Allergy to cashew nuts and peanuts

Anaphylaxis due to the ingestion of peanuts is a serious, common condition, known to both the general public and physicians. Recently, an increasing number ofpatients with an anaphylactic reaction after eating small amounts of cashew nuts have been reported. In three children, a boy aged 7 and two girls aged 9 and 10 years, respectively, with heterogeneous case histories involving allergic upper airway and conjunctival symptoms and constitutional eczema, allergy for cashew nuts was diagnosed in the first two and allergy for peanuts in the third. They were given dietary advice and an adrenaline auto-injector for emergencies. In most cases, a detailed food history, together with the demonstration of IgE against cashew nuts by means of serology or skin prick tests, are sufficient to establish the diagnosis. If the clinical relevance of a sensitisation to cashew nuts is unknown, a food provocation test may be necessary. The treatment consists of dietary intervention, and an adrenaline auto-injector is prescribed for a serious anaphylactic reaction. So far, three major allergens from the cashew nut (Anacardium occidentale) have been identified and purified.     

LTP Allergy Follow-Up Study: Development of Allergy to New Plant Foods 10 Years Later

Introduction: Allergy to nonspecific lipid transfer protein (nsLTP) is the main cause of plant-food allergy in Spain. nsLTPs are widely distributed in the plant kingdom and have high cross-reactivity but extremely variable clinical expression. Little is known about the natural evolution of this allergy, which complicates management. The objective of this study was to assess the development of allergy to new plant foods in nsLTP-sensitized patients 10 years after diagnosis. Methods: One hundred fifty-one patients showing specific IgE to nsLTP determined by ISAC (Thermofisher) were included. After clinical workup (i.e., anamnesis, skin test, and challenge when needed), these patients were divided into two groups: 113 patients allergic to one or more plant food (74.5%) and 38 patients not allergic to any plant food (25.1%). Ten years later, a telephone interview was conducted to check whether patients had developed additional allergic reactions to plant foods. Results: Ten years after diagnosis, 35 of the 113 (31%) plant-food-allergic patients sensitized to nsLTP reported reactions to new, previously tolerated plant foods, mainly Rosaceae/Prunoideae fruits and nuts followed by vegetables, Rosacea/Pomoideae fruits, legumes, and cereals. Five out of 38 (13.2%) patients previously sensitized to nsLTP but without allergy to any plant food had experienced allergic reactions to some plant food: two to Rosaceae/Prunoideae fruits, two to Rosaceae/Prunoideae fruit and nuts, and one to legumes. Conclusion: Patients sensitized to nsLTP developed allergic reactions to other plant foods, mainly Rosaceae-Prunoideae fruits and nuts. This was more frequent among plant-food-allergic patients than among those who had never had plant-food allergy.     

Food allergy: nuts and tree nuts

Nuts are a well-defined cause of food allergy, which affect approximately 1 % of the general population in the UK and the USA. There do appear to be differences in the frequency of nut allergy between different countries because of different dietary habits and cooking procedures. For example, in the USA and France, peanuts are one of the most frequent causes of food allergy, but in other countries, it seems to be less common. Genetic factors, in particular, appear to play a role in the development of peanut allergy. While the majority of nut allergens are seed storage proteins, other nut allergens are profilins and pathogenesis-related protein homologues, considered as panallergens because of their widespread distribution in plants. The presence of specific IgE antibodies to several nuts is a common clinical finding, but the clinical relevance of this cross-reactivity is usually limited. Allergic reactions to nuts appear to be particularly severe, sometimes even life-threatening, and fatal reactions following their ingestion have been documented. Food allergy is diagnosed by identifying an underlying immunological mechanism (i.e. allergic testing), and establishing a causal relationship between food ingestion and symptoms (i.e. oral challenges). In natural history investigations carried out in peanut-allergic children, approximately 20 % of the cases outgrew their allergy or developed oral tolerance. The treatment of nut allergies should include patient and family education about avoiding all presentations of the food and the potential for a severe reaction caused by accidental ingestion. Patients and families should be instructed how to recognise early symptoms of an allergic reaction and how to treat severe anaphylaxis promptly.     

Increased incidence of latex allergy in children with allergic diseases in Japan

The incidence of latex allergy is increasing in Japanese adults. However, the changing incidence of latex allergy in children with or without allergic diseases has not been reported in detail. After obtaining written informed consent from parents, Japanese children under 14 years of age were studied. In total, 776 non-atopic children, 802 children with allergic rhinitis (AR), 706 children with bronchial asthma (BA) and 844 children with atopic eczema/dermatitis syndrome (AEDS) were asked about symptoms of latex allergy, and tested by serum latex-specific IgE, skin prick test to latex allergen and latex-glove-wearing test between 2001 and 2003. All the patients were outpatients at Ujitakeda Hospital, while the non-atopic children were children of the staff of Ujitakeda Hospital or Unitika Ltd. This was a retrospective study. The incidence of latex allergy in 2001/2002/2003 was 1.4/3.1/4.7% in non-atopic children, 3.1/5.1/9.1% in AR patients, 3.6/6.5/10.3% in BA patients and 6.1/11.3/15.9% in AEDS patients, respectively. Moreover, although no cases of anaphylactic shock were noted in allergic patients in 2001, two and eight cases were noted in 2002 and 2003, respectively. These results indicate that the incidence of latex allergy is increasing in paediatric patients with allergic diseases. A latex-reduced environment may be desirable in future.     

Usefulness of a questionnaire and RAST in screening of health care workers allergic to latex

BACKGROUND: The prevalence of latex mediated IgE allergy in health care workers varies, according to the various studies, from 0.5% to 16. 7%. The onset of latex allergy involves aspects concerning the worker's health, the need for job transfer and possible retraining. In any case, the use of latex gloves in health care environments cannot be discarded, since they offer more efficacious protection from biological agents, compared to gloves of different materials. OBJECTIVES: Our objectives were to verify the prevalence of latex allergy in a sample of 515 health care workers and evaluate the usefulness of RAST and a questionnaire especially organized to identify potentially allergic subjects, at the same time limiting the number of false positive and false negative results. METHODS: 515 health care workers of the ASUR Zone7-Ancona local health unit accepted to answer to a questionnaire and to undergo a RAST testfor latex. Those with positive responses to the questionnaire or to RAST were later invited to undergo further allergological tests (prick and prick by prick). The questionnaire was revised according to the results obtained, thus increasing its positive predictiveness. RESULTS: Prevalence of latex allergy in our sample was 1, 7%, positive predictiveness of RAST was rather low (31.3%), but increased considerably if combined with the modified questionnaire (62.5%). The Prick by Prick test gave more specific results than the Prick test. CONCLUSIONS: The proposed questionnaire can reduce the number of false positive workers needing to undergo further allergological tests and may be usefully applied in the screening of latex mediated IgE allergy in health care workers.     

儿童食物皮肤点刺试验结果分析与过敏控制

目的:分析皮肤点刺试验(skin prick test,SPT)阳性结果,指导家长在喂养过程中控制由食物引起的过敏反应。方法:随机收集2009年6月～2010年10月在南京市妇幼保健院儿保门诊接受健康体检的6个月～2岁儿童195例(排除各种急性期疾病及中、重度湿疹),进行牛奶、鸡蛋、鱼、虾、小麦5种常见食物的SPT,对其阳性结果进行分析。结果:轻微湿疹儿童对食物过敏的有50.75%,正常儿童对食物过敏的有11.47%,轻微湿疹患儿食物过敏发生率高于正常儿童,两者有显著差异(P<0.05)。不同食物过敏原阳性率在各月龄组儿童均表现为鸡蛋>虾>鱼>牛奶>小麦,且随着年龄增长食物过敏阳性率有降低趋势。结论:食物过敏在儿童中发生率较高,尤其是患有轻微湿疹的儿童,根据儿童过敏的特点,应早期避免接触食物过敏原,在辅食添加的过程中逐一添加、循序渐进,从而有效控制食物过敏的发生。     

常见变应性疾病吸入性变应原检测结果分析

目的研究沧州地区吸入性变应原在变应性疾病分布等方面的特点,为治疗和预防提供依据。方法 对2009-2010年诊断为慢性荨麻疹、变应性鼻炎、哮喘、变应性结膜炎患者共302例和对照组43例进行了18种吸入性变应原的皮肤点刺试验,对检测结果进行分析。结果 302例变应性疾病患者中192例变应原呈阳性反应,阳性率63.6%,变应原皮肤点刺试验阳性率前4位的变应原依次是尘螨、尘土、蒿属花粉、黑曲霉;慢性荨麻疹患者的变应原阳性率为42.9%低于变应性鼻炎、哮喘、变应性结膜炎患者的阳性率71.7%、79.6%、70.3%;儿童组变应原阳性率70.6%高于成人组60.0%。结论 尘螨、尘土、蒿属花粉是沧州地区主要变应原;对于慢性荨麻疹患者应注意变应原以外的其他原因;随年龄的增长变应原阳性率降低。     

Nut consumption has favorable effects on lipid profiles of Korean women with metabolic syndrome

Nut consumption has been studied for its cardioprotective effects. However, the findings of clinical intervention studies are inconsistent; and no intervention studies have been conducted in the Korean population. We hypothesized that nut supplementation may have favorable influence on metabolic markers. Therefore, this study aimed to investigate the effects of nut consumption on metabolic parameters and biomarkers related to inflammation, oxidative stress, and endothelial function in Korean adults with metabolic syndrome. To this end, we designed a randomized, parallel, controlled dietary intervention study (ClinicalTrials.gov NCT02023749). Subjects with metabolic syndrome and a body mass index of at least 23 kg/m² were randomized to the Control group and the Nut group, which received supplementation with 30 g/d of mixed nuts (walnuts, peanuts, and pine nuts) for 6 weeks. Sixty volunteers were included in the final analysis. Metabolic markers were evaluated at baseline and at the end of the study. Total cholesterol and non–high-density lipoprotein cholesterol levels significantly improved in the Nut group compared to those in the Control group (P = .023 and P = .016, respectively) in women. Biomarkers related to inflammation, oxidative stress, and endothelial function did not significantly change from baseline in either group. Thus, supplementing a usual diet with mixed nuts for 6 weeks had favorable effects on several lipid parameters in Korean women with metabolic syndrome. These findings present a possible mechanism for the cardioprotective effects of nut consumption.     

海口地区1 496例过敏性疾病儿童过敏原皮肤点刺 结果分析

摘要:目的　了解海口地区过敏性疾病儿童常见过敏原分布情况,探讨有效避免过敏原的方法。方法　采用阿罗格过敏原点刺试剂盒,包括6种吸入性过敏原与13种食物过敏原液,对1496例患儿进行19种常见过敏原皮肤点刺实验。结果　1496例儿童中阳性例数有1240例,阳性率达82.9%,吸入性过敏原中,阳性率前3位分别为粉尘螨（51.7%）、户尘螨（51.0%）及蟑螂（26.3%）;其次是蒿属花粉（24.9%）、猫毛（20.2%）,食物过敏原中阳性率前3位分别为鸡蛋黄（26.8%）、黄鳝（25.2%）及牛肉（21.3%）;其次是海虾（20.7%）、扇贝（20.7%）等。在吸入性过敏原中,粉尘螨、户尘螨、蟑螂及狗毛在3个年龄段的反应强度差异有统计学意义,粉尘螨、户尘螨反应强度在年龄组间两两比较皆差异有统计学意义,学龄期组蟑螂反应强度与其他年龄组比较差异有统计学意义。食物过敏原中,牛奶、牛肉、鸡蛋、海虾、海蟹、芒果及扇贝在3个年龄段的反应强度差异有统计学意义,婴幼儿组牛奶、鸡蛋及海蟹反应强度与其他年龄组比较差异有统计学意义,学龄期组扇贝反应强度与其他年龄组比较差异有统计学意义。结论　粉尘螨、户尘螨是海口地区儿童重要吸入性过敏原,鸡蛋为主要食物过敏原。早期对儿童进行过敏原筛查,采取有效预防措施,可减少儿童过敏性疾病发生。     

In Vivo and In Vitro Assessment and Proteomic Analysis of the Effectiveness of Physical Treatments in Reducing Allergenicity of Hazelnut Proteins

Hazelnut is a widespread nut species, especially present in Europe, that can be consumed raw or roasted thanks to its pleasant taste and nutritional properties. In addition to renowned beneficial properties hazelnuts contain several proteins capable of inducing food allergy in sensitized individuals, including Cor a 2 (a profilin), Cor a 8 (a lipid transfer protein), Cor a 9 (an 11S seed storage globulin, legumin-like), and Cor a 11 (a 7S seed storage globulin, vicilin-like). In the present paper we investigated the effectiveness of autoclave-based treatments in decreasing the allergic potential of hazelnut as assessed by submitting the treated material to an in vivo skin prick test and an in vitro immunoblot analysis, with sera of allergic individuals exposed to the treated food material. This preliminary analysis showed that autoclave treatment preceded by hydration and/or followed by drying seems to be a promising approach and appears to be effective in reducing the allergenicity of hazelnuts in most patients, probably due to the denaturation of most major and minor allergenic proteins. This work opens up the opportunity to produce hypoallergenic hazelnut derivatives that can be tolerated by allergic subjects.     

中小学生坚果摄入行为及其与肥胖的关联

目的 探讨我国中、小学生坚果摄入现状及其与肥胖发生的关联。方法 2012年11月,采用方便样本整群抽样的方法选取北京、湖南、宁夏3个省市的城市和农村中、小学校19所,使用自填式结构问卷收集学生过去一周食用坚果的情况(一周几把)。通过学校体检记录和现场测量两种方式获得身高、体重数据,采用生物电阻抗体成分测量仪MC-980(TANITA,中国广州东莞百利达健康器材有限公司生产)测量部分超重肥胖儿童的体脂肪率。采用多因素Logistic回归方法,在控制地区、城乡、性别、年级、父母受教育程度和家庭经济情况等因素的影响后,分析坚果摄入行为与肥胖发生的关系。结果 4 164名9~18岁儿童少年提供合格问卷。平均年龄(13.2±2.4)岁,平均体质指数(body mass index,BMI)(21.0±4.5)kg/m²。超重肥胖者占36.3%,超重肥胖儿童平均体脂率(fat%):(35.2±7.8)%。过去一周吃过坚果的比例为70.3%。儿童过去一周没吃坚果者超重肥胖发生率明显高于吃坚果者(P<0.05),而每天吃坚果的多少与肥胖发生率未见明显剂量-反应关系(P>0.05)。Logistic多元回归分析结果发现:每天摄入坚果1把及以上,发生超重肥胖的危险性是过去一周没吃坚果学生的0.75倍(95%CI:0.61～0.92)。结论 不吃坚果是儿童少年发生超重肥胖的独立危险因素。     

Health benefits of nut consumption

Nuts (tree nuts and peanuts) are nutrient dense foods with complex matrices rich in unsaturated fatty and other bioactive compounds: high-quality vegetable protein, fiber, minerals, tocopherols, phytosterols, and phenolic compounds. By virtue of their unique composition, nuts are likely to beneficially impact health outcomes. Epidemiologic studies have associated nut consumption with a reduced incidence of coronary heart disease and gallstones in both genders and diabetes in women. Limited evidence also suggests beneficial effects on hypertension, cancer, and inflammation. Interventional studies consistently show that nut intake has a cholesterol-lowering effect, even in the context of healthy diets, and there is emerging evidence of beneficial effects on oxidative stress, inflammation, and vascular reactivity. Blood pressure, visceral adiposity and the metabolic syndrome also appear to be positively influenced by nut consumption. Thus it is clear that nuts have a beneficial impact on many cardiovascular risk factors. Contrary to expectations, epidemiologic studies and clinical trials suggest that regular nut consumption is unlikely to contribute to obesity and may even help in weight loss. Safety concerns are limited to the infrequent occurrence of nut allergy in children. In conclusion, nuts are nutrient rich foods with wide-ranging cardiovascular and metabolic benefits, which can be readily incorporated into healthy diets.     

儿童过敏性疾病过敏原检测阳性结果分析及护理管理

目的 分析265例儿童过敏性疾病患儿过敏原阳性反应结果分布情况,为防治该种疾病提供依据.方法 采用皮肤点刺试验对265例过敏性疾病患儿（其中过敏性鼻炎158例和哮喘107例）进行过敏原皮肤点刺试验.结果 在265例过敏性疾病患儿过敏原结果阳性反应中,发现吸入性过敏原显著高于食入性过敏原.吸入性过敏原主要为粉尘螨和屋尘螨,粉尘螨阳性反应为255例,占81.2％;屋尘螨阳性反应为235例,占74 8％;其次为蟑螂46例,占14.6％;海虾和海蟹过敏原为食入性过敏原,阳性反应分别为30例和28例,分别占9.5％和8.9％.结论 认为过敏原检测能为过敏性疾病的预防、诊断和治疗提供依据.     

Perceptions of Nut Consumption amongst Australian Nutrition and Health Professionals: An Online Survey

Habitual nut consumption is associated with reduced risk of chronic diseases; however, consumption levels in Australia are below recommendations. This study examined perceptions and knowledge regarding nut consumption among Australian healthcare professionals and their provision of nut consumption recommendations. A cross-sectional online survey of Australian health professionals was conducted in February–April 2020. Questions in the survey included demographic details, participants’ perceptions of nut consumption, and nut consumption recommendations they may make to clients and patients. A total of 204 health professionals completed the survey, of which 84% were dietitians or nutritionists. Health professionals demonstrated basic nutritional knowledge regarding nut consumption; however, non-dietitians/nutritionists lacked knowledge of long-term benefits of nut consumption. Dietitians/nutritionists were more likely to agree that nuts are healthy and do not cause weight gain when compared to non-dietitians/nutritionists (p = 0.021). A total of 63% of health professionals advised at least some of their clients to eat more nuts, and this was higher among dietitians/nutritionists (68%) than non-dietitians/nutritionists (31%). While basic nutritional knowledge regarding nut consumption was observed among all health professionals, there is scope for further education, particularly for non-dietitians/nutritionists, to ensure that nutrition information provided to patients and clients is accurate and reflects the current evidence base.     

潍坊地区过敏性鼻炎和支气管哮喘患儿过敏原检测结果分析

目的 了解潍坊地区过敏性鼻炎、支气管哮喘患儿的主要过敏原,为过敏性疾病的预防及诊治提供参考。方法 对234例患儿(71例过敏性鼻炎、84例支气管哮喘、46例过敏性鼻炎合并支气管哮喘)进行皮肤点刺试验(SPT),并对试验结果进行统计学分析。结果 234例被检测患儿中阳性201例(85.90%)。最常见的两种过敏原为屋尘螨和粉尘螨,分别占总阳性例数的79.10%、77.11%;其余依次为带鱼(17.91%)、狗上皮(17.41%)、海虾(16.92%)、牛奶(13.43%)、青霉菌(12.44%)等;吸入性过敏原组SPT阳性率显著高于食物类过敏原组(P＜0.001);过敏性鼻炎、支气管哮喘、过敏性鼻炎合并支气管哮喘三组,SPT阳性率分别为88.75%、86.60%、80.70%,且三组间SPT阳性率差异均无统计学意义(P＞0.05)。结论 屋尘螨、粉尘螨是潍坊地区最常见的过敏原;随年龄的增长吸入性过敏原皮肤点刺的阳性率有增高趋势,食物类过敏原阳性率随年龄的增长而减少;吸入性过敏原是儿童过敏性鼻炎和支气管哮喘最常见的诱发因素。     

哈尔滨市香坊区学龄儿童牛乳蛋白过敏状况调查

目的了解儿童牛乳蛋白过敏(cowmilk protein allergy,CMPA)现状,为CMPA的防治和致敏食物的监管提供科学依据。方法以自编问卷、皮肤点刺试验、德国敏筛试纸实验作为初步诊断依据,对哈尔滨市5840名6～10岁学龄儿童进行筛查,分析牛乳蛋白过敏的影响因素。结果在有效答卷5720份中,自诉牛乳蛋白过敏的学生196例,其中47例皮肤点刺实验、德国敏筛试纸均呈阳性,CMPA发生率为0.82%。牛乳蛋白过敏多为皮疹,其次为胃肠过敏。除对牛乳蛋白过敏外,同时也对其他食物过敏。喂养方式、其他食物过敏情况、父母过敏情况是CMPA发生的影响因素。结论应采取母乳喂养、推荐食用低致敏婴儿配方粉等综合措施预防和治疗CMPA。     

Association of Nut Consumption with Cardiometabolic Risk Factors in the 2008/2009 New Zealand Adult Nutrition Survey

Nut consumption has been associated with improvements in risk factors for chronic disease in populations within North America, Europe and Iran. This relationship has not been investigated in New Zealand (NZ). The associations between nut consumption and cardiometabolic risk factors among New Zealanders were examined. Data from the 24-h diet recalls of 4721 participants from the NZ Adult Nutrition Survey 2008/2009 (2008/2009 NZANS) were used to determine whole and total nut intake. Anthropometric data and blood pressure were collected, as well as blood samples analysed for total cholesterol (total-C) and HDL cholesterol (HDL-C), glycated haemoglobin (HbA1c), C-reactive protein (CRP) and folate. Participants were classified according to their five-year cardiovascular disease (CVD) risk. Both whole and total nut consumers had significantly lower weight, body mass index (BMI), waist circumference and central adiposity than non-nut consumers (all p ≤ 0.044). Whole blood, serum and red blood cell folate concentrations were significantly higher among whole nut consumers compared to non-whole nut consumers (all p ≤ 0.014), with only serum folate higher in total nut consumers compared to non-total nut consumers (p = 0.023). There were no significant differences for blood pressure, total-C, HDL-C and HbA1c; however, significant negative associations between total nut consumption and CVD risk category (p < 0.001) and CRP (p = 0.045) were apparent. Nut consumption was associated with more favourable body composition and a number of risk factors, which could collectively reduce chronic disease.     

New guidelines for managing cow's milk allergy in infants

The prevalence of allergic disease has increased markedly over the last 50 years. Food allergy usually manifests in early childhood as part of the so-called atopic march and most commonly includes one or more of the following foods: cow's milk, hen's egg, soy, peanuts and tree nuts, wheat, sesame seed, kiwi fruit and seafood. In the UK about 2% of infants develop cow's milk protein allergy (CMPA), but as many as 15% of infants present with symptoms suggestive of an adverse reaction to cow's milk protein. The diagnosis of CMPA is based on one or more of the following: a detailed clinical history, allergy test results (skin prick testing [SPT] and/or specific immunoglobulin E [IgE]) and, if required, supervised incremental milk challenges. The majority of UK primary care centres do not have access to these tests and may also be unfamiliar with the interpretation or results. In addition, they do not have the facilities for supervised food challenges. Empirical treatment is often required pending confirmation of allergy or referral to a specialist centre, but requires clear guidelines. No consensus guidelines currently exist for the diagnosis and management of CMPA in the UK. An international task force has recently published proposed guidelines for the management of CMPA. These provide separate algorithms covering the diagnosis and management of CMPA for both breast-fed and formula-fed infants and discuss the use of hypoallergenic formulae, elimination diets and diagnostic tests. Revisions and adaptations for the UK market are required and are discussed in this article.     

Nut consumption and risk of heart failure in the Physicians' Health Study I

BACKGROUND: Heart failure is highly prevalent among older adults and is associated with high cost and societal burden. Although previous studies have reported beneficial effects of dietary factors on heart failure predictors, no previous study has examined whether frequent consumption of nuts is associated with a lower risk of heart failure in a large prospective cohort. OBJECTIVE: We examined the association between nut consumption and incident heart failure to determine whether such a relation is modified by overweight or obesity. DESIGN: This was a prospective cohort study of 20,976 participants from the Physicians' Health Study I. Nut consumption was assessed with a simple abbreviated food questionnaire, and self-reported heart failure was ascertained by follow-up questionnaires. We used Cox regression to estimate relative risks of heart failure. RESULTS: After an average follow-up of 19.6 y, 1,093 new cases of heart failure occurred. Nut consumption was not associated with the risk of developing heart failure in this cohort: multivariable adjusted hazard ratios were 1.0 (reference), 0.98 (95% CI: 0.83, 1.15), 1.06 (95% CI: 0.89, 1.27), and 1.01 (95% CI: 0.84, 1.22) for nut consumption of <1, 1, and > or =2 servings/wk, respectively (P for linear trend: 0.64). The lack of a meaningful relation between nut intake and incident heart failure was seen in both lean and overweight or obese participants (P for interaction: 0.96). CONCLUSION: Our data do not provide evidence for an association between nut consumption and incident heart failure in US male physicians. However, our data cannot rule out possible benefits of nut consumption on subtypes of heart failure not prevalent in this cohort.     

Nuts: Natural Pleiotropic Nutraceuticals

Common nuts (tree nuts and peanuts) are energy-dense foods that nature has gifted with a complex matrix of beneficial nutrients and bioactives, including monounsaturated and polyunsaturated fatty acids, high-quality protein, fiber, non-sodium minerals, tocopherols, phytosterols, and antioxidant phenolics. These nut components synergize to favorably influence metabolic and vascular physiology pathways, ameliorate cardiovascular risk factors and improve cardiovascular prognosis. There is increasing evidence that nuts positively impact myriad other health outcomes as well. Nut consumption is correlated with lower cancer incidence and cancer mortality, and decreased all-cause mortality. Favorable effects on cognitive function and depression have also been reported. Randomized controlled trials consistently show nuts have a cholesterol-lowering effect. Nut consumption also confers modest improvements on glycemic control, blood pressure (BP), endothelial function, and inflammation. Although nuts are energy-dense foods, they do not predispose to obesity, and in fact may even help in weight loss. Tree nuts and peanuts, but not peanut butter, generally produce similar positive effects on outcomes. First level evidence from the PREDIMED trial shows that, in the context of a Mediterranean diet, consumption of 30 g/d of nuts (walnuts, almonds, and hazelnuts) significantly lowered the risk of a composite endpoint of major adverse cardiovascular events (myocardial infarction, stroke, and death from cardiovascular disease) by ≈30% after intervention for 5 y. Impressively, the nut-supplemented diet reduced stroke risk by 45%. As they are rich in salutary bioactive compounds and beneficially impact various health outcomes, nuts can be considered natural pleiotropic nutraceuticals.