1. Nut consumption and diseases 實習生：張瀞文 指導老師：蕭佩珍營養師 1

2. About nut low in sodium contain a variety of nutrients (unsaturated fatty acids, fiber,magnesium and potassium )→ possible beneficial effects on blood pressure, stroke, atrial fibrillation. 2

3. Association? nut HTNAFStroke 3

4. Nut consumption and risk of hypertension in US male physicians Luc Djousse´, Tamara Rudich, J. Michael Gaziano Clinical Nutrition 28 (2009) 10–14 4

5. Introduction Lifestyle factors (low sodium intake, DASH diet, weight control, and exercise among other factors) could play an important role in the prevention of hypertension. Nut consumption has been associated with a lower risk of type 2 diabetes and weight gain. 5

6. 15,966 participants and free of HTN Nut consumption Results Follw up for 15 years self-reported, simple abbreviated semi-quantitative FFQ 8423 new cases 6

7. simple abbreviated semi-quantitative FFQ 12 months post-randomization(1983-1985) Nuts (small packet or 1 oz) Possible response categories rarely/never 1–3/month 1/week 2–4/week 5–6/week daily 7+/week 7

8. Results Table 1 Baseline characteristics of 15,966 US male physicians according to nut consumption. 8423 new cases of HTN 8

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10. Results Table 2 Hazard ratios (95%CI) for hypertension according to nut consumption. Model 1 ： Adjusted for age (<45, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75þ y) Body mass index (<25, 25–29, 30 kg/m2), smoking (never, former, current smoker), alcohol consumption (<1, 1–4, 5–7, 8þ drinks/week), and history of diabetes. Model 2 ： Additional control for exercise (0, 1, 2–4, 5þ/week), fruit and vegetable intake(<3, 3–4, 5–6, 7–13, 14þ servings/week), breakfast cereal (0, 1, 2–6, and 7þ/week)and type (whole grain vs. refined); red meat (quintiles); fish (quintiles); dairy(quintiles); multivitamin use, treatment assignment, and history of hypercholesterolemia/treatment for hypercholesterolemia. 10

11. Results Table 3 Hazard ratios (95% CI) for hypertension according to nut consumption and overweight/obesity. 11

12. Discussion We observed v.s This association was mainly observed among lean subjects. Nut consumption HTN 12

13. Conclusion limited to lean individuals. Frequent consumption of nuts lower risk of incident hypertension 13

14. Nut consumption and risk of atrial fibrillation in the Physicians’ Health Study Khawaja et al. Nutrition Journal 2012, 11:17 14

15. Introduction Atrial Fibrillation is highly prevalent in clinical practice. Nuts are relatively cheap and widely available and thereby can serve as a cost-effective means to prevent AF. 15

16. 21,054 participants and free of AF Nut consumption Results Follw up for 20 years self-reported, simple abbreviated semi-quantitative FFQ 3317 new cases health status, risk factors, dietary, and lifestyle factors by questionnaires. 16

17. AF: based on self-reported First detected episode of AF (1)Paroxysmal (self terminating usually lasting < 7 days) (2)Persistent (non- self terminating usually lasting > 7 days). (3)Recurrent if two or more episodes of AF and permanent AF if Persistent AF is long lasting. 17

18. Results Table 1 Baseline characteristic of 21,054 US male physicians according to nut consumption. 20 years follow ： 3317 new cases 18

19. Results Table 2 Hazard ratios (95% CI) for atrial fibrillation according to nut consumption in Physicians’ Health Study 19

20. Modle 1: Age (< 45, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+ y) BMI (< 25, 25-29.9, and 30+ kg/m2) aspirin, beta-carotene, physical activity (1 or more times per week vs. < 1 per week),smoking (never, past and current smokers) cereal servings per week (≤ 1, 2-6, ≥ 7), fruit/vegetable servings per week (continuous), alcohol consumption (none, monthly, weekly, daily) history of hypertension, hypercholesterolemia, diabetes. 20

21. Discussion Our findings: v.s AF Nut consumption meaningful association 21

22. Conclusion Beneficial effects of nuts have been reported on numerous outcomes considered to be important risk factors for developing AF. nut consumption risk of incident AF NO significant association 22

23. Nut Consumption and Risk of Stroke in US Male Physicians Luc Djoussé J. Michael Gaziano Carlos Kase5, and Tobias Kurth Clin Nutr. 2010 October ; 29(5): 605–609. 23

24. Introduction Hypertension is a major risk factor for stroke and can be influenced by modifiable lifestyle factors including diet. 24

25. 21,078 participants and free of stroke Nut consumption Results Follw up for 21 years self-reported, simple abbreviated semi-quantitative FFQ 1424 new cases 25

26. Ascertainment of stroke Incident stroke was collected through yearly follow- up questionnaires, medical records, ischemic, hemorrhagic and unknown subtypes 26

27. Results Table 1 Baseline characteristics of 21,078 US male physicians according to nut consumption. 21 years follow : 1424 incident cases 27

28. Results Table 2 Baseline characteristics of 21,078 US male physicians according to incident stroke 28

29. Results Table 3 Hazard ratios (95% CI) for hemorrhagic, ischemic, and total stroke according to nut consumption The J-shaped 29

30. Discussion Our findings: v.s risk of total or ischemic stroke Nut consumption meaningful association 30

31. Discussion The J-shaped relation observed between nut consumption and hemorrhagic stroke merits some comments. omega-3 fatty acids contained in nuts may be partially responsible for the observed increased risk of hemorrhagic stroke with consumption of nuts or more times per week. 31

32. Conclusion There is suggestive J-shaped relation between nut consumption and hemorrhagic stroke. nut consumption risk of total or ischemic stroke NO significant association 32

33. limitation male physicians Nut consumption was assessed only once changed their dietary habits unable to adjust for total energy intake and other nutrients consumed by study subjects. types of nuts consumed, preparation While the number of stroke events is large, the number of stroke subtypes according to nut consumption categories is relatively small. 33

34. Summary Significant association Nut consumption and risk of hypertension No significant association Nut consumption and risk of AF No significant association Nut consumption and risk of stroke 34

35. Thank you 35