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Nut consumption and risk of stroke

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Abstract

Nut consumption has been inconsistently associated with risk of stroke. Our aim was to carry out a meta-analysis of prospective studies to assess the relation between nut consumption and stroke risk and mortality. Pertinent studies were identified by a search of PubMed and Embase through June 2014 and by reviewing the references of retrieved articles. Prospective cohort studies that reported relative risks (RRs) with 95 % confidence intervals (CIs) for the association between nut consumption and risk of stroke were included. Six articles including nine independent prospective cohorts with 476,181 participants were included in the meta-analysis. The pooled RR of stroke was 0.90 (95 % CI 0.83–0.98) comparing the highest with the lowest nut consumption. Stratifying by gender, significant inverse association was observed for females (RR 0.88; 95 % CI 0.78–0.98). Sensitivity analysis restricted to studies with adjustment for common confounding factors showed similar results, strengthening the association between nut consumption and stroke risk. Moreover, we observed a trend toward an inverse association between higher nut consumption and stroke mortality (RR 0.86; 95 % CI 0.69–1.06), although it is not significant. Current evidence indicated that nut consumption is inversely associated with risk of stroke.

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References

  1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–128.

    Article  PubMed  Google Scholar 

  2. Kris-Etherton PM, Hu FB, Ros E, Sabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr. 2008;138:1746S–51S.

    CAS  PubMed  Google Scholar 

  3. Gonzalez CA, Salas-Salvado J. The potential of nuts in the prevention of cancer. Br J Nutr. 2006;96(Suppl 2):S87–94.

    Article  CAS  PubMed  Google Scholar 

  4. Grundy SM, Denke MA. Dietary influences on serum lipids and lipoproteins. J Lipid Res. 1990;31:1149–72.

    CAS  PubMed  Google Scholar 

  5. Myers VH, Champagne CM. Nutritional effects on blood pressure. Curr Opin Lipidol. 2007;18:20–4.

    Article  CAS  PubMed  Google Scholar 

  6. Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA. 2002;288:2554–60.

    Article  PubMed  Google Scholar 

  7. Psaltopoulou T, Sergentanis TN, Panagiotakos DB, Sergentanis IN, Kosti R, Scarmeas N. Mediterranean diet, stroke, cognitive impairment, and depression: a meta-analysis. Ann Neurol. 2013;74:580–91.

    Article  PubMed  Google Scholar 

  8. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.

    Article  CAS  PubMed  Google Scholar 

  9. Afshin A, Micha R, Khatibzadeh S, Mozaffarian D. Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2014;100:278–88.

    Article  CAS  PubMed  Google Scholar 

  10. Misirli G, Benetou V, Lagiou P, Bamia C, Trichopoulos D, Trichopoulou A. Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population. Am J Epidemiol. 2012;176:1185–92.

    Article  PubMed  Google Scholar 

  11. Eguchi E, Iso H, Tanabe N, Wada Y, Yatsuya H, Kikuchi S, Inaba Y, Tamakoshi A. Healthy lifestyle behaviours and cardiovascular mortality among Japanese men and women: the Japan collaborative cohort study. Eur Heart J. 2012;33:467–77.

    Article  PubMed  Google Scholar 

  12. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  CAS  PubMed  Google Scholar 

  13. Stang A. Critical evaluation of the Newcastle–Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  14. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  15. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose–response data. Stata J. 2006;6:40–57.

    Google Scholar 

  16. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175:66–73.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Yochum LA, Folsom AR, Kushi LH. Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women. Am J Clin Nutr. 2000;72:476–83.

    CAS  PubMed  Google Scholar 

  18. He K, Merchant A, Rimm EB, Rosner BA, Stampfer MJ, Willett WC, Ascherio A. Dietary fat intake and risk of stroke in male US healthcare professionals: 14 year prospective cohort study. BMJ. 2003;327:777–82.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Djousse L, Gaziano JM, Kase CS, Kurth T. Nut consumption and risk of stroke in US male physicians. Clin Nutr. 2010;29:605–9.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Bernstein AM, Pan A, Rexrode KM, Stampfer M, Hu FB, Mozaffarian D, Willett WC. Dietary protein sources and the risk of stroke in men and women. Stroke. 2012;43:637–44.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Yaemsiri S, Sen S, Tinker L, Rosamond W, Wassertheil-Smoller S, He K. Trans fat, aspirin, and ischemic stroke in postmenopausal women. Ann Neurol. 2012;72:704–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC, Fuchs CS. Association of nut consumption with total and cause-specific mortality. N Engl J Med. 2013;369:2001–11.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Sabate 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.

    Article  CAS  PubMed  Google Scholar 

  24. Cooke JP, Tsao P, Singer A, Wang BY, Kosek J, Drexler H. Anti-atherogenic effect of nuts: is the answer NO? Arch Intern Med. 1993;153:896–99, 902.

  25. Dreher ML, Maher CV, Kearney P. The traditional and emerging role of nuts in healthful diets. Nutr Rev. 1996;54:241–5.

    Article  CAS  PubMed  Google Scholar 

  26. Fraser GE. Diet and coronary heart disease: beyond dietary fats and low-density-lipoprotein cholesterol. Am J Clin Nutr. 1994;59:1117S–23S.

    CAS  PubMed  Google Scholar 

  27. Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, Klag MJ. Effects of oral potassium on blood pressure. Meta-analysis of randomized controlled clinical trials. JAMA. 1997;277:1624–32.

    Article  CAS  PubMed  Google Scholar 

  28. Beyer FR, Dickinson HO, Nicolson DJ, Ford GA, Mason J. Combined calcium, magnesium and potassium supplementation for the management of primary hypertension in adults. Cochrane Database Syst Rev. 2006;19:CD004805.

  29. Streppel MT, Arends LR, van ‘t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med. 2005;165:150–6.

    Article  PubMed  Google Scholar 

  30. Appel LJ. The effects of protein intake on blood pressure and cardiovascular disease. Curr Opin Lipidol. 2003;14:55–9.

    Article  CAS  PubMed  Google Scholar 

  31. Zhang Z, Xu G, Liu D, Zhu W, Fan X, Liu X. Dietary fiber consumption and risk of stroke. Eur J Epidemiol. 2013;28:119–30.

    Article  PubMed  Google Scholar 

  32. Zhang Z, Xu G, Yang F, Zhu W, Liu X. Quantitative analysis of dietary protein intake and stroke risk. Neurology. 2014;83:19–25.

    Article  CAS  PubMed  Google Scholar 

  33. Wang X, Qin X, Demirtas H, Li J, Mao G, Huo Y, Sun N, Liu L, Xu X. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis. Lancet. 2007;369:1876–82.

    Article  CAS  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

    Zhizhong Zhang, Gelin Xu, Wusheng Zhu & Xinfeng Liu

  2. Department of Environmental Health, Harvard School of Public Health, Harvard University, Boston, MA, USA

    Yongyue Wei

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  1. Zhizhong Zhang
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  2. Gelin Xu
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  3. Yongyue Wei
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  4. Wusheng Zhu
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  5. Xinfeng Liu
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Correspondence to Xinfeng Liu.

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Zhang, Z., Xu, G., Wei, Y. et al. Nut consumption and risk of stroke. Eur J Epidemiol 30, 189–196 (2015). https://doi.org/10.1007/s10654-015-9999-3

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  • DOI: https://doi.org/10.1007/s10654-015-9999-3

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