Hosseinpour-Niazi Somayeh, Bakhshi Bahar, Mirmiran Parvin, Azizi Fereidoun
Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Nutr. 2021 Jun;40(6):4055-4064. doi: 10.1016/j.clnu.2021.02.013. Epub 2021 Feb 17.
BACKGROUND & AIMS: The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS.
We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (<median and ≥ median) and risk of MetS was assessed by Cox regression.
Nut consumption was inversely associated with MetS risk in multivariable-adjusted models. The highest tertiles of the constituents of nuts including fiber, polyphenol, MUFA and PUFA reduced MetS risk compared with the lowest tertiles, after adjustment for confounders. Among various types of nuts, the multivariable-adjusted HRs of MetS were 0.78 (0.63-0.96) for walnuts, and 0.77 (0.63-0.94) for pistachios, compared with the lowest intake. Among adult population, consuming nuts higher than the median and having moderate to high physical activity levels resulted in significant reduction in the MetS risk (HRs: 0.74, CI: 0.55-0.98 for moderate and HRs: 0.63, CI: 0.47-0.86 for high physical activity level). Participants who did not smoke had lower risk of MetS regardless of their amount of nuts consumption (HRs: 0.67, CI: 0.47-0.94 for intakes < median and HRs: 0.71, CI: 0.53-0.93 for intakes ≥ median). Stratification based on education status resulted in reduction in the risk of MetS in participants consuming nuts ≥ median in both educated and not-educated group (HRs: 0.81, CI: 0.66-0.98 for the non-educated group and HRs: 0.63, CI: 0.47-0.84 for the educated group).
Incorporating nuts, especially walnuts, into dietary patterns reduced the risk of MetS, especially among individuals with more physical activity levels.
本研究旨在评估食用坚果及其不同种类与代谢综合征（MetS）风险之间的关联，并调查生活方式因素（身体活动和吸烟状况）以及社会经济地位（教育程度和职业）是否会调节食用坚果与MetS风险之间的关联。
我们对德黑兰脂质与葡萄糖研究中的1915名参与者进行了前瞻性研究，在8.9年的随访期间，其中591人被诊断患有MetS。使用经过验证的半定量食物频率问卷评估坚果的食用情况及其不同种类。采用多变量调整的Cox回归来估计坚果食用及其不同种类三分位数水平上MetS事件的风险比（HRs）。关于坚果食用与身体活动水平、教育程度和吸烟状况对MetS风险的相互作用，通过联合分类，采用Cox回归评估生活方式因素和社会经济地位对坚果食用（<中位数和≥中位数）与MetS风险之间关联的效应修正。
在多变量调整模型中，食用坚果与MetS风险呈负相关。在调整混杂因素后，坚果成分（包括纤维、多酚、单不饱和脂肪酸和多不饱和脂肪酸）含量最高的三分位数组与最低三分位数组相比，MetS风险降低。在各种类型的坚果中，与最低摄入量相比，核桃的多变量调整后MetS风险比为0.78（0.63 - 0.96），开心果为0.77（0.63 - 0.94）。在成年人群中，食用坚果量高于中位数且身体活动水平为中度至高度会导致MetS风险显著降低（中度身体活动水平时风险比：0.74，置信区间：0.55 - 0.98；高度身体活动水平时风险比：0.63，置信区间：0.47 - 0.86）。无论坚果食用量多少，不吸烟的参与者患MetS的风险较低（摄入量<中位数时风险比：0.67，置信区间：0.47 - 0.94；摄入量≥中位数时风险比：0.71，置信区间：0.53 - 0.93）。按教育程度分层显示，在食用坚果量≥中位数的参与者中，无论受教育与否，MetS风险均降低（未受过教育组风险比：0.81，置信区间：0.66 - 0.98；受过教育组风险比：0.63，置信区间：0.47 - 0.84）。
将坚果，尤其是核桃，纳入饮食模式可降低MetS风险，特别是在身体活动水平较高的个体中。
