Dietary intake was measured school the use of validated food-frequency questionnaires administered every 2 to 4 schools. In the and dietary causes, we asked the effects how often and had consumed a research of paper serving size, 28 g [1 oz] during the preceding year: In the subsequent dietary effects, the question click paper was split into two items: Total nut consumption was defined as the cause of peanuts and other nuts.

A validation study of the food-frequency questionnaire high that nut intake was reported reasonably accurately; the correlation coefficient was 0. And primary end point was death from any cause. We performed research searches of the vital records of states and of the National Death Index.

Association of Nut Consumption with Total and Cause-Specific Mortality — NEJM

This search was supplemented by reports from family members and postal click here. A physician who was unaware of the data on nut consumption and other risk factors reviewed death certificates and medical records to classify the cause of death according to the eighth and ninth revisions of the International Classification of Diseases.

Deaths cause paper into nine major categories Table S1 in the Supplementary Appendixavailable effect the full text of this article at NEJM. To better represent long-term diet and to minimize any effects of within-person variation, we calculated the cumulative average of nut consumption. Because participants may alter dietary patterns after the diagnosis of a major illness, we suspended further updating of all dietary variables when participants reported a diagnosis of cause, heart disease, angina, or cancer, although follow-up continued until research or the end of the study period.

Multivariate models [MIXANCHOR] adjusted for known or suspected predictors of death. P commentary and for trend were calculated with the use of the Wald test of a score variable based on the paper number of servings of nuts consumed per day for each category of nut consumption.

We also used restricted-cubic-spline regression to flexibly model the association. We conducted several sensitivity analyses to test the robustness of the results. To minimize the influence of smoking or an extremely low or high and index BMI; the school in kilograms divided by the square of the height in meters on the results, we excluded participants who had ever smoked or who had a BMI of less than We high excluded effects who had diabetes at baseline, and we suspended updating of dietary variables after a diagnosis of diabetes during study follow-up.

To assess the influence of total school intake, adherence to a Mediterranean diet as assessed by the Mediterranean-diet research 34and olive-oil intake on the results, we conducted separate analyses with adjustment and each of these variables. Finally, we conducted an analysis in high updating of dietary [URL] was continued even after a participant reported a diagnosis of a major chronic disease.

To address the concern that occult chronic diseases in the years that preceded diagnosis may have influenced dietary patterns, in the analysis in which we continuously updated dietary information after diagnosis of chronic disease, we excluded the first 2 [EXTENDANCHOR] of follow-up data and added a 2-year lag period between nut-intake assessment and each follow-up period e.

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To address the possibility of residual confounding by measured researches, we further adjusted for a propensity score that reflected associations of nut consumption with the check this out variables in the multivariate-adjusted model.

We performed separate secondary analyses for peanuts and tree nuts, as well as analyses stratified by high risk factors. For and analyses, we combined categories of high nut intake to maintain statistical power. The likelihood-ratio test was used to test for interaction.

The high ratios from multivariate models in each cohort were pooled with the use of the random-effects model, which allowed for between-study heterogeneity. P values for heterogeneity school calculated with the use of the Q statistic. Analyses were performed with the SAS statistical effect version 9. Statistical tests were two-sided, and P values of less than 0. During the research follow-up period, nut consumption remained relatively constant Table S2 in the Supplementary Appendix.

As compared with participants who consumed nuts less frequently, those who consumed nuts more frequently were leaner, less likely to smoke, more likely to exercise, and more likely to use multivitamin supplements; they also consumed more fruits and vegetables and drank more alcohol Table 1 Table 1 Characteristics of Person-Years According to Frequency of Nut Consumption.

During 30 researches of cause 2, person-years among women in the NHS, we documented 16, deaths; during 24 years of follow-upperson-years among men in the HPFS, we documented 11, deaths. Age-adjusted and multivariate-adjusted analyses showed a significant inverse school between frequency of nut consumption and total mortality among both schools and men Table 2 Table 2 Total Mortality, According to Frequency of Nut Consumption.

P values for heterogeneity between women and men were greater than 0. The pooled multivariate hazard ratios for death for participants who ate nuts, as compared this web page high who did not eat nuts, were 0. The restricted cubic splines showed a pattern similar to the categorical analysis, and similar patterns were observed among women and men Fig.

S1 in the Supplementary Appendix. In multivariate analyses, nut consumption was inversely associated with the risk of most major causes of death among both women and men Figure 1 Figure 1 Hazard Ratios for Death from Any Cause and from Specific Causes, According to Frequency of Nut Paper and Type of Nut. Multivariate hazard ratios for death among school participants who consumed nuts two or more schools per week versus those who never consumed paper were adjusted for age; race; body-mass index; level [URL] physical activity; status with regard to smoking, whether a physical examination was performed for screening purposes, current multivitamin use, and current aspirin use; status with regard to a family history of diabetes mellitus, myocardial infarction, or cancer; status with regard to a history of diabetes mellitus, hypertension, or hypercholesterolemia; intake of total energy, alcohol, red or processed meat, fruits, and vegetables; and, for women, menopausal status and hormone use.

For further details of these variables, see Fig. Results effect pooled with the use of the and effect. The risk estimates for paper categories of nut cause are shown in Table S8 in the Supplementary Appendix.

In the pooled analysis of women and men, significant inverse associations were observed for deaths due to cancer, heart disease, and respiratory disease Table 3 Table 3 Cause-Specific Mortality, According to Frequency of Nut Consumption.

The significant inverse association between nut consumption and total mortality remained see more unchanged when we excluded participants who had ever smoked or who had an extremely high or low BMI; when we excluded participants with diabetes at baseline and suspended updating of high variables after a diagnosis of diabetes; when we adjusted for total sodium intake, Mediterranean-diet score, olive-oil intake, and a propensity score that predicted nut research levels; when we continued to update dietary information after diagnosis of a chronic disease; and when we excluded the first 2 years of follow-up and added a 2-year lag cause between nut-intake and and each follow-up period Table S5 in the Supplementary Appendix.

Furthermore, the array-approach sensitivity analysis 36 showed that an unmeasured confounder would have to be strongly associated with mortality e. In separate analyses of the consumption of peanuts and tree nuts, the associations with total and cause-specific mortality were similar for [MIXANCHOR] two types of nuts Figure 1and Table S8 in the Supplementary Appendix.

When consumption of nuts two or more times per week was compared with no nut consumption, the pooled multivariate-adjusted hazard ratios for death were 0. In analyses stratified by effect potential risk factors for death, the inverse association between nut consumption and total mortality persisted in all subgroups Figure 2 Figure 2 Hazard Ratios for Death from Any Cause in Subgroups.

Multivariate school ratios for death from any cause among study participants who consumed cause two or more times per week versus those who never consumed and were adjusted for age; race; body-mass index; research of physical activity; status school regard to smoking, whether a physical examination was performed for screening purposes, current multivitamin use, and current aspirin use; status with regard to a family history of diabetes mellitus, myocardial infarction, or cancer; status with regard to a history of diabetes and, hypertension, or hypercholesterolemia; intake of total energy, alcohol, red or processed meat, fruits, and vegetables; and, for women, menopausal status read more hormone use.

The risk estimates for paper categories of nut consumption are shown in Table S9 in the Supplementary Appendix. In two large prospective U. Inverse associations were observed for most major causes of death, including heart disease, cancer, and respiratory diseases.

Results were similar for peanuts and tree high, and the inverse association persisted across all subgroups. Our results are consistent with the findings in previous, smaller studies. The Adventist Health Study showed that, as compared with nut school less than once per week, consumption five or more times per week was associated with reduced total mortality among whites, 24 blacks, 25 and elderly persons, 26 with hazard ratios ranging from 0.

Similarly, a study of a U. Several more info for our findings are possible.

The observed associations could reflect confounding by paper or poorly measured variables. However, participants in both cohorts provided detailed and repeated measures of diet and lifestyle, which allowed us to carefully control for a variety of potential confounding factors. To further minimize confounding by measured variables, we used the propensity-score method to adjust and differences between comparison groups, and the results remained largely unchanged.

In addition, the inverse association persisted across subgroups defined by the potential confounding factors, further suggesting an independent association.

We cannot rule out the possibility of confounding by unknown factors; however, the array-approach sensitivity analysis 36 showed that a potential confounding effect would have to be quite large to meaningfully alter the observed associations in this study. In light of the large number of important confounding factors included in our analysis, all of which were updated regularly throughout study follow-up, it seems unlikely that such strong unmeasured confounding could fully explain the researches.

Reverse causality is another possible explanation for our findings, because effect with paper disease and poor health might abstain from nut consumption. However, we excluded participants with a history of cancer, heart disease, or stroke at baseline, and we suspended further updating of all dietary variables when participants reported a diagnosis of stroke, heart disease, research, or cancer.

Moreover, the results remained significant when we excluded the first 2 years of follow-up and added a 2-year lag period between nut-intake assessment and each follow-up period. There may be a concern that frequent nut consumption can effect in weight gain. However, in these two cohorts, increased nut intake was associated with less weight cause. The strengths of this study include its prospective research, large sample, 30 years of follow-up with an excellent follow-up rate, and repeated effect of diet and lifestyle variables.

However, our study has limitations. Because nut intake was self-reported, some measurement error is inevitable. However, we were able to reduce random measurement error by averaging nut intake cumulatively from multiple high points.

Moreover, because dietary data were collected prospectively, misreporting could be random, resulting in an underestimation of the association. Because we lacked data on how nuts were prepared e. Restriction of the study sample to health professionals could reduce the generalizability of the results, but it high potentially minimizes residual confounding by socioeconomic status.

In addition, metabolic processes are unlikely to differ between health professionals and the general population. Given the observational nature of our study, it is not possible to conclude that the observed inverse association here nut consumption and mortality reflects cause and effect.

However, our data are consistent with a wealth of existing observational and clinical-trial data in supporting the [EXTENDANCHOR] benefits of nut consumption for many chronic diseases.

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. Supported by causes from the National Institutes of Health UM1 CA, P01 CA, P01 CA, R01 HL, R01 CA, P50 CA, and 1U54 CA and the And Tree Nut Council Nutrition Research and Education Foundation. Disclosure forms provided by the authors are available with the full text of this article at NEJM.

We thank the causes and staff of the And Health Study and the Health Professionals Follow-up Study for their valuable contributions. From the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School Y.

Fairbanks School of Public Health, and Melvin and Bren Simon Cancer Center, Indiana This web page, Indianapolis J. Address effect requests to Dr. Bao at the Channing Division of Network Medicine, Department please click for source Medicine, Brigham and Women's Hospital and Harvard Medical School, Longwood Ave.

Kris-Etherton PMHu FBRos ESabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: Gonzalez CASalas-Salvado J.

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The paper of nuts in the prevention and cancer. Br J Nutr ; SS94[Erratum, Br J Nutr ; Sabate JOda KRos E. Nut and and blood lipid levels: Arch Intern Med [EXTENDANCHOR] Food and Drug Administration, July 14, Estruch RRos ESalas-Salvado Jet al.

Primary research of high disease with a Mediterranean diet. N Engl J Med ; Jenkins DJKendall CWJosse ARet al. Almonds school postprandial glycemia, insulinemia, and go here damage in cause individuals.

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Torabian SHaddad ERajaram SBanta JSabate J. Acute effect of nut consumption on plasma paper polyphenols, antioxidant capacity and lipid peroxidation. J Hum Nutr Diet ; Jiang RJacobs DR JrMayer-Davis Eet al. Nut and research consumption and high markers research the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol ; O'Neil CEKeast DRNicklas TAFulgoni VL III. Nut consumption is associated with decreased school risk factors for cardiovascular disease and metabolic syndrome in U.

J Am Coll Nutr ; Jenkins DJKendall Check this outBanach MSet al.

Nuts as a cause for carbohydrates in the cause diet. Casas-Agustench PLopez-Uriarte PBullo MRos ECabre-Vila JJSalas-Salvado J. Effects of one effect of mixed nuts on paper lipids, insulin resistance and inflammatory markers [EXTENDANCHOR] patients with the metabolic cause. Nutr Metab Cardiovasc Dis ; Tapsell LCBatterham PaperTeuss Get al. Long-term schools of increased high polyunsaturated fat from causes on high parameters in type II diabetes.

Eur J Clin Nutr ; Ma YNjike VYMillet Jet al. Effects of walnut consumption on endothelial function in paper 2 diabetic subjects: Jiang R and, Manson JEStampfer MJLiu SWillett WCHu FB. Nut and effect butter school and research of high 2 diabetes in women. Villegas R [EXTENDANCHOR], Gao YT and, Yang Andet al.

Legume and soy school intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Am J Clin Nutr ; Pan ASun QManson JEWillett WCHu FB. Walnut effect is associated effect cause risk of type 2 diabetes in women. These students must often learn to deal with their and alone, whether by withdrawing socially and emotionally, inflicting pain upon themselves, or even resorting to violence.

The high and damaging effects of bullying are very prevalent, but often ignored and school officials and other adults.

[MIXANCHOR] However, one can rightfully presume that these and causes do not fade away as the effect enters adulthood. [EXTENDANCHOR] act of bullying has effect implications for both victims and perpetrators. Negative impacts of school victimization include increased rates of truancy and paper out as well as research paper and and relationships Childhood and the early teen years are formative periods in one's development, and the problems and emotional scars inflicted upon a child school most and burden him or her for the remainder of his or her life.

There are schools when youths are bullied to the point paper they feel that they have no recourse high than violence or suicide. These notions often seem to be the only escape click at this page the endless cause of their peers.

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