Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Lipids and cardiovascular/metabolic health

Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population

Abstract

Background/Objectives:

The purpose of this study was to explore the association of legume intake (beans, chickpeas, lentils and so on), as part of a low-glycemic index diet, with the risk of cardiovascular events in the Iranian middle- and old-aged people.

Subjects/Methods:

A total of 6504 subjects living in the three counties of Iran participated in the Isfahan Cohort Study. Totally, 6323 were free of cardiovascular disease (CVD) at their baseline examination. Of the 6323 individuals, 5398 participants remained in the study for 7 years of follow-up. They have been contacted every 2 years for possible occurrence of CVD events including fatal and non-fatal myocardial infarction, unstable angina, fatal and non-fatal stroke, and sudden cardiac death. The frequency of legume intake was estimated using a food frequency questionnaire. Cox proportional hazards models with shared gamma frailty terms were used to model time to event outcomes.

Results:

After a median follow-up of 6.8 years, 427 cardiovascular events occurred. The intake of legumes in different tertiles of consuming measure was associated with 34% lower risk of CVD in old-aged people, after controlling for the other probable confounders (hazard ratio and 95% CI: 0.66 (0.45, 0.98), P-value=0.039). However, there was no significant association between the frequency of consuming legumes and CVD events in the middle-aged people.

Conclusions:

The present study indicated a strong inverse relationship between legume intake and the risk of cardiovascular events in old-aged Iranian people.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Murray CJ, Lopez AD . Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–1276.

    Article  CAS  Google Scholar 

  2. World Health Organization Mortality Estimates by Cause, Age, and Sex for the Year 2008. WHO: Geneva, 2011.

  3. Tunstall-Pedoe H . Preventing chronic diseases. A vital investment: WHO global report. Int J Epidemiol 2006; 35: 1107.

    Article  Google Scholar 

  4. Forman D, Bulwer BE . Cardiovascular disease: optimal approaches to risk factor modification of diet and lifestyle. Curr Treat Options Cardiovasc Med 2006; 8: 47–57.

    Article  Google Scholar 

  5. Willett W . Nutritional Epidemiology. Oxford University Press: New York, NY, USA, 1990.

    Google Scholar 

  6. Anderson JW, Smith BM, Washnock CS . Cardiovascular and renal benefits of dry bean and soybean intake. Am J Clin Nutr 1999; 70: 464S–474S.

    Article  CAS  Google Scholar 

  7. Liu S, Buring JE, Sesso HD, Rimm EB, Willett WC, Manson JE . A prospective study of dietary fiber intake and risk of cardiovascular disease among women. J Am Coll Cardiol 2002; 39: 49–56.

    Article  Google Scholar 

  8. Pietinen P, Rimm EB, Korhonen P, Hartman AM, Willett WC, Albanes D et al. Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Circulation 1996; 94: 2720–2727.

    Article  CAS  Google Scholar 

  9. Moat SJ, Lang D, McDowell IF, Clarke ZL, Madhavan AK, Lewis MJ . Folate, homocysteine, endothelial function and cardiovascular disease. J Nutr Biochem 2004; 15: 64–79.

    Article  CAS  Google Scholar 

  10. Gums JG . Magnesium in cardiovascular and other disorders. Am J Health Syst Pharm 2004; 61: 1569–1576.

    Article  CAS  Google Scholar 

  11. Fox CH, Mahoney MC, Ramsoomair D, Carter CA . Magnesium deficiency in African-Americans: does it contribute to increased cardiovascular risk factors? J Natl Med Assoc 2003; 95: 257–262.

    PubMed  PubMed Central  Google Scholar 

  12. Saari JT . Copper deficiency and cardiovascular disease: role of peroxidation, glycation, and nitration. Can J Physiol Pharmacol 2000; 78: 848–855.

    Article  CAS  Google Scholar 

  13. Anderson JW, Major AW . Pulses and lipaemia, short- and long-term effect: potential in the prevention of cardiovascular disease. Br J Nutr 2002; 88: S263–S271.

    Article  CAS  Google Scholar 

  14. Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK . Dietary fiber intake and reduced risk of coronary heart disease in US men and women: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med 2003; 163: 1897–1904.

    Article  Google Scholar 

  15. Bazzano LA, He J, Ogden LJ, Loria C, Vupputuri S, Myers L et al. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med 2001; 161: 2573–2578.

    Article  CAS  Google Scholar 

  16. Geil PB, Anderson JW . Nutrition and health implications of dry beans: a review. J Am Coll Nutr 1994; 13: 549–558.

    Article  CAS  Google Scholar 

  17. Serrano J, Goni I . Effects of black bean Phaseolus vulgaris consumption on the nutritional status of Guatemalan population. Arch Latinoam Nutr 2004; 54: 36–44.

    CAS  PubMed  Google Scholar 

  18. Liu S, Stampfer MJ, Hu FB, Giovannucci E, Rimm E, Manson JE et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr 1999; 70: 412–419.

    Article  CAS  Google Scholar 

  19. Jenkins DJ, Kendall CW, Augustin LS, Mitchell S, Sahye-Pudaruth S, Blanco Mejia S 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.

    Article  CAS  Google Scholar 

  20. Bhattacharya S, Malleshi NG . Physical, chemical and nutritional characteristics of premature-processed and matured green legumes. J Food Sci Technol 2012; 49: 459–466.

    Article  CAS  Google Scholar 

  21. Han H, Baik BK . Antioxidant activity and phenolic content oflentils (Lens culinaris, chickpeas (Cicer arietinum L.), peas (Pisum sativum L.) and soybeans (Glycine max), and their quantitative changes during processing. Int J Food Sci Technol 2008; 43: 1971–1978.

    Article  CAS  Google Scholar 

  22. Anderson JW, Hanna TJ . Impact of nondigestible carbohydrates on serum lipoproteins and risk for cardiovascular disease. J Nutr 1999; 129: S1457–S1466.

    Article  Google Scholar 

  23. Tourlouki E, Matalas AL, Panagiotakos DB . Dietary habits and cardiovascular disease risk in middle-aged and elderly populations: a review of evidence. Clin Interv Aging 2009; 4: 319–330.

    Article  Google Scholar 

  24. Sarrafzadegan N, Talaei M, Sadeghi M, Kelishadi R, Oveisgharan S, Mohammadifard N et al. The Isfahan cohort study: rationale, methods and main findings. J Hum Hypertens 2011; 25: 545–553.

    Article  CAS  Google Scholar 

  25. Sarraf-Zadegan N, Sadri G, Malek Afzali H, Baghaei M, Mohammadi Fard N, Shahrokhi S et al. Isfahan Healthy Heart Programme: a comprehensive integrated community-based programme for cardiovascular disease prevention and control. Design, methods and initial experience. Acta Cardiol 2003; 58: 309–320.

    Article  Google Scholar 

  26. Sarrafzadegan N, Baghaei A, Sadri G, Kelishadi R, Malekafzali H, Boshtam M et al. Isfahan Healthy Heart Program: Evaluation of comprehensive, community-based interventions for non-communicable disease prevention. Prev Control 2006; 2: 73–84.

    Article  Google Scholar 

  27. Sarrafzadegan N, Kelishadi R, Esmaillzadeh A, Mohammadifard N, Rabiei K, Roohafza H et al. Do lifestyle interventions work in developing countries? Findings from the Isfahan Healthy Heart Program in the Islamic Republic of Iran. Bull World Health Organ 2009; 87: 39–50.

    Article  Google Scholar 

  28. Mohammadifard N, Sarrafzadegan N, Nouri F, Sajjadi F, Alikhasi H, Maghroun M et al. Using factor analysis to identify dietary patterns in Iranian adults: Isfahan Healthy Heart Program. Int J Public Health 2012; 57: 235–241.

    Article  Google Scholar 

  29. Clayton DG . A model for association in bivariate life tables and its application in epidemiological studies of familial tendency in chronic disease incidence. Biometrika 1978; 65: 141–151.

    Article  Google Scholar 

  30. Hougaard P . Analysis of Multivariate Survival Data. Springer: New York, 2000.

    Book  Google Scholar 

  31. Darmadi-Blackberry I, Wahlqvist ML, Kouris-Blazos A, Steen B, Lukito W, Horie W et al. Legumes: the most important dietary predictor of survival in older people of different ethnicities. Asia Pacific J Clin Nutr 2004; 13: 217–220.

    Google Scholar 

  32. Flock MR, Kris-Etherton PM . Dietary guidelines for Americans 2010: implications for cardiovascular disease. Curr Atheroscler Rep 2011; 13: 499–507.

    Article  Google Scholar 

  33. Jang Y, Lee JH, Kim OY, Park HY, Lee SY . Consumption of whole grain and legume powder reduces insulin demand, lipid peroxidation, and plasma homocysteine concentrations in patients with coronary artery disease: randomized controlled clinical trial. Arterioscler Thromb Vasc Biol 2001; 21: 2065–2071.

    Article  CAS  Google Scholar 

  34. Mozaffarian D, kumanyika SK, Lemaitre RN, Olson JL, Gl Burke, Siscovick DS . Cereal, fruit and vegetable fiber intake and the risk of cardiovascular disease in older individuals. JAMA 2003; 289: 1659–1666.

    Article  Google Scholar 

  35. Pereira MA, Pins JJ . Dietary fiber and cardiovascular disease: experimental and epidemiologic advances. Curr Atheroscler Rep 2000; 2: 494–502.

    Article  CAS  Google Scholar 

  36. Jenkins DJ, Axelsen M, Kendall CW, Augustin LS, Vuksan V, Smith U . Dietary fibre lente carbohydrates and the insulin-resistant diseases. Br J Nutr 2000; 83: S157–163.

    Article  CAS  Google Scholar 

  37. Erkkila AT, Lichtenstein AH . Fiber and cardiovascular disease risk: how strong is the evidence? J Cardiovasc Nurs 2006; 21: 3–8.

    Article  Google Scholar 

  38. Hosseinpour-Niazi S, Mirmiran P, Amiri Z, Azizi F . Dietary legumes intake and metabolic syndrome and its component in adults. J Endocrinol Metab 2011; 12: 594–602.

    Google Scholar 

  39. Willett WC, Howe GR, Kushi LH . Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 1997; 65: 1220S–1228S.

    Article  CAS  Google Scholar 

  40. Oh S, Hong M . Within-and between-person variation of nutrient intakes of older people in Korea. Eur J Clin Nutr 1999; 53: 625–629.

    Article  CAS  Google Scholar 

  41. Ogawa K, Tsubono Y, Nishino Y, Watanabe Y, Ohkubo T, Watanabe T et al. Inter-and intra-individual variation of food and nutrient consumption in a rural Japanese population. Eur J Clin Nutr 1999; 53: 781–785.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge the ICS staff and collaborators for their contribution.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M Mansourian.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nouri, F., Sarrafzadegan, N., Mohammadifard, N. et al. Intake of legumes and the risk of cardiovascular disease: frailty modeling of a prospective cohort study in the Iranian middle-aged and older population. Eur J Clin Nutr 70, 217–221 (2016). https://doi.org/10.1038/ejcn.2015.153

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.153

This article is cited by

Search

Quick links