Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial

Table 3 Hazard ratios of cardiovascular mortality according to the frequency of nut consumption (including and not including walnuts)

Cardiovascular mortality	Never	1 to 3 servings/week	>3 servings/week	Pfor trend
Frequency of total nut consumption:	n = 2,118	n = 2,803	n = 2,295
Cardiovascular death, % (n)	1.7 (36)	0.8 (23)	1.0 (22)
Person-years, n	8,724	12,168	10,185
Crude model	1 (Reference)	0.44 (0.26 to 0.74)	0.50 (0.29 to 0.85)	0.101
Multivariable model 1	1 (Reference)	0.44 (0.26 to 0.76)	0.47 (0.27 to 0.82)	0.075
Multivariable model 2	1 (Reference)	0.41 (0.24 to 0.71)	0.41 (0.23 to 0.73)	0.042
Multivariable model 3	1 (Reference)	0.42 (0.24 to 0.74)	0.45 (0.25 to 0.81)	0.091
Frequency of walnut consumption:	n = 2,916	n = 2,547	n = 1,753
Cardiovascular death, % (n)	1.6 (46)	0.7 (18)	1.0 (17)
Person-years, n	12,124	11,122	7,825
Crude model	1 (Reference)	0.41 (0.24 to 0.71)	0.55 (0.31 to 0.96)	0.037
Multivariable model 1	1 (Reference)	0.42 (0.24 to 0.74)	0.54 (0.30 to 0.95)	0.040
Multivariable model 2	1 (Reference)	0.39 (0.22 to 0.69)	0.49 (0.27 to 0.88)	0.022
Multivariable model 3	1 (Reference)	0.41 (0.23 to 0.73)	0.53 (0.29 to 0.98)	0.047
Frequency of consumption of other nuts (excluding walnuts):	n = 3,308	n = 2,643	n = 1,265
Cardiovascular death, % (n)	1.3 (43)	1.1 (28)	0.8 (10)
Person-years, n	13,936	11,573	5,566
Crude model	1 (Reference)	0.76 (0.47 to 1.22)	0.57 (0.28 to 1.13)	0.129
Multivariable model 1	1 (Reference)	0.73 (0.45 to 1.20)	0.48 (0.23 to 0.97)	0.056
Multivariable model 2	1 (Reference)	0.70 (0.43 to 1.15)	0.40 (0.19 to 0.83)	0.021
Multivariable model 3	1 (Reference)	0.74 (0.45 to 1.23)	0.42 (0.20 to 0.89)	0.031

One serving of nuts equals 28 g. Cox regression models were used to assess the risk of cardiovascular mortality by frequency of nut consumption. Multivariable model 1 was adjusted for age (years), sex, and intervention group. Model 2 was additionally adjusted for BMI (kg/m²), smoking status (never, former, current smoker), educational level (illiterate/primary education, secondary education, academic/graduate), leisure time physical activity (MET-min/day), history of diabetes (yes/no), history of hypercholesterolemia (yes/no), use of oral antidiabetic medication (yes/no), use of antihypertensive medication (yes/no), use of statins (yes/no), and total energy intake (kcal/day). Model 3 was also adjusted for dietary variables in quintiles (vegetables, fruits, red meat, eggs, and fish), alcohol intake (continuous, adding a quadratic term) and Mediterranean diet adherence (13-point score). All models were stratified by recruitment centre. Extremes of total energy intake were excluded.

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