Exploration of Musculoskeletal Diseases

Table 1. Newcastle–Ottawa risk of bias assessment for observational studies (n = 7).

Author (year), study design	Selection				Comparability		OUTCOME for Cross- Sectional Studies			Total stars
Author (year), study design	S1	S2	S3	S4	C1	C2	E1/O1	E2/O2	E3	Total stars
Wild et al. (2024), Cohort [14]	*	-	*	*	*	*	*	*	*	8/9
Wang et al. (2023), Cohort [13]	*	-	*	*	*	*	*	*	*	8/9
Jun and Shin (2024), Cross-sectional [31]	*	-	*	N/A	*	*	*	*	N/A	6/7
Xu et al. (2025), Cross-sectional [16]	*	-	*	N/A	*	*	*	*	N/A	6/7
Mazumdar et al. (2025), Cross-sectional [33]	?	*	*	N/A	*	*	*	*	N/A	6/7
Feyesa et al. (2025), Cross-sectional [15]	*	-	*	N/A	*	-	*	*	N/A	5/7
Garrido-Miguel et al. (2021), Cross-sectional [30]	*	*	*	N/A	*	-	*	*	N/A	6/7

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Selection: S1 representativeness of the sample; S2 non-respondents’ rate; S3 ascertainment of the exposure; S4 definition of the control. Comparability: C1 study controls for main confounders (age and sex); C2 study controls for any additional potential confounders. Exposure: E1 ascertainment of exposure; E2 same method of ascertainment of cases and controls; E3 non-response rate. Outcome: O1 assessment of outcome; O2 statistical analysis. 1 failed category; high quality, 2 or more failed categories; lower scores.

Supplementary materials

The supplementary tables for this article are available at: https://www.explorationpub.com/uploads/Article/file/1007138_sup_1.pdf.

Declarations

Acknowledgments

During the preparation of this work, the author(s) used Elicit AI solely for language editing and grammatical improvement of the manuscript. After using the tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.

Author contributions

LA: Investigation, Writing—original draft, Writing—review & editing. RS: Investigation, Writing—original draft, Writing—review & editing. SJ: Conceptualization, Writing—review & editing, Supervision. All authors read and approved the submitted version.

Conflicts of interest

Shanil Juma, who is an Editorial Board member of Exploration of Musculoskeletal Diseases, had no involvement in the decision-making or the review process of this manuscript. The other authors declare no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

The primary data for this article were sourced online from databases listed in the methods. Referenced articles are accessible on PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar. Additional supporting data are available from the corresponding author upon request.

Funding

Not applicable.

Copyright

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References

Schousboe JT, Langsetmo L, Kats AM, Boyd C, Sheets KM, Fink HA, et al. The association of frailty with health care costs using the FRAIL scale. Aging Clin Exp Res. 2026;38:48. [DOI] [PubMed] [PMC]

Vezza T, Canet F, de Marañón AM, Bañuls C, Rocha M, Víctor VM. Phytosterols: Nutritional Health Players in the Management of Obesity and Its Related Disorders. Antioxidants. 2020;9:1266. [DOI] [PubMed] [PMC]

Cardoso BR, Duarte GBS, Reis BZ, Cozzolino SMF. Brazil nuts: Nutritional composition, health benefits and safety aspects. Food Res Int. 2017;100:9–18. [DOI] [PubMed]

Steffen LM, Yi SY, Duprez D, Zhou X, Shikany JM, Jacobs DR Jr. Walnut consumption and cardiac phenotypes: The Coronary Artery Risk Development in Young Adults (CARDIA) study. Nutr Metab Cardiovasc Dis. 2021;31:95–101. [DOI] [PubMed] [PMC]

Rajaram S, Damasceno NRT, Braga RAM, Martinez R, Kris-Etherton P, Sala-Vila A. Effect of Nuts on Markers of Inflammation and Oxidative Stress: A Narrative Review. Nutrients. 2023;15:1099. [DOI] [PubMed] [PMC]

Ros E, Nunez I, Perez-Heras A. A walnut diet improves endothelial function in hypercholesterolemic subjects. A randomized crossover trial. ACC Curr J Rev. 2004;13:19–20. [DOI]

Griel AE, Kris-Etherton PM, Hilpert KF, Zhao G, West SG, Corwin RL. An increase in dietary n-3 fatty acids decreases a marker of bone resorption in humans. Nutr J. 2007;6:2. [DOI] [PubMed] [PMC]

Orchard TS, Ing SW, Lu B, Belury MA, Johnson K, Wactawski-Wende J, et al. The association of red blood cell n-3 and n-6 fatty acids with bone mineral density and hip fracture risk in the women’s health initiative. J Bone Miner Res. 2012;28:505–15. [DOI] [PubMed] [PMC]

Ghazzawi HA, Hussain MA, Raziq KM, Alsendi KK, Alaamer RO, Jaradat M, et al. Exploring the Relationship between Micronutrients and Athletic Performance: A Comprehensive Scientific Systematic Review of the Literature in Sports Medicine. Sports. 2023;11:109. [DOI] [PubMed] [PMC]

10.

Zhang X, Zhong Y, Rajabi S. Polyphenols and post-exercise muscle damage: a comprehensive review of literature. Eur J Med Res. 2025;30:260. [DOI] [PubMed] [PMC]

11.

McKenna MJ. The Roles of Ionic Processes in Muscular Fatigue During Intense Exercise1. Sports Med. 1992;13:134–45. [DOI] [PubMed]

12.

Arya SS, Salve AR, Chauhan S. Peanuts as functional food: a review. J Food Sci Technol. 2015;53:31–41. [DOI] [PubMed] [PMC]

13.

Wang R, Hannan MT, Wang M, Schwartz AW, Lopez-Garcia E, Grodstein F. Long-Term Consumption of Nuts (Including Peanuts, Peanut Butter, Walnuts, and Other Nuts) in Relation to Risk of Frailty in Older Women: Evidence from a Cohort Study. J Nutr. 2023;153:820–7. [DOI] [PubMed] [PMC]

14.

Wild H, Nurgozhina M, Gasevic D, Coates AM, Woods RL, Ryan J, et al. Nut consumption and disability-free survival in community-dwelling older adults: a prospective cohort study. Age Ageing. 2024;53:e53. [DOI] [PubMed] [PMC]

15.

Feyesa I, George ES, Scott D, Abbott G, Hettiarachchi J, Daly RM, et al. Nut Intake, Functional Limitations, and Quality of Life in Older Adults: Findings From NHANES 2003–2012. J Cachexia Sarcopenia Muscle. 2025;16:e70022. [DOI] [PubMed] [PMC]

16.

Xu J, Pu K, Sun W, Pang C, Li D, Zang S. Association of nut consumption and sarcopenia in Chinese older adults. Sci Rep. 2025;15:17598. [DOI] [PubMed] [PMC]

17.

Nieman DC, Scherr J, Luo B, Meaney MP, Dréau D, Sha W, et al. Influence of Pistachios on Performance and Exercise-Induced Inflammation, Oxidative Stress, Immune Dysfunction, and Metabolite Shifts in Cyclists: A Randomized, Crossover Trial. PLoS ONE. 2014;9:e113725. [DOI] [PubMed] [PMC]

18.

Philpott J, Kern M, Hooshmand S, Carson I, Rayo V, North E, et al. Pistachios as a recovery food following downhill running exercise in recreational team-sport individuals. Eur J Sport Sci. 2023;23:2400–10. [DOI] [PubMed]

19.

Oliver-Pons C, Sala-Vila A, Cofán M, Serra-Mir M, Roth I, Valls-Pedret C, et al. Effects of walnut consumption for 2 years on older adults' bone health in the Walnuts and Healthy Aging (WAHA) trial. J Am Geriatr Soc. 2024;72:2471–82. [DOI] [PubMed]

20.

Bulló M, Amigó-Correig P, Márquez-Sandoval F, Babio N, Martínez-González MA, Estruch R, et al. Mediterranean Diet and High Dietary Acid Load Associated with Mixed Nuts: Effect on Bone Metabolism in Elderly Subjects. J Am Geriatr Soc. 2009;57:1789–98. [DOI] [PubMed]

21.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. [DOI] [PubMed] [PMC]

22.

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. [DOI] [PubMed]

23.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. [DOI] [PubMed] [PMC]

24.

The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. Ottawa (ON): Ottawa Hospital Research Institute; [cited 2026 May 12]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

25.

Kamoun A, Yahia A, Farjallah MA, Maaloul R, Marzougui H, Bouaziz M, et al. Concurrent training associated with moderate walnut consumption improved isokinetic strength, subjective sleep quality, cognitive performance and postural balance in elderly active men: a randomized controlled trial. Aging Clin Exp Res. 2024;36:50. [DOI] [PubMed] [PMC]

26.

Rayo VU, Thayer I, Galloway SDR, Hong MY, Hooshmand S, Liu C, et al. Influence of pistachios on force production, subjective ratings of pain, and oxidative stress following exercise-induced muscle damage in moderately trained athletes: A randomized, crossover trial. Metab Open. 2022;16:100215. [DOI] [PubMed] [PMC]

27.

Siegel L, Rooney J, Marjoram L, Mason L, Bowles E, van Keulen TV, et al. Chronic almond nut snacking alleviates perceived muscle soreness following downhill running but does not improve indices of cardiometabolic health in mildly overweight, middle-aged, adults. Front Nutr. 2024;10:1298868. [DOI] [PubMed] [PMC]

28.

Rayo VU, Cervantes M, Hong MY, Hooshmand S, Jason N, Liu C, et al. Almond Consumption Modestly Improves Pain Ratings, Muscle Force Production, and Biochemical Markers of Muscle Damage Following Downhill Running in Mildly Overweight, Middle-Aged Adults: A Randomized, Crossover Trial. Curr Dev Nutr. 2024;8:104432. [DOI] [PubMed] [PMC]

29.

Moriguchi Watanabe L, Bueno AC, de Lima LF, Ferraz-Bannitz R, Dessordi R, Guimarães MP, et al. Genetically determined variations of selenoprotein P are associated with antioxidant, muscular, and lipid biomarkers in response to Brazil nut consumption by patients using statins. Br J Nutr. 2022;127:679–86. [DOI] [PubMed]

30.

Garrido-Miguel M, Martínez-Vizcaíno V, Fernández-Rodríguez R, Martínez-Ortega IA, Hernández-Castillejo LE, Bizzozero-Peroni B, et al. The Role of Physical Fitness in the Relationship between Nut Consumption and Body Composition in Young Adults. Nutrients. 2021;13:2126. [DOI] [PubMed] [PMC]

31.

Jun S, Shin S. Association between nut consumption and low muscle strength among Korean adults. Br J Nutr. 2024;131:894–900. [DOI] [PubMed]

32.

Platt ID, Josse AR, Kendall CW, Jenkins DJ, El-Sohemy A. Postprandial effects of almond consumption on human osteoclast precursors—an ex vivo study. Metabolism. 2011;60:923–9. [DOI] [PubMed]

33.

Mazumdar S, Shuvo SD, Khuku TK, Adnan MM, Hossain MS, Kamal MM, et al. Associations of functional foods consumption with gastrointestinal and musculoskeletal conditions: a cross-sectional study among Bangladeshi adults. BMJ Open. 2025;15:e103593. [DOI] [PubMed] [PMC]

34.

Chauhan A, Chauhan V. Beneficial Effects of Walnuts on Cognition and Brain Health. Nutrients. 2020;12:550. [DOI] [PubMed] [PMC]

35.

de Oliveira EP, Burini RC. Carbohydrate-Dependent, Exercise-Induced Gastrointestinal Distress. Nutrients. 2014;6:4191–9. [DOI] [PubMed] [PMC]

36.

Scrivin R, Slater G, Mika A, Rauch C, Young P, Martinez I, et al. The impact of 48 h high carbohydrate diets with high and low FODMAP content on gastrointestinal status and symptoms in response to endurance exercise, and subsequent endurance performance. Appl Physiol Nutr Metab. 2024;49:773–91. [DOI] [PubMed]

37.

Nieman DC, Omar AM, Kay CD, Kasote DM, Sakaguchi CA, Lkhagva A, et al. Almond intake alters the acute plasma dihydroxy-octadecenoic acid (DiHOME) response to eccentric exercise. Front Nutr. 2023;9:1042719. [DOI] [PubMed] [PMC]

38.

Caporossi D, Jackson MJ, Henriquez-Olguin C. Intracellular and extracellular redox signals during exercise and aging. Free Radic Biol Med. 2026;242:521–34. [DOI] [PubMed]

39.

Venkataraman P, Krishnamoorthy G, Selvakumar K, Arunakaran J. Oxidative Stress Alters Creatine Kinase System in Serum and Brain Regions of Polychlorinated Biphenyl (Aroclor 1254)-Exposed Rats: Protective Role of Melatonin. Basic Clin Pharmacol Toxicol. 2009;105:92–7. [DOI] [PubMed]

40.

Handy DE, Loscalzo J. The role of glutathione peroxidase-1 in health and disease. Free Radic Biol Med. 2022;188:146–61. [DOI] [PubMed] [PMC]

41.

Fenton TR, Tough SC, Lyon AW, Eliasziw M, Hanley DA. Causal assessment of dietary acid load and bone disease: a systematic review & meta-analysis applying Hill's epidemiologic criteria for causality. Nutr J. 2011;10:41. [DOI] [PubMed] [PMC]