Open Access Highly Accessed Open Badges Research article

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

Marta Guasch-Ferré12, Mònica Bulló12, Miguel Ángel Martínez-González3, Emilio Ros24, Dolores Corella5, Ramon Estruch26, Montserrat Fitó27, Fernando Arós28, Julia Wärnberg9, Miquel Fiol10, José Lapetra112, Ernest Vinyoles12, Rosa Maria Lamuela-Raventós13, Lluís Serra-Majem14, Xavier Pintó15, Valentina Ruiz-Gutiérrez16, Josep Basora12, Jordi Salas-Salvadó12* and on behalf of the PREDIMED study group

Author Affiliations

1 Human Nutrition Unit, Hospital Universitari de Sant Joan de Reus, Faculty of Medicine and Health Sciences, IISPV (Institut d’Investigació Sanitària Pere Virgili), Universitat Rovira i Virgili, Reus, Spain

2 CIBERobn (Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición), Institute of Health Carlos III, Madrid, Spain

3 Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain

4 Lipid Clinic, Department of Endocrinology and Nutrition, Institut d’Investigacions Biomediques August Pi Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain

5 Department of Preventive Medicine, University of Valencia, València, Spain

6 Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain

7 Cardiovascular Risk and Nutrition Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona Biomedical Research Park, Barcelona, Spain

8 Department of Cardiology, University Hospital Txagorritxu, Vitoria, Spain

9 Department of Preventive Medicine, University of Malaga, Malaga, Spain

10 Institute of Health Sciences, University of Balearic Islands and Hospital Son Espases, Palma de Mallorca, Spain

11 Department of Family Medicine, Primary Care Division of Sevilla, San Pablo Health Center, Sevilla, Spain

12 Primary Health Care Division and Research, Instituto de Investigaciones Biomédicas August Pi i Sunyer-Jordi Gol, Barcelona, Spain

13 INSA, University of Barcelona, Barcelona, Spain

14 Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain

15 Lipids and Vascular Risk Unit, Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain

16 Instituto de la Grasa, Consejo Superior de Investigaciones Científicas, Sevilla, Spain

For all author emails, please log on.

BMC Medicine 2013, 11:164  doi:10.1186/1741-7015-11-164

Published: 16 July 2013



Prospective studies in non-Mediterranean populations have consistently related increasing nut consumption to lower coronary heart disease mortality. A small protective effect on all-cause and cancer mortality has also been suggested. To examine the association between frequency of nut consumption and mortality in individuals at high cardiovascular risk from Spain, a Mediterranean country with a relatively high average nut intake per person.


We evaluated 7,216 men and women aged 55 to 80 years randomized to 1 of 3 interventions (Mediterranean diets supplemented with nuts or olive oil and control diet) in the PREDIMED (‘PREvención con DIeta MEDiterránea’) study. Nut consumption was assessed at baseline and mortality was ascertained by medical records and linkage to the National Death Index. Multivariable-adjusted Cox regression and multivariable analyses with generalized estimating equation models were used to assess the association between yearly repeated measurements of nut consumption and mortality.


During a median follow-up of 4.8 years, 323 total deaths, 81 cardiovascular deaths and 130 cancer deaths occurred. Nut consumption was associated with a significantly reduced risk of all-cause mortality (P for trend <0.05, all). Compared to non-consumers, subjects consuming nuts >3 servings/week (32% of the cohort) had a 39% lower mortality risk (hazard ratio (HR) 0.61; 95% CI 0.45 to 0.83). A similar protective effect against cardiovascular and cancer mortality was observed. Participants allocated to the Mediterranean diet with nuts group who consumed nuts >3 servings/week at baseline had the lowest total mortality risk (HR 0.37; 95% CI 0.22 to 0.66).


Increased frequency of nut consumption was associated with a significantly reduced risk of mortality in a Mediterranean population at high cardiovascular risk.

Please see related commentary: webcite.

Trial registration International Standard Randomized Controlled Trial Number (ISRCTN): 35739639. Registration date: 5 October 2005.

Cancer; Cardiovascular; Mortality; Nuts; PREDIMED study