Nut consumption and the risk of hypertension: a systematic review and dose response meta-analysis of prospective studies
Author(s)
Metoudi, Michael
Sadler, Isabelle
Kassam, Shireen
Aune, Dagfinn
Type
Journal Article
Abstract
Background: Previous studies have suggested that a high intake of nuts may reduce the risk of hypertension, however, the available data have been limited. Several additional studies have recently been published on the topic. We therefore conducted a systematic review and meta-analysis of cohort studies on nut consumption and hypertension to provide an updated assessment of the evidence.
Methods: PubMed and Embase databases were searched up to 4th April 2026 for prospective cohort studies with adjusted relative risk estimates published in the English language on the association between nut consumption and hypertension risk. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between nut consumption and hypertension. We used World Cancer Research Fund (WCRF) criteria to assess the strength of the evidence.
Results: Eight studies (20,665 cases, 143,380 participants) were included in the meta-analysis. The summary RR for the highest vs. lowest category of nut intake was 0.84 (95% CI: 0.77-0.91, I2=50%, pheterogeneity=0.05, n=8) and per 28 g/d was 0.80 (95% CI: 0.71-0.89, I2=75%, pheterogeneity<0.0001, n=8). There was no indication of publication bias with Begg's test (p=0.71) or Egger's test (p=0.10) or by visual inspection of the funnel plot. There was some indication of nonlinearity (pnonlinearity=0.07) and there was a 26% reduction in risk when comparing 30g/d vs. 0 g/d. Using WCRF criteria to assess the strength of evidence, we graded the likelihood of causality as probable.
Conclusion: In this meta-analysis of prospective cohort studies, we found further evidence for a reduced risk of hypertension with higher intake of nuts. These findings support dietary guideline recommendations to include a serving of nuts per day.
Methods: PubMed and Embase databases were searched up to 4th April 2026 for prospective cohort studies with adjusted relative risk estimates published in the English language on the association between nut consumption and hypertension risk. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between nut consumption and hypertension. We used World Cancer Research Fund (WCRF) criteria to assess the strength of the evidence.
Results: Eight studies (20,665 cases, 143,380 participants) were included in the meta-analysis. The summary RR for the highest vs. lowest category of nut intake was 0.84 (95% CI: 0.77-0.91, I2=50%, pheterogeneity=0.05, n=8) and per 28 g/d was 0.80 (95% CI: 0.71-0.89, I2=75%, pheterogeneity<0.0001, n=8). There was no indication of publication bias with Begg's test (p=0.71) or Egger's test (p=0.10) or by visual inspection of the funnel plot. There was some indication of nonlinearity (pnonlinearity=0.07) and there was a 26% reduction in risk when comparing 30g/d vs. 0 g/d. Using WCRF criteria to assess the strength of evidence, we graded the likelihood of causality as probable.
Conclusion: In this meta-analysis of prospective cohort studies, we found further evidence for a reduced risk of hypertension with higher intake of nuts. These findings support dietary guideline recommendations to include a serving of nuts per day.
Date Acceptance
2026-07-17
Citation
British Journal of Nutrition
ISSN
0007-1145
Publisher
Cambridge University Press
Journal / Book Title
British Journal of Nutrition
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
License URL
Publication Status
Accepted