Nuts about pemphigus? A cross-sectional investigation into the role of nuts intake in modulating disease severity

Background Given the anti-inflammatory properties of nuts, their consumption might play a role in reducing inflammation and the severity of pemphigus vulgaris (PV). However, limited evidence exists regarding the association between nut intake and PV severity. Thus, this cross-sectional study investigates the relationship between PV severity and the consumption of total nuts as well as specific nut varieties. Methods This study included 138 PV patients, of whom 108 had a Pemphigus Disease Area Index (PDAI)<15 and 30 had a PDAI≥15. Dietary intake was evaluated using a validated 168-item food frequency questionnaire, and consumption of total nuts and subtypes (peanuts, hazelnuts, almonds, walnuts and pistachios) was categorised into quartiles. Results While no significant association was found between individual nut types and PV severity, individuals with the highest total nut intake (including peanuts, hazelnuts, almonds, walnuts and pistachios) were 92% less likely to experience increased PV severity compared with those with the lowest intake (OR: 0.08; 95% CI 0.01 to 0.38). This association remained significant after adjusting for age, sex and energy intake (OR: 0.072; 95% CI 0.01 to 0.36). Further adjustments for corticosteroid use and physical activity did not alter the strength or significance of the association (OR: 0.08; 95% CI 0.01 to 0.42). Conclusion Our findings suggest that higher total nut consumption is inversely associated with PV severity, though no such link was observed for specific nut subtypes. Prospective cohort studies are needed to validate these results.