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22 November, 2021 Feature Articles

Barriers and Facilitators to Nut Consumption

Barriers and Facilitators to Nut Consumption


Nuts are a core food which are recommended to be eaten regularly. However, research suggests that, on average, we currently don’t eat enough nuts at levels linked with health benefits.


By: Elizabeth Neale, Georgie Tran, Rachel Brown

Dr. Elizabeth Neale is an Advanced Accredited Practising Dietitian and Lecturer at the University of Wollongong, Australia. Elizabeth’s research interests include the impact of nut consumption on risk factors for chronic diseases, and the evidence-based framework in nutrition, with a particular focus on systematic reviews and meta-analyses in nutrition. Georgie Tran is an Accredited Practising Dietitian. She is completing a PhD at the University of Wollongong in translational research of healthy eating and active living in children. Dr. Rachel Brown is a Professor at the University of Otago, NZ. Her research interests include the health benefits of regular nut consumption.


Nuts are a healthy food which we should aim to regularly include in our diet. Nuts are rich in protein, unsaturated fats (“good fats”), fibre, and vitamins and minerals such as folate, vitamin E, and magnesium (1). The scientific evidence tells us that regularly eating nuts is linked with many health benefits. For example, regularly including nuts in our diet is associated with lower risk of cardiovascular disease (such as having a heart attack or stroke) (2-5).  In clinical trials where participants are provided with nuts, eating nuts has been found to result in improvements in total cholesterol, low-density lipoprotein cholesterol (“bad cholesterol”) and triglycerides (6-8).

As a result of the benefits from eating nuts, they are recommended in dietary guidelines around the world (9). The exact amount recommended differs slightly between countries; however, it’s typically recommended that we eat around 30 grams of nuts per day. This should be within a healthy diet rich in vegetables, fruits, whole grains, dairy, and protein foods such as fish, lean meat and poultry, eggs, legumes, and soy products. Population studies have found that there are several characteristics which are often associated with higher consumption of nuts. For example, people who eat more nuts tend to have a higher level of education or socio-economic status (10- 12), and tend to live healthier lifestyles overall (10, 13).

However, research suggests that, on average, we don’t currently eat the recommended amount of nuts on a regular basis. In Australia, less than 40% of the population reported eating nuts, with only 2.2% of the population meeting the recommendation to eat 30 grams of nuts per day (11). Similarly, less than 30% of New Zealanders reported eating nuts, and the average intake of nuts was 5.2 grams, well below the recommended 30 grams (12). Similar patterns are seen for the United States and countries in Europe. In the United States, mean intake of nuts was found to be 3.3 grams of nuts per day (10, 14). In a study of 10 different European countries, there was variation in the amount of nuts eaten between countries (with higher nut intake in Southern European countries such as Spain), but overall, less than a third of the population reported eating nuts on the day of the study (15).

Given that intakes of nuts tend to fall far below the recommendations, it is important to consider the factors that might hinder or encourage people to regularly include nuts in their diet. Next, we discuss a range of barriers and facilitators to nut consumption which have been reported in the scientific literature.

One factor which is often reported as discouraging people from regularly eating nuts is concern regarding their effect on body weight. A number of studies have suggested that consumers are confused or worried that eating nuts will cause them to gain weight (16, 17). Interestingly, the scientific evidence suggests that this is a myth.  

While it is true that nuts are high in energy and fat, the research suggests that eating nuts does not lead to weight gain (18). There are a number of reasons for this. Research suggests that due to the structure of nuts, we are not able to absorb all of the fat from nuts when we eat them, meaning that we instead excrete the fat in our faeces (19, 20). Eating nuts may also help us feel fuller for longer, so we eat less at subsequent meals, and may also lead to increases in the amount of energy we burn (21). Taken together, these factors mean that regularly including nuts in a healthy diet does not lead to weight gain.

Another reported barrier to nut intake was the price of nuts. Concerns regarding the cost of nuts have been reported in studies from a number of countries, including New Zealand (12), Australia (22), China (23), and the United States (24). While nuts tend to be less expensive than other snacks like cereal bars (12), concerns regarding price are clearly a common barrier for consumers. Furthermore, individuals who have problems with their teeth can find it difficult to eat nuts. For these individuals, nut spreads such as peanut or almond spread might be a suitable alternative.

There are also factors that may encourage individuals to eat more nuts. Surveys of consumers and health professionals have found that nuts are thought to be tasty, and are seen to be a healthy and nutritious food (16, 22, 25), but they are often not aware of the exact health benefits of eating nuts (17). Highlighting health benefits in public health messages could encourage greater intakes. Consumers also reported that they ate nuts because they were a good source of protein and energy, and were convenient and portable (26). Consumers have also reported that they would be likely to eat nuts if a doctor or other health professional recommended, they do so (24, 27), which suggests that advice from health professionals might be a strategy for encouraging greater nut intake.



Given the known benefits of regular nut intake on our health, and the large gap between recommended nut intakes and the amounts consumed, we need to explore strategies to encourage regular nut consumption. Addressing the common barriers such as confusion relating to the effect of nuts on weight could be a potential strategy to increase nut consumption.

References
1. Ros E. Health benefits of nut consumption. Nutrients. 2010;2(7):652-82.
2. Eneroth H, Wallin S, Leander K, Nilsson Sommar J, Akesson A. Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B(1) Exposure. Nutrients. 2017;9(12).
3. Zhou D, Yu H, He F, Reilly KH, Zhang J, Li S, et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies. The American Journal of Clinical Nutrition. 2014;100(1):270-7.
4. Luo C, Zhang Y, Ding Y, Shan Z, Chen S, Yu M, et al. Nut consumption and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a systematic review and meta analysis. The American Journal of Clinical Nutrition. 2014;100(1):256-69.
5. Mayhew AJ, de Souza RJ, Meyre D, Anand SS, Mente A. A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality. The British journal of nutrition. 2016;115(2):212-25. 6. Coates AM, Hill AM, Tan SY. Nuts and Cardiovascular Disease Prevention. Curr Atheroscler Rep. 2018;20(10):48.
7. Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med. 2010;170(9):821-7.
8. Del Gobbo LC, Falk MC, Feldman R, Lewis K, Mozaffarian D. Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta analysis, and dose-response of 61 controlled intervention trials. The American Journal of Clinical Nutrition. 2015;102(6):1347- 56.
9. Neale EP, Tapsell, L.C. Nuts in Healthy Dietary Patterns and Dietary Guidelines. Health Benefits of Nuts and Dried Fruits. Boca Raton, FL, USA: CRC Press; 2020.
10. O'Neil CE, Nicklas TA, Fulgoni VL, 3rd. Tree nut consumption is associated with better nutrient adequacy and diet quality in adults: National Health and Nutrition Examination Survey 2005-2010. Nutrients. 2015;7(1):595-607. 11. Nikodijevic CJ, Probst YC, Batterham MJ, Tapsell LC, Neale EP. Nut consumption in a representative survey of Australians: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey. Public Health Nutr. 2020;23(18):3368- 78.
12. Brown RC, Tey SL, Gray AR, Chisholm A, Smith C, Fleming E, et al. Patterns and predictors of nut consumption: results from the 2008/09 New Zealand Adult Nutrition Survey. Br J Nutr. 2014;112(12):2028-40.
13. Dikariyanto V, Berry SE, Pot GK, Francis L, Smith L, Hall WL. Tree nut snack consumption is associated with better diet quality and CVD risk in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008-2014. Public Health Nutr. 2020;23(17):3160-9.
14. O'Neil CE, Fulgoni VL, 3rd, Nicklas TA. Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005-2010. Nutr J. 2015;14:64.
15. Jenab M, Sabate, J., Slimani, N., Ferrari, P., Mazuir, M., Casagrande, C., Deharveng, G., Tjonneland, A., Olsen, A., Overvad, K., et al. Consumption and portion sizes of tree nuts, peanuts and seeds in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Br J Nutr. 2006;96:S12-S23.
16. Yong LC, Gray AR, Chisholm A, Leong SL, Tey SL, Brown RC. Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand. Public Health Nutr. 2017;20(17):3166-82.
17. Neale EP, Tran G, Brown RC. Barriers and Facilitators to Nut Consumption: A Narrative Review. Int J Environ Res Public Health. 2020;17(23).
18. Guarneiri LL, Cooper JA. Intake of Nuts or Nut Products Does Not Lead to Weight Gain, Independent of Dietary Substitution Instructions: A Systematic Review and Meta-Analysis of Randomized Trials. Advances in Nutrition. 2020.
19. Mandalari G, Grundy MM, Grassby T, Parker ML, Cross KL, Chessa S, et al. The effects of processing and mastication on almond lipid bioaccessibility using novel methods of in vitro digestion modelling and micro-structural analysis. The British journal of nutrition. 2014;112(9):1521-9.
20. Ellis PR, Kendall CW, Ren Y, Parker C, Pacy JF, Waldron KW, et al. Role of cell walls in the bioaccessibility of lipids in almond seeds. Am J Clin Nutr. 2004;80(3):604- 13.
21. Mattes RD, Kris-Etherton PM, Foster GD. Impact of peanuts and tree nuts on body weight and healthy weight loss in adults. J Nutr. 2008;138(9):1741S-5S.
22. Tran G. Investigating the Role of Nutrition Information and Misinformation in Dietetic Practice: A Case Study Exploring the Perceptions of Nut Consumption in Health Professionals and Consumers [Bachelor’s Thesis]. Wollongong, Australia: University of Wollongong; 2020.
23. Hong L, Yao, L., Xie, P., Li, W. An empirical study on consumer purchase intention for nuts and influencing factors - Survey based on consumers from Zhejiang. Food Control. 2020;117.
24. Pawlak R, Colby S, Herring J. Beliefs, benefits, barriers, attitude, intake and knowledge about peanuts and tree nuts among WIC participants in eastern North Carolina. Nutr Res Pract. 2009;3(3):220-5.
25. Brown RC, Gray AR, Yong LC, Chisholm A, Leong SL, Tey SL. A comparison of perceptions of nuts between the general public, dietitians, general practitioners, and nurses. PeerJ. 2018;6:e5500.
26. Yong LC, Gray AR, Chisholm A, Leong SL, Tey SL, Brown RC. Barriers to and facilitators and perceptions of nut consumption among the general population in New Zealand. Public Health Nutrition. 2017;20(17):3166-82.
27. Pawlak R, et al. Perception of nut intake among individuals with or at risk for heart disease and/or diabetes. J Behav Health. 2012;1:185-8.
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