(OR03-05-26) Total and Specific Nut Intake, Risk of Type 2 Diabetes, and Substitution Analyses: Results From Three US Cohort Studies

Saturday, July 25, 2026

9:06 AM - 9:18 AM ET

Location: National Harbor 10-11

Emerging Leaders in Nutrition Science Poster Competition

Student Interest Group (SIG) Three-Minute Thesis (3MT) Competition

Presenting Author(s)

QZ

Qianyan Zheng, MS

Graduate student
Harvard T.H. Chan School of Public Health
Newton, Massachusetts, United States

Disclosure information not submitted.

Co-Author(s)

TX

Tong Xia

Brigham and Women’s Hospital and Harvard Medical School, Harvard T. H. Chan School of Public Health, United States
Frank B. Hu, MD, MPH, PhD (he/him/his)

Chair, Department of Nutrition; Fredrick J. Stare Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
WW

Walter Willett, PhD

Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
QS

Qi Sun

Harvard T.H. Chan School of Public Health, Brigham and Women's Hospital and Harvard Medical School, United States
JM

JoAnn E. Manson, MD MPH DrPH

Brigham and Women's Hospital and Harvard Medical School; Harvard T.H. Chan School of Public Health
Boston, Massachusetts, United States
DH

Danielle E. Haslam

Brigham and Women’s Hospital and Harvard Medical School, Harvard T. H. Chan School of Public Health, United States
MG

Marta Guasch-Ferre

Harvard T.H. Chan School of Public Health, University of Copenhagen, United States
SB

Shilpa N. Bhupathiraju

Brigham and Women’s Hospital and Harvard Medical School, Harvard T. H. Chan School of Public Health, United States

Disclosure(s):

Frank B. Hu, MD, MPH, PhD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To examine the associations of total and specific nut intake with type 2 diabetes (T2D) risk and to estimate the effect of replacing less healthful foods (e.g., refined grains, red meat, processed meat, French fries, and chips) with nuts on T2D risk.

Methods: This prospective cohort study included participants from the Nurses’ Health Study (NHS, 1984-2020), NHS II (1991-2021), and Health Professionals Follow-up Study (HPFS, 1986-2018). Cumulative nut intake was assessed using validated repeated semiquantitative food frequency questionnaires. Self-reported T2D was confirmed by a validated supplemental questionnaire. We used time-varying multivariable Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: The analytical sample included 73,148 women from NHS (mean [SD] baseline age: 50.2 [7.2] y), 90,410 women from NHS II (36.1 [4.7] y), and 42,163 men from HPFS (53.0 [9.5] y). Over 5,190,719 person-years of follow-up, we documented 22,477 incident T2D cases. In multivariable-adjusted models without body mass index (BMI), higher intakes of total nuts, peanut butter, total tree nuts, and walnuts were inversely associated with T2D risk. For each 3-servings/week increment, HRs (95% CIs) were 0.93 (0.90, 0.95) for total nuts, 0.90 (0.86, 0.95) for peanut butter, 0.88 (0.84, 0.93) for total tree nuts, and 0.92 (0.85, 0.99) for walnuts. Peanuts were not significantly associated with T2D risk. Additional adjustment for updated BMI attenuated most associations to null, except for peanut butter (0.93 [0.89, 0.98]). Replacing three servings/week of red meat, processed meat, or French fries with total nuts or specific nut types was consistently associated with lower T2D risk (pooled HRs 0.61–0.92). Additional adjustment with BMI attenuated these associations, although replacing French fries with nuts (pooled HRs 0.79–0.87), and red meat with several nut types (pooled HRs 0.90–0.95) remained associated with T2D risk.

Conclusions: Higher nut intake was associated with lower T2D risk, an association largely explained by BMI. Replacing red meat, processed meat, and French fries with nuts was associated with lower T2D risk, underscoring nut-based substitutions as a concrete, actionable strategy for T2D prevention.

Funding Sources: NIH