Cited by 509Nuts composition and effectsNutritional Studies and DietCardiovascular Health and Risk Factors

Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis

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Afshin, Ashkan, Micha, Renata, Khatibzadeh, Shahab, Mozaffarian, Dariush·2014·The American Journal of Clinical Nutrition

Abstract

Background Relations between the consumption of nuts and legumes and risk of ischemic heart disease (IHD), stroke, and diabetes have not been well established.Objective We systematically investigated and quantified associations of nut and legume consumption with incident IHD, stroke, and diabetes.Design We systematically searched multiple databases to identify randomized controlled trials or observational studies that examined the relations. Studies were excluded if they reported only intermediate physiologic measures, soft cardiovascular outcomes, or crude risk estimates. Data were extracted independently and in duplicate. We assessed pooled dose-response relations by using a generalized least-squares trend estimation, and prespecified sources of heterogeneity were assessed by using metaregression. The potential for publication bias was explored by using funnel plots, Begg's and Egger's tests, and Duval and Tweedie trim-and-fill methods.Results Of 3851 abstracts, 25 observational studies (23 prospective and 2 retrospective studies) and 2 trial reports met inclusion criteria and comprised 501,791 unique individuals and 11,869 IHD, 8244 stroke, and 14,449 diabetes events. The consumption of nuts was inversely associated with fatal IHD (6 studies; 6749 events; RR per 4 weekly 28.4-g servings: 0.76; 95% CI: 0.69, 0.84; I(2) = 28%), nonfatal IHD (4 studies; 2101 events; RR: 0.78; 0.67, 0.92; I(2) = 0%), and diabetes (6 studies; 13,308 events; RR: 0.87; 0.81,0.94; I(2) = 22%) but not stroke (4 studies; 5544 events). Legume consumption was inversely associated with total IHD (5 studies; 6514 events; RR per 4 weekly 100-g servings: 0.86; 0.78, 0.94; I(2) = 0%) but not significantly associated with stroke (6 studies; 6690 events) or diabetes (2 studies; 2746 events). A meta-regression did not identify the effect modification by age, duration of follow-up, study location, or study quality. Mixed evidence was seen for publication bias, but analyses by using the Duval and Tweedie trim-and-fill method did not appreciably alter results.Conclusion This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.

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  1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of obser- vational studies in epidemiology: a proposal for reporting. Meta- analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.

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Authors
Afshin, A., Micha, R., Khatibzadeh, S., & Mozaffarian, D.
Affiliations
Agricultural University of Athens (GR)
Corresponding author
Afshin, Ashkan
Venue
The American Journal of Clinical Nutrition
Publisher
Elsevier BV
Published
2014-07
Volume
100
Issue
1
Pages
278-288
ISSN
0002-9165 (ISSN-L)
OpenAlex
W2119341913
Cited by
509
References
59
Citations by year
2026: 12 · 2025: 24 · 2024: 28 · 2023: 38 · 2022: 55 · 2021: 50 · 2020: 47 · 2019: 59 · 2018: 67 · 2017: 44 · 2016: 40 · 2015: 36 · 2014: 9
FWCI
4.89
Type
journal article
Language
en
Open access
Locations
  • American Journal of Clinical Nutrition (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Heart, Lung, and Blood Institute Cardiovascular Epidemiology Training Grant
  • Environment, and Global Health (T32 HL098048)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Nuts composition and effects
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
nuts, Fabaceae, ischemic heart disease, stroke, diabetes mellitus, cardiovascular risk, dietary intake, dose-response relationship, dietary fiber, polyunsaturated fatty acids, omega-3 fatty acids, omega-6 fatty acids, dietary sodium, potassium intake, dietary magnesium, dietary calcium, dietary iron, dietary zinc
MeSH terms
Diabetes Mellitus, Type 2, Diet, Humans, Fabaceae, Nuts, Risk Factors, Incidence, Randomized Controlled Trials as Topic, Databases, Factual, Myocardial Ischemia, Stroke, Endpoint Determination, Observational Studies as Topic

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