Abstract

Nuts are an important part of healthy diets and have cardiovascular and metabolic benefits. However, their impact on cognitive health, particularly among stroke survivors at higher risk of cognitive decline, remains underexplored. This study primarily aimed to investigate the cross-sectional relationship between nut intake and cognitive function in stroke-free participants from the Framingham Heart Study Offspring cohort. It also cross-sectionally examined the association between nut intake and neurotrophic factors and brain volume in this population, and explored these associations in stroke survivors. Further, it investigated whether nut intake was related to incident stroke and dementia over a 10-year follow-up. In models adjusted for demographics, lifestyle, and health-related covariates, nut intake was positively associated with global cognition in stroke-free people (<i>β</i>: 0.007 per gram of nut intake; 95% CI: 0.001-0.013; <i>n</i> = 1742). In stratified analyses, higher nut intake was associated with better cognitive scores in individuals with low diet quality (<i>n</i> = 348; <i>β</i>: 0.022; 95%CI: 0.012-0.033) and low physical activity (<i>n</i> = 350; <i>β</i>: 0.015; 95%CI: 0.005-0.026), and it was associated with larger brain volume in highly active individuals (<i>n</i> = 317; <i>β</i>: 0.059; 95%CI: 0.002-0.115). Higher nut consumption was associated with higher concentration of serum vascular endothelial growth factor in stroke survivors (<i>n</i> = 28; <i>β</i>: 13.256; 95%CI: 1.064-25.448). Over a 10-year follow-up, 49 stroke and 61 dementia cases were identified, with no association between nut intake and incidence. These preliminary findings suggest that higher nut consumption may benefit cognitive function, particularly in individuals with lifestyle-related cardiovascular risk.