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Nutrients 2017, 9(12), 1355; https://doi.org/10.3390/nu9121355

Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B1 Exposure

1
National Food Agency, Box 622, 751 26 Uppsala, Sweden
2
Institute of Environmental Medicine (IMM), Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden
3
Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
*
Author to whom correspondence should be addressed.
Received: 31 October 2017 / Revised: 24 November 2017 / Accepted: 4 December 2017 / Published: 13 December 2017
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Abstract

Nuts are rich in nutrients and mounting evidence shows that consumption reduces cardiovascular disease (CVD) incidence. Nuts may also be a major source of aflatoxin B1, a potent liver carcinogen and the risk/benefit balance is unknown. Based on national statistics and data from the PREDIMED intervention trial, we estimated the potential CVD-reduction if Swedes aged 55–79 consumed 30 g nuts/day, instead of the current national average of five grams per day. We also assessed the reduction in disability-adjusted life years (DALYs) due to myocardial infarction (MI) and stroke. We estimated the aflatoxin B1 exposure from nuts and calculated the margin of exposure. The approximation that one nanogram aflatoxin B1/kg body weight/day results in one additional liver cancer case/10 million person-years was used to estimate the number of liver cancer cases. The increased nut consumption scenario prevented more than 7000 CVDs in 2013 (306/100,000 person-years) and contributed to about 55,000 saved DALYs for stroke and 22,000 for MI. The concomitant increase in aflatoxin B1 exposure caused an estimated zero to three additional cases of liver cancer, corresponding to 159 DALYs spent, emphasizing the associated risks. Increased nut consumption, as part of a varied healthy diet, is warranted even when aflatoxin B1 exposure is taken into account. However, efforts to reduce aflatoxin exposure from food are essential. View Full-Text
Keywords: nuts; healthy diet; risk-and benefit assessment; cardiovascular disease; myocardial infarction; stroke; aflatoxin; liver cancer; disability-adjusted life years nuts; healthy diet; risk-and benefit assessment; cardiovascular disease; myocardial infarction; stroke; aflatoxin; liver cancer; disability-adjusted life years
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Eneroth, H.; Wallin, S.; Leander, K.; Nilsson Sommar, J.; Åkesson, A. Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B1 Exposure. Nutrients 2017, 9, 1355.

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