Nuts and your health

1. Nuts and your health Dr. Peter Pribis 2014

2. Adventist Health Study Fraser GE, Sabate J, Beeson WL & Strahan MT. A possible protective effect of nut consumption on risk of coronary heart disease: the Adventist Health Study Arch Inter Med 1992; 152:1416-1424

3. Adventist Health StudyAll participants (%)

4. Adventist Health StudyVegetarian participants (%)

5. Nuts consumption and risk of MIAdjusted for age, gender, smoking, exercise, weight, hypertension, consumption of whole wheat bread and beef*p<0.005; ** p<0.0001 • % risk of MI • * • **

6. Nuts consumption and risk of MIAdjusted for age*p<0.001; § p<0.001 for Trend • % risk of MI • * • § • * • §

7. Nuts consumption and risk of MIAdjusted for age and gender *p<0.001; **p<0.05; § p<0.001 for Trend; † p<0.05 for Trend • % risk of MI • ** • † • * • §

8. Nuts consumption and risk of MIAdjusted for age and gender *p<0.001; § p<0.001 for Trend • % risk of MI • § • * • * • §

9. Nuts consumption and risk of MIAdjusted for age and gender *p<0.001; **p<0.01; § p<0.01 for Trend; † p<0.001 for Trend • % risk of MI • † • * • ** • §

10. Nuts and cancer • Adventist with the highest nut consumption have the lowest mortality • Nuts consumption promotes longevity Fraser GE, Sabaté J, Beeson WL. Nuts, nuts good for your heart...? Arch Intern Med 1992;152: 2507-8.

11. Walnuts and serum lipid levels • Sabaté J, Fraser GE, Burke K, Knutsen SF, Bennett H & Lindsted KD. Effects of walnuts on serum lipid levels and blood pressure in normal men. • N Engl J Med 1993;328: 603-7

12. The Walnuts StudyStudy Design • 18 Men • Age 21 - 43 years (mean 30 years) • BMI 18.7 - 30.6 ( mean 23.8) • Cholesterol (range) 137 - 250 mg/dl (3.54-6.47 mmol/l) • Blood pressure (mean) 109 / 72 mm Hg • 5 days • 4 weeks • 4 weeks • Introduction • First period • Second period

13. Meal Plan Energy: 2500 - 2600 Kcal/Day Fatty acids: Saturated: 6-9 g/Day Mono: 7-8 g/Day Poly: 9-16 g/Day

14. Total cholesterol (mg/dl) • 202 • 180 • 185 • 198 • 158 • 160 • Reference • Walnuts

15. LDL-Cholesterol (mg/dl)

16. HDL-Cholesterol (mg/dl)

17. Nurses Health Study • Health Professionals Follow Up Study • Iowa Women’s Health Study • Cholesterol and Recurrent Event Study

18. The story of statins reversed

19. Adventist Health StudyMultivariate estimates of effects of high- vs. low-risk values of individual behavioral risk factors Fraser GE & Shavlik DJ Ten years of life? Does it matter. Arch Intern Med 2001;161:1645-52

20. Nut Consumption and Total and Cause-Specific Mortality • Bao Y, Han J, Hu FB, Giovannucci EL, Stampfer MJ, Willett WC & Fuchs CS. Association of Nuts Consunption with Total and Cause-Specific Mortality. • N Engl J Med 2013;369: 2001-11

21. Methods • Cohort studies • Nurses Health Study (76,464 nurses) • Health Professionals Follow-up Study (42,498 physicians, dentist, pharmacist, veterinarians) • Nuts intake updated every 2 to 4 years

22. Selected Characteristics of Participants According to Frequency if Nuts Consumption

23. Total Mortality According to Frequency of Nut Consumption in Woman (p<0.001)

24. Total Mortality According to Frequency of Nut Consumption in Man (p<0.001)

25. Total Mortality According to Frequency of Nut Consumption(Pooled) (p<0.001)

26. Walnuts and Cognition • Pribis P, Bailey RN, Russell AA, Kilsby MA, Hernandez M, Craig WJ, Grahales T, Shavlik DJ & Sabate J. Effects of Walnuts consumption on cognitive performance in yong adults • Br J Nutr 2012; 107(9): 1393-1401

27. Washout period • 6 weeks • Experimental group • Walnuts • 8 weeks • Control group • Walnuts • 8 weeks • Experimental group • Placebo • 8 weeks • Control group • Placebo • 8 weeks • Environmental control group • No dietary intervention • 8 weeks • Environmental control group • No dietary intervention • 8 weeks

28. Gender distribution

29. Selected characteristics

30. Ethnicity

31. Class standing

32. Vegetarian Status

33. 385 kcal 20 g walnuts 2.52 g ALA 3 slices 1040 kcal /60 g (1/2 cup) walnuts 287 kcal No walnuts 0.21 g ALA 3 slices 775 kcal

34. Food displacement • Females - less milk, cheese, dried fruits, cereals • Males - less milk, cereals, pasta, bread • drunk more soy and rice milk more

35. Patterns in the test meal consumption

36. Patterns in the test meal consumption

37. Trend in weight week 1 to 8 Males 1.8 kg (3.9 lb) ± 1.3; Females 0.7 kg (1.5 lb) ± 0.8; p = 0.000

38. Trend in weight week 9 to 16 Males 0.7 kg (1.5 lb) ± 2.3; p = 0.228 / Females 0.3 kg (0.6 lb) ± 1.4; p = 0.287

39. Biological indicators

40. WMS-III The Wechsler Memory Scale • Memory test • Immediate • Delayed • Working memory • Auditory • Visual • Recall (unprompted) • Recognition (prompted)

41. WMS-III The Wechsler Memory Scale • Memory test (11 subcategories) • Logical memory • Faces • Verbal memory • Numbers • Family pictures • Auditory memory • Immediate memory • Delayed memory • General memory • Auditory memory • Visual memory

42. WMS-III • The Wechsler Memory Scale • No changes • Differences - -3.7 to 2.8 % • No significance • Norms - 50th to 80th percentile

43. APM Raven’s Advanced Progressive Matrices • Fluid (decontextualized) intelligence • Non-verbal, clear thinking abilities, logical reasoning, symbolic thinking, identifying relationships

44. APM Δ0.55% (95CI% -2.70 - 3.80), p=0.735

45. APM Raven’s Advanced Progressive Matrices • Fluid intelligence very stable • Norms • Males - 81st percentile, IQ 113 • Females - 64th percentile, IQ 105

46. WGCTA The Watson-Glaser Critical Thinking Appraisal • Crystalized intelligence (contextualized) • Verbal, defining problem, selecting relevant information, recognizing assumption, formulating hypothesis, evaluate conclusions

47. WGCTA The Watson-Glaser Critical Thinking Appraisal • Inference • Recognition of Assumption • Deduction • Interpretation • Evaluation of Arguments • Total score

48. WGCTA Both sexes • *

49. WGCTA - Inference - Both Sexes Δ11.2% (95CI% 2.86 - 19.55), p=0.009

50. WGCTA - Inference - Females Δ13.71% (95CI% 1.75 - 25.66), p=0.026