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Adv Nutr. 2019 Nov 1;10(Supplement_4):S308-S319. doi: 10.1093/advances/nmz113.

Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies.

Viguiliouk E1,2,3, Glenn AJ1,2,3, Nishi SK1,2,3, Chiavaroli L1,2,3, Seider M1,2,3, Khan T1,2,3, Bonaccio M4, Iacoviello L4,5, Mejia SB1,2,3, Jenkins DJA1,2,3,6,7,8, Kendall CWC1,2,3,9, Kahleová H10,11, Rahelić D12, Salas-Salvadó J13,14, Sievenpiper JL1,2,3,7,8.

Author information

Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.
Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Physicians Committee for Responsible Medicine, Washington, DC, USA.
Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Department of Endocrinology, Diabetes and Clinical Pharmacology, Dubrava University Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia.
CIBER Fisiopatología de la Obesidad y Nutrición (CIBER Obn), Instituto de Salud Carlos III, Madrid, Spain.
Human Nutrition Department, IISPV, Universitat Rovira i Virgili, Reus, Spain.


To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted an umbrella review and updated systematic review and meta-analysis (SRMA) of prospective cohort studies of the association between dietary pulses with or without other legumes and cardiometabolic disease outcomes. We searched the PubMed, MEDLINE, EMBASE, and Cochrane databases through March 2019. We included the most recent SRMAs of prospective cohort studies and new prospective cohort studies published after the census dates of the included SRMAs assessing the relation between dietary pulses with or without other legumes and incidence and mortality of cardiovascular diseases (CVDs) [including coronary heart disease (CHD), myocardial infarction (MI), and stroke], diabetes, hypertension, and/or obesity. Two independent reviewers extracted data and assessed risk of bias. Risk estimates were pooled using the generic inverse variance method and expressed as risk ratios (RRs) with 95% CIs. The overall certainty of the evidence was assessed using the GRADE approach. Six SRMAs were identified and updated to include 28 unique prospective cohort studies with the following number of cases for each outcome: CVD incidence, 10,261; CVD mortality, 16,168; CHD incidence, 7786; CHD mortality, 3331; MI incidence, 2585; stroke incidence, 8570; stroke mortality, 2384; diabetes incidence, 10,457; hypertension incidence, 83,284; obesity incidence, 8125. Comparing the highest with the lowest level of intake, dietary pulses with or without other legumes were associated with significant decreases in CVD (RR: 0.92; 95% CI: 0.85, 0.99), CHD (RR: 0.90; 95% CI: 0.83, 0.99), hypertension (RR: 0.91; 95% CI: 0.86, 0.97), and obesity (RR: 0.87; 95% CI: 0.81, 0.94) incidence. There was no association with MI, stroke, and diabetes incidence or CVD, CHD, and stroke mortality. The overall certainty of the evidence was graded as "low" for CVD incidence and "very low" for all other outcomes. Current evidence shows that dietary pulses with or without other legumes are associated with reduced CVD incidence with low certainty and reduced CHD, hypertension, and obesity incidence with very low certainty. More research is needed to improve our estimates. This trial was registered at as NCT03555734.


GRADE; cardiovascular disease; diabetes; hypertension; legumes; meta-analysis; obesity; prospective cohort; pulses; systematic review

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