± 1.0 0.747

BMI (kg/m2) 22.6 ± 3.3 23.2 ± 3.5 23.1 ± 4.1 0.776

Omega-3 intake (g) 0.7 ± 1.1 0.6 ± 0.6 0.7 ± 1.0 0.788

Selected characteristics

Category n (%)

Caucasian 41 (43)

African-american 21 (22)

Hispanic 13 (14)

Asian 10 (11)

Mixed 9 (10)

Ethnicity

Category n (%)

Freshman 24 (25)

Sophomore 21 (22)

Junior 26 (27)

Senior 18 (19)

Graduate 7 (7)

Class standing

Category n (%)

Vegan 7 (7)

Lacto-ovo-vegetarian 25 (26)

Pesco-vegetarian 2 (2)

Non-vegetarain 62 (65)

Vegetarian Status

• 385 kcal

• 20 g walnuts

• 2.52 g ALA

• 3 slices 1040 kcal /60 g (1/2 cup) walnuts

• 287 kcal

• No walnuts

• 0.21 g ALA

• 3 slices 775 kcal

Food displacement

• Males - less milk, cereals, pasta, bread

• drunk more soy and rice milk more

• Females - less milk, cheese, dried fruits, cereals

Patterns in the test meal consumption

One Two Three

52%

26% 22%

Patterns in the test meal consumption

Breakfast Lunch Dinner Snacks

42%

19% 19% 20%

Trend in weight week 1 to 8Males 1.8 kg (3.9 lb) ± 1.3; Females 0.7 kg (1.5 lb) ± 0.8; p = 0.000

Week 01 Week 02 Week 03 Week 04 Week 05 Week 06 Week 07 Week 08130

138

146

154

162

170

162.3164.6 165.1 165.9 165.7 165.3 166.1 166.3

139.1 139.8 139.8141.3

139.9 139.6 139.9138.5

Males Females

Trend in weight week 9 to 16Males 0.7 kg (1.5 lb) ± 2.3; p = 0.228 / Females 0.3 kg (0.6 lb) ± 1.4; p = 0.287

Week 09 Week 10 Week 11 Week 12 Week 13 Week 14 Week 15 Week 16130

138

146

155

163

171168.8 169.7

164.1

169.6 169.2 169.6 168.5170.6

138.1134.8 133.6

137.3 137.1 137.5135.5

138.7

Males Females

Biological indicators

Plasma concentration of fatty acids (µg/mL)

Walnuts Placebo p

18:2n-6 (omega 6) 248.3 ± 88.3 223.6 ± 66.4 0.013

18:3n-3 (omega 3) 9.9 ± 6.7 5.9 ± 2.3 <0.001

WMS-IIIThe Wechsler Memory Scale

• Memory test

• Immediate

• Delayed

• Working memory

• Auditory

• Visual

• Recall (unprompted)

• Recognition (prompted)

WMS-IIIThe Wechsler Memory Scale

• Memory test (11 subcategories)

• Logical memory

• Faces

• Verbal memory

• Numbers

• Family pictures

• Auditory memory

• Immediate memory

• Delayed memory

• General memory

• Auditory memory

• Visual memory

• No changes

• Differences - -3.7 to 2.8 %

• No significance

• Norms - 50th to 80th percentile

WMS-III• The Wechsler Memory Scale

APMRaven’s Advanced Progressive Matrices

• Fluid (decontextualized) intelligence

• Non-verbal, clear thinking abilities, logical reasoning, symbolic thinking, identifying relationships

APMΔ 0.55% (95CI% -2.70 - 3.80), p=0.735

Series126.0

26.5

27.0 26.9

26.8

Walnuts Placebo

APMRaven’s Advanced Progressive Matrices

• Fluid intelligence very stable

• Norms

• Males - 81st percentile, IQ 113

• Females - 64th percentile, IQ 105

WGCTAThe Watson-Glaser Critical Thinking Appraisal

• Crystalized intelligence (contextualized)

• Verbal, defining problem, selecting relevant information, recognizing assumption, formulating hypothesis, evaluate conclusions


• Inference

• Recognition of Assumption

• Deduction

• Interpretation

• Evaluation of Arguments

• Total score

WGCTABoth sexes

Inference Recognition Deduction Interpretation Evaluation Total0

15

31

46

9.812.4 11.7 12.1 12.2

45.7

8.812.1 11.6 12.1 12

44.1

Walnuts Placebo

*

WGCTA - Inference - Both SexesΔ 11.2% (95CI% 2.86 - 19.55), p=0.009

Walnuts Placebo8.0

9.0

10.0 9.85

8.86

WGCTA - Inference - FemalesΔ 13.71% (95CI% 1.75 - 25.66), p=0.026

Walnuts Placebo8.0

9.0

10.0

10.01

8.8


• Crystalized intelligence unstable

• Norms

• Males - 50th percentile

• Females - 30th percentile

POMSProfile of mood states

• 65 adjectives

• 5 point Likert scale - “not at all” to “extremely”

POMSProfile of mood states

• Six mood domains

• Tension-Anxiety (T)

• Depression-Dejection (D)

• Anger-Hostility (A)

• Vigor-Activity (V)

• Fatigue-Inertia (F)

• Confusion-Bewilderment (C)

• Total Mood Disturbance (TMD) - (T+D+A+F+C)-V

POMSBoth sexes - all differences non-significant

T D A V F C TMD0

8

15

23

30

38

11.29.7

6.4

13.8

10.2 9.51

33.4

11.8 12.1

7.4

13.110 9.54

37.8

Walnuts Placebo

POMSMales - Anger-Hostility p=0.013/0.057; TMD p=0.043

T D A V F C TMD0

8

16

24

32

40

9.1 9.46.5

15.6

10 9.3

28.9

11.212.8

9.4

13.710.3 9.9

39.9

Walnuts Placebo

*

*

Fat composition of nuts

Total fat (g)

Saturated fat (g)

Mono (g) Poly (g)

Almonds (24 pieces)

14.5 1.5 10 3

Hazelnuts (12 pieces)

18 1 15 2

Walnuts (14 halves)

18 2 5 11

Peanuts (35 pieces)

13.5 2 7 4.5

Cashew (18 pieces)

13 2.5 8 2.5

Pistachios (47 pieces)

14 2 8 4

Pecans (35 pieces)

19 2 12 5

AlmondAlmonds, raw (prunus dulcis) - 100 g

Source: USDA Nutrient Database for Standard References, 2001

Energy(kcal)

578

Protein (g) 21.26 Fat (g) 50.64Carbohydrate (g)

19.74

Arginin (g)

2.47

Lysin (g)0.6

SFA (g)3.88

MUFA (g)32.16

PUFA (g)12.21

Sugar (g)4.8

Fiber (g)11.8

Vitamins and phytosterols

Vitamin E (mg)

26.18

Alpha-Tocopherol (mg)

25.87

Beta-Tocopherol (mg)

0.43

Gama-Tocopherol (mg)

0.89

Delta-Tocopherol (mg)

0.25

Riboflavin (mg)

0.81

Folic Acid (mg)29.00

Phytosterols (mg)120.00

Minerals

Calcium (mg)

240.00

Magnesium (mg)275.00

Potassium (mg)728.00

Sodium (mg)

1.00

Zinc (mg)3.36

Copper (mg)

1.1

Phosphorus (mg)

474.00

Selenium (microg)4.4

Conclusion• Daily nuts

consumption protects again fatal and non-fatal MI, stroke, diabetes, possibly cancer, cognitive disorders

• 28-50 g/day (1/4 cup)

Documents

Nuts and your health Dr. Peter Pribis 2014. Adventist Health Study Fraser GE, Sabate J, Beeson WL & Strahan MT. A possible protective effect of nut consumption