title: Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial.
abstract: BACKGROUND
  Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person.
  
  
  METHODS
  We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED ('PREvención con DIeta MEDiterránea') study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality.
  
  
  RESULTS
  During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend<0.05, all). Compared to non-consumers, subjects consuming nuts>3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts>3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66).
  
  
  CONCLUSIONS
  Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk.Please see related commentary: http://www.biomedcentral.com/1741-7015/11/165.
  
  
  BACKGROUND
  Clinicaltrials.gov. International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.
authors.affiliation: Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d'Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Guasch-Ferré
authors.forename: Mònica
authors.initials: M
authors.lastname: Bulló
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Martínez-González
authors.forename: Emilio
authors.initials: E
authors.lastname: Ros
authors.forename: Dolores
authors.initials: D
authors.lastname: Corella
authors.forename: Ramon
authors.initials: R
authors.lastname: Estruch
authors.forename: Montserrat
authors.initials: M
authors.lastname: Fitó
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Julia
authors.initials: J
authors.lastname: Wärnberg
authors.forename: Miquel
authors.initials: M
authors.lastname: Fiol
authors.forename: José
authors.initials: J
authors.lastname: Lapetra
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Lamuela-Raventós
authors.forename: Lluís
authors.initials: L
authors.lastname: Serra-Majem
authors.forename: Xavier
authors.initials: X
authors.lastname: Pintó
authors.forename: Valentina
authors.initials: V
authors.lastname: Ruiz-Gutiérrez
authors.forename: Josep
authors.initials: J
authors.lastname: Basora
authors.forename: Jordi
authors.initials: J
authors.lastname: Salas-Salvadó
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003327:Coronary Disease / Q000208:ethnology / Q000401:mortality* / Q000517:prevention & control*; D038441:Diet, Mediterranean; D005247:Feeding Behavior / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009754:Nuts; D000069463:Olive Oil; D010938:Plant Oils / Q000008:administration & dosage; D012307:Risk Factors; D013030:Spain / Q000208:ethnology
chemical_list: D000069463:Olive Oil; D010938:Plant Oils