Tree nut consumption and its association with health outcomes among adults in the national health and nutrition examination survey

Tree nuts are nutrient dense, and their consumption has been associated with improvements in health outcomes. This dissertation includes two separate studies. The first study estimated the prevalence of cardiovascular disease (CVD) risk factors, cardiometabolic (CM) risk factors, and cardiovascular health metrics (CVHMs) among US adults and across race and ethnic groups. The most prevalent health risk factors in the overall sample were hypertension (45%), obesity (40%), and fasting plasma glucose ≥100 mg/dL or hypoglycemic medication use (51%). The most prevalent health behavior and factors in the overall sample were ideal physical activity (59%) and ideal smoking status (57%). Mexican Americans and non-Hispanic Blacks had elevated risk for some, but not all, CVD and CM risk factors compared to non-Hispanic Whites and non-Hispanic Asians. The second study estimated usual intake of tree nuts and examined the association between tree nut consumption and health outcomes among US adults. Approximately 8% of participants (n=1238) reported consuming at least ¼ oz/d (7.09 g) of tree nuts and had a mean usual intake of 39.5 ± 1.8 g/d (SE). Mexican Americans (33.6 ± 4.4 g/d) and other Hispanics (32.5 ± 5.2g/d) mean usual intake of tree nuts was less compared to non-Hispanic Blacks (48.2 ± 3.1 g/d). CVD and CM risk factors prevalence and means were lower among tree nut consumers than non-consumers. Tree nut consumers were less likely to have obesity (31% vs. 40%, P <.001) and reduced high-density lipoprotein (22% vs. 30%, P <.001), and a lower mean waist circumference (97.1 ± 0.7 vs. 100.5 ± 0.3 cm, P <.001) and apolipoprotein B (87.5 ± 1.2 vs. 91.8 ± 0.5 mg/dL, P = .004) than non-consumers. While most US adults do not consume tree nuts, modest consumption was associated with decreased prevalence of CVD and CM risk factors and better for some health outcome measures. Inclusion of tree nuts as part of a healthy diet offers an approach to further reduce health disparities and persisting differences among racial and ethnic groups which is vital to achieving the American Heart Association vision of all people having ideal cardiovascular health, living healthier and longer.