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Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis
Open accessAbstract
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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“Minimally processed, plant-derived foods such as fruits, nonstarchy vegetables, beans/legumes, and nuts/seeds are consistently linked to better cardiometabolic outcomes (Figure 6).142-145”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [145]
Experimental — accuracy not yet measuredIn the citing paper
“Yet, many foods with growing evidence for cardiometabolic benefits – e.g., berries,301 nuts,145 extra-virgin olive oil34 – are rich in phenolics”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [145]
In the citing paper
“Extra-virgin olive oil and mixed nuts, and perhaps high-oleic canola oil, appear to be good dietary choices to improve cardiometabolic health.24, 25, 34, 35, 145, 255”
From Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review (2016) · cites this paper as [145]
In the citing paper
“In a meta-analysis of five observational studies, 100 grams of legumes four times/week is inversely associated with CHD (RR: 0.86; 95% CI: 0.78–0.94) (232).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [232]
In the citing paper
“However, that study and another meta-analysis of eight prospective cohort studies found no association between legumes and diabetes (207) or stroke (232,233).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [232]
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Liang, Y., Zhang, X., Duan, M., Hu, C., Li, H., & Yang, M. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1729653
Shamsi, F. S., Soodejani, M. T., & Shoraka, H. R. (2026) · Discover Public Health · doi:10.1186/s12982-026-01518-9
Metadata
- 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)
- PMC
- PMC4144102
- 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
- bronze
- doi.org
- Licence
- 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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