Nut consumption and risk of cardiovascular disease events and all-cause mortality: A systematic review and dose–response meta-analysis of prospective cohort studies - 05/12/25

Doi : 10.1016/j.acvd.2025.08.010

Mengna Liu ^a, Mengmeng Wang ^a, Xueru Fu ^a, Xinxin He ^a, Mengdi Wang ^a, Yijia Su ^a, Ge Liu ^a, Fulan Hu ^b, Ming Zhang ^b, Yang Zhao ^a,⁎ , Dongsheng Hu ^a,^⁎

^a Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China

^b Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, Guangdong, China

^⁎ Corresponding author. ^∗∗ Co-corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 05 December 2025

Graphical abstract

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Highlights

•	This meta-analysis assessed associations between nuts and CVD events and mortality.
•	Thirty-three articles (63 prospective cohort studies) in adults were included.
•	Nut consumption was associated with reduced CHD, stroke and CVD.
•	It was also associated with reduced CVD mortality and all-cause mortality.
•	Nuts are therefore a practical, beneficial addition to the diet.

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Abstract

Background

Evidence for the effects of nut consumption on cardiovascular disease (CVD) events and all-cause mortality has been reported inconsistently.

Aims

To assess the associations between nut consumption and CVD events and all-cause mortality.

Methods

We searched the Web of Science, Embase and PubMed up until 24 October 2023. In order to compute relative risks (RRs) and 95% confidence intervals (CIs), random-effects models were employed. Restricted cubic splines were performed to explore potential linear or non-linear associations. Heterogeneity was assessed (Cochran Q statistic) and quantified ( I ² -statistic). NutriGrade assessed the certainty of the evidence.

Results

Thirty-three publications (63 studies) were included. Comparisons between individuals with the highest versus lowest intake of nuts resulted in RRs (95% CIs) for coronary heart disease (CHD), stroke, CVD, CVD mortality and all-cause mortality of 0.81 (0.75–0.87), 0.91 (0.84–0.99), 0.86 (0.82–0.91), 0.74 (0.70–0.78) and 0.77 (0.73–0.81), respectively. With per 28-g increases in weekly nut intake, the RRs (95% CIs) for CHD, stroke, CVD, CVD mortality and all-cause mortality were 0.96 (0.95–0.97), 0.99 (0.97–1.01), 0.98 (0.97–0.99), 0.90 (0.86–0.94) and 0.92 (0.90–0.94), respectively. Nut intake was linearly associated with incidence of stroke ( P _{non-linearity} = 0.691), CVD ( P _{non-linearity} = 0.101) and CVD mortality ( P _{non-linearity} = 0.069) and non-linearly associated with CHD ( P _{non-linearity} < 0.05) and all-cause mortality ( P _{non-linearity} < 0.001).

Conclusions

This systematic review and meta-analysis revealed an association between nut consumption and reduced risk of CVD and all-cause mortality. It highlighted the importance of nuts as a dietary supplement in the primary prevention of CVD and all-cause mortality.

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Keywords : Nut consumption, All-cause mortality, Cardiovascular disease, Dose–response