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.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective cohort studies
PubMed 31728500 · doi:10.1093/advances/nmz113
What was done
An umbrella review and updated systematic review and meta-analysis of prospective cohort studies was conducted to support clinical practice guidelines. Searches of PubMed, MEDLINE, EMBASE, and Cochrane through March 2019 identified 6 prior systematic reviews and additional cohort studies examining dietary pulses with or without other legumes and cardiometabolic disease outcomes. Data from 28 unique prospective cohort studies were extracted by two independent reviewers, pooled using generic inverse variance random-effects meta-analysis (comparing highest versus lowest intake categories), and certainty was rated using GRADE.
What was found
Comparing highest to lowest intake categories, pulse consumption was associated with statistically significant risk reductions in: - CVD incidence: RR 0.92 (95% CI: 0.85, 0.99; 10,261 cases) - CHD incidence: RR 0.90 (95% CI: 0.83, 0.99; 7,786 cases) - Hypertension incidence: RR 0.91 (95% CI: 0.86, 0.97; 83,284 cases) - Obesity incidence: RR 0.87 (95% CI: 0.81, 0.94; 8,125 cases) No significant associations were found for MI incidence (2,585 cases), stroke incidence (8,570 cases), diabetes incidence (10,457 cases), CVD mortality (16,168 cases), CHD mortality (3,331 cases), or stroke mortality (2,384 cases). Certainty of evidence was rated low for CVD incidence and very low for all other endpoints.
Why it matters
This review provides quantitative synthesis across 28 cohorts showing modest inverse associations between pulse intake and key cardiometabolic conditions, though the low certainty indicates substantial residual uncertainty in the evidence base.
Limits
The analysis relied exclusively on observational cohort studies with potential confounding and measurement error. Many studies pooled dietary pulses with other legumes rather than assessing pulses in isolation. No significant reductions were detected for diabetes incidence or cardiovascular mortality.
Cited by
- supports Consumption of legumes such as lentils, chickpeas, and beans has been consistently linked in large studies to reduced cardiovascular risk and reduced all-cause mortality.