Nut consumption and risk of cardiovascular disease events and all-cause mortality: A systematic review and dose-response meta-analysis of prospective cohort studies.

2026-03
Archives of cardiovascular diseases 119(3)
- Mengna Liu
- Mengmeng Wang
- Xueru Fu
- Xinxin He
- Mengdi Wang
- Yijia Su
- Ge Liu
- Fulan Hu
- Ming Zhang
- Yang Zhao
- Dongsheng Hu

PubMed: 41350177
DOI: 10.1016/j.acvd.2025.08.010

Study Design

Type: Meta-Analysis
Methods: Searched Web of Science, Embase and PubMed up until 24 October 2023; random-effects models; restricted cubic splines; heterogeneity assessed with Cochran Q and I²; NutriGrade assessed certainty

Background

Evidence for the effects of nut consumption on cardiovascular disease (CVD) events and all-cause mortality has been reported inconsistently.

Aims

To assess the associations between nut consumption and CVD events and all-cause mortality.

Methods

We searched the Web of Science, Embase and PubMed up until 24 October 2023. In order to compute relative risks (RRs) and 95% confidence intervals (CIs), random-effects models were employed. Restricted cubic splines were performed to explore potential linear or non-linear associations. Heterogeneity was assessed (Cochran Q statistic) and quantified (I²-statistic). NutriGrade assessed the certainty of the evidence.

Results

Thirty-three publications (63 studies) were included. Comparisons between individuals with the highest versus lowest intake of nuts resulted in RRs (95% CIs) for coronary heart disease (CHD), stroke, CVD, CVD mortality and all-cause mortality of 0.81 (0.75-0.87), 0.91 (0.84-0.99), 0.86 (0.82-0.91), 0.74 (0.70-0.78) and 0.77 (0.73-0.81), respectively. With per 28-g increases in weekly nut intake, the RRs (95% CIs) for CHD, stroke, CVD, CVD mortality and all-cause mortality were 0.96 (0.95-0.97), 0.99 (0.97-1.01), 0.98 (0.97-0.99), 0.90 (0.86-0.94) and 0.92 (0.90-0.94), respectively. Nut intake was linearly associated with incidence of stroke (P_{non-linearity}=0.691), CVD (P_{non-linearity}=0.101) and CVD mortality (P_{non-linearity}=0.069) and non-linearly associated with CHD (P_{non-linearity}<0.05) and all-cause mortality (P_{non-linearity}<0.001).

Conclusions

This systematic review and meta-analysis revealed an association between nut consumption and reduced risk of CVD and all-cause mortality. It highlighted the importance of nuts as a dietary supplement in the primary prevention of CVD and all-cause mortality.