title: Nut consumption and risk of stroke in US male physicians.
abstract: OBJECTIVE
  While nut consumption has been shown to lower the risk of hypertension and coronary disease, it is not known whether nut consumption is associated with the risk of stroke. We sought to examine whether nut consumption is associated with total and subtypes of stroke.
  
  
  METHODS
  Prospective cohort of 21,078 participants from the Physicians' Health Study (1982-2008) who were free of stroke at baseline. Nut consumption was assessed using a simple 19-item food questionnaire and stroke cases were confirmed after reviewing medical records. We used Cox's proportional hazards regression to estimate relative risks of total, ischemic, and hemorrhagic stroke according to consumption of any nuts.
  
  
  RESULTS
  During a mean follow up of 21.1 years, 1424 incident cases of stroke occurred (219 hemorrhagic, 1189 ischemic, and 16 of undetermined cause). There was no statistically significant association between nut consumption and total or ischemic stroke. In contrast, there was a suggestive non-linear relation between nut intake and hemorrhagic stroke: compared to subjects who did not consume nuts, multivariable-adjusted hazard ratios (95% CI) for hemorrhagic stroke for subjects consuming nuts <1, 1, 2-4, 5-6, and ≥7 times/week were 1.13 (0.78-1.62), 1.05 (0.70-1.58), 0.49 (0.27-0.89), 1.50 (0.79-2.84), and 1.84 (0.95-3.57), respectively (p for quadratic trend 0.12).
  
  
  CONCLUSIONS
  Our data showed no association between nuts and ischemic stroke and suggested a J-shaped relation between nut consumption and hemorrhagic stroke. Replication of our findings in the general population is warranted.
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA. ldjousse@rics.bwh.harvard.edu
authors.forename: Luc
authors.initials: L
authors.lastname: Djoussé
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Kase
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology*; D004311:Double-Blind Method; D005247:Feeding Behavior; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D009754:Nuts; D010820:Physicians / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
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