Patterns and predictors of nut consumption: results from the 2008/09 New Zealand Adult Nutrition Survey

Improved Recognition of the Nutrition and Health Benefits of Nuts and Seeds Within the Health Star Rating System

Background: The health benefits associated with the consumption of nuts and seeds are well established, yet this food group is known to be the furthest from the recommended intake; therefore, actions aiming to increase nut intake are needed. The main front-of-pack communication device in Australia, the Health Star Rating (HSR), inadvertently penalises nuts with negative points associated with energy and saturated fat content. Methods: This study aims to suggest options to policy makers by (i) examining how the HSR rates a sample of 82 nuts, seeds and products containing them and (ii) testing three sets of moderate adjustments of the HSR algorithm on the sampled products: discounting the energy from nuts and seeds (S1), discounting the saturated fat from nuts and seeds (S2) and applying an adapted algorithm based on that for 'oils and spreads' for foods with ≥50% nuts and seeds (S3). Results: All three scenarios improved the Spearman correlation between the HSR score and the nut and seed content (-0.80, -0.75 and -0.71 for S1, S2 and S3, respectively) compared to the original HSR (-0.66). Products with more than 50% of their weight being nuts and seeds benefited much more from these adjustments than those below 50%. For all scenarios, but most clearly for S3, the products that had a lower HSR score than the original HSR (the healthier products) benefited more from the changes brought about by the adjusted algorithms than those of lower nutritional quality. The HSR of foods that contained no nuts or seeds remained unchanged. Conclusions: With minor changes to the HSR algorithm, nut and seed products could be brought into alignment with the current evidence, encouraging their regular inclusion in dietary patterns, which could help guide consumers at the supermarket shelf.

Knowledge, practices and perceptions of energy labelling of nut products among Australian consumers and stakeholders: an online survey

BACKGROUND

Nut consumption in Australia is low, perhaps due to concerns with weight gain. However, nut consumption is not associated with increased weight, in part because of their lower metabolisable energy. Current energy labelling for nuts use Atwater factors, which over-represent the available energy from nuts. Therefore, this research aimed to examine stakeholders' knowledge, practices and perceptions of displaying true metabolisable energy on nutrition labels and its perceived impact on nut consumption.

METHODS

An anonymous and voluntary survey was conducted online. Eligible respondents lived in Australia, were aged 18 years or older and had either no formal nutrition education (consumer group) or had formal training and were working as a stakeholder (stakeholder group; working in nutrition/dietetics, public health, food industry, food regulation or nut growing). Convenience sampling and snowballing were used to recruit respondents primarily via online advertisement.

RESULTS

Three hundred and forty-eight respondents (63.2% female; 71.0% aged 18-39 years; 69.0% Bachelor's degree or higher) were included in the analyses. A larger proportion of stakeholders agreed that nut consumption assists with weight management (67.9%) compared with consumers (47.6%). Theoretical food packaging showing both Atwater and metabolisable energy in the nutrition information panel was favoured among consumers and stakeholders, though 62.3% of consumers reported that a lower metabolisable energy of nuts would not impact their consumption.

CONCLUSIONS

This study indicates a need to further investigate the impact of metabolisable energy labelling on nut intake. Further education about the relationship between nuts and body weight is required for consumers and stakeholders.

Mediators of the association between nut consumption and cardiovascular diseases: a two-step mendelian randomization study

Previous observational studies have reported inconsistent associations between nut consumption and cardiovascular diseases (CVD). This study aims to identify the causal relationship between different types of nuts consumption and CVD, and to quantify the potential mediating effects of cardiometabolic factors. We utilized Genome-Wide Association Study (GWAS) data to assess the causal effects of nut consumption on CVD using two-sample Mendelian randomization (MR) and a two-step MR analysis. The inverse variance weighted (IVW) method indicated that processed (salted or roasted) peanuts were potentially and positively associated with ischaemic heart disease (IHD) (OR 1.4866; 95%CI 1.0491-2.1065). No causal relationships were found between nuts consumption and other CVD outcomes, including atrial fibrillation, angina, coronary atherosclerosis, coronary heart disease, IHD, myocardial infarction, subarachnoid hemorrhage, intracerebral haemorrhage and stroke. Both MR-Egger and median-based methods yielded similar results to IVW. Furthermore, in the two-step MR analysis, fasting insulin, low-density lipoprotein cholesterol and fasting blood glucose were identified as mediators in the potential causal relationship between processed peanuts and IHD, explaining 16.98%, 6.38% and 4.91% of the mediation, respectively. In total, these mediators accounted for 28.27% of the association between salted or roasted peanuts and IHD.

The role of nutrition education in the pharmacy curriculum using the example of knowledge about the health benefits of nuts

In recent years, nuts have gained importance because of their nutritional benefits in promoting health and preventing chronic diseases. Despite their recognized role as part of healthy dietary patterns, global consumption is below recommended levels, necessitating an investigation of factors influencing consumption and the impact of nutrition education.

Objective

To investigate the attitudes, knowledge and consumption habits of students in Serbia regarding the consumption of nuts and to examine the role and importance of food- or nutrition-related topics in academic curricula in promoting positive attitudes and habits regarding the consumption of nuts among pharmacy students.

Methods

An electronic questionnaire was used to collect data for this cross-sectional study. A total of 509 responses were collected, including 382 from pharmacy students (75.0%) and 127 from non-pharmacy students (25.0%).

Results

Attitudes toward eating nuts were generally positive, with statistically significant differences found between pharmacy students and non-pharmacy students for 10 statements. The knowledge levels differed, with the mean total number of correct answers in the total sample being 3.9 ± 2.5 (R: 0-11, Mdn: 4) out of 13, and there was a statistically significant difference (p < 0.05) between pharmacy students and non-pharmacy students on 8 out of 13 knowledge questions. The study revealed that students obtained information about the health benefits of nuts, mainly from college lectures (51.9%) and mass media (60.9%). More than half of the students (57.8%) expressed a desire for additional information about nuts, which influenced their attitudes significantly more than their level of knowledge.

Conclusion

The results showed that pharmacy students had better knowledge and more positive attitudes toward the consumption of nuts compared to non-pharmacy students. Although completion of nutrition-related courses showed some positive influence, this was not statistically significant for most attitudes and beliefs. These findings underscore the potential value of integrating comprehensive nutrition education into pharmacy curricula, as the combination of knowledge and positive attitudes fostered by pharmacy and nutrition education will enable future health professionals to play a critical role in promoting healthier and sustainable eating habits in the population.

Metabolisable energy from nuts and patterns of nut consumption in the Australian population: a secondary analysis of the 2011-12 National Nutrition and Physical Activity Survey

BACKGROUND

Nut intake is not associated with increased body weight, which may be explained by their metabolisable energy, among other factors. Therefore, total energy intake may be overestimated among nut consumers. This study aimed to describe the metabolisable energy from nuts and nut consumption patterns in the Australian population.

METHODS

A nut-specific database was expanded to include metabolisable energy of nuts (based on nut type and form) and applied to the 2011-12 National Nutrition and Physical Activity Survey (NNPAS). Participants were Australians aged 2 years and older from the 2011-12 NNPAS (n = 12,153, with n = 4,765 nut consumers). Mean metabolisable energy intake was compared with mean energy intake using Atwater factors in nut consumers. Additionally, nut consumption patterns were explored, including the proportion of nuts consumed at meals and snacks.

RESULTS

Among nut consumers, mean metabolisable energy from nuts based only on nut type was 241.2 (95% confidence interval [CI]: 232.0, 250.5) kJ/day and mean metabolisable energy considering both nut type and form was 260.7 (95% CI: 250.2, 271.2) kJ/day. Energy intake from nuts using Atwater factors was 317.6 (95% CI: 304.8, 330.3) kJ/day. Nuts were more likely to be consumed at snack occasions, with approximately 63% of nut intake occurring as a snack.

CONCLUSION

Application of metabolisable energy to the 2011-12 NNPAS has a significant impact on calculation of energy intake from nuts. Nut consumption patterns identified a majority of nut consumption occurring as snacks. These findings may inform strategies to support nut consumption in Australia.

The Metabolizable Energy and Lipid Bioaccessibility of Tree Nuts and Peanuts: A Systematic Review with Narrative Synthesis of Human and In Vitro Studies

Nuts are an energy-dense food, yet regular consumption is not associated with weight gain. A proportion of the fats found within nuts remains encapsulated within cell walls and cannot be digested. Metabolizable energy (ME) can be explored by measuring fecal fat excretion in human studies and fat release among in vitro studies. This systematic review with narrative synthesis aimed to examine the ME of tree nuts and peanuts (PROSPERO CRD42021252287). PubMed, MEDLINE, CINAHL, Cochrane, and Embase databases were searched to June 2021. Both in vitro and human studies (adults ≥18 y) were included. Data was synthesized via narrative synthesis with results reported in summary tables and compared between form, processing, and dose of nuts, where available. Twenty-one studies were included. The ME of nuts was consistently lower than that predicted by Atwater factors for investigated nut types (almonds, cashews, hazelnuts, pistachios, walnuts, and peanuts). The mechanisms may relate to a lower fat release from nuts, hence higher fecal fat excretion; however, this review did not consider the digestibility of carbohydrates and protein, which should be considered when interpreting the outcomes. ME was influenced by nut type (ME = 22.6 kJ/g for pistachios; ME = 18.5 kJ/g for raw almonds), physical form (flour > chopped > whole nuts), heat processing (butter > roasted > raw) and dose of consumption. The lower-than-expected ME may explain a lack of association between nut intake and body weight observed in the literature and has implications for the development of food composition databases, food labeling, and informing dietary guidelines. However, the strength of the evidence base was reduced by the variation in methods used between studies, suggesting that further clinical trials are needed to determine the impact of the findings of this review for clinical dietetics.

Comparing the effects of consuming almonds or biscuits on body weight in habitual snackers: A one-year randomized controlled trial

PURPOSE

Almonds are nutrient-rich, providing a healthier alternative to many snack foods. Studies report health benefits with regular almond consumption without adverse weight gain. However, most interventions have been relatively short or have included additional dietary advice. Taking a pragmatic approach, we compared consumption of almonds versus biscuits on body weight and other health outcomes in a population of regular snackers of discretionary foods, hypothesizing the almonds will displace some of the less healthful snacks in their current diets.

METHODS

We randomly assigned 136 non-obese habitual discretionary snack consumers to receive almonds or biscuits daily for one-year. These isocaloric snacks provided either 10% of participants' total energy (TE) requirements or 1030 kJ (equivalent to 42.5 g almonds), whichever was greater. Anthropometry, blood biomarkers, diet, appetite, sleep, and, physical activity, were assessed at baseline, 3, 6, and 12 months, and body composition and resting metabolic rate at baseline and 12 months.

RESULTS

The difference in changes for body weight from baseline to 12 months was not statistically significant (geometric means 67.1 kg and 69.5 kg for almonds and 66.3 kg and 66.3 kg for biscuits, P = 0.275). There were no statistically significant differences in changes for body composition or other non-dietary outcomes (all P ≥ 0.112). Absolute intakes of protein; total, polyunsaturated, and monosaturated fat; fibre; vitamin E; calcium; copper; magnesium; phosphorous; and zinc, and % TE from total monounsaturated, and polyunsaturated fat statistically significantly increased from baseline (all P ≤ 0.033), while % TE from carbohydrate and sugar statistically significantly (both P ≤ 0.014) decreased from baseline, in the almond compared to the biscuit group.

CONCLUSIONS

Almonds can be incorporated into the diets of habitual snackers to improve diet quality, without evidence for changes in body weight, compared to a popular discretionary snack food.

TRIAL REGISTRATION

ACTRN12618001758291 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375610&isReview=true.

Why Should Pistachio Be a Regular Food in Our Diet?

The pistachio is regarded as a relevant source of biologically active components that, compared to other nuts, possess a healthier nutritional profile with low-fat content composed mainly of monounsaturated fatty acids, a high source of vegetable protein and dietary fibre, remarkable content of minerals, especially potassium, and an excellent source of vitamins, such as vitamins C and E. A rich composition in terms of phytochemicals, such as tocopherols, carotenoids, and, importantly, phenolic compounds, makes pistachio a powerful food to explore its involvement in the prevention of prevalent pathologies. Although pistachio has been less explored than other nuts (walnut, almonds, hazelnut, etc.), many studies provide evidence of its beneficial effects on CVD risk factors beyond the lipid-lowering effect. The present review gathers recent data regarding the most beneficial effects of pistachio on lipid and glucose homeostasis, endothelial function, oxidative stress, and inflammation that essentially convey a protective/preventive effect on the onset of pathological conditions, such as obesity, type 2 diabetes, CVD, and cancer. Likewise, the influence of pistachio consumption on gut microbiota is reviewed with promising results. However, population nut consumption does not meet current intake recommendations due to the extended belief that they are fattening products, their high cost, or teething problems, among the most critical barriers, which would be solved with more research and information.

Perceptions of Nut Consumption amongst Australian Nutrition and Health Professionals: An Online Survey

Habitual nut consumption is associated with reduced risk of chronic diseases; however, consumption levels in Australia are below recommendations. This study examined perceptions and knowledge regarding nut consumption among Australian healthcare professionals and their provision of nut consumption recommendations. A cross-sectional online survey of Australian health professionals was conducted in February-April 2020. Questions in the survey included demographic details, participants' perceptions of nut consumption, and nut consumption recommendations they may make to clients and patients. A total of 204 health professionals completed the survey, of which 84% were dietitians or nutritionists. Health professionals demonstrated basic nutritional knowledge regarding nut consumption; however, non-dietitians/nutritionists lacked knowledge of long-term benefits of nut consumption. Dietitians/nutritionists were more likely to agree that nuts are healthy and do not cause weight gain when compared to non-dietitians/nutritionists (p = 0.021). A total of 63% of health professionals advised at least some of their clients to eat more nuts, and this was higher among dietitians/nutritionists (68%) than non-dietitians/nutritionists (31%). While basic nutritional knowledge regarding nut consumption was observed among all health professionals, there is scope for further education, particularly for non-dietitians/nutritionists, to ensure that nutrition information provided to patients and clients is accurate and reflects the current evidence base.

Lack of association between nuts and legumes consumption and metabolic syndrome in young Iranian nurses

BACKGROUND

Most studies have investigated the association between dietary pattern and risk of metabolic syndrome. Limited studies have examined the association between nuts and legumes as a food group and metabolic syndrome. This study explored the association between nuts and legumes and components of metabolic syndrome in Iranian nurses.

METHODS

This cross-sectional study included a representative sample of 420 female nurses of Isfahan who were randomly selected. Nuts and legumes consumption was assessed using a validated dish-based semi quantitative food frequency questionnaire (FFQ). Metabolic syndrome was defined by the National Cholesterol Education Program's Adult Treatment Panel III (ATP III). Linear and logistic regression tests were used to study the association between nuts and legumes consumption and metabolic syndrome and its components.

RESULTS

Mean age of study participants was 35 years. The prevalence of the metabolic syndrome among study participants was 3.6%. Consumption of nuts and legumes was not associated with waist circumference either before (β = -0.01, P = 0.24) or after adjusting for potential confounders (β = -0.18, P = 0.41). The same findings were also observed for diastolic blood pressure (DBP) (β = 0.001, P = 0.42), serum triglyceride (TG) (β = 0.07, P = 0.32), high-density lipoprotein cholesterol (HDL-C) (β = 0.008, P = 0.65) and fasting blood sugar (FBS) (β = -0.001, P = 0.94). We failed to find a significant association between consumption of nuts and legumes and systolic blood pressure (SBP) after adjusting for confounders (β = 0.002, P = 0.38). Individuals in the highest category of nuts and legume consumption did not had elevated odds for metabolic syndrome after adjusting for potential confounders (OR = 0.89, 95% CI = 0.08-9.80, P = 0.93).

CONCLUSIONS

Nuts and legumes consumption was not associated with metabolic syndrome or its components. Prospective studies are needed to investigate further this association.

Is a Handful an Effective Way to Guide Nut Recommendations?

Dietary guidelines recommend consuming 30 g of nuts per day to reduce the risk of chronic disease. A 'handful' is commonly used to guide consumers. Research is lacking on how this translates into actual gram amounts. This study quantified the grams of nuts represented by different portion size measures, including a 'handful' and '30 g serving' among 120 participants. Each participant was randomised to a sequence where they received three of six different nut types (from almonds, cashews, hazelnuts, macadamias, peanuts, and walnuts) and were instructed to take a: 'usual serving', 'handful', 'small handful', 'large handful', and '30 g serving' of each. Combining all nut types, the median 'handful' was 36.3 g, compared to 28.7 g for the estimated '30 g serving' and 24.8 for the 'usual serving'. The 'large handful' was approximately double the 'handful' (61.3 g), whereas the 'small handful' was about half (16.7 g). Eighty-three percent of portions chosen were at least 80% of the recommended 30 g intake when participants were asked to take a 'handful', compared to 63% for the '30 g serving'. It appears a 'handful' can be used as a practical tool to guide recommended nut intakes, and increases the amount selected compared to instructions to take a '30 g serving'.

Barriers and Facilitators to Nut Consumption: A Narrative Review

Habitual nut intake is associated with a range of health benefits; however, population consumption data suggests that most individuals do not meet current recommendations for nut intake. The literature has highlighted a range of barriers and facilitators to nut consumption, which should be considered when designing strategies to promote nut intake. Common barriers include confusion regarding the effects of nut consumption on body weight, perceptions that nuts are high in fat, or too expensive, and challenges due to dentition issues or nut allergies. Conversely, demographic characteristics such as higher education and income level, and a healthier lifestyle overall, are associated with higher nut intakes. Health professionals appear to play an important role in promoting nut intake; however, research suggests that knowledge of the benefits of nut consumption could be improved in many health professions. Future strategies to increase nut intake to meet public health recommendations must clarify misconceptions of the specific benefits of nut consumption, specifically targeting sectors of the population known to have lower nut consumption, and educate health professionals to promote nut intake. In addition, given the relatively small body of evidence exploring barriers and facilitators to nut consumption, further research exploring these factors is justified.

Nut consumption in a representative survey of Australians: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey

Objective:

Nut consumption is associated with a range of health benefits. The current study aimed to examine nut consumption in the 2011–2012 National Nutrition and Physical Activity Survey (NNPAS) and to investigate associations between nut intake, nutrient intake and anthropometric and blood pressure measurements.

Design:

Secondary analysis of the 2011–2012 NNPAS. Usual consumption of nuts in the 2011–2012 NNPAS was determined, and nut consumption was compared with population recommendations of 30 g nuts per day. The relationship between nut consumption and intakes of key nutrients, anthropometric outcomes (weight, BMI and waist circumference) and blood pressure was examined using linear regression for participants aged over 18 years.

Setting:

Australia.

Participants:

Australians (2 years and older, n 12 153) participating in the representative 2011–2012 NNPAS.

Results:

Mean nut intake was 4·61 (95 % CI: 4·36, 4·86) g/d, with only 5·6 % of nut consumers consuming 30 g of nuts per day. Nut consumption was associated with significantly greater intakes of fibre, vitamin E, Fe, Mg and P. There was no association between nut consumption and body weight, BMI, waist circumference, or blood pressure.

Conclusions:

Exploration of nut consumption in a representative sample of Australians identified that nut intake does not meet recommendations. Higher nut consumption was not adversely associated with higher body weight, aligning with the current evidence base. Given the current levels of nut consumption in Australia, strategies to increase nut intake to recommended levels are required.

Does 'activating' nuts affect nutrient bioavailability?

Claims in the lay literature suggest soaking nuts enhances mineral bioavailability. Research on legumes and grains indicate soaking reduces phytate levels, however, there is no evidence to support or refute these claims for nuts. We assessed the effects of different soaking regimes on phytate and mineral concentrations of whole and chopped almonds, hazelnuts, peanuts, and walnuts. The treatments were: 1. Raw; 2. soaked for 12 h in salt solution; 3. soaked for 4 h in salt solution; 4. soaked for 12 h in water. Phytate concentrations were analysed using high-performance liquid chromatography (HPLC) and minerals by inductively coupled plasma mass spectrometry (ICP-MS). Differences in phytate concentrations between treated and untreated nuts were small, ranging from -12% to +10%. Overall, soaking resulted in lower mineral concentrations, especially for chopped nuts, and did not improve phytate:mineral molar ratios. This research does not support claims that 'activating' nuts results in greater nutrient bioavailability.

Latin American consumption of major food groups: Results from the ELANS study

BACKGROUND

The Latin American (LA) region is still facing an ongoing epidemiological transition and shows a complex public health scenario regarding non-communicable diseases (NCDs). A healthy diet and consumption of specific food groups may decrease the risk of NCDs, however there is a lack of dietary intake data in LA countries.

OBJECTIVE

Provide updated data on the dietary intake of key science-based selected food groups related to NCDs risk in LA countries.

DESIGN

ELANS (Latin American Study of Nutrition and Health) is a multicenter cross-sectional study assessing food consumption from an urban sample between15 to 65 years old from 8 LA countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Two 24-HR were obtained from 9,218 individuals. The daily intake of 10 food groups related to NCDs risk (fruits; vegetables; legumes/beans; nuts and seeds; whole grains products; fish and seafood; yogurt; red meat; processed meats; sugar-sweetened beverages (ready-to-drink and homemade)) were assessed and compared to global recommendations.

RESULTS

Only 7.2% of the overall sample reached WHO's recommendation for fruits and vegetables consumption (400 grams per day). Regarding the dietary patterns related to a reduced risk of NCDs, among the overall sample legumes and fruits were the food groups with closer intake to the recommendation, although much lower than expected (13.1% and 11.5%, respectively). Less than 3.5% of the sample met the optimal consumption level of vegetables, nuts, whole grains, fish and yogurt. Largest country-dependent differences in average daily consumption were found for legumes, nuts, fish, and yogurt. Mean consumption of SSB showed large differences between countries.

CONCLUSION

Diet intake quality is deficient for nutrient-dense food groups, suggesting a higher risk for NCDs in the urban LA region in upcoming decades. These data provide relevant and up-to-date information to take urgent public health actions to improve consumption of critically foods in order to prevent NCDs.

The Consumption of Nuts is Associated with Better Dietary and Lifestyle Patterns in Polish Adults: Results of WOBASZ and WOBASZ II Surveys

In recent years, the concept of the health benefits of synergistic dietary patterns as opposed to individual foods or food constituents has been developed. The aim of this study was to determine whether nut consumption is associated with healthier nutrition and lifestyle. The research was based on complete data obtained during two Polish National Multi-Centre Health Examination Surveys-WOBASZ (2003-2005) and WOBASZ II (2013-2014). Of the 12,946 participants who completed dietary assessments, 299 subjects reported consuming any quantity of whole nuts. A control group of 1184 non-nut consumers from both surveys was randomly selected for the study, with age, gender, study (WOBASZ, WOBASZ II), educational level, and season-related interactions taken into account. In this study, nut consumption was associated with favorable food and lifestyle choices, excluding smoking. Better dietary quality consisted of having a higher Healthy Diet Indicator score, an increased intake of polyphenols and antioxidants, lower intake of red meat, but higher of poultry and fruit, more frequent consumption of antiatherogenic food products, and less frequent consumption of processed meats. There was also greater interest in special diets, such as weight-loss diet. In addition, nut eaters were more physically active in their leisure time. While limited by 24-h recall of nut intake and possible misclassification of nut/non-nut consumer status, this research supports the synergistic health-promoting attitudes of those who were classified as nut consumers.

Legume Protein Consumption and the Prevalence of Legume Sensitization

Sensitization and allergy to legumes can be influenced by different factors, such as exposure, geographical background, and food processing. Sensitization and the allergic response to legumes differs considerably, however, the reason behind this is not yet fully understood. The aim of this study is to investigate if there is a correlation between legume protein consumption and the prevalence of legume sensitization. Furthermore, the association between sensitization to specific peanut allergens and their concentration in peanut is investigated. Legume sensitization data (peanut, soybean, lupin, lentil, and pea) from studies were analyzed in relation to consumption data obtained from national food consumption surveys using the European Food Safety Authority (EFSA), Global Environment Monitoring System (GEMS), and What We Eat in America-Food Commodity Intake Database (WWEIA-FCID) databases. Data were stratified for children <4 years, children 4⁻18 years, and adults. Sufficient data were available for peanut to allow for statistical analysis. Analysis of all age groups together resulted in a low correlation between peanut sensitization and relative peanut consumption (r = 0.407), absolute peanut consumption (r = 0.468), and percentage of peanut consumers (r = 0.243). No correlation was found between relative concentrations of Ara h 1, 2, 3, 6, 7, and 8 in peanut and sensitization to these peanut allergens. The results indicate that the amount of consumption only plays a minor role in the prevalence of sensitization to peanut. Other factors, such as the intrinsic properties of the different proteins, processing, matrix, frequency, timing and route of exposure, and patient factors might play a more substantial role in the prevalence of peanut sensitization.

A comparison of perceptions of nuts between the general public, dietitians, general practitioners, and nurses

BACKGROUND

Nut consumption at the population level remains low despite the well-documented benefits of their consumption, including their cardioprotective effects. Studies have suggested that advice from health professionals may be a means to increase nut consumption levels. Understanding how nuts are perceived by the public and health professionals, along with understanding the public's perceptions of motivators of and deterrents to consuming nuts, may inform the development of initiatives to improve on these low levels of consumption. The aim of this cross-sectional study was to compare perceptions of nuts among three groups of health professionals (dietitians, general practioners, and practice nurses) and the general public in New Zealand (NZ), along with motivators of and deterrents to consuming nuts amongst the general public and their experiences of receiving advice around nut consumption.

METHODS

The NZ electoral roll was used to identify dietitians, general practitioners (GPs), and practice nurses, based on their free-text occupation descriptions, who were then invited to complete a questionnaire with 318, 292, and 149 respondents respectively. 1,600 members of the general public were randomly selected from the roll with 710 respondents. Analyses were performed using chi-squared tests to look at differences in categorical variables and linear regression for differences in other variables between the four survey groups.

RESULTS

Although there were significant differences between the four groups regarding the perceptions of nuts, in general there was agreement that nuts are healthy, high in protein and fat, are filling, and some nuts are high in selenium. We noted frequent agreement that the general public participants would consume more if nuts: improved health (67%), were more affordable (60%), or improved the nutrient content (59%) and balance of fats (58%) within their diets. Over half the respondents reported they would eat more nuts if they were advised to do so by a dietitian or doctor, despite less than 4% reporting they had received such advice. The most frequently selected deterrents to increasing nut consumption were: cost (67%), potential weight gain (66%), and leading to eating too much fat (63%).

DISCUSSION

It is concerning that so few among the general public report receiving advice to consume more nuts from health professionals, especially given their apparent responsiveness to such advice. Health professionals could exploit the motivators of nut consumption, while also addressing the deterrents, to promote nut intake. These factors should also be addressed in public health messages to encourage regular nut consumption among the public. Educational initiatives could also be used to improve the nutritional knowledge of GPs and practice nurses with regard to nuts, although even dietitians were unsure of their knowledge in some cases.

Current nut recommendation practices differ between health professionals in New Zealand

OBJECTIVE

Despite evidence linking regular nut consumption with reduced chronic disease risk, population-level intakes remain low. Research suggests nut-promoting advice from doctors facilitates regular nut consumption. However, there is no information on current nut recommendation practices of health professionals. The aim of the present study was to examine the advice provided by health professionals regarding nut consumption.

DESIGN

In this cross-sectional study, participants were invited to complete a survey including questions about their nut recommendation practices.

SETTING

New Zealand (NZ).

SUBJECTS

The NZ Electoral Roll was used to identify dietitians, general practitioners and practice nurses.

RESULTS

In total 318 dietitians, 292 general practitioners and 149 practice nurses responded. Dietitians were more likely (82·7 %) to recommend patients increase consumption of nuts than general practitioners (55·5 %) and practice nurses (63·1 %; both P<0·001). The most popular nuts recommended were almonds, Brazil nuts and walnuts, with most health professionals recommending raw nuts. The most common recommendation for frequency of consumption by dietitians and practice nurses was to eat nuts every day, while general practitioners most frequently recommended 2-4 times weekly, although not statistically significantly different between professions. Dietitians recommended a significantly greater amount of nuts (median 30 g/d) than both general practitioners and practice nurses (20 g/d; both P<0·001).

CONCLUSIONS

Dietitians were most likely to recommend consumption of nuts in accordance with current guidelines, but there are opportunities to improve the adoption of nut consumption recommendations for all professions. This may be a viable strategy for increasing population-level nut intakes to reduce chronic disease.

Nut Consumption and Cardiovascular Risk Factors: A Cross-Sectional Study in a Mediterranean Population

Nuts are often considered beneficial for health, yet few studies have examined determinants of their intake and the associations between nut consumption and various cardiovascular disease risk factors. The aim of this study was to identify factors associated with nut intake in a Mediterranean population, in Croatia, and to investigate the association of nut intake and various cardiovascular risk factors.

METHODS

Subjects from the Island of Vis, Island of Korčula and the City of Split were included in this cross-sectional study (n = 4416 in total; 4011 without known cardiovascular disease). Survey responses, medical records and clinically relevant measurements were utilized. Multivariate ordinal and logistic regression models were used in the analysis, adjusting for known confounding factors.

RESULTS

As low as 5% of all subjects reported daily, and 11% reported weekly, nut consumption. The characteristics associated with more frequent nut intake were female gender (Odds ratio (OR) = 1.39; 95% confidence interval (CI) 1.19-1.62), highest level of education (1.42; 1.15-1.76) and material status (1.58; 1.29-1.93), smoking abstinence (1.21; 1.04-1.42 in never-smokers and 1.22; 1.02-1.46 in ex-smokers), Mediterranean diet adherence (1.87; 1.62-2.15), and absence of central obesity (1.29; 1.09-1.53), absence of diabetes (1.30; 1.02-1.66) and metabolic syndrome (1.17; 1.01-1.36). Subjects who consumed nuts had more favorable waist-to-height (overall p = 0.036) and waist-to-hip ratios (0.033), lesser odds of elevated fibrinogen (p < 0.001 in both weekly and monthly nut consumers) and reduced high-density lipoprotein (HDL) cholesterol (p = 0.026), compared to non-consumers.

CONCLUSIONS

It appears that frequent nut consumption is an integral part of a healthy lifestyle and better socioeconomic status. A beneficial association of nut intake with cardiovascular risk factors was confirmed in this study.

Associations between Nut Consumption and Health Vary between Omnivores, Vegetarians, and Vegans

Regular nut consumption is associated with reduced risk factors for chronic disease; however, most population-based studies lack consideration of effect modification by dietary pattern. The UK Women’s Cohort Study (UKWCS) provides an ideal opportunity to examine relationships between nut consumption and chronic disease risk factors in a large sample with diverse dietary patterns. Nut and nutrient intake from 34,831 women was estimated using a food frequency questionnaire among self-identified omnivores, vegetarians and vegans. In this cross-sectional analysis, higher nut consumption was associated with lower body weight (difference between highest and lowest consumption categories from adjusted model: 6.1 kg; 95% CI: 4.7, 7.6) body mass index (BMI, 2.4 units difference; 95% CI: 1.9, 2.9), and waist circumference (2.6 cm difference; 95% CI: 1.4, 3.8) (all p for linear trend < 0.001). Higher nut consumption was also associated with reduced prevalence of high cholesterol and high blood pressure; having a history of heart attack, diabetes and gallstones; and markers of diet quality (all adjusted p for linear trend ≤ 0.011). Higher nut consumption appeared overall to be associated with greater benefits amongst omnivores compared to vegetarians and vegans. Findings support existing literature around beneficial effects of nut consumption and suggest that benefits may be larger among omnivores. Nut promotion strategies may have the highest population impact by specifically targeting this group.

Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand

OBJECTIVE

Despite considerable evidence supporting the health benefits of regular nut consumption, nut intakes remain lower than recommended among many populations. Understanding how the general population perceives nuts could inform strategies to promote regular nut consumption and increase intakes among the general public.

DESIGN

Cross-sectional study. Participants were invited to complete a questionnaire which included information on nut consumption and knowledge and perceptions of nuts.

SETTING

The study was set in New Zealand (NZ).

SUBJECTS

Participants (n 1600), aged 18 years or over, were randomly selected from the NZ electoral roll.

RESULTS

A total of 710 participants completed the questionnaire (response rate 44 %). More than half of the respondents believed that nuts are healthy, filling, high in protein and high in fat. The most common reason cited by consumers for eating nuts was taste (86 % for nuts, 85 % for nut butters), while dental issues was the most frequent reason for avoidance. About 40 % of respondents were not aware of the effects of nut consumption on lowering blood cholesterol and CVD risk.

CONCLUSIONS

Despite overall basic knowledge of the nutritional value of nuts, a substantial proportion of the general population was unaware of the cardioprotective effects of nuts. The present study identified common motivations for eating and avoiding nuts, as well as perceptions of nuts which could affect intake. These should guide the content and direction of public health messages to increase regular nut consumption. The public's knowledge gaps should also be addressed.

Perceptions and Knowledge of Nuts amongst Health Professionals in New Zealand

Despite their nutritional value, population-level nut consumption remains low. Studies suggest that individuals would eat more nuts on their doctor’s advice, making health professionals potentially important for promoting nut consumption. This cross-sectional study aimed to examine the perceptions and knowledge of nuts and the predictors of nut promotion among health professionals in New Zealand. Dietitians, general practitioners (GPs), and practice nurses were identified from the Electoral Roll and invited to complete a questionnaire (n = 318, 292, and 149 respondents respectively). Over one-fifth of GPs and practice nurses believed that eating nuts could increase blood cholesterol concentrations and cause weight gain. The most common perceptions overall were that nuts are healthy; high in protein, fat, and calories; and are satiating. Nut consumption was recommended for reasons relating to these perceptions and because of nuts’ selenium content. Conversely, reasons for suggesting the consumption of fewer nuts included that they were high in calories and fat, would cause weight gain, and concerns regarding allergies and cost. All groups of health professionals were more likely to promote nut consumption if they perceived nuts to reduce the risk of diabetes (all p ≤ 0.034). Education could improve health professionals’ knowledge regarding the effects of nut consumption on blood cholesterol and body weight, alongside other health benefits, which should improve the advice given to patients and may thereby increase nut consumption.

Do dry roasting, lightly salting nuts affect their cardioprotective properties and acceptability?

PURPOSE

Previous studies have reported improvements in cardiovascular disease (CVD) risk factors with the consumption of raw nuts. However, around one-third of nuts consumed are roasted and salted. Thus, it is important to determine whether roasting and salting nuts affect the health benefits observed with raw nuts. This study aimed to compare the effects of consuming two different forms of hazelnuts on cardiovascular risk factors and acceptance.

METHODS

Using a randomised crossover design, 72 participants were asked to consume 30 g/day of either raw or dry roasted, lightly salted hazelnuts for 28 days each. CVD risk factors were measured at the beginning and end of each treatment period. "Desire to consume" and "overall liking" for both forms of hazelnuts were assessed daily using a 150-mm visual analogue scale.

RESULTS

Body composition, blood pressure, plasma total and low-density lipoprotein-cholesterol, apolipoprotein A1 and B100, glucose and α-tocopherol concentrations did not differ between forms of hazelnuts (all P ≥ 0.054). High-density lipoprotein (HDL)-cholesterol (P = 0.037) and triacylglycerol (P < 0.001) concentrations were significantly lower following the consumption of dry roasted, lightly salted hazelnuts when compared to the raw hazelnuts. Compared with baseline, consuming both forms of hazelnuts significantly improved HDL-cholesterol and apolipoprotein A1 concentrations, total-C/HDL-C ratio, and systolic blood pressure without significantly changing body composition. Acceptance ratings did not differ between forms of hazelnuts and remained high throughout the study.

CONCLUSION

Dry roasting and lightly salting nuts do not appear to negate the cardioprotective effects observed with raw nut consumption, and both forms of nuts are resistant to monotony. Public health messages could be extended to include dry roasted and lightly salted nuts as part of a heart healthy diet.

Nut consumption is associated with better nutrient intakes: results from the 2008/09 New Zealand Adult Nutrition Survey

A limited number of studies have examined associations between nut consumption and nutrient intakes or diet quality. None has investigated these associations in the Southern Hemisphere. The purpose of this study was to examine associations between nut consumption and nutrient intakes among adult New Zealanders. Data from the 24-h recalls of 4721 participants from the cross-sectional 2008/09 New Zealand Adult Nutrition Survey (2008/09 NZANS) were used to determine whole nut intake and total nut intake from all sources as well as nutrient intakes. Regression models, both unadjusted and adjusted for potential confounders, were used to estimate differences in nutrient intakes between those consuming and those not consuming nuts. From adjusted models, compared with non-whole nut consumers, whole nut consumers had higher intakes of energy and percentage of energy from total fat, MUFA and PUFA, whereas percentage of energy from SFA and carbohydrate was lower (all P≤0·025). After the additional adjustment for energy intake, whole nut consumers had higher intakes of dietary fibre, vitamin E, folate, Cu, Mg, K, P and Zn (all P≤0·044), whereas cholesterol and vitamin B12 intakes were significantly lower (both P≤0·013). Total nut consumption was associated with similar nutrient profiles as observed in whole nut consumers, albeit less pronounced. Nut consumption was associated with better nutrient profiles, especially a lower intake of SFA and higher intakes of unsaturated fats and a number of vitamins and minerals that could collectively reduce the risk for chronic disease, in particular for CVD.

Association of Nut Consumption with Cardiometabolic Risk Factors in the 2008/2009 New Zealand Adult Nutrition Survey

Nut consumption has been associated with improvements in risk factors for chronic disease in populations within North America, Europe and Iran. This relationship has not been investigated in New Zealand (NZ). The associations between nut consumption and cardiometabolic risk factors among New Zealanders were examined. Data from the 24-h diet recalls of 4721 participants from the NZ Adult Nutrition Survey 2008/2009 (2008/2009 NZANS) were used to determine whole and total nut intake. Anthropometric data and blood pressure were collected, as well as blood samples analysed for total cholesterol (total-C) and HDL cholesterol (HDL-C), glycated haemoglobin (HbA1c), C-reactive protein (CRP) and folate. Participants were classified according to their five-year cardiovascular disease (CVD) risk. Both whole and total nut consumers had significantly lower weight, body mass index (BMI), waist circumference and central adiposity than non-nut consumers (all p ≤ 0.044). Whole blood, serum and red blood cell folate concentrations were significantly higher among whole nut consumers compared to non-whole nut consumers (all p ≤ 0.014), with only serum folate higher in total nut consumers compared to non-total nut consumers (p = 0.023). There were no significant differences for blood pressure, total-C, HDL-C and HbA1c; however, significant negative associations between total nut consumption and CVD risk category (p < 0.001) and CRP (p = 0.045) were apparent. Nut consumption was associated with more favourable body composition and a number of risk factors, which could collectively reduce chronic disease.