Results:

A total of 16,217 men and women with diabetes at baseline or diagnosed during follow-up were included. Compared with participants who consumed total nuts <1 serving/month, those who consumed nuts were more likely to be older; had a lower body mass index, and higher level of physical activity; were less likely to smoke; more likely to use aspirin and lipid-lowering medication; and had a higher consumption of total energy, alcohol, fruits, and vegetables. During 223,682 and 254,923 person-years of follow-up, there were 3,336 incident CVD cases and 5,682 deaths.

Higher total nut consumption was associated with a lower risk of CVD incidence and mortality. After adjustment for potential confounders, participants who consumed ≥5 servings of total nuts per week (1 serving = 28 g), compared with those who consumed <1 serving per month, had a significantly lower incidence of total CVD (hazard ratio [HR], 0.83; 95% confidence interval [CI], 0.71-0.98; p trend = 0.01). A similar pattern was noted for coronary heart disease (CHD) incidence (HR, 0.80; 95% CI, 0.67-0.96; p trend = 0.005), CVD mortality (HR, 0.66; 95% CI, 0.52-0.84; p trend < 0.001), and for all-cause mortality (HR, 0.69; 95% CI, 0.61-0.77; p trend < 0.001). Total nut consumption was not significantly associated with risk of stroke incidence or cancer mortality. Higher tree nut consumption was associated with lower risk of total CVD, CHD incidence, and mortality due to CVD, cancer, and all causes, while peanut consumption was associated with lower all-cause mortality only (all p trend < 0.001). Participants who increased consumption of total nuts after being diagnosed with diabetes had an 11% lower risk of CVD, a 15% lower CHD risk, a 25% lower CVD mortality, and a 27% lower all-cause mortality compared to those participants who did not change their consumption of total nut consumption.