Original Article | Published:

Carbohydrates, glycemic index and diabetes mellitus

Substitution of red meat with legumes in the therapeutic lifestyle change diet based on dietary advice improves cardiometabolic risk factors in overweight type 2 diabetes patients: a cross-over randomized clinical trial

European Journal of Clinical Nutrition volume 69, pages 592597 (2015) | Download Citation

Subjects

Abstract

Background/Objective:

The objective of this study was to determine the effects of substitution of red meat with legumes in the Therapeutic Lifestyle Change (TLC) diet on cardiometabolic risk factors in type 2 diabetes patients based on dietary education.

Subjects/Methods:

This study was a randomized, controlled, cross-over trial. Thirty-one participants (24 women and 7 men; age: 58.1±6.0 years) with type 2 diabetes were randomly assigned to consume a control diet (legume-free TLC diet) and legume-based TLC diet for 8 weeks. Legume-based TLC diet was the same as the control diet, but the legume-based TLC group was advised to replace two servings of red meat with legumes, 3 days per week. After the interventional period, a washout period was conducted for 4 weeks. The groups were then advised to follow the alternate treatment for 8 weeks. Cardiometabolic risk factors were measured.

Results:

Compared with the legume-free TLC diet, the legume-based TLC diet significantly decreased fasting blood glucose (P=0.04), fasting insulin (P=0.04), triglyceride concentrations (P=0.04) and low-density lipoprotein cholesterol (P=0.02). Total cholesterol concentrations decreased after consumption of both TLC diet and legume TLC diet; however, the data did not differ significantly between the two diets. body mass index (BMI), waist circumference, systolic and diastolic blood pressures did not change significantly after consumption of either the legume-free TLC diet or the legume-based TLC diet.

Conclusions:

Dietary advice given for substitution of red meat with legume intakes within a TLC diet-improved lipid profiles and glycemic control among diabetes patients, which were independent from BMI change. This trial was registered in the Iranian Registry of Clinical Trials (http://www.irct.ir) as IRCT201202251640N7.

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References

  1. 1.

    , , , , , . Type II diabetes mellitus and cardiovascular risk factors: current therapeutic approaches. Exp Clin Cardiol 2007; 12: 17–28.

  2. 2.

    , . Red meat, dietary heme iron, and risk of type 2 diabetes: the involvement of advanced lipoxidation end products. Adv Nutr 2013; 4: 403–411.

  3. 3.

    , , , , . Intake of fruit, berries, and vegetables and risk of type 2 diabetes in Finnish men: the Kuopio Ischaemic Heart Disease Risk Factor Study. Am J Clin Nutr 2014; 99: 328–333.

  4. 4.

    , , , . Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr 2013; 98: 1066–1083.

  5. 5.

    , , , . Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 2013; 28: 845–858.

  6. 6.

    , , , , , , . Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women's Health Study. Am J Clin Nutr 2008; 87: 162–167.

  7. 7.

    , , , , . Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2011; 21: 94–103.

  8. 8.

    , , , , . Therapeutic effects of soy isoflavones on α-amylase activity, insulin deficiency, liver-kidney function and metabolic disorders in diabetic rats. Nat Prod Res 2011; 25: 244–255.

  9. 9.

    US Department of Agriculture, US Department of Health and Human Services Dietary Guidelines for Americans 2010: .

  10. 10.

    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the NationalCholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–3421.

  11. 11.

    , , , . Effect of soy nuts on blood pressure and lipid levels in hypertensive, prehypertensive, and normotensive postmenopausal women. Arch Intern Med 2007; 167: 1060–1067.

  12. 12.

    , , , , . Soy milk consumption, inflammation, coagulation, and oxidative stress among type 2 diabetic patients with nephropathy. Diabetes Care 2012; 35: 1981–1985.

  13. 13.

    Institute of Medicine of the National Academies, Food and Nutrition Board. Dietary reference intakes: for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. The National Academy Press: Washington, DC167. 2002, pp 1060–1067.

  14. 14.

    Institute of Medicine of the National Academies, Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. The National Academy Press: Washington DC. 2005, pp 107–264.

  15. 15.

    , , . A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities. Obes Rev 2014; 15: 392–407.

  16. 16.

    , . Nutritional quality of legumes, and their role in cardiometabolic risk prevention: a review. J Med Food 2013; 16: 185–198.

  17. 17.

    , , . Effects of dietary propionate on carbohydrate and lipid metabolism in healthy volunteers. Am J Gastroenterol 1990; 85: 549–553.

  18. 18.

    , . Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 1996; 3: 213–219.

  19. 19.

    , , , , , et al. A high legume low glycemic index diet improves serum lipid profiles in men. Lipids 2010; 45: 765–775.

  20. 20.

    , , , . A legume-based hypocaloric diet reduces proinflammatory status and improves metabolic features in overweight/obese subjects. Eur J Nutr 2011; 50: 61–69.

  21. 21.

    , , , . A hypocaloric diet enriched in legumes specifically mitigates lipid peroxidation in obese subjects. Free Radic Res 2007; 41: 498–506.

  22. 22.

    , , , , , et al. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2014; 186: E252–E262.

  23. 23.

    , , . Effects of dietary fibers on disturbances clustered in the metabolic syndrome. J Nutr Biochem 2008; 19: 71–84.

  24. 24.

    , . Phytochemicals for Health, the Role of Pulses. J Agric Food Chem 2007; 55: 7981–7994.

  25. 25.

    , , , , , et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2012; 172: 1653–1660.

  26. 26.

    , , . Chickpeas may influence fatty acid and fiber intake in an ad libitum diet, leading to small improvements in serum lipid profile and glycemic control. J Am Diet Assoc 2008; 108: 1009–1013.

  27. 27.

    , , , , , et al. Associations between red meat intake and biomarkers of inflammation and glucose metabolism in women. Am J Clin Nutr 2014; 99: 352–360.

  28. 28.

    , , , , , et al. Consumption of a legume-enriched, low-glycemic index diet is associated with biomarkers of insulin resistance and inflammation among men at risk for colorectal cancer. J Nutr 2010; 140: 60–67.

  29. 29.

    , , . Effects of long-term consumption and single meals of chickpeas on plasma glucose, insulin, and triacylglycerol concentrations. Am J Clin Nutr 2004; 79: 390–395.

  30. 30.

    , , , , , et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia 2009; 52: 1479–1495.

  31. 31.

    , , , , , et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ 2008; 336: 1348–1351.

  32. 32.

    , , , , , et al. Daily non-soy legume consumption reverses vascular impairment due to peripheral artery disease. Atherosclerosis 2013; 230: 310–314.

  33. 33.

    , , . Legume-, fish-, or high-protein-based hypocaloric diets: effects on weight loss and mitochondrial oxidation in obese men. J Med Food 2009; 12: 100–108.

  34. 34.

    , , , . Combining functional features of whole-grain barley and legumes for dietary reduction of cardiometabolic risk: a randomised cross-over intervention in mature women. Br J Nutr 2014; 111: 706–714.

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Acknowledgements

The authors acknowledge Ms N Shiva for critical editing of English grammar and syntax of the manuscript. This study was funded by grant no. 411 from the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Author Contributions

The project idea for this study was from S.H. The project was designed by P.M, S.H and F.A. S.H, and M.H analyzed and interpreted the data; S.H and P.M prepared the manuscript. All authors read and approved the final manuscript. Overall F.A supervised the project and approved the final version of the manuscript to be submitted.

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Affiliations

  1. Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • S Hosseinpour-Niazi
  2. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • S Hosseinpour-Niazi
  3. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • P Mirmiran
  4. Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • M Hedayati
  5. Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    • F Azizi

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Competing interests

The authors declare no conflict of interest.

Corresponding author

Correspondence to P Mirmiran.

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DOI

https://doi.org/10.1038/ejcn.2014.228

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