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. 2019 Mar 30;11(4):754.
doi: 10.3390/nu11040754.

Nut Consumptions as a Marker of Higher Diet Quality in a Mediterranean Population at High Cardiovascular Risk

Maria Del Mar Bibiloni  1   2   3 , Alicia Julibert  4   5   6 , Cristina Bouzas  7   8   9 , Miguel A Martínez-González  10   11   12 , Dolores Corella  13   14 , Jordi Salas-Salvadó  15   16 , M Dolors Zomeño  17   18 , Jesús Vioque  19   20 , Dora Romaguera  21   22 , J Alfredo Martínez  23   24   25 , Julia Wärnberg  26   27 , José López-Miranda  28   29 , Ramón Estruch  30   31 , Aurora Bueno-Cavanillas  32   33 , Fernando Arós  34   35 , Francisco Tinahones  36   37 , Lluis Serra-Majem  38   39 , Vicente Martín  40   41 , José Lapetra  42   43 , Clotilde Vázquez  44   45 , Xavier Pintó  46   47 , Josep Vidal  48   49 , Lidia Daimiel  50 , Miguel Delgado-Rodríguez  51   52 , Pilar Matía  53 , Emilio Ros  54   55 , Rebeca Fernández-Carrión  56   57 , Antonio Garcia-Rios  58   59 , M Angeles Zulet  60   61 , Domingo Orozco-Beltrán  62   63 , Helmut Schröder  64   65 , Montserrat Fitó  66   67 , Mónica Bulló  68   69 , Josep Basora  70   71 , Juan Carlos Cenoz  72   73 , Javier Diez-Espino  74   75 , Estefanía Toledo  76   77 , Josep A Tur  78   79   80
Affiliations

Nut Consumptions as a Marker of Higher Diet Quality in a Mediterranean Population at High Cardiovascular Risk

Maria Del Mar Bibiloni et al. Nutrients. .

Abstract

Background: Nut consumption has been associated with improved nutrient adequacy and diet quality in healthy adult populations but this association has never been explored in individuals at high cardiovascular risk.

Objective: to assess the associations between consumption of nuts and nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk.

Design: baseline assessment of nutritional adequacy in participants (n = 6060, men and women, with ages 55⁻75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary cardiovascular prevention randomized trial.

Methods: nut intake was assessed using a validated food frequency questionnaire. Participants who reported consuming zero quantity of nuts were classified as 'non-nut consumers'. 'Nut consumers' were participants who reported consuming any quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI).

Results: eighty-two percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile range: 6.0⁻25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D, E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence to the Mediterranean diet (Mediterranean diet score, MDS).

Conclusions: nut consumers had better nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.

Keywords: Mediterranean diet; cardiovascular risk disease; diet quality; nut consumption; nutrient adequacy.

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Conflict of interest statement

J.S.-S. reports serving on the board of and receiving grant support through his institution from International Nut and Dried Fruit Council; receiving consulting personal fees from Danone, Font Vella Lanjaron, Nuts for Life, and Eroski; and receiving grant support through his institution from Nut and Dried Fruit Foundation and Eroski. ER reports grants, non-financial support, and other fees from California Walnut Commission and Alexion; personal fees and non-financial support from Merck, Sharp and Dohme; personal fees, non-financial support and other fees from Aegerion, and Ferrer International; grants and personal fees from Sanofi Aventis; grants from Amgen and Pfizer and; personal fees from Akcea, outside of the submitted work. X.P. reports serving on the board of and receiving consulting personal fees from Sanofi Aventis, Amgen, and Abbott laboratories; receiving lecture personal fees from Esteve, Lacer and Rubio laboratories. M.D.-R. reports receiving grants from the Diputación Provincial de Jaén and the Caja Rural de Jaén. L.D. reports grants from Fundación Cerveza y Salud. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Mean (with standard deviation (SD)) number of nutrients with intakes not meeting the recommended levels across quintiles of nut consumption (g/day). Nut consumption range in each of the quintiles: Q1: <4.2 g/day, n = 911; Q2: 4.2–8.3 g/day, n = 1058; Q3: 8.4–14.5 g/day, n = 868; Q4: 14.6–29.3, n = 1093; Q5: ≥29.4 g/day, n = 1039. DRI, dietary reference intake; Q, quintile. Differences in means between quintiles were tested by one-way ANOVA (p < 0.001) with Bonferroni’s post-hoc test. Different letters indicate statistically significant differences between quintile groups.
See this image and copyright information in PMC

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