Elsevier

Clinical Nutrition

Volume 37, Issue 3, June 2018, Pages 906-913
Clinical Nutrition

Original article
Legume consumption is inversely associated with type 2 diabetes incidence in adults: A prospective assessment from the PREDIMED study

https://doi.org/10.1016/j.clnu.2017.03.015Get rights and content

Summary

Background & aims

Legumes, a low-energy, nutrient-dense and low glycemic index food, have shown beneficial effects on glycemic control and adiposity. As such, legumes are widely recommended in diabetic diets, even though there is little evidence that their consumption protects against type 2 diabetes. Therefore the aim of the present study was to examine the associations between consumption of total legumes and specific subtypes, and type 2 diabetes risk. We also investigated the effect of theoretically substituting legumes for other protein- or carbohydrate-rich foods.

Methods

Prospective assessment of 3349 participants in the PREvención con DIeta MEDiterránea (PREDIMED) study without type 2 diabetes at baseline. Dietary information was assessed at baseline and yearly during follow-up. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for type-2 diabetes incidence according to quartiles of cumulative average consumption of total legumes, lentils, chickpeas, dry beans and fresh peas.

Results

During a median follow-up of 4.3 years, 266 new cases of type 2 diabetes occurred. Individuals in the highest quartile of total legume and lentil consumption had a lower risk of diabetes than those in the lowest quartile (HR: 0.65; 95% CI: 0.43, 0.96; P-trend = 0.04; and HR: 0.67; 95% CI: 0.46–0.98; P-trend = 0.05, respectively). A borderline significant association was also observed for chickpeas consumption (HR 0.68; 95% CI: 0.46, 1.00; P-trend = 0.06). Substitutions of half a serving/day of legumes for similar servings of eggs, bread, rice or baked potato was associated with lower risk of diabetes incidence.

Conclusions

A frequent consumption of legumes, particularly lentils, in the context of a Mediterranean diet, may provide benefits on type 2 diabetes prevention in older adults at high cardiovascular risk.

Trial registration

The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005.

Section snippets

Background

Type 2 diabetes is recognised as a major public health issue worldwide. According to the International Diabetes Federation (IDF), type 2 diabetes affected 415 million adults in 2015 and it is estimated that this figure will increase to 642 million in 2040 [1]. Type 2 diabetes is associated with significant systemic consequences, including microvascular and macrovascular complications affecting the quality of life and decreasing the life expectancy [2]. Therefore, it is imperative to identify

Study population

The present data was analysed using an observational prospective design conducted within the frame of the PREDIMED (PREvención con DIeta MEDiterránea) trial (PREDIMED website: http://www.predimed.es) [24]. The PREDIMED study (registered at http://www.controlled-trials.com as ISRCTN35739639) was a randomized, multi center, parallel-group clinical trial conducted in Spain between October 2003 and December 2010. The main aim of the trial was to evaluate the effectiveness of the MedDiet on the

Results

During a median follow-up of 4.3 years, 266 incident cases of type 2 diabetes were documented. Baseline characteristics of the study population according to energy-adjusted quartiles of total legume intake are presented in Table 1. Participants in the highest quartile of total legume consumption were less likely to have higher education and had higher BMI and fasting plasma glucose levels than those in the bottom quartile. They also had a lower intake of total energy, dietary fat and alcohol

Discussion

To the best of our knowledge, this is the first prospective study conducted in senior Mediterranean individuals at high cardiovascular risk evaluating the association between consumption of total legumes and its different varieties, and type 2 diabetes. The present study revealed that a higher consumption of total legumes, especially lentils, was associated with a lower risk of type 2 diabetes development. The consumption of chickpeas was borderline significantly associated with a lower risk of

Conclusions

In summary, the current data suggests that a frequent consumption of legumes and particularly lentils could provide benefits on type 2 diabetes development in senior adults at high cardiovascular risk. The substitution of legumes for other protein- or carbohydrate-rich foods is also associated with a lower risk of type 2 diabetes. The present study supports an increased consumption of legumes for type 2 diabetes prevention. However, given the mixed results from previous researches, further

Authors' responsibilities

ER, DC, RE, MF, LS-M, FA, RML-R, M Fiol, JL and JS-S designed the research. NB-T, AD-L, NR-E, ER, PB-C, DC, RE, MF, LS-M, FA, RML-R, M Fiol, JMS-L, JD-E, OP and JS-S conducted the research. NB-T and JS-S analysed the data. NB-T, AD-Land JS-S wrote the paper. NB-T and JS-S had primary responsibility for final content. All authors read and approved the final manuscript.

Conflict of interest statement and Funding sources

The authors disclose no conflict of interest related with the article.

Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN) is an initiative of the Instituto de Salud Carlos III (ISCIII) of Spain which is supported by FEDER funds (CB06/03). Supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through grants provided to research networks specifically developed for the trial (RTIC G03/140 and RD 06/0045)

Acknowledgements

The authors thank all the participants for their collaboration, all the PREDIMED personnel for their assistance and all the personnel of affiliated primary care centers for making the study possible. CIBEROBN is an initiative of ISCIII, Spain.

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