Study Investigates Role of Almonds and Other Nuts in Reducing All-Cause Mortality Rate

NEW DELHI, November 28, 2013 /PRNewswire/ --

A new study published in the New England Journal of Medicine (NEJM) reveals that people who ate nuts such as almonds, at least seven times per week had a 20 percent lower all-cause mortality rate (death from any cause) compared to those who did not eat nuts.

The study also establishes a significant association between the consumption of nuts such as almonds and a lower incidence of death due to heart diseases, cancer and respiratory diseases.

According to Dr. Karen Lapsley, Chief Scientific Officer for the Almond Board of California, "This study adds to the current strong body of evidence which demonstrates that eating nuts daily, including almonds, confers health benefits and supports long-term health. Nuts deliver many good attributes in a small, satisfying package."

At a time when cardiovascular diseases are estimated to cause nearly 3 million deaths per annum in India, accounting for 25% of all mortality [1], this research suggests that incorporating nuts on a daily basis is simple lifestyle change that could hold significant benefits. Additionally, the study reveals that those consuming nuts such as almonds more frequently were found to be leaner, tending to exhibit more indicators of a healthy lifestyle than those who reported eating nuts less frequently. For example, they were less likely to smoke, more likely to exercise and more likely to eat fruits and vegetables.  Control of cholesterol is a vital factor in reducing the risk of cardiovascular disease. Research has found that consuming almonds on a regular basis can lower total cholesterol and LDL (bad) cholesterol [2], [3] while preserving HDL (good) cholesterol. [4] Almonds are also a very good option for those with type-2 diabetes. It has been found that including almonds in a healthy diet has beneficial effects on body weight, blood sugar, cholesterol levels and markers of inflammation, which may lower risk for heart disease in adults with type-2 diabetes.[5], [6], [7]

The NEJM study notes in the discussion section that the nutrients in nuts, such as unsaturated fatty acids, protein, fiber, vitamins, minerals and antioxidants, may confer heart-protective, anti-carcinogenic and anti-inflammatory properties [8]. The study also states that findings are based on self-reported data from questionnaires, and that the researchers lacked data on how nuts were prepared. For example, whether the nuts consumed were salted, roasted or raw. While this study found an association between nut consumption and mortality, a number of recent studies specifically back almonds as a nutritious addition to heart-healthy and weight conscious diets.

Earlier this year, a major clinical trial conducted in Spain reported that roughly 30% of heart attacks, strokes and deaths from heart disease were reduced in study participants at high cardiac risk by switching to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables [9]. The study participants, who were at increased risk for heart disease, followed either a Mediterranean diet or a low-fat diet for nearly five years. The Mediterranean diet included extra-virgin olive oil or mixed nuts including almonds - roughly one ounce per day. While the study results cannot be credited to just one nut, it illustrates how almonds can be a delicious addition to your heart-smart diet. Further research is needed to determine if the findings of this study can be generalized to those at lower cardiac risk.

Ishi Khosla, Clinical Nutritionist and Director, Centre for Dietary Counselling, says, "Nuts, such as almonds, provide a powerful nutrient package including plant protein, hunger-fighting fiber, healthy monounsaturated fats, and important vitamins and minerals. All of these may present cardioprotective, anticarcinogenic, anti-inflammatory and antioxidant properties. In fact, ounce for ounce, almonds are higher in protein, fiber, calcium, vitamin E, riboflavin and niacin than any other tree nut."

"Part of the reason people consuming more nuts such as almonds tend to be leaner is because may be that these nuts provide satiety. Satiating snacks with protein and fiber can help curb hunger pangs between meals, which in turn may helps in reducing the urge to snack on less nutritious options", added Ms. Khosla. This is also supported by a study published in the European Journal of Clinical Nutrition, last month, which found that eating 1.5 ounces of dry-roasted, lightly salted almonds daily helped curb participants' appetites and significantly improved vitamin E and monounsaturated ("good") fat intake [10]. The 137 adult participants were at increased risk for Type II diabetes and were not given any other dietary instruction other than to follow their usual diet and exercise plan. After a month of snacking on 250 calories from almonds daily, participants did not gain weight. While the study was only four weeks in duration, it suggests snacking on almonds can be a weight-wise strategy.

Another study supporting almonds for a healthy weight was published last year [11]. Measuring digestibility, researchers found that we actually absorb about 20% fewer calories from whole almonds than stated on the nutrition facts panel, suggesting that because of their rigid cell structure, not all calories are available for absorption. Further research is needed to better understand how this technique for calculating calories could potentially affect the calorie count of other foods. But it is encouraging news for dieters who want a nutrient-dense snack for fewer calories.

In 2003, the U.S. Food and Drug Administration approved the following qualified health claim on the heart-healthy impact of nuts: Scientific evidence suggests, but does not prove, that eating 1.5 ounces per day of most nuts, such as almonds, as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.

Study Details:

Methodology

• Female study participants were enrolled in 1976, and male participants in 1986, with 30 and 24 years of follow-up respectively. Follow-up questionnaires were sent biennially with follow-up rates exceeding 90% in each 2-year cycle for both male and female cohorts.
• Men and women with a history of cancer, heart disease, or stroke were excluded from the study.
• Nut consumption was assessed at baseline and updated every 2 to 4 years via validated food frequency questionnaires.
  • The dietary questionnaires asked participants how often they had consumed a serving of nuts (serving size 28 grams [1 ounce]) during the preceding year.
• The primary endpoint was death from any cause.
• To better represent long-term diet and to minimize any effects of variation across participants, researchers calculated the cumulative average of nut consumption. Because participants may alter dietary patterns after the diagnosis of a major illness, researchers suspended further updating of all dietary variables when participants reported a diagnosis of stroke, heart disease, angina, or cancer, although follow up continued until death or the end of the study period.
• Cox proportional-hazards models were used to estimate hazard ratios and 95% confidence intervals.

Results

• Compared with those who did not eat nuts, individuals who consumed nuts (serving size of one ounce) seven or more times per week had a 20% lower death rate from all causes. This association was dose-dependent.
• Consumption of nuts was significantly inversely associated with total and cause-specific mortality in both men and women, independent of other predictors for death.
• In addition, there were significant inverse associations for deaths due to cancer, heart disease and respiratory (lung) disease in both men and women.
• Those who consumed more nuts were also leaner, and tended to more frequently report components of a healthy lifestyle, such as smoking less and exercising more.

[1] (http://ajcn.nutrition.org/content/79/4/582.long#ref-1) Cardiovascular diseases in India cause 3 million deaths per year, accounting for 25% of all mortality

[2] Jaceldo-Siegl, K., J. Sabate, M. Batech, G.E. Fraser. Influence of body mass index and serum lipids on the cholesterol-lowering effects of almonds in free-living individuals. Nutr. Metab. Cardiovasc. Dis. 2011; 21:S7-S13. 

[3] Berryman, C.E., A.G. Preston, W. Karmally, R.J. Deckelbaum, P.M. Kris-Etherton. Effects of almond consumption on the reduction of LDL-cholesterol: a discussion of potential mechanisms and future research directions. Nutr Rev 2011; 69(4):171-185.

[4] Spiller GA, Jenkins DA, Bosello O, Gates JE, Cragen LN, Bruce B. Nuts and plasma lipids: an almonds-based diet lowers LDL-C while preserving HDL-C. J Am Coll Nutr 1998; 17(3): 285-90.

[5] Hollis J, Mattes R. Effect of chronic consumption of almonds on body weight in healthy humans. Br J Nutr 2007; 98: 651-656.

[6] Li, S.-C., Y.-H. Liu, W.-H. Chang, C.-M. Chen, C.-Y. O. Chen, J.-F. Liu. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes. Metabolism. 2011. Apr;60(4):474-9.

[7] Liu, J.-F., Y.-H. Liu, C.-M. Chen, W.-H. Chang, C.-Y. O. Chen. The effect of almonds on inflammation and oxidative stress in Chinese patients with type 2 diabetes mellitus: a randomized crossover feeding trial. Eur J Nutr 2013; 52:927-935.

[8] Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC, Fuchs CS. Association of nut consumption with total and cause-specific mortality. N Engl J Med 2013;369:2001-11.

[9] Estruch R, Ros E, Salas-Salvadó J, Covas, M-I, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M,  Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. N Engl JMed 2013; 368:1279-90

[10] Tan YT, Mattes RD. Appetitive, dietary and health effects of almonds consumed with meals or as snacks: a randomised, controlled trial. Eur J Clin Nutr 2013;67:1205-14.

[11] Novotny JA, Gebauer SK, Baer DJ. Discrepancy between the Atwater factor predicted and empirically measured energy values of almonds in human diets.  Am J Clin Nutr . 2012; 96(2):296-301.

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