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

Table 4 Hazard ratios of cancer mortality according to the frequency of nut consumption (including and not including walnuts)

Cancer 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
Cancer death, % (n)	2.1 (44)	1.9 (52)	1.5 (34)
Person-years, n	8,724	12,168	10,185
Crude model	1 (Reference)	0.82 (0.55 to 1.23)	0.64 (0.41 to 1.00)	0.070
Multivariable model 1	1 (Reference)	0.77 (0.51 to 1.16)	0.54 (0.34 to 0.86)	0.015
Multivariable model 2	1 (Reference)	0.79 (0.52 to 1.20)	0.60 (0.37 to 0.96)	0.052
Multivariable model 3	1 (Reference)	0.79 (0.52 to 1.20)	0.60 (0.37 to 0.98)	0.064
Frequency of walnut consumption:	n = 2,916	n = 2,547	n = 1,753
Cancer death, % (n)	2.1 (62)	1.9 (48)	1.1 (20)
Person-years, n	12,124	11,122	7,825
Crude model	1 (Reference)	0.82 (0.56 to 1.20)	0.48 (0.29 to 0.80)	0.005
Multivariable model 1	1 (Reference)	0.76 (0.52 to 1.12)	0.41 (0.25 to 0.69)	0.001
Multivariable model 2	1 (Reference)	0.77 (0.52 to 1.14)	0.46 (0.27 to 0.77)	0.003
Multivariable model 3	1 (Reference)	0.76 (0.51 to 1.12)	0.46 (0.27 to 0.79)	0.005
Frequency of consumption of other nuts (excluding walnuts):	n = 3,308	n = 2,643	n = 1,265
Cancer death, % (n)	2.0 (66)	1.6 (43)	1.7 (21)
Person-years, n	13,936	11,573	5,566
Crude model	1 (Reference)	0.77 (0.52 to 1.13)	0.79 (0.48 to 1.29)	0.439
Multivariable model 1	1 (Reference)	0.74 (0.50 to 1.10)	0.68 (0.41 to 1.14)	0.213
Multivariable model 2	1 (Reference)	0.79 (0.53 to 1.18)	0.73 (0.43 to 1.23)	0.318
Multivariable model 3	1 (Reference)	0.79 (0.53 to 1.18)	0.75 (0.44 to 1.27)	0.369

One serving of nuts equals 28 g. Cox regression models were used to assess the risk of cancer 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.

ISSN: 1741-7015