Associations of Nut Consumption with All-Cause Mortality among Individuals with Type 2 Diabetes

Xuena Zhang; Yunjing Ou; Lin Li; Zhenzhen Wan; Qi Lu; Tingting Geng; Yujie Liu; Zixin Qiu; Kai Zhu; Kun Yang; An Pan; Gang Liu

doi:10.1016/j.tjnut.2023.08.004

Associations of Nut Consumption with All-Cause Mortality among Individuals with Type 2 Diabetes

J Nutr. 2023 Oct;153(10):3003-3011. doi: 10.1016/j.tjnut.2023.08.004. Epub 2023 Aug 3.

Authors

Xuena Zhang¹, Yunjing Ou², Lin Li², Zhenzhen Wan², Qi Lu², Tingting Geng³, Yujie Liu², Zixin Qiu², Kai Zhu², Kun Yang⁴, An Pan⁵, Gang Liu⁶

Affiliations

¹ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Hospital Infection Management, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China.
⁴ Department of Endocrinology, Affiliated Dongfeng Hospital, Hubei University of Medicine, Shiyan, China.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: liugang026@hust.edu.cn.

PMID: 37543215
DOI: 10.1016/j.tjnut.2023.08.004

Abstract

Background: Nuts are energy-dense, high-fat foods, and whether nut consumption influences mortality risk among individuals with type 2 diabetes (T2D) remains unclear.

Objectives: This study aimed to investigate the associations of nut consumption with all-cause mortality among adults with T2D and to further explore the potential mediation effects of cardiometabolic biomarkers.

Methods: The current analysis included 5090 US participants with T2D from the National Health and Nutrition Examination Survey (1999-2014). Cox proportional hazards models were conducted to estimate hazard ratio (HR) and 95% confidence interval (CI).

Results: After 35,632 person-y of follow-up, 1174 deaths were documented. Higher nut consumption was significantly associated with a lower risk of all-cause mortality among individuals with T2D. After multivariable adjustment including lifestyles and dietary factors, diabetes duration, and glycated hemoglobin, compared with participants who did not consume nuts, the HR (95% CI) for those who consumed nuts over 3.5 ounce equivalent (oz.eq)/wk was 0.64 (0.50, 0.82; P-trend < 0.001) for all-cause mortality. A linear dose-response relationship was observed between nut consumption and all-cause mortality among individuals with T2D (P_overall=0.004, P_nonlinearity=0.35). In substitution analyses, replacing one serving of red and processed meat, refined grains, eggs, and dairy foods with one serving of nuts was associated with a 18% to 22% lower risk of all-cause mortality. In addition, mediation analysis suggested that C-reactive protein and γ-glutamine transaminase explained 6.7% and 9.1% of the relationship between nut consumption with all-cause mortality, respectively.

Conclusions: Higher nut consumption was significantly associated with lower all-cause mortality among individuals with T2D. These findings indicate a potential benefit of nut consumption in the prevention of premature death among individuals with T2D.

Keywords: diabetes; epidemiology; mortality; nuts.