Association of Nut Consumption with Total and Cause-Specific Mortality. Ying Bao, M.D., Sc.D., Jiali Han, Ph.D., Frank B. Hu, M.D., Ph.D., Edward L. Giovannucci, M.D., Sc.D., Meir J. Stampfer, M.D., Dr.P.H., Walter C. Willett, M.D., Dr.P.H., and Charles S. Fuchs, M.D., M.P.H. N Engl J Med 2013; 369:2001-2011 November 21, 2013 DOI: 10.1056/NEJMoa1307352

“In two large prospective U.S. cohorts, we found a significant, dose-dependent inverse association between nut consumption and total mortality, after adjusting for potential confounders. As compared with participants who did not eat nuts, those who consumed nuts seven or more times per week had a 20% lower death rate. Inverse associations were observed for most major causes of death, including heart disease, cancer, and respiratory diseases. Results were similar for peanuts and tree nuts, and the inverse association persisted across all subgroups…our data are consistent with a wealth of existing observational and clinical-trial data in supporting the health benefits of nut consumption for many chronic diseases. In addition, nutrients in nuts, such as unsaturated fatty acids, high-quality protein, fiber, vitamins (e.g., folate, niacin, and vitamin E), minerals (e.g., potassium, calcium, and magnesium), and phytochemicals (e.g., carotenoids, flavonoids, and phytosterols), may confer cardioprotective, anticarcinogenic, antiinflammatory, and antioxidant properties. Indeed, clinical trials have shown that nut consumption has beneficial effects on some intermediate markers of chronic diseases, such as high cholesterol levels,3oxidation,6,7 endothelial dysfunction,13 hyperglycemia, and insulin resistance. Moreover, recent findings from the PREDIMED trial have shown a protective effect of a Mediterranean diet against cardiovascular disease, and one component of the diet was the availability of an average of 30 g of nuts per day. In conclusion, our analysis of samples from these two prospective cohort studies showed significant inverse associations of nut consumption with total and cause-specific mortality. Nonetheless, epidemiologic observations establish associations, not causality, and not all findings from observational studies have been confirmed in controlled, randomized clinical trials.”