From the Department of Nutrition (G.L., M.G.-F., Y.H., Y.L., F.B.H., E.B.R., Q.S.), Harvard T.H. Chan School of Public Health, Boston, MA.
Channing Division of Network Medicine, Department of Medicine (M.G.-F., F.B.H., E.B.R., J.E.M., Q.S.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Circ Res. 2019 Mar 15;124(6):920-929. doi: 10.1161/CIRCRESAHA.118.314316.
The evidence regarding the potential health benefits of nut consumption among individuals with type 2 diabetes mellitus is limited.
To examine intake of total and specific types of nuts, including tree nuts and peanuts, in relation to subsequent risk of cardiovascular disease (CVD), including coronary heart disease and stroke, and all-cause and cause-specific mortality among individuals with diabetes mellitus.
This prospective analysis included 16 217 men and women with diabetes mellitus at baseline or diagnosed during follow-up (Nurses' Health Study: 1980-2014, Health Professionals Follow-Up Study: 1986-2014). Nut consumption was assessed using a validated food frequency questionnaire and updated every 2 to 4 years. During 223 682 and 254 923 person-years of follow-up, there were 3336 incident CVD cases and 5682 deaths, respectively. Higher total nut consumption was associated with a lower risk of CVD incidence and mortality. The multivariate-adjusted hazard ratios (95% CIs) for participants who consumed 5 or more servings of total nuts per week (1 serving=28 g), compared with those who consumed <1 serving per month, were 0.83 (0.71-0.98; P trend=0.01) for total CVD incidence, 0.80 (0.67-0.96; P trend=0.005) for coronary heart disease incidence, 0.66 (0.52-0.84; P trend <0.001) for CVD mortality, and 0.69 (0.61-0.77; P trend <0.001) for all-cause mortality. Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality. For specific types of nuts, higher tree nut consumption was associated with lower risk of total CVD, coronary heart disease incidence, and mortality because of CVD, cancer, and all causes, whereas peanut consumption was associated with lower all-cause mortality only (all P trend <0.001). In addition, compared with participants who did not change the consumption of total nuts from pre- to post-diabetes mellitus diagnosis, participants who increased consumption of total nuts after diabetes mellitus diagnosis had an 11% lower risk of CVD, a 15% lower coronary heart disease risk, a 25% lower CVD mortality, and a 27% lower all-cause mortality. The associations persisted in subgroup analyses stratified by sex/cohort, body mass index at diabetes mellitus diagnosis, smoking status, diabetes mellitus duration, nut consumption before diabetes mellitus diagnosis, or diet quality.
Higher consumption of nuts, especially tree nuts, is associated with lower CVD incidence and mortality among participants with diabetes mellitus. These data provide novel evidence that supports the recommendation of incorporating nuts into healthy dietary patterns for the prevention of CVD complications and premature deaths among individuals with diabetes mellitus.
关于食用坚果对 2 型糖尿病患者潜在健康益处的证据有限。
研究总摄入量和特定类型坚果（包括树坚果和花生）与心血管疾病（CVD）风险（包括冠心病和中风）以及糖尿病患者的全因和特定原因死亡率之间的关系。
本前瞻性分析纳入了基线或随访期间诊断为糖尿病的 16217 名男性和女性（护士健康研究：1980-2014 年，健康专业人员随访研究：1986-2014 年）。使用经过验证的食物频率问卷评估坚果摄入量，并每 2 至 4 年更新一次。在 223682 和 254923 人年的随访期间，分别发生了 3336 例 CVD 事件和 5682 例死亡。总坚果摄入量较高与 CVD 发病和死亡率降低相关。与每月食用<1 份相比，每周食用 5 份或更多份总坚果的参与者的多变量调整后的危险比（95%CI）分别为：0.83（0.71-0.98；P趋势=0.01），0.80（0.67-0.96；P趋势=0.005），0.66（0.52-0.84；P趋势<0.001），0.69（0.61-0.77；P趋势<0.001）。总坚果摄入量与中风发病或癌症死亡率风险无显著相关性。对于特定类型的坚果，较高的树坚果摄入量与总 CVD、冠心病发病和 CVD、癌症和全因死亡率降低相关，而花生摄入量仅与全因死亡率降低相关（所有 P趋势<0.001）。此外，与从糖尿病前到糖尿病后总坚果摄入量未改变的参与者相比，糖尿病后总坚果摄入量增加的参与者 CVD 发病风险降低 11%，冠心病发病风险降低 15%，CVD 死亡率降低 25%，全因死亡率降低 27%。这些关联在按性别/队列、糖尿病诊断时的体重指数、吸烟状况、糖尿病持续时间、糖尿病诊断前的坚果摄入量或饮食质量分层的亚组分析中仍然存在。
食用坚果（尤其是树坚果）较多与糖尿病患者 CVD 发病和死亡率降低相关。这些数据提供了新的证据，支持将坚果纳入健康饮食模式以预防糖尿病患者 CVD 并发症和过早死亡的建议。
