Frequent consumption of legumes associated with lower risk of diabetes
Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study
Literature - Becerra-Tomás N, Díaz-López A, Rosique-Esteban N, et al. - Clin Nutr. 2017; published online ahead of printBackground
Legumes are protein- and fibre-rich foods with a low glycaemic index. They are recommended by guidelines in diabetic diets, due to their beneficial effects on glycaemic control and adiposity [1-4]. However, studies evaluating these associations show inconsistent results and the independent association between non-soy legume intake and type 2 diabetes mellitus (T2DM) has not been adequately studied [5,6].
In this study, the associations between the consumption of total non-soy legumes and its different subtypes (dry beans, chickpeas, lentils and fresh peas) and the risk of T2DM development were evaluated in a Mediterranean population at high cardiovascular risk. Moreover, the effect the substitution of other protein- and carbohydrate-rich foods by legumes was assessed. For this, data from the Spanish PREDIMED (PREvención con DIeta MEDiterránea) trial (2003-2010) were used, including 3349 non-diabetic participants at baseline of whom 266 developed T2DM within the 4.3 years of follow-up.
Main results
- Compared with those in the lowest quartile, participants in the highest quartile of total legumes consumption had a lower risk of T2DM, after adjusting for the overall dietary pattern score and BMI (HR 0.65, 95% CI 0.43-0.96, P trend=0.04).
- Compared with those in the lowest quartile, individuals in the highest quartile of lentil intake had a 33% lower risk of T2DM incidence (HR 0.67, 95% CI 0.46-0.98, P trend=0.05).
- When comparing the 4th with the 1st quartile of chickpeas consumption, a borderline significant inverse association with T2DM development was observed (HR 0.68, 95% CI 0.46-1.00, P trend=0.06).
- The results were similar when the consumption of total legumes, lentils, chickpeas, dry beans and fresh peas was modelled as a continuous variable per 30 g/day increase.
- There was an inverse association of incident T2DM with total legumes (HR 0.55, 95% CI 0.32-0.93, P=0.03) and lentil consumption (HR 0.18, 95% CI, 0.05-0.65, P=0.01), while the consumption of chickpeas, dry beans and fresh peas was unrelated.
- For foods rich in protein, the risk of T2DM was 50% lower when half a serving/day of eggs was substituted with half a serving/day of legumes.
- Although there was a trend towards a lower risk of T2DM, the association was non-significant when fish or meat were replaced with legumes (HR 0.58, 95% CI 0.32-1.05, P=0.07 and HR 0.59, 95% CI 0.34-1.03, P=0.07, respectively).
- For carbohydrate-rich food, a 44%, 47%, 52% and 51% lower risk of T2DM development was observed when wholemeal bread, white bread, rice and baked potato, respectively, were replaced with legumes.
- In a sensitivity analysis adjusting for updated BMI rather than baseline BMI, total legumes lentils and chickpeas consumption was associated with a lower risk of T2DM (HR for legumes consumption 0.65, 95% CI 0.43-0.96, P=0.03, HR for lentils consumption 0.68, 95% CI 0.47-0.98, P=0.05, HR for chickpeas consumption 0.67, 95% CI 0.46-0.99, P=0.05).
- In a sensitivity analysis excluding participants with cancer or CVD incidence during follow-up, Individuals in the highest quartile of total legumes and lentils consumption had a lower risk of T2DM development compared with those in the lowest quartile (HR 0.61, 95% CI 0.40-0.93, P trend=0.03 and HR 0.60, 95% CI 0.41-0.90, P trend=0.04, respectively).
Conclusion
In a Mediterranean population at high CV risk, the frequent consumption of legumes and particularly lentils was associated with a lower risk of T2DM. The substitution other protein- or carbohydrate-rich foods by legumes was also associated with a lower risk of T2DM. These findings support the increased consumption of legumes for the prevention of T2DM.
References
1. McCrory MA, Hamaker BR, Lovejoy JC, et al. Pulse consumption, satiety, and weight management. Adv Nutr An Int Rev J 2010;1:17-30.
2. Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008. Diabetes Care 2008;31:2281-3.
3. Mann JI, De Leeuw I, Hermansen K, et al. Evidence-based nutritional approaches to the treatment and prevention of diabetes mellitus. Nutr Metab Cardiovasc Dis 2004;14:373-94.
4. American Diabetes Association, Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 2008;31(Suppl 1):S61-78.
5. Agrawal S, Ebrahim S. Association between legume intake and self-reported diabetes among adult men and women in India. BMC Public Health 2013;13:706.
6. Dhillon PK, Bowen L, Kinra S, et al. Legume consumption and its association with fasting glucose, insulin resistance and type 2 diabetes in the Indian Migration Study. Public Health Nutr 2016:1-10.
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