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The Adventist Health Study

Gary E. Fraser, MB, ChB, PhD, MPH, FRACP; Joan Sabate, MD, DrPH; W. Lawrence Beeson, MSPH; T. Martin Strahan, MBBS, DrPH, FRACP

Arch Intern Med. 1992;152(7):1416-1424.

Abstract
bkground.—
Although dietary factors are suspected to be important determinants of coronary heart disease (CHD) risk, the direct evidence is relative-lse.

Methods.—
The Adventist Health Study is a prospective cohort investigation of 31 208 non-Hispanic white California Seventh-Day Adventists. Extensive dietary information was obtained at baseline, along with the values of traditional coronary risk factors. These were related to risk of definite fatal CHD or definite nonfatal- dial infarction.

Results.—
Subjects who consumed nuts frequently (more than four times per week) experienced substantially fewer definite fatal CHD events (relative risk, 0.52; 95% confidence interval [CI], 0.36 to 0.76) and definite nonfatal myocardial infarctions (relative risk, 0.49; 95% CI, 0.28 to 0.85), when compared with those who consumed nuts less than once per week. These findings persisted on covariate adjustment and were seen in almost all of 16 different subgroups of the population. Subjects who usually consumed whole wheat bread also experienced lower rates of definite nonfatal myocardial infarction (relative risk, 0.56; 95% CI, 0.35 to 0.89) and definite fatal CHD (relative risk, 0.89; 95% CI, 0.60 to 1.33) when compared with those who usually ate white bread. Men who ate beef at least three times each week had a higher risk of definite fatal CHD (relative risk, 2.31; 95% CI, 1.11 to 4.78), but this effect was not seen in women or for the nonfatal myocardial infarction end point.

Conclusion.—
Our data strongly suggest that the frequent consumption of nuts may protect against risk of CHD events. The favorable fatty acid profile of many nuts is one possible explanation for such an effect.

(Arch Intern Med. 1992;152:1416-1424)

Author Affiliations
From the Center for Health Research, School of Public Health, Loma Linda (Calif) University. Dr Strahan is now with the Warburton Health Care Centre and Hospital, Donna Buang Road, Warburton, Vic, Australia. Dr Sabate was a research fellow of the American Heart Association, California Affiliate.

Footnotes
Accepted for publication November 5, 1991.

Reprint requests to Center for Health Research, School of Public Health, Nichol Hall, Loma Linda University, Loma Linda, CA 92350 (Dr Fraser).

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