Evidence map›Paper›PMID 24898241›Full record

SynthesisThe American journal of clinical nutrition2014

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

Ashkan Afshin, Renata Micha, Shahab Khatibzadeh, Dariush Mozaffarian

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The American journal of clinical nutrition, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 214 papers, 31 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
214citing papers in PubMed, 31 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

214 citing papers in PubMed, 31 syntheses or guidelines pooled it.

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  4. [WHO guideline on carbohydrate intake for adults and children].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2024
    Guideline
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154 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

Ashkan AfshinFrom the Departments of Epidemiology (AA, RM, SK, and DM), Global Health and Population (AA), and Nutrition (DM), Harvard School of Public Health, Boston, MA; the Unit of Human Nutrition, Agricultural University of Athens, Athens, Greece (RM); and the Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (DM).
Renata MichaFrom the Departments of Epidemiology (AA, RM, SK, and DM), Global Health and Population (AA), and Nutrition (DM), Harvard School of Public Health, Boston, MA; the Unit of Human Nutrition, Agricultural University of Athens, Athens, Greece (RM); and the Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (DM).
Shahab KhatibzadehFrom the Departments of Epidemiology (AA, RM, SK, and DM), Global Health and Population (AA), and Nutrition (DM), Harvard School of Public Health, Boston, MA; the Unit of Human Nutrition, Agricultural University of Athens, Athens, Greece (RM); and the Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (DM).
Dariush MozaffarianFrom the Departments of Epidemiology (AA, RM, SK, and DM), Global Health and Population (AA), and Nutrition (DM), Harvard School of Public Health, Boston, MA; the Unit of Human Nutrition, Agricultural University of Athens, Athens, Greece (RM); and the Division of Cardiovascular Medicine and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (DM).

Funding

CVD Epidemiology Training Program in Behavior, the Environment and Global HealthT32HL098048 · NHLBI · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Goodarz Danaei, ERIC B RIMM · 2009 to 2026
$6.9M
NHLBI NIH HHS T32 HL098048
6 · The paper itself

Abstract

backgroundRelations between the consumption of nuts and legumes and risk of ischemic heart disease (IHD), stroke, and diabetes have not been well established.

objectiveWe systematically investigated and quantified associations of nut and legume consumption with incident IHD, stroke, and diabetes.

designWe 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.

resultsOf 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.

conclusionThis systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.

Indexed as

DietFabaceaeNutsDatabases, FactualDiabetes Mellitus, Type 2Endpoint DeterminationHumansIncidenceMyocardial IschemiaObservational Studies as TopicRandomized Controlled Trials as TopicRisk FactorsStroke

Identifiers

PMID24898241
PMCPMC4144102

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.