Background: Nut consumption has been associated with improved nutrient adequacy and
diet quality in healthy adult populations but this association has never been explored in individuals
at high cardiovascular risk. Objective: to assess the associations between consumption of nuts and
nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk. Design:
baseline assessment of nutritional adequacy in participants (n = 6060, men and women, with ages
55–75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary
cardiovascular prevention randomized trial. Methods: nut intake was assessed using a validated
food frequency questionnaire. Participants who reported consuming zero quantity of nuts were
classified as ‘non-nut consumers’. ‘Nut consumers’ were participants who reported consuming any
quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and
folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was
estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet
quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet
score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI). Results: eighty-two
percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile
range: 6.0–25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D,
E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely
to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of
inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence
to the Mediterranean diet (Mediterranean diet score, MDS). Conclusions: nut consumers had better
nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of
the Spanish government, ISCIII through the Fondo de Investigación para la Salud (FIS), which is co-funded
by the European Regional Development Fund (four coordinated FIS projects led by Jordi Salas-Salvadó and
Josep Vidal, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462,
PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696,
PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347,
PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926), the Especial
Action Project entitled: Implementación y evaluación de una intervención intensive sobre la actividad física
Cohorte PREDIMED-PLUS grant to Jordi Salas-Salvadó, the European Research Council (Advanced Research
Grant 2013–2018; 340918) grant to Miguel Ángel Martínez–Gonzalez, the Recercaixa grant to Jordi Salas–Salvadó
(2013ACUP00194), the grant from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016),
the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant, and CIBEROBN and
FEDER funds (CB06/03), ISCIII. Josep A. Tur, Maria del Mar Bibiloni, Alicia Julibert and Cristina Bouzas are
granted by Grant of support to research groups no. 35/2011 (Balearic Islands Gov.; FEDER funds) and EU-COST
ACTION CA16112. None of the funding sources took part in the design, collection, analysis or interpretation of
the data, or in the decision to submit the manuscript for publication