Nut consumption and musculoskeletal health: a systematic review

Abstract

Background: Age-related functional decline, frailty, sarcopenia, and disability contribute to loss of independence and financial burden in aging populations. Nuts contain bioactive compounds, including polyphenols, antioxidants, vitamins, minerals, and unsaturated fatty acids that may support musculoskeletal health. This systematic review evaluated the association between nut consumption and musculoskeletal outcomes, including muscle recovery, strength, bone health, frailty, and functional limitations in adults. Methods: This systematic review was conducted in accordance with PRISMA guidelines and included randomized controlled trials and observational studies. Electronic databases included PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar, and were searched from inception through January 2026. Eligible studies included those with nut intake, participants aged ≥ 18 years, and reported musculoskeletal outcomes related to muscle function, bone health, frailty, sarcopenia, or disability related measures. Risk of bias was assessed using the Cochrane RoB 2.0 tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Results: Seventeen studies met the inclusion criteria, including 9 randomized controlled trials, 1 non-randomized controlled trial, and seven observational studies. Sample sizes ranged from 14 to 71,704 participants. Exercise recovery trials suggested modest benefits of almonds and pistachios on muscle soreness and recovery biomarkers, while walnut supplementation demonstrated improvements in cognition, sleep quality, and balance in older adults. Bone findings were mixed, with walnut consumption showing neutral effects on bone mineral density, while almond studies demonstrated reduced osteoclast activity in mechanistic models. Observational studies consistently linked higher nut intake with lower frailty risk, functional limitations, and sarcopenia incidence in older adults. Discussion: The findings suggest that regular nut consumption may support musculoskeletal health, particularly muscle recovery and preservation of functional capacity. Heterogeneity across study designs, nut type, intervention duration, and reliance on observational data limits causal inference. Larger, long-term randomized controlled trials are needed to clarify dose-response relationships and clinically meaningful musculoskeletal outcomes. This trial was registered at the Open Science Framework (OSF) as https://doi.org/10.17605/OSF.IO/XNE3Y.