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Nut consumption, vegetarian diets, ischemic heart disease risk, and all-cause mortality: evidence from epidemiologic studies.

Perhaps one of the most unexpected and novel findings in nutritional epidemiology in the past 5 y has been that nut consumption seems to protect against ischemic heart disease (IHD). Frequency and quantity of nut consumption have been documented to be higher in vegetarian than in nonvegetarian populations. Nuts also constitute an important part of other plant-based diets, such as Mediterranean and Asian diets. In a large, prospective epidemiologic study of Seventh-day Adventists in California, we found that frequency of nut consumption had a substantial and highly significant inverse association with risk of myocardial infarction and death from IHD. The Iowa Women's Health Study also documented an association between nut consumption and decreased risk of IHD. The protective effect of nuts on IHD has been found in men and women and in the elderly. Importantly, nuts have similar associations in both vegetarians and nonvegetarians. The protective effect of nut consumption on IHD is not offset by increased mortality from other causes. Moreover, frequency of nut consumption has been found to be inversely related to all-cause mortality in several population groups such as whites, blacks, and the elderly. Thus, nut consumption may not only offer protection against IHD, but also increase longevity.

Aged↗

Frequent nut consumption and decreased risk of cholecystectomy in women.

BACKGROUND: Gallstone disease is a major source of morbidity in the developed countries. Nuts are rich in several compounds that may protect against gallstone disease. OBJECTIVE: The association between nut intake and cholecystectomy was examined in a large cohort of women. DESIGN: We prospectively studied nut (peanuts, other nuts, and peanut butter) consumption in relation to the risk of cholecystectomy in a cohort of 80,718 women from the Nurses' Health Study who were 30-55 y old in 1980 and had no history of gallstone disease. As part of the Nurses' Health Study, the women reported on questionnaires mailed to them every 2 y both their consumption of nuts and whether they had undergone cholecystectomy. The women were followed through 2000. RESULTS: During 1,393,256 person-years of follow-up from 1980 to 2000, we documented 7831 cholecystectomies. After adjustment for age and other known or suspected risk factors, women who consumed > or =5 units of nuts (1 unit = 1 oz or 28.6 g nuts)/wk (frequent consumption) had a significantly lower risk of cholecystectomy (relative risk: 0.75; 95% CI: 0.66, 0.85; P for trend < 0.0001) than did women who never ate nuts or who ate <1 unit/mo (rare consumption). Further adjustment for fat consumption (saturated fat, trans fat, polyunsaturated fat, and monounsaturated fat) did not materially alter the relation. In analyses examining consumption of peanuts and other nuts separately, both were associated with a lower risk of cholecystectomy. CONCLUSION: In women, frequent nut consumption is associated with a reduced risk of cholecystectomy.

Adult↗

Addicted schoolchildren: prevalence and characteristics of areca nut chewers among primary school children in Karachi, Pakistan.

OBJECTIVES: To evaluate the habits of betel quid use and areca nut chewing among school-aged children in Karachi, Pakistan. Areca nut (betel nut) is chewed by itself, in various scented preparations, and in betel quid (containing betel leaf, areca nut, slaked lime, condiments, sweeteners and sometimes tobacco) in various parts of Pakistan and India. It is associated with carcinogenesis, foreign body aspiration in children and oral submucous fibrosis, and may aggravate asthma. METHODS: We selected a stratified random sample of 160 primary school children between 4 and 16 years of age in Baba Island, Karachi. RESULTS: Seventy-four per cent of the children (118/159) used areca nut and 35% (55/159) used betel quid daily. More boys chewed areca nut than girls (72% vs 30%). The proportion of areca nut users increased by grade (from 48% in first grade to 90% in fifth grade). Most areca users first tried it with a family member (42%) or a friend (26%), and most (68%) consumed three or more packets a day. Children with fathers with three or fewer years of education were more likely to use areca nut (OR 3.2; 95% CI 1.2-8.4), and children whose mothers helped with homework less likely (OR 0.5; 95% CI 0.2-0.91; P = 0.027) to use it. Boys (OR 6.6; 95% CI 2.3-18.7) and areca nut users (OR 8.8; 95% CI2.8-27.0) were more likely to use betel quid. CONCLUSION: To reduce the use of areca nut, the Pakistan Government should consider imposing taxes on it, limiting advertising and actively communicating its health risks to the public.

Adolescent↗

Socio-economic aspects of areca nut use.

The socio-economic aspects of areca nut consumption have been overlooked. A narrative review was conducted to establish some of these features of areca nut consumption. Medline, Pubmed and the World Wide Web were searched using the terms: areca nut, betel nut, areca catechu and pan masala. Further analysis was conducted of datasets describing aspects of United Kingdom areca nut sales and consumption. South Asian economies at different stages of development have varying areca nut cultivation practices, employment opportunities and marketing strategies. Attempts at regulation of areca nut import and sales are described. Retail practice among the South Asian communities of the United Kingdom was found to reflect the diverse consumer practices current in their countries of origin. A study of areca nut consumption patterns and motivations among Bangladeshi women resident in East London identified differences between those chewing areca nut in paan with and without tobacco. Further research into the socio-economic aspects of areca nut consumption is needed which should be multidisciplinary in focus, of sound scientific quality and incorporating the opinions of consumers.

Adolescent↗

Anaphylaxis to pine nuts and immunological cross-reactivity with pine pollen proteins.

Despite the wide use of pine nuts, the fruit of Pinus pinea, only a few reports of allergic reactions to them have been published. We present herein a case of food allergy to pine nuts in a patient who showed no clinical symptoms to pine pollen despite the presence in her serum of specific IgE antibodies. In order to verify whether the reaction against pine nuts was IgE mediated, specific IgE against pine nuts and pollen were evaluated by skin-prick test, prick by prick and RAST. Immunoblotting and immunoblotting-inhibition were used to evaluate the allergenic components of both extracts and their cross-reactivity. Prick by prick with fresh pine nuts and RAST with pine nut and pine pollen extracts showed that the patient had high levels of specific IgE against both extracts. Immunoblotting experiments showed the presence in serum of IgE antibodies against several components in pine nuts and pollen. Immunoblotting-inhibition experiments demonstrated the presence of some cross-reacting components. These data confirm the existence of food allergy induced by pine nuts. This sensitization to pine nuts developed with no symptoms of pine pollinosis. Development of pollinosis may require a longer time of exposure to allergens. Based on the cross-reactivity between pine nut and pine pollen extracts, cosensitization to these two allergens could be possible.

Adult↗

Tree nut allergens.

Allergic reactions to tree nuts can be serious and life threatening. Considerable research has been conducted in recent years in an attempt to characterize those allergens that are most responsible for allergy sensitization and triggering. Both native and recombinant nut allergens have been identified and characterized and, for some, the IgE-reactive epitopes described. Some allergens, such as lipid transfer proteins, profilins, and members of the Bet v 1-related family, represent minor constituents in tree nuts. These allergens are frequently cross-reactive with other food and pollen homologues, and are considered panallergens. Others, such as legumins, vicilins, and 2S albumins, represent major seed storage protein constituents of the nuts. The allergenic tree nuts discussed in this review include those most commonly responsible for allergic reactions such as hazelnut, walnut, cashew, and almond as well as those less frequently associated with allergies including pecan, chestnut, Brazil nut, pine nut, macadamia nut, pistachio, coconut, Nangai nut, and acorn.

Allergens↗

Serum lipid effects of a high-monounsaturated fat diet based on macadamia nuts.

BACKGROUND: Recent studies have identified potential beneficial effects of eating nuts, most of which have substantial amounts of monounsaturated fats. Macadamia nuts are 75% fat by weight, 80% of which is monounsaturated. OBJECTIVE: To examine variations in serum lipid levels in response to a high-monounsaturated fat diet based on macadamia nuts. METHODS: A randomized crossover trial of three 30-day diets was conducted in 30 volunteers aged 18 to 53 years from a free-living population. Each was fed a "typical American" diet high in saturated fat (37% energy from fat); an American Heart Association Step 1 diet (30% energy from fat); and a macadamia nut-based monounsaturated fat diet (37% energy from fat) in random order. Serum total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were measured. RESULTS: Mean total cholesterol level after the typical American diet was 5.20 mmol/L (201 mg/dL). After the Step 1 diet and the macadamia nut diet, total cholesterol level was 4.99 mmol/L (193 mg/dL) and 4.95 mmol/L (191 mg/dL), respectively. Low-density lipoprotein cholesterol level was 3.37 mmol/L (130 mg/dL) (typical diet), 3.21 mmol/L (124 mg/dL) (Step 1 diet), and 3.22 mmol/L (125 mg/dL) (macadamia nut diet). High-density lipoprotein cholesterol level was 1.43 mmol/L (55 mg/dL) (typical), 1.34 mmol/L (52 mg/dL) (Step 1), and 1.37 mmol/L (53 mg/dL) (macadamia nut). Lipid values after the Step 1 and macadamia nut diets were significantly different from those after the typical diet (P<.05). CONCLUSIONS: The macadamia nut-based diet high in monounsaturated fat and the moderately low-fat diet both had potentially beneficial effects on cholesterol and low-density lipoprotein cholesterol levels when compared with a typical American diet.

Adolescent↗

Nut-like oil seeds: food for monkeys, chimpanzees, humans, and probably ape-men.

The hypothetical hyperrobust australopithecine gnathic nutcracker adaptation is reexamined in light of ecobotanical information on edible wild nuts provided by the flora of tropical and subtropical Africa. The nut producing species are tree-forms. Those of the forest region do not as a rule produce fruits with edible mesocarps. In contrast, the woodland savanna species (particularly in the Zambezian region) characteristically provide an important whole fruit, i.e., a nutritious mesocarp in addition to edible oil-rich nut seeds. These fruits drop from the tree before they are fully mature and go through the final ripening phase on the ground. They are important seasonal foods for a variety of vertebrates, including primates, elephants, and antelope. Altogether the nuts exhibit a broad range of toughness values, measured here as strength under compression. The woodland nuts are not as tough (177-934 kg force, breaking load) as those of the tropical forest (192-1,673 kg force). The seed-predators of the woodland species include squirrels, baboons, warthogs, and parrots. Paleoecological analyses indicate that it was the woodland nuts that were probably available to Australopithecus boisei and A. robustus. Preliminary estimates of adult male gnathic nut-cracking capabilities suggest that A. boisei could have orally cracked a significant portion of the woodland nuts. In spite of this, ecobotanical data indicate that we can probably reject the hypothesis that these hominids were year-round gnathic nut-cracking specialists. Both the indirect and direct evidence support this conclusion.

Africa↗

HPLC-ICP-MS determination of selenium distribution and speciation in different types of nut.

In addition to determination of total selenium in nuts, the element distribution among different fractions (lipid extract, low molecular weight, and protein fractions), and speciation analysis were studied. Improved precision for total selenium determination was observed after elimination of lipids. Because selenium was not detected in any of the lipid extracts obtained from the different types of nuts (ICP-MS), in each determination and/or speciation procedure used in this work lipids were extracted (chloroform-methanol, 2:1) and discarded before analysis. In agreement with previously reported data, high selenium levels were found in Brazil nuts (those purchased without shells contained approximately a quarter the content than those purchased with shells) and significantly lower levels in walnuts, cashews, and pecans nuts. Low-molecular-weight compounds were extracted with perchloric acid (0.4 mol L(-1)) to furnish a fraction containing 3 to 15% of the total selenium in different types of nuts. The proteins were isolated from nut samples by dissolution in 0.1 mol L(-1) sodium hydroxide and subsequent precipitation with acetone. They were then dissolved in phosphate buffer pH 7.5. Analysis of protein fractions focused on selenium in two possible states - weakly and firmly bound to proteins. Results obtained for Brazil nuts by size-exclusion chromatography with on-line ICP-MS detection, in the absence and in the presence of beta-mercaptoethanol, showed that approximately 12% of total selenium was weakly bound to proteins. To obtain information about firmly bound selenium, the protein extracts were hydrolyzed enzymatically with proteinase K. Speciation was performed by means of ion-pairing HPLC-ICP-MS. The primary species found in all types of nuts was Se-methionine (19-25% of total selenium for different types of nuts).

Chromatography, High Pressure Liquid↗

IgE cross-reactivity between the major peanut allergen Ara h 2 and tree nut allergens.

Allergy to peanut and tree nuts is characterised by a high frequency of life-threatening anaphylactic reactions and typically lifelong persistence. Although peanut is the most common cause of nut allergy, peanut allergic patients are frequently also sensitive to tree nuts. It is not known if this is due to cross-reactivity between peanut and tree nut allergens. In this study, the major peanut allergen Ara h 2 was cloned from peanut cDNA, expressed in E. coli cells as a His-tag fusion protein and purified using a Ni-NTA column. Immunoblotting, ELISA and basophil activation indicated by CD63 expression all confirmed the IgE reactivity and biological activity of rAra h 2. To determine whether or not this allergen plays a role in IgE cross-reactivity between peanut and tree nuts, inhibition ELISA was performed. Pre-incubation of serum from peanut allergic patients with increasing concentrations of almond or Brazil nut extract inhibited IgE binding to rAra h 2. Purified rAra h 2-specific serum IgE antibodies also bound to proteins present in almond and Brazil nut extracts by immunoblotting. This indicates that the major peanut allergen, Ara h 2, shares common IgE-binding epitopes with almond and Brazil nut allergens, which may contribute to the high incidence of tree nut sensitisation in peanut allergic individuals.

2S Albumins, Plant↗

Nuts, body weight and insulin resistance.

Traditionally, nuts have been considered a staple food, but because of their high energy and fat content are not considered good for body weight control or insulin sensitivity. Frequent consumption of nuts reduces the risk of coronary artery disease and type-2 diabetes and nut-enriched diets favourably alter blood lipids in normal and hypercholesterolemic individuals under controlled and free-living dietary conditions. However, whether or not frequent consumption of nuts can cause weight gain and impair insulin sensitivity is not fully understood. Review of the available data to date suggests that adding nuts to habitual diets of free-living individuals does not cause weight gain. In fact, nuts have a tendency to lower body weight and fat mass. In the context of calorie-restricted diets, adding nuts produces a more lasting and greater magnitude of weight loss among obese subjects while improving insulin sensitivity. Further studies are needed to clarify the effect of long-term (>/= year) consumption of nuts on body weight and their role in altering insulin sensitivity both in normal and type-2 diabetics. In the meantime, there is sufficient evidence to promote the inclusion of nuts as part of healthy diets.

Body Weight↗

Areca nut extracts reduce the intracellular reactive oxygen species and release of myeloperoxidase by human polymorphonuclear leukocytes.

BACKGROUND AND OBJECTIVE: Polymorphonuclear leukocytes (PMN) represent the first line of host defense. Areca nut extract inhibits the bactericidal activity of, and the release of superoxide anion (O2- ) by, PMN. This study investigated the effects of areca nut extract on the intracellular production of reactive oxygen species (ROS) and on the extracellular release of lysosomal enzyme, myeloperoxidase (MPO), by PMN. The effects of arecoline, a principal component of areca nut, were also examined. MATERIAL AND METHODS: Human PMN were treated with various concentrations of areca nut extract or arecoline followed by treatment with Hanks' balanced salt solution, with or without cytochalasin B and fMet-Leu-Phe (CB/fMLP). The viability of PMN was determined using propidium iodide staining and flow cytometry. The presence of intracellular ROS was determined using 2',7'-dichlorofluorescin diacetate and fluorometry. MPO release was determined using a substrate assay. RESULTS: Areca nut extract (25 and 50 microg/ml) significantly decreased the viability of PMN. The intracellular levels of ROS and the extracellular release of MPO were induced in PMN by CB/fMLP. Exposure of PMN to areca nut extract (up to 25 microg/ml) or to arecoline (up to 2 mg/ml) did not directly affect the levels of ROS and MPO activity. However, under conditions that did not affect the viability of PMN, the ability of CB/fMLP to trigger production of intracellular ROS and release of MPO in human PMN was significantly suppressed by areca nut extract and arecoline. CONCLUSION: Areca nut impaired the activation of PMN by CB/fMLP that might decrease the effectiveness of PMN in the host defense. Alternatively, exposure of PMN to areca nut extract could decrease the capacity of PMN to damage tissues.

Areca↗

Nut allergy in schoolchildren: a survey of schools in the Severn NHS Trust.

AIMS: To assess the extent of the problem of nut allergy in schoolchildren within the Severn NHS Trust. To determine how well informed schools are about the condition, their policies and attitudes, and the action that would be taken in the event of an acute reaction. METHODS: A questionnaire addressed to the head teacher was sent to 100 randomly selected mainstream schools in the Severn NHS Trust. RESULTS: Response rate was 83%. There were a total of 21 868 pupils in the schools. Forty five (54%) schools had at least one child currently known to be allergic. The total in all the schools was 87 (0.4%). Only 31 (36%) children had medication available in school. Of these, 18 (58%) had EpiPen alone. Twenty schools (44%) with an allergic child either had no staff trained to administer medication or did not respond to the question. Two (4%) schools with an allergic child had a support assistant for the pupils. Only 19 (43%) schools with a nut allergic child gave information to all teachers about nut allergy and only 21 (47%) gave information to dinner supervisors and other assistants. In only 23 (51%) schools with an allergic child were the cook and catering staff aware of all the children with a nut allergy. Ten (22%) schools with an allergic child served only "nut free dinners". Fourteen (31%) schools with a nut allergic child could not name a single sign of a mild acute allergic reaction (compared to 34 (89%) schools without an allergic child). Fifteen (33%) schools with an allergic child could not state a single sign of a severe acute allergic reaction (compared with 33 (87%) schools without a nut allergic child). CONCLUSION: Schools are not sufficiently well informed about nut allergy and management of acute allergic reactions. Policies and attitudes vary. We have revised the information given to schools regarding nut allergy and prepared a new information pack.

Anti-Allergic Agents↗

Allergy to Anacardiaceae: description of cashew and pistachio nut allergens.

Some members of the Anacardiaceae family, such as cashew nut, pistachio nut and mango, have been reported to cause immediate allergic reactions. We report three cases of anaphylaxis to cashew nuts. With the aim of describing the allergens existing in cashew and pistachio nuts, patients were prick tested with cashew and pistachio extracts. Specific IgE against both nuts was studied by CAP and SDS-PAGE/immunoblotting. It was found that skin tests and specific IgE to cashew and pistachio nuts were positive in the three patients. Both nuts showed several protein bands in SDS-PAGE. The strongest IgE-binding bands had similar molecular weights (15, 30 and 60 kDa) in cashew and pistachio nuts. These main bands were found to be sensitive to reducing agents. It was concluded that these three patients suffered immediate reactions to cashew nut due to an IgE-mediated mechanism.

Adult↗

[Oral allergy syndrome due to cashew nuts in the patient without pollinosis].

A 26-year-old woman felt tingling on her tongue and itching both in the throat and on the face immediately after she put a cashew nut on her tongue. She had a history of atopic dermatitis and bronchial asthma, but not of pollinosis. CAP-FEIA and skin prick test (SPT) were positive for cashew nuts. The results showed negative for peanuts and other tree nuts than cashew nuts. Consequently, she was diagnosed with oral allergy syndrome due to cashew nuts. In addition, the result of skin prick test with cashew nuts normalized one year after she began avoiding cashew nuts, indicating that cashew nuts allergy would be due to sensitization by itself rather than to cross-reactivity between cashew nuts and pollens in this case.

Adult↗

Acute toxicities of betel nut: rare but probably overlooked events.

BACKGROUND: Betel nut chewing has long been a social habit in Taiwan and other Asian and tropical countries. It produces various autonomic and psychoneurologic effects including tachycardia, flushing, warmth, cholinergic activation, alertness, and euphoria. Although the oral carcinogenic effects are well known, data concerning its acute toxicity are few. To better understand the toxicity of betel nut, cases reported to the Taiwan Poison Control Center as probable or possible betel nut-related toxicity (January 1988-June 1998) were reviewed. In the 17 cases suitable for review (14 males, 3 females, age 21 to 60 years), the most common manifestations were tachycardia/palpitations (7); tachypnea/dyspnea (6); hypotension and sweating (5); vomiting, dizziness, and chest discomfort (4); abdominal colic, nausea, numbness, and coma (3); and acute myocardial infarction and related manifestations (2). The reported quantity of betel nut used was low (1 to 6 nuts), except an extract of 100 betel nuts was used in 1 case and 66 chewed in another. Most cases recovered within 24 hours after the exposure. One patient developed probable acute myocardial infarction and ventricular fibrillation and died despite repeated cardiac defibrillation. Although betel nut chewing is widespread, significant toxicity as reported to a poison center is rare. Because most betel nut-related effects are transient and mild in nature, the incidence of such events is likely to be underreported. Nevertheless, betel nut chewing can produce significant cholinergic, neurological, cardiovascular, and gastrointestinal manifestations. It is possible that it may aggravate cardiac diseases in susceptible patients but this hypothesis must be further investigated. Treatment is symptomatic. With timely support, rapid and complete recovery is anticipated but a small risk of major complications cannot yet be discounted.

Adult↗

Prevalence and characteristics of areca nut chewers among junior high school students in Changhua county, Taiwan.

Some studies indicate that betel quid and its ingredients chewing can produce cell mutagenicity and tumorigenicity. In Taiwan studies, betel quid chewing is the main cause of submucous fibrosis and oral cancer. Understanding the distribution and characteristics of the areca nut chewing population is one of the first steps in the effort to prevent these oral diseases. A stratified cluster random sample of 2442 junior high school students in Changhua county, Taiwan, were surveyed for the habit of areca nut chewing. Significantly more male students chewed areca nut than female students (9.2% vs 0.9%). The proportion of students who were chewing areca nuts increased with increasing (seventh to ninth) grades. Areca nut was used by junior high school students at a higher rate in village (rural) areas as compared to town (semi-urban) and city (urban) areas (6.4%, 3.7% and 3.0%, respectively). More students in the ordinary achievement classes were chewing areca nuts than those in the high achievement classes (8.4% vs 1.6%). Areca nut chewing students tended to have users in their families. Cigarette smoking and alcohol drinking were positively associated with areca nut chewing. More than half (53.6%) of the areca nut chewing students first experimented with this habit with a family member, most often the father or grandfather.

Adolescent↗

The effect of areca nut on salivary and selected oral microorganisms.

The aim of this study was to investigate the effect on the growth of salivary and selected oral microorganisms of areca nut, aqueous extracts of the nut, its major alkaloid arecoline and the components tannic acid and catechin of its tannin fraction. The antibacterial properties of the above were tested on Streptococcus mutans, Streptococcus salivarius, Candida albicans and Fusobacterium nucleatum and, as a control, Staphylococcus aureus. This was followed by investigating its effect on salivary organisms cultured from the saliva after chewing boiled areca nut. Extracts inhibited the growth of the selected organisms in a concentration dependent manner, baked and boiled nuts being significantly more potent than raw nut. Growth of C. albicans was the least affected by the nut extracts. Tannic acid was strongly antibacterial but not catechin or arecoline. No antibacterial effect could be demonstrated on salivary organisms after chewing the nut for 5 minutes but exposure of saliva to the cud for 1 hour caused a significant depression of bacterial growth. It is concluded that the hydrolysable tannins in the tannin fraction, which include tannic acid, are responsible for the antibacterial properties of the nut and that prolonged intraoral exposure to the nut can suppress bacteria in the mouth.

Analysis of Variance↗