title: Nut consumption and risk of cardiovascular disease, total cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies.
abstract: BACKGROUND
  Although nut consumption has been associated with a reduced risk of cardiovascular disease and all-cause mortality, data on less common causes of death has not been systematically assessed. Previous reviews missed several studies and additional studies have since been published. We therefore conducted a systematic review and meta-analysis of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality.
  
  
  METHODS
  PubMed and Embase were searched for prospective studies of nut consumption and risk of cardiovascular disease, total cancer, and all-cause and cause-specific mortality in adult populations published up to July 19, 2016. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The burden of mortality attributable to low nut consumption was calculated for selected regions.
  
  
  RESULTS
  Twenty studies (29 publications) were included in the meta-analysis. The summary RRs per 28 grams/day increase in nut intake was for coronary heart disease, 0.71 (95% CI: 0.63-0.80, I2= 47%, n = 11), stroke, 0.93 (95% CI: 0.83-1.05, I2= 14%, n = 11), cardiovascular disease, 0.79 (95% CI: 0.70-0.88, I2= 60%, n = 12), total cancer, 0.85 (95% CI: 0.76-0.94, I2= 42%, n = 8), all-cause mortality, 0.78 (95% CI: 0.72-0.84, I2= 66%, n = 15), and for mortality from respiratory disease, 0.48 (95% CI: 0.26-0.89, I2= 61%, n = 3), diabetes, 0.61 (95% CI: 0.43-0.88, I2= 0%, n = 4), neurodegenerative disease, 0.65 (95% CI: 0.40-1.08, I2= 5.9%, n = 3), infectious disease, 0.25 (95% CI: 0.07-0.85, I2= 54%, n = 2), and kidney disease, 0.27 (95% CI: 0.04-1.91, I2= 61%, n = 2). The results were similar for tree nuts and peanuts. If the associations are causal, an estimated 4.4 million premature deaths in the America, Europe, Southeast Asia, and Western Pacific would be attributable to a nut intake below 20 grams per day in 2013.
  
  
  CONCLUSIONS
  Higher nut intake is associated with reduced risk of cardiovascular disease, total cancer and all-cause mortality, and mortality from respiratory disease, diabetes, and infections.
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. d.aune@imperial.ac.uk.|Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. d.aune@imperial.ac.uk.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Aune
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
authors.forename: NaNa
authors.initials: N
authors.lastname: Keum
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.|Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care & Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Lars T
authors.initials: LT
authors.lastname: Fadnes
authors.affiliation: The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK.
authors.forename: Darren C
authors.initials: DC
authors.lastname: Greenwood
authors.affiliation: Department of Preventive Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
authors.forename: Serena
authors.initials: S
authors.lastname: Tonstad
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Lars J
authors.initials: LJ
authors.lastname: Vatten
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Teresa
authors.initials: T
authors.lastname: Norat
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D004032:Diet; D006801:Humans; D009026:Mortality; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D009754:Nuts; D011446:Prospective Studies; D012306:Risk
keywords: All-cause mortality; Cancer; Cardiovascular disease; Cause-specific mortality; Meta-analysis; Nuts; Peanuts