Legume consumption in adults and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis

Intake of fruit, vegetables and pulses, and all-cause, cardiovascular and cancer mortality: Results from a population-based prospective study

OBJECTIVES

The aim of this study was to explore the association of fruit, vegetable, and pulses consumption with all-cause, cardiovascular, and cancer mortality.

STUDY DESIGN

This prospective study included 66,933 individuals from three Spanish health surveys linked to the national death registry up to December 2022.

METHODS

Adjusted Poisson regression models were used to analyze the data, categorizing fruit, vegetable and pulses intake according to Spanish dietary recommendations and using splines to examine non-linear relationships.

RESULTS

No clear association was found between pulses intake and mortality. Consuming fruits and vegetables ≥2 times/day reduced all-cause mortality risk by 20 % (95%CI = 10%-29 %) and 17 % (95%CI = 7%-26 %) respectively, compared with <3 times/week. Combined intake of fruits and vegetables from 1 to 1.99 to ≥5 times/day showed reductions in all-cause and CVD mortality ranging from 16 % (95%CI = 5%-26 %) to 30 % (95%CI = 20%-39 %), and from 25 % (95%CI = 5%-41 %) to 35 % (95%CI = 14%-50 %), respectively, compared with <1 time/day. No additional benefits against all-cause and CVD mortality for intakes of fruits over 2-3 times/day, but gradual reductions in mortality risk for vegetable intake of 2-5 times/day were observed. Combined intake showed protection up to intakes of 10 times/day, notably for CVD mortality. Associations were similar but weaker for cancer mortality.

CONCLUSIONS

This study suggests that significant benefits of fruits and, specially, vegetables intake might go beyond the recommended five servings a day. Confirmation of these results could lead to specific dietary recommendations to prevent chronic diseases.

A New Mediterranean Lifestyle Pyramid for Children and Youth: A Critical Lifestyle Tool for Preventing Obesity and Associated Cardiometabolic Diseases in a Sustainable Context

Cardiovascular disease risk factors begin in childhood and track into adulthood, increasing the possibility of impaired cardiometabolic health. Adopting healthy dietary patterns can help curb childhood obesity, a worrisome epidemic problem at present. In the era of personalized nutrition, dietary recommendations should be adapted to different stages of life, including children (older than 3 y) and adolescents. In this study, we present an updated version of the Mediterranean Lifestyle Pyramid addressed to children and adolescents, which may be used as a prevention tool by health professionals, teachers, and stakeholders. This pyramid arises from a consensus position between participants in an International Congress on Mediterranean diet held in Barcelona. During this meeting, after reviewing all literature published, a consensus was reached on the new Mediterranean Lifestyle Pyramid for kids including details such as labels of the pyramid, position of foods, servings, type of foods, and healthy lifestyle habits. All components of the pyramid are supported by the most recent scientifically sound research and are based upon top-level evidence in nutritional sciences. Fruit, vegetables, legumes, nuts, wholegrains, and extra-virgin olive oil continue to be at the basis of the pyramid, but the importance of an adequate intake of fish, dairy products, and meat during these particular ages, when body and brain development occurs, is also considered. The promotion of physical activity, adequate sleep, and good emotional health are emphasized, as well as the consumption of seasonal and local products, and overall sustainability. Improving dietary habits in early stages of life should increase health in adulthood and reduce future incidence of noncommunicable chronic diseases. The Mediterranean diet and its graphic representation in the Lifestyle Pyramid should be a health-fostering tool not only for adults and children but also for the entire planet because it promotes the diversity of species, respect for the earth, and the local economy.

Legume intakes on cardiometabolic profile and gut microbiome function: systematic review and meta-analyses of randomised controlled trials

BACKGROUND

Legumes are widely considered one of the most beneficial food groups to consume. They are high in fibre and plant-based protein as well as naturally low in sodium, saturated fats, and sugars. However, legumes do not feature prominently in the modern diet, and previous evidence syntheses show inconsistent results on cardiometabolic risk profile when increasing legume intakes. This review examines the impact of legume intake on cardiometabolic profile and gut microbiome.

METHODS

EMBASE, OVID Medline, and the Cochrane Central Register of Controlled Trials were searched up to 15 May 2024 with checking of relevant reference lists and bibliographies. Relevant data were extracted into pre-tested forms and risk of bias was assessed with Cochrane RoB2. Searches, screening, and risk of bias assessment were done independently by two reviewers. We have considered trials where legumes were provided to adults, with and without pre-existing conditions (i.e. type 2 diabetes, heart disease or dyslipidaemia), in randomised controlled trials of at least six weeks duration on cardiometabolic risk factors and gut microbiome outcomes. Trial data were pooled using random effects models. Prespecified regression analyses were then performed to identify the factors influencing pooled results. Certainty of evidence was assessed with GRADE.

RESULTS

We identified 30 papers of 24 trials with 33 eligible comparisons where legumes (daily average 86 g (range 2-251)) were provided to 1,938 participants. No eligible studies reported on microbiome outcomes. There was moderate certainty evidence that higher legume intakes improved total cholesterol (mean difference (MD) -0.23mmol/L, 95%CI -0.33 to -0.13), LDL cholesterol (MD -0.16mmol/L (-0.24 to -0.08)), and fasting blood glucose (MD -0.18mmol/L (-0.30 to -0.06)). The majority of trial comparisons (70%) provided an isoenergetic control food. Pooled results were influenced by underlying differences between trials such as type and format of legumes provided, but not consistently across multiple outcomes.

CONCLUSIONS

Increasing legume intakes improved some blood lipid and glucose parameters, but not all. Isoenergetic comparisons in trials may obscure changes in cardiometabolic risk factors due to greater satiation or reduced intake, and no trials greater than six weeks duration were identified to consider the microbiome-mediated health effects with greater legume intakes. Future trials in these areas are necessary.

TRIAL REGISTRATION

Prospero ID CRD42023456953.

Utilization of plant-based foods for effective prevention of chronic diseases: a longitudinal cohort study

The present study examined optimal dietary patterns of eight plant-based foods for preventing chronic diseases, including hypertension, stroke, myocardial infarction, and diabetes, using data from the China Health and Nutrition Survey (CHNS). We applied generalized estimating equations to assess time-based changes and gender differences, using residual balancing weights to control time-varying confounders, and employed a restricted cubic spline model to explore dose-response relationships by gender. The findings suggested that a high intake of vegetables and whole grains, along with moderate amounts of fruits, fungi and algae, could help reduce the risk of developing these four chronic diseases simultaneously. Additionally, men could benefit from moderate refined grain consumption, while women should consider increasing their intake of nuts and seeds. Our results indicated that adopting a plant-based diet could provide non-linear protective effects against chronic diseases, with the magnitude of this protection varying by gender.

Yellow pea-based pasta's impacts on the salt intake, glycemic parameters and oxidative stress in healthy individuals: a randomized clinical trial

Pea (Pisum sativum L.), a widely cultivated legumes globally, is attracting interest as a functional food owing to its antioxidant properties derived from nutritional components such as polyphenols. We previously reported that yellow pea-based pasta (YPP) aids in controlling blood glucose and enhances the sensitivity to saltiness. This study examined the antioxidant effect of YPP and its effects on the salt intake and postprandial blood glucose levels by simulating a real-life scenario. In this open, parallel-group, randomized controlled trial, 40 healthy adult men and women aged 20-65 years, whose salt intake exceeded the target salt equivalent level of the Japanese dietary intake standard, were allocated to the following groups (n = 20): the group consuming one serving of YPP per day and the group maintaining their regular daily dietary habits. The participants who were allocated to the YPP group showed significantly improved oxidative stress markers (BAP/d-ROMs ratio change: control =  - 0.11, YPP = 0.27, p = 0.044; lipid peroxide change: control = 0.11, YPP =  - 0.25, p < 0.001) than control participants. The effects on salt intake and blood glucose levels were limited. In conclusion, YPP may serve as a functional staple food that improves oxidative stress.

Impact of dietary risk on global ischemic heart disease: findings from 1990-2019

Ischemic heart disease (IHD) is a condition in which the heart is starved of oxygen. Knowing the dietary risk factors implementing appropriate nutritional interventions in this regard seems essential. Therefore, the present study was carried out to determine the epidemiological features of IHD affected by dietary risks. This study used data from the Global Burden of Disease (GBD) study. In this study, we collected information on death, years lived with disability (YLD), and disability-adjusted life years (DALYs) of IHD affected by dietary risks in one hundred thousand people with 95% confidence based on the direct Age Standard Rate (ASR). We applied these data based on the Socio-demographic Index (SDI). In 2019, the number of IHD deaths, YLDs, and DALYs attributable to dietary risks was 62.43 million (95% UI [50.97-73.63] per 100,000 population), 36.88 (95% UI [23.87-53.32] per 100,000 population), and 1271.32 (95% UI [1061.29-1473.75] per 100,000 population), respectively. We found that the lowest DALYs of IHD affected by dietary risks by ASR are for high SDI countries. Most dietary risk factors related to IHD in countries with high and high middle SDI were related to a diet high in red and processed meat, sodium, and low in legumes, but in countries with low and low middle SDI, it was related to a diet low in fiber, fruit, nuts and seeds, PUFA, seafood W3 fatty acids, vegetables and whole grain. Considering that the dietary risk factors related to IHD are different based on SDI, it is necessary to consider nutritional interventions according to SDI.

Legumes and pulses - a scoping review for Nordic Nutrition Recommendations 2023

Consumption of legumes and pulses is associated with various health outcomes. Therefore, when updating the Nordic Nutrition Recommendations (NNR), summarizing the best available evidence on key health outcomes regarded as relevant for the Nordic and Baltics related to the consumption of legumes was essential. The aim of this scoping review was to evaluate the updated evidence on the effect of the consumption of legumes and pulses on various health outcomes, as well as their dose-response relationship in updated systematic reviews and meta-analyses. The scoping review is built on a de novo systematic review published in 2023 and additional searches on the consumption of legumes and pulses and its various health outcomes, including cardiovascular disease (CVD), cancer, type 2 diabetes, and obesity. Current available evidence shows that the consumption of legumes and pulses is associated with a lower risk of several cancers (evidence: low-moderate), and lower all-cause mortality (evidence: moderate). The associations with CVDs are neutral or inverse, with studies generally showing favourable changes in biomarkers for CVDs. Legume consumption is associated with a lower risk of obesity (evidence: low). For type 2 diabetes, no association was found with incidence, but trials on consumption of legumes and pulses and biomarkers generally indicated protective effects. Overall, the current evidence supports dietary recommendations to increase the consumption of legumes and pulses.

Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet

Over the last decades, the Mediterranean diet gained enormous scientific, social, and commercial attention due to proven positive effects on health and undeniable taste that facilitated a widespread popularity. Researchers have investigated the role of Mediterranean-type dietary patterns on human health all around the world, reporting consistent findings concerning its benefits. However, what does truly define the Mediterranean diet? The myriad of dietary scores synthesizes the nutritional content of a Mediterranean-type diet, but a variety of aspects are generally unexplored when studying the adherence to this dietary pattern. Among dietary factors, the main characteristics of the Mediterranean diet, such as consumption of fruit and vegetables, olive oil, and cereals should be accompanied by other underrated features, such as the following: (i) specific reference to whole-grain consumption; (ii) considering the consumption of legumes, nuts, seeds, herbs and spices often untested when exploring the adherence to the Mediterranean diet; (iii) consumption of eggs and dairy products as common foods consumed in the Mediterranean region (irrespectively of the modern demonization of dietary fat intake). Another main feature of the Mediterranean diet includes (red) wine consumption, but more general patterns of alcohol intake are generally unmeasured, lacking specificity concerning the drinking occasion and intensity (i.e., alcohol drinking during meals). Among other underrated aspects, cooking methods are rather simple and yet extremely varied. Several underrated aspects are related to the quality of food consumed when the Mediterranean diet was first investigated: foods are locally produced, minimally processed, and preserved with more natural methods (i.e., fermentation), strongly connected with the territory with limited and controlled impact on the environment. Dietary habits are also associated with lifestyle behaviors, such as sleeping patterns, and social and cultural values, favoring commensality and frugality. In conclusion, it is rather reductive to consider the Mediterranean diet as just a pattern of food groups to be consumed decontextualized from the social and geographical background of Mediterranean culture. While the methodologies to study the Mediterranean diet have demonstrated to be useful up to date, a more holistic approach should be considered in future studies by considering the aforementioned underrated features and values to be potentially applied globally through the concept of a "Planeterranean" diet.

Plasma metabolite profile of legume consumption and future risk of type 2 diabetes and cardiovascular disease

BACKGROUND

Legume consumption has been linked to a reduced risk of type 2 diabetes (T2D) and cardiovascular disease (CVD), while the potential association between plasma metabolites associated with legume consumption and the risk of cardiometabolic diseases has never been explored. Therefore, we aimed to identify a metabolite signature of legume consumption, and subsequently investigate its potential association with the incidence of T2D and CVD.

METHODS

The current cross-sectional and longitudinal analysis was conducted in 1833 PREDIMED study participants (mean age 67 years, 57.6% women) with available baseline metabolomic data. A subset of these participants with 1-year follow-up metabolomics data (n = 1522) was used for internal validation. Plasma metabolites were assessed through liquid chromatography-tandem mass spectrometry. Cross-sectional associations between 382 different known metabolites and legume consumption were performed using elastic net regression. Associations between the identified metabolite profile and incident T2D and CVD were estimated using multivariable Cox regression models.

RESULTS

Specific metabolic signatures of legume consumption were identified, these included amino acids, cortisol, and various classes of lipid metabolites including diacylglycerols, triacylglycerols, plasmalogens, sphingomyelins and other metabolites. Among these identified metabolites, 22 were negatively and 18 were positively associated with legume consumption. After adjustment for recognized risk factors and legume consumption, the identified legume metabolite profile was inversely associated with T2D incidence (hazard ratio (HR) per 1 SD: 0.75, 95% CI 0.61-0.94; p = 0.017), but not with CVD incidence risk (1.01, 95% CI 0.86-1.19; p = 0.817) over the follow-up period.

CONCLUSIONS

This study identified a set of 40 metabolites associated with legume consumption and with a reduced risk of T2D development in a Mediterranean population at high risk of cardiovascular disease.

TRIAL REGISTRATION

ISRCTN35739639.