Nutritional Quality of Legumes,and Their Role in Cardiometabolic Risk Prevention: A Review

Abstract

Legumes (including alfalfa, clover, lupins, green beans and peas, peanuts, soybeans, dry beans, broad beans, dry peas, chickpeas, and lentils) represent an important component of the human diet in several areas of the world, especially in the developing countries, where they complement the lack of proteins from cereals, roots, and tubers. In some regions of the world, legume seeds are the only protein supply in the diet. The health benefits of legume consumption have received rising interest from researchers, and their consumption and production extends worldwide. Among European countries, higher legume consumption is observed around the Mediterranean, with per capita daily consumption between 8 and 23 g, while in Northern Europe, the daily consumption is less than 5 g per capita. The physiological effects of different legumes vary significantly. These differences may result from the polysaccharides composition, in particular, the quantity and variety of dietary fibers and starch, protein make-up, and variability in phytochemical content. The majority of legumes contain phytochemicals: bioactive compounds, including enzyme inhibitors, phytohemagglutinins (lectins), phytoestrogens, oligosaccharides, saponins, and phenolic compounds, which play metabolic roles in humans who frequently consume these foods. Dietary intake of phytochemicals may provide health benefits, protecting against numerous diseases or disorders, such as coronary heart disease, diabetes, high blood pressure and inflammation. The synergistic or antagonistic effects of these phytochemical mixtures from food legumes, their interaction with other components of the diet, and the mechanism of their action have remained a challenge with regard to understanding the role of phytochemicals in health and diseases. Their mitigating effects and the mechanism of their action need to be further addressed if we are to understand the role of phytochemicals in health and diseases. This review provides an overview of the nutritional quality of legumes and their potential contribution in cardiometabolic risk prevention.

Introduction

N umerous observational epidemiologic data have shown an inverse relationship between the consumption of fruits, vegetables, and legumes and cardiovascular disease (CVD) risk factors, including obesity, hypertension, diabetes mellitus, and metabolic syndrome.^1

–7 In recent decades, the Mediterranean Diet (MedDiet) has emerged as a healthy dietary pattern that protects against CVD and other chronic diseases.^8
–10 Since then, there have been several reports that adoption of a MedDiet pattern is related with reduced mortality and improvements in cardiovascular risk factor levels that could be explained by the presence of many of the constituents of these foods.⁹ The MedDiet pattern is usually represented in the form of a pyramid,⁷ the base of which refers to foods which are suggested to be consumed most frequently: daily consumption of nonrefined cereals and products, such as whole-grain bread, legumes, pasta, and rice.

The nutritional value of legumes is gaining considerable interest in developed countries because of the demand for healthy foods. Pulse grains are high in proteins, carbohydrates, and dietary fibers and are a rich source of other nutritional components.^11,12 Their consumption and production extends worldwide. Common seeds, such as bean (Phaseolus vulgaris), lentil (Lens culinaris), pea (Pisum sativum), chickpea (Cicer arietinum), and faba bean (Vicia faba, known as broad bean or fava bean) are the most widely consumed legumes throughout the Mediterranean area. In Europe, legume consumption has increased in the last decade (annually averaging 3.9 kg per capita), with differences between countries. Greece, Portugal, and Spain (annually averaging 6 kg per capita) consume the most of legumes. Frequent legume consumption (four or more times weekly compared with less than once a week) has been associated with 22% and 11% lower risk of coronary heart disease (CHD) and CVD, respectively.¹³

Epidemiological studies provide convincing evidence that a diet rich in antioxidants is associated with a lower incidence of degenerative diseases. Legumes produce primary and secondary metabolites and other phytochemicals.¹⁴ Whole grains and legumes contain a complex mixture of phytochemicals possessing potent antioxidants.

Phytochemicals may have adverse effects, as they limit the digestibility of proteins and carbohydrates, interfere with mineral bioavailability, induce pathological changes in intestine and liver tissues thus affecting metabolism, inhibit a number of enzymes, and bind nutrients making them unavailable.¹⁵ They also produce intestinal gas and cause much discomfort to individuals who consume beans.¹⁶ These factors negatively affect the nutritive value of beans through direct and indirect reactions.¹⁷

On the other hand, phytochemicals have a remarkable impact on the health care system and may provide therapeutic health benefits, including the prevention and/or treatment of diseases and physiological disorders.^18,19 They possess certain pharmacological properties in human health, such as antioxidant, anti-inflammatory, hepatoprotective, hypolipidemic, hypotensive, as well as prevention of aging, diabetes, osteoporosis, DNA damage, heart diseases, and other disorders.

This article will attempt to provide a review on the nutritional quality of legumes in the improvement of cardiometabolic risk prevention.

Discussion

Nutritional quality of legume seeds

Legumes are an excellent source of many essential nutrients, including vitamins, minerals, fibers, antioxidants, and other bioactive compounds, as well as being associated with health-promoting benefits, such as reducing risk for CVD.^17
–19

The most-consumed staple foods, such as beans, soybeans, lentils, peas, and chickpeas, are all legumes. Lupin is once again gaining great interest for its health benefits.²⁰ Legumes are low in fat²¹ and rich in proteins²¹ and complex carbohydrates,²² displaying a low glycemic index and high content of fibers, polyunsaturated fatty acids (PUFAs), and magnesium.

Legumes contain a number of bioactive substances, including enzyme inhibitors, lectins, phytates, oligosaccharides, and phenolic compounds that play metabolic roles in humans or animals consuming frequently these foods.²¹

Legume proteins

Legume seeds, compared to cereal grains, are rich in high-quality protein, providing people with a highly nutritious food resource.²³ Dietary proteins are not only a source of constructive and energetic compounds like amino acids (AA), but they may also play a bioactive role by themselves and/or can be the precursors of biologically active peptides with various physiological functions. The protein content of legume seeds ranges from 17%–20% (dry weight) in peas and beans to 38%–40% in soybean and lupins,²⁴ depending on the species.²⁵ This contrasts with the protein content of cereals, which is about 7%–13%, but is similar to that of meats (18%–25%).

The approximate composition and energy content of important legumes are shown in Table 1. The nutritional quality of food proteins is determined largely by their essential AA composition and digestibility, and is often reported as biological value, protein digestibility, protein efficiency ratio, or net protein utilization.²⁷ Data on protein content in pulses, types of pulse proteins, their functional properties, and the processing effects are reported by Boye et al. ²⁸

Table 1.

Approximate Composition and Energy Content of Various Legumes

Boiled legumes	Crude proteins (g) ^a	Carbohydrates (g) ^b	Crude fibers (g)	Total lipids (g)	Energy (kJ)
Chickpeas	7.7	21.9	3.1	10.1	633
Peas	6.8	18.2	2.0	9.7	517
Lentils	7.8	18.9	0.3	9.5	506
Pinto beans	7.4	17.7	1.1	7.0	478
White lupines	11.5	18.3	4.0	3.6	628

According to Kalogeropoulos et al. ²² (modified). Cooked dry legumes (on 100 g fresh wt).

Calculated by Kjeldahl nitrogen N×6.25.

Calculated by difference (100−water−protein−fat−ash).

Legume seeds contain several comparatively minor proteins, including protease and amylase inhibitors, lectins, lipoxygenase, defense proteins, and others, which for various reasons are relevant to the nutritional/functional quality of the seeds.²³ Enzyme inhibitors can diminish protein digestibility, and lectins can reduce nutrient absorption, but both have little effect after cooking. Phytic acid can diminish mineral bioavailability. Some phenolic compounds can reduce protein digestibility and mineral bioavailability, and galactooligosaccharides may cause flatulence. On the other hand, these same compounds may have protective effects. Some legume and cereal lectins can inhibit the growth of experimental animals and reduce the digestibility and biological value of dietary proteins.²⁹

Legume lipids and vitamin E

Legume seeds contain 2%–21% fat with beneficial composition of exogenic unsaturated fatty acids (FAs) as linoleic (18:2) acid (21%–53%). Legume lipids are rich in α-linolenic (18:3) acid (ALA) (4%–22%), which is an essential FA for the biosynthesis of ω3 PUFA ranged 2.5%–41.7% of FA.²¹ The ω3 FA comprising exclusively of ALA are predominant in the most bean varieties, while ω6 FAs (mainly linoleic acid) are abundant in the other legume types. The chickpeas have the highest monounsaturated fatty acids (MUFA) content (34.2 g/100 g), while butter beans have the highest saturated fatty acids (SFA) content (28.7 g/100 g), and kidney beans have the highest content of PUFA (71.1 g/100 g). Lupins contain a higher MUFA level (mainly oleic acid) and a lower SFA content.²² All legumes are very low in trans-FA, representing <1% of total FAs.²²

Vitamin E (tocopherols and tocotrienols), a well known antioxidant, acts as a free radical scavenger, more specifically within cell membranes by preventing the oxidation of polyunsaturated lipids by free radicals, such as the hydroxyl radical. In addition, it influences cellular responses to oxidative stress by modulating signal transduction pathways. The tocopherol content is higher in seeds and legumes than in cereals. Soybeans are an important source of tocopherols, which have health-beneficial properties.³⁰ The proposed antioxidant mechanisms result in a reduced susceptibility of low density lipoprotein cholesterol (LDL-C) particles to oxidation via a scavenging action of lipid peroxyl and alkoxyl radicals, thus breaking the chain reaction of lipid peroxidation. Chickpeas (C. arietinum) show the highest vitamin E activity (∼3 mg/100 g seeds), followed by soybean (∼1.8 mg/100 g seeds) and lupins, broad beans, and peas (with values ranging 1.25–1.0 mg/100 g of seeds), whereas lentils and species of Phaseolus genus have much lower contents (0.6 mg and 0.3 mg/100 g seeds, respectively). Peas contain greater amounts of α- than β+γ-tocopherols (10.4 and 5.7 mg/100 g, respectively) and chickpeas contain similar levels of α- and β+χ-tocopherols (6.9 and 5.5 mg/100 g, respectively).³¹

Legume fibers

Compared to cereal grains, legumes are a very good source of dietary fibers.¹¹ Dietary fibers include resistant starch, nonstarch polysaccharides (cellulose, hemicellulose, pectin, gums, and β-glucans), nondigestible oligosaccharides, and lignin.^11,32 The ratio of soluble to insoluble fibers in legumes is comparable to that of grains (approximately 1:3 for both),³³ 100 g of chickpea edible portion contain 17.4 g of total dietary fibers compared to 12.7 g for wheat.³⁴ High consumption of soluble fibers is associated with a decrease in serum total cholesterol (TC), in LDL-C, and is inversely correlated with CHD mortality rates.³² In addition, an important consumption of dietary fibers, in particular resistant starch, is related with improved glucose tolerance and insulin sensitivity.¹¹ Dietary fibers may also be beneficial against obesity. It has been suggested that a state of satiety may be reached faster and last longer after ingestion of high fiber foods, because they are bulkier and take longer to eat than lower fiber foods³⁵ and delay gastric emptying.³⁶

Legumes contain a considerable amount of resistant starch, which is any starch that resists to digestion by amylase in the small intestine and progresses to the large intestine for fermentation by the gut bacteria. Resistant starch is associated with reduced glycemic response, which can be beneficial to insulin-resistant individuals and those with diabetes.^37,38 In addition to a high resistant-starch content, legumes also have a higher ratio of slow-digestible to rapid-digestible starch, compared to other carbohydrate foods.³⁹ Carbohydrates that are digested slowly also result in a low glycemic index (GI) and are associated with lower postprandial glucose levels compared with high GI carbohydrates.^40,41

In healthy subjects, some investigations^42,43 have shown the same hypoglycemic effects after a single chickpea-based breakfast. However, no significant effect was observed after a long-term (6 weeks) treatment, and the lack of change could be due to the selected normal subjects in this study.⁴³

Phytochemicals in legumes: composition and source

Legumes contain, in addition to the health-promoting components (fibers, proteins, resistant starch, and minerals), numerous phytochemicals endowed with useful biological activities.^17
–19

Phytochemicals are largely classified as polyphenols, flavonoids, isoflavonoids, anthocyanidins, phytoestrogens, terpenoids, carotenoids, limonoids, phytosterols, glucosinolates, phytohemagglutinins, and fibers.^14,17

Numerous studies reveal that selected polyphenols exhibit strong protective actions on many pathological conditions, particularly those triggered by oxidative stress, such as CVD and metabolic disorders.^18,19 The major sources of dietary polyphenols are cereals, legumes (beans and pulses), oilseeds, fruits, vegetables, and some beverages.

Phytic acid and phenolic compounds

Phytic acid exhibits antioxidant activity and protects against DNA damage; phenolic compounds have antioxidant and other important physiological and biological properties,^44

–47 and galactooligosaccharides may elicit prebiotic activity. These compounds can have complementary and overlapping mechanisms of action, including regulation of detoxifying enzymes, stimulation of the immune system functionality, regulation of lipid metabolism, antioxidant, antimutagen, and antiangiogenic properties. Although lectins and protease inhibitors are traditionally considered as protein antinutritional compounds, data have shown their potential in the treatment and/or the prevention of obesity and hypertension, so the use of the term “antinutritional” has been reconsidered.⁴⁴

In a recent study, the simple polyphenols detected in various legumes are mainly phenolic acids and flavonoids.²² The concentrations of simple polyphenols determined in these cooked legumes ranged from 321 to 2404 μg/100 g fresh weight in green split peas and big lentils, respectively, and decreased in the following order: lentils > chickpeas > pinto beans > lupins > white beans varieties, broad beans, and split peas. Secondary metabolites are considered antinutrients, simultaneously conferring health benefits, so these secondary metabolites are currently marketed as functional foods and nutraceutical ingredients.

Flavonoids

Flavonoids have a similar structure to estrogens and have the capacity to exert both estrogenic and antiestrogenic effects and provide possible protection against heart disease. The precursors of these substances are widespread in the plant kingdom, mainly found in leguminosae and are especially abundant in soybean and its products, legumes, whole grains, and cereals. Among the biological activities of the flavonoids, they act against free radicals, free radical-mediated cellular signaling, inflammation, and platelet aggregation.¹⁸

Isoflavonoids

Isoflavonoids are another subclass of phenolic phytonutrients. Soybeans are an unusually concentrated source of isoflavones (including genistein and daidzein), and soy is the major source of dietary isoflavones. The isoflavones of soy have received considerable attention owing to their binding to the estrogen receptor class of compounds, thus representing activity of a number of phytochemicals termed phytoestrogens. Five of the most-reported isoflavones are genistein, daidzein, coumestrol, formononetin, and biochanin A. Soybeans are rich in isoflavones (610–2440 μg/g), lentils do not contain significant amounts of these isoflavones (0.23–0.4 μg/g), whereas the soy sprout is a potent source of coumestrol, the major coumestan.³⁴ Chickpeas contain 0.04 mg/100 g daidzein, 0.06 mg/100 g genistein, 0.14 mg/100 g formononetin, and ∼1.7 mg/100 g biochanin A. Soybeans have high levels of daidzein (47 mg/100 g) and genistein (74 mg/100 g), but contain less formononetin and biochanin A, compared to chickpeas (0.03 and 0.07 mg/100 g, respectively).⁴⁸

Isoflavones have received great interest for their potential in preventing CVD, and several mechanistic studies suggest their probable efficiency. Some of these actions are related to the compounds' ability to act in a similar way to estrogens. Genistein, daidzein, and biochanin A have been reported as estrogen-related receptor α (ERRα) agonists. The orphan ERRs comprising ERRα, ERRβ, and ERRγ bind and regulate transcription via estrogen response elements, but do not bind endogenous estrogens. ERRα is involved in energy homeostasis, and so is a likely target for metabolic disorder treatment.⁴⁹ The peroxisome proliferator-activated receptors (PPAR) α and PPARγ active compounds are used to correct dyslipidemia and to restore glycemia balance, respectively. Formononetin, biochanin A, genistein, and daidzein act as PPARα and PPARγ activators. Biochanin A, and formononetin in particular, are of interest, since they are active at low doses (1–4 μmol/L).⁵⁰ These compounds are both present in high amounts in chickpeas compared to soybeans, and in diabetes mellitus, the pulse intake, such as chickpeas, may be of a great benefit.⁴⁸

Phytosterols

Phytosterols are natural compounds structurally similar to mammalian cell-derived cholesterol. The best dietary sources of phytosterols are unrefined vegetable oils, seeds, cereals, nuts, and legumes. Kalogeropoulos et al. ²² reported that phytosterols content of cooked dry legumes exhibit a different phytosterols profile, ranging from 13.5 mg/100 g fresh weight in black-eyed beans to 53.6 mg/100 g in lupins. β-sitosterol predominates in all cases, comprising 50%–85% of determined phytosterols and present in high concentration in chickpeas (38.52 mg/100 g). Campesterol and D5-avenasterol concentrations represent, respectively, 11.9 and 5.89 mg/100 g in white lupins, while stigmasterol content is 7.97 mg/100 g in medium white beans.

Phytosterols with potential effects on obesity are diosgenin, campesterol, brassicasterol, sitosterol, stigmasterol, and guggulsterone. High intakes of these compounds can also protect against atherosclerosis⁵¹ and decrease serum TC and LDL-C levels.⁵² Mechanistically, phytosterols compete with cholesterol for micelle formation in intestinal lumen and inhibit cholesterol absorption. Their influence on intestinal genes and transcription factors makes phytosterols key regulators in metabolism and cholesterol transport in the expression of liver genes.⁵³

Phytoestrogens

Phytoestrogens in food legumes are nonsteroidal phytochemicals quite similar in structure and function to gonadal estrogen hormone. They offer an alternative therapy for hormone replacement therapy with beneficial effects on the cardiovascular system, and may even improve menopausal symptoms.¹⁹ They have antioxidant effects due to their polyphenolic nature, including modulation of steroid metabolism or of enzymes detoxification, interference with calcium transport, and positive effects on lipid and lipoprotein profiles.^54
–56 Coumestrol and 4′-methoxy-coumestrol are two potent types of coumestans mainly found in sprouted legumes.¹⁹

Saponins

Saponins have been found in many edible legumes (lupins, lentils, and chickpeas, as well as soy, various beans, and peas). Saponins in food legumes, especially in beans, have varying degrees of hemolytic and foam-producing activity. The hyperlipidemic⁴⁸ or hypolipidemic action of saponins has not been well-studied and the results can be conflicting.⁵⁷ However, some studies suggest that saponins may reduce cholesterol through the formation of an insoluble complex with cholesterol, thus preventing its absorption in the intestine. Additionally, some saponins increase the excretion of bile acids, an indirect method in decreasing cholesterol.⁵⁸

Alkaloids

In general, the majority of alkaloids from legumes are present in lupins. The alkaloid trigonelline⁵⁹ has been found in peas,⁶⁰ and it is possible that targeted studies of chickpeas and lentils would also reveal low levels of alkaloids as well.⁴⁸ As a broad chemical class, alkaloids demonstrate a diversity of biological activities. One of the most intriguing recent reports discusses the enhancement of insulin secretion by lupin quinolizidine alkaloids.⁶¹ These data show that this increased secretion only occurs in the presence of relatively high glucose levels and so may be of relevance for managing diabetes mellitus.

Legumes consumption

Legumes represent an important component of the human diet in several countries,^21,22 especially in the developing countries, where they are considered as a complement to the lack of protein from cereals, roots, and tubers²² and in vegetarian diets.

In some regions of the world, legume seeds are the only protein supply in the diet. For these reasons, the health benefits of legume consumption have received rising interest from researchers, and their consumption and production has extended worldwide.²²

The total world value for leguminous crops is thought to be approximately two billion US dollars per annum.²³ The world crop production according to Campos-Vega et al.²¹ and FAOSTAT data⁶¹ was: dry beans (Phaseolus spp. including several species now in Vigna) in America, Africa, and Asia, 1.162 metric tons; chickpea (C. arietinum) in Asia and Middle East, 0.478 metric tons; lentils (Lens culinaris), 0.199 metric tons. Importation of pulses occurs most frequently in populated countries, such as India and Egypt, where pulses are a staple of the diet.⁴⁴

Approximately 20 leguminous species are used as dry grains in appreciable amounts for human nutrition. Among these, the pea (P. sativum) is highly consumed in Asian countries, common bean (P. vulgaris) in Latin America and African countries, chickpea (C. arietinum) in India, and lentil (L. culinaris) in countries of the Middle East. In Brazil, the common bean is the most popular food product, having been considered for a long time as the basic food of great importance for the population in both rural and urban areas.²³ In the United States, daily per capita consumption of navy beans at 1.3 lb (∼590 g) ranks second only to pinto beans at 3.6 lb (∼1633 g).⁶² Baked beans are popular in Britain, with a per capita consumption of 4 times that in the United States.⁶³ Despite a growing interest in their health benefits, legume consumption in Australia, at 9.8 g/day, is lower than in many other countries.⁶⁴

Among European countries, higher legume consumption is observed around the Mediterranean area, with daily consumptions between 8 and 23 g per capita, while in Northern Europe, daily consumptions are less than 5 g per capita.⁶⁵

In 1990, the World Health Organization (WHO) recommended consuming at least 30 g of legumes and seeds per day to aid the prevention of chronic diseases.⁶⁶ In 2005, the Dietary Guidelines for Americans recommend including 0.5 cups (∼130 g) in the diet, several times a week for a good health. In total, the weekly recommendation is 3.5 cups (∼910 g).⁶⁷ The recommended amount of grain is 6–8 servings per day, and the American Health Association (AHA) recommends that at least half of these should come from whole-grain sources.⁶⁸ Serving size examples include one slice of whole meal bread, 1 oz (∼28.3 g) dry whole-grain cereals, and 0.5 cups (∼130 g) cooked brown rice, whole-grain pasta, or cereal.

The traditional way of legume preparation includes soaking in water followed by cooking, treatment expected to alter their macro- and micro-constituents composition, with the exception of lupins and chickpeas, which are occasionally consumed as a snack. Legumes are usually consumed boiled as soup.

Beneficial effects of legume seeds: legumes and cardiometabolic risk

The health benefits of beans, legume consumption or legume-based diets have received increasing attention from researchers and the media. However, observational studies investigating habitual intake of legumes in relation to chronic diseases are limited. Indeed, the physiological effects of legumes vary significantly. These differences may result from polysaccharide composition, in particular, quantity and variety of dietary fibers and starch, protein make-up, and variability in phytochemical content.⁶⁹

Legumes and CVD

It has been confirmed that the consumption of grains, including pulses, legumes, and legume-based diets, contribute to a balanced diet and can prevent some chronic diseases, including diabetes mellitus and CVD.⁶³ For these reasons, legumes are considered an ideal complement to cereals in vegetarian diets and have gained increasing attention as functional food items. Within the context of healthier diet adoption, it is recommended that legumes consumption should increase in the Western diet.⁷⁰

Studies in rats have shown that chickpea consumption can normalize triacylglycerols (TG) levels in hypercholesterolemic rats.⁷¹ In humans, consumption of legumes, as part of a normal diet, has been suggested beneficial in the prevention and treatment of diabetes and diabetes-related diseases, including CHD and metabolic syndrome.⁷² Frequent legume consumption is likely to have a significant beneficial effect on CHD risk, by reducing serum TC, LDL-C, and TG levels,⁷³ and rising high-density lipoprotein-cholesterol (HDL-C).⁷⁴ In hypercholesterolemic adults, the serum TC and LDL-C concentrations were decreased by ∼6% and ∼5%, respectively, after baked bean consumption.⁶³ In this investigation, participants were asked to consume a single 1/2 cup serving of vegetarian baked beans or carrots, as well as the brine or packaged liquid food, for 8 weeks, as part of their usual diet. In contrast, there was no change in serum TC and LDL-C, when navy beans were fed with other legumes (80 g or ∼1/3 cup) to free-living hypercholesterolemic participants.⁷⁵ Reduction in serum TC by 1% lowers risk for CHD by ∼2%. Similarly, each 1% reduction in serum LDL-C decreases risk for CHD by ∼1%.⁷⁶ Results from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study indicate that men and women who reported consuming legumes 4 or more times per week had a 22% and 11% lower risk of CHD and CVD, respectively, compared with those who consumed legumes less than once a week.¹³

In an early study of 9632 participants free of CVD at their baseline examination in the First National Health and Nutrition Examination Survey (NHANES 1) and Epidemiological Follow-up Study (NHEFS), Bazzano et al. ⁷⁷ observed that legume consumption was significantly and inversely associated with risk of CHD and CVD. Over an average of 19 years of follow-up, 1802 incident cases of CHD and 3680 incident cases of CVD were found.

Moreover, whole grains intake was associated with a reduced incidence of fatal and nonfatal CHD in many large prospective population studies,⁷⁸ suggesting a 20%–30% reduced risk of CHD in persons with a daily intake of ≥3 servings of whole-grain foods. A Costa Rican study observed that myocardial infarction (MI) survivors and their matched controls had a 38% lower risk of MI if they consume at least 1/3 cup of cooked beans per day. Consuming greater amounts than this provided the same risk reduction but did not provide additional protection against MI.⁷⁷

In a 5-country longitudinal study of food habits among the elderly, legume consumption was the best predictor of survival. Risk of death was reduced by 8% for each daily 20 g intake of legumes.⁷⁹

Furthermore, independent association between legume intake and systemic inflammation is not well-documented. Recently, data have shown that legume consumption is inversely associated with serum concentrations of adhesion molecules and inflammatory biomarkers (serum concentrations of high-sensitive C reactive protein (hs-CRP), tumor necrosis factor α [TNFα], and interleukin [IL]–6) among Iranian women.⁸⁰ The favorable association of legume consumption with molecule adhesion and inflammatory biomarkers might be explained by the low GI values of legumes.

The biologic mechanisms underlying these relations are not entirely understood. One possible mechanism through which dietary factors have been reported to influence metabolic health is a modulation of inflammation and endothelial function.¹

Legumes, metabolic syndrome, and diabetes

Higher intakes of plant foods, such as vegetables, whole-grain foods, and legumes, but not fruit juice, have been associated with a substantially lower risk of insulin resistance and diabetes and improved glycemic control, in either normal or insulin-resistant individuals.^74,81,82

In a large prospective study, the risk of diabetes mellitus was 38% and 47% lower, in Chinese women consuming a high intake of total legumes and soybeans, respectively, than in those with a low intake, after adjustment for body mass index (BMI) and other factors.⁶⁵ Legumes contain slow-release carbohydrates and are rich in soluble fibers, factors known to improve glycemic control. The role of fibers, energy density, carbohydrates, GI, glycemic load, and protein in energy regulation and weight control, in general, have been reviewed in detail elsewhere.^83,84

Beneficial effects of soy protein were demonstrated in Iranian women with the metabolic syndrome⁸⁵ by improving lipid metabolism. These postmenopausal women also showed reduced inflammatory markers, as well as reduced insulin resistance.⁸⁶ High legume intakes were associated with lower blood pressure and serum TC, compared with low legume intakes.⁸⁷ Villegas et al. ⁸¹ have reported that legumes have been linked with the prevention and treatment of diabetes. In humans, chickpea (C. arietinum) consumption decreased serum TC levels, ⁸⁸ potentially reducing CHD risk, and has been associated with managing diabetes and lowering LDL-C levels.^89,90 In addition, the nutritional characteristics of lentils have been associated with lipid-lowering effects in humans and on diabetes mellitus incidence.^89,90 Indeed, high legume intakes were related with a low incidence of diabetes mellitus, compared with a low legume consumption.⁸⁷ A similar result indicated that the diet rich in legumes was linked with a substantially low diabetes risk.⁹¹ Chickpeas may also be beneficial in the treatment of diabetes mellitus because they have a low GI, indicating that consuming an equiavailable carbohydrate portion of chickpeas results in lowering postprandial blood glucose response, as compared with standard white wheat flour bread, through having high levels of slowly digestible starch.⁴¹

Legumes are rich in fibers, magnesium, and other components that are associated with improved glucose and inflammatory responses.⁷⁷ The viscous fiber content of legumes tends to slow down carbohydrate digestion, decreasing the GI of the diet, thus contributing to enhanced HDL-C concentrations and insulin sensitivity.⁹²

Legumes and obesity

The prevalence of obesity is substantially increasing worldwide.⁹³ High legume intakes were associated with lower BMI, compared with low legume intakes.⁸⁷ In a recent study, Venn et al. ⁹⁴ have shown that incorporation of pulses and whole-grain foods into a weight loss program resulted in an important reduction in waist circumference, compared with the group consuming a control diet, although no difference in weight loss was noted between groups.

Papanikolaou and Fulgoni⁹⁵ reported association between bean consumption with dietary quality and obesity risk in >8000 adult participants in the NHANES 1999–2002 using data from a single, multiple pass, 24-h dietary recall. They found that individuals who had consumed a variety of beans or baked beans presented significantly low body weight compared with those who had not consumed beans. In addition, the odds of being obese (BMI >30 kg/m²) was significantly lower in variety bean and baked bean consumers, compared with nonconsumers (odds ratio=0.78 and 0.77, respectively).

Soluble dietary fiber in chickpeas has been demonstrated to have a beneficial effect on weight loss and weight management.^89,90 Yannakoulia et al. ⁹⁶ have noted that whole grain intake has been associated with high adiponectin levels. In a cross-sectional study of 220 apparently healthy adult Mediterranean women, it has been shown that adherence to a dietary pattern characterized by high intake of legumes, whole grain cereals and low-fat dairy products, as well as low intake of refined cereals, was significantly and positively associated with adiponectin levels, after controlling potential confounders.

A recent feeding trial found that adherence to an energy-restricted, legume-based diet for 8 weeks led to a significant reduction in concentrations of hs-CRP5 and complement component 3, but not in IL–6 and TNFα, compared with an energy-restricted, legume-free diet.⁹⁷

Phytochemicals in legumes: their importance in cardiometabolic risk

Similarly to other vegetables and fruits, legumes are an excellent source of many essential nutrients, including vitamins, minerals, fibers, phytochemicals, and antioxidants, as well as being associated with health-promoting benefits, such as lowering risk for chronic diseases, including CHD.¹⁹

Phytochemicals in legumes and their antihyperlipidemic effect

Some data have reported that phytochemicals in legumes may have a beneficial effect on hyperlipemia (Table 2). Indeed, the consumption of pulse grains has been reported to lower serum cholesterol and increase the cholesterol saturation levels in the bile.⁴⁸ A dietary study conducted on humans over a 7-week period showed that serum LDL-C was significantly reduced during the consumption of a diet consisting of beans, lentils, and field peas.⁹⁸ The study showed that consumption of pulses lowered LDL-C by partially interrupting the enterohepatic circulation of the bile acids and enhancing the cholesterol saturation by increasing the cholesterol hepatic secretion. Other pulse components in the diet may also have contributed to the observed effect, in particular saponins, which are hydrolyzed by intestinal bacteria to diosgenin, may have exerted a beneficial effect.⁹⁹ High proportions of soy in a diet were also reported to increase HDL-C and reduce TC, LDL-C, and plasma TG levels.¹⁰⁰

Table 2.

Phytochemicals of Legumes and Their Antihyperlipidemic Effects

Phytochemicals of legumes	Antihyperlipidemic effects	References
Isoflavones	Normalize triacylglyceride levels in hypercholesterolemic rats	Zulet et al. (1999)⁷¹
Phytosterols	Reduce blood cholesterol levels; have ability to lower total cholesterol and LDL-C	Schonfeld (2010);⁵¹ Prakash and Gupta (2011)¹⁹
Phytosterols (diosgenin, campesterol, brassicasterol, sitosterol, stigmasterol, and guggulsterone)	Inhibit cholesterol absorption	Duane (1997);⁹⁸ Izar et al. (2011)⁵²
	Raise HDL-C, resulting in reduced risk of CVDs	Prakash and Gupta (2011);¹⁹ Izar et al. (2011)⁵²
Saponins, phytic acid	May reduce cholesterol through the formation of an insoluble complex with cholesterol, thus preventing absorption in the intestine	Sidhu and Oakenfull (1986);⁵⁸ Prakash and Gupta (2009);¹⁰⁵ Shimelis (2009);¹⁰⁶ Prakash and Gupta (2011)¹⁹
	Hypolipidemic effects	Alzorriz and Hernandez (1999);¹⁰⁴ Shi et al. (2004)¹⁰³
Saponins, phytoestrogens	Modulation of steroid metabolism interference with calcium transport and favorable effects on lipid (TG) and lipoprotein profiles; direct effect on lipids, inhibition of platelet aggregation, and antioxidant effects	Kuiper et al. (1998);⁵⁵ Beck et al. (2003);⁵⁶ Oseni et al. (2008)⁵⁴

LDL-C, low-density lipoprotein-cholesterol; HDL-C, high-density lipoprotein-cholesterol; CVD, cardiovascular diseases; TG, triacylglycerols

Fenugreek (Trigonella foenum graecum) and isolated fenugreek fractions have been shown to act as hypocholesterolaemic agents in both animal and human studies.¹⁰¹ Faba beans (V. faba) also have lipid-lowering effects.¹⁰¹ It has been suggested that these novel sources of legumes may provide health benefits when included in the daily diet.¹⁰¹

Legumous phytosterols and saponins have beneficial effect against hyperlipidemia (Table 2).^102

–106 A study on Rhesus male and female monkeys has shown that isoflavone-intact soy protein supplementation involves a hypocholesterolaemic effect that appears to be significantly related to pretreatment plasma cholesterol.¹⁹

Antioxidant phytochemicals in legumes and their role in lipoperoxidation and radical scavenging effect

Several studies suggest that the regular consumption of whole grains reduces the risk of chronic disease associated with oxidative damage.^107
–109 However, such studies on legumes are sparse, though a few short studies on screening of in vitro antioxidant activity of legumes have been documented (Table 3).^110
–112

Table 3.

Antioxidant Phytochemicals in Legumes and Their Role in Lipoperoxidation and Radical Scavenging Effect

Phytochemicals in legumes	Health benefits and brief description of mechanism	References
Phenolic compounds (lentils, chickpeas, green peas, soybeans)	Acting as antioxidants	van Acker et al. (1998);¹⁰⁷ Kris-Etherton et al. (2002);¹¹² Scalbert et al. (2005);¹¹¹ Sreeramulu et al. (2009);¹¹⁰ Prakash and Gupta (2011);¹⁹ Marathe et al. (2011)¹⁰⁹
	Inhibit autoxidation of unsaturated lipids, thus preventing the formation of oxidized LDL, which is considered to induce cardiovascular disease	Amic et al. (2003)¹⁰⁸
	Modify LDL oxidation	Bhathena and Velasquez (2002)¹¹⁷
Flavonoids, isoflavonoids (soybeans)	Strong natural antioxidants with free radical scavenging activity; exert synergistic actions in scavenging free radicals.	Sharma et al. (2011);¹⁸ Prakash and Gupta (2011)¹⁹
Phytoestrogens; soy isoflavone metabolite	Increase in bioavailability of nitric oxide (NO)	Hwang et al. (2003)¹¹⁸

Legumes contain varied amounts of polyphenols and possess a wide range of antioxidant activity (Table 3). Cowpea (brown and red), horse gram, common beans (black, red, brown, and beige), soybean, and fenugreek show excellent antioxidant activity. While faba beans (V. faba) and mung beans (P. aureus, V. radiatus) may also be a good source of antioxidants,¹⁰¹ chickpea (cream, green, and big brown), pea (white and green), and lablab bean (cream and white) show very weak antioxidant potential. Thus, most of the varieties having a light-colored seed coat, except soybean, exhibit low antioxidant activity, while legumes having dark-colored seed coats, do not always possess high antioxidant activity (e.g., moth bean, black pea, black gram, lentils).

Natural polyphenols exert their beneficial health effects by their antioxidant activity, these compounds are capable to remove free radicals, chelate metal catalysts, activate antioxidant enzymes, reduce α-tocopherol radicals and inhibit oxidases.^107,108 Phenolic phytochemicals inhibit oxidation of unsaturated lipids, thus preventing the formed oxidized LDL, which is considered to induce CVD (Table 3).

The antiradical activity of phenolics is principally based on the redox properties of their hydroxyl groups and the structural relationships between different parts of their chemical structure.^113,114 Adherence to legume-enriched weight loss diets have also resulted in improvement in features of metabolic syndrome and reduction in mitochondrial oxidation and lipid peroxidation.

Moreover, in vitro studies have shown that genistein, a specific inhibitor for tyrosine kinases,¹¹⁵ might prevent the development of atheroma, by inhibiting cell adhesion and proliferation, LDL oxidation, and by altering growth factor activity. Finally, a soy isoflavone-rich diet improves coronary vascular reactivity in monkeys, similar to that observed with estrogens.¹¹⁶ Phytic acid has also been shown to have a positive effect due to its antioxidant effect.

Antioxidant phytochemicals in legumes and their antidiabetic effect

Many studies in humans and animals suggest that phytochemicals in legumes (soy) have beneficial effects on diabetes mellitus (Table 4). Some studies have examined whether the consumption of legumes containing diets have an effect on glucose and lipid metabolism or on hormones controlling their metabolism.^119,120 For example, mung beans (P. aureus, V. radiatus) and soy are thought to be beneficial as an antidiabetic low GI food.^101,119,120 Fenugreek (T. foenum graecum) and isolated fenugreek fractions have been shown to act as hypoglycaemic (and hypocholesterolaemic) agents, in both animal and human studies.¹⁰¹ The unique dietary fiber composition and the high saponin content in fenugreek appear to be responsible for these therapeutic properties.

Table 4.

Phytochemicals in Legumes and Their Antidiabetic and Antiobesity Effect

Phytochemicals in legumes	Health benefits and brief description of mechanism	References
Alkaloids	Managing type 2 diabetes	Lopez et al. (2004)⁶¹
Phytic acid	May have health benefits for diabetes patients; lowers blood glucose response by reducing the rate of starch digestion and slowing the gastric emptying	Lopez et al (2004).⁶¹
Genistein and daidzein	Decrease the insulin response to an oral glucose load	Shimelis (2009)¹⁰⁶
Polyphenols	Reduce the diabetes risk	Randhir and Shetty (2007)¹¹⁹
Phytoestrogens	Beneficial effect on obesity and diabetes	Bhathena and Velasquez (2002)¹¹⁷
	Potential role in weight management is unclear	McCrory (2010)¹²⁴
Phenolic compounds	May suppress growth of the adipose tissue through their anti-angiogenic activity and by modulating adipocyte metabolism	Badimon et al. (2010);¹²⁷ Mulvihill and Huff (2010)¹²⁸
	Reduce the obesity risk	González-Castejón and Rodriguez-Casado (2011)¹²⁹
Phytic acid (myo-inositol hexaphosphate)	May help delay postprandial glucose absorption, which could contribute to satiety and delay the return of hunger	Thompson et al. (1987)¹³⁰
Saponins in soy	Anti-obesity effect	Kawano-Takahashi et al. (1986)¹³¹
Phytochemicals (in general)	Suppress growth of adipose tissue, inhibit differentiation of preadipocytes, stimulate lipolysis, and induce apoptosis of existing adipocytes, thereby reducing adipose tissue mass	Marathe et al. (2011)¹⁰⁹
Lupin quinolizidine alkaloids	Enhancement of insulin secretion	Lopez et al. (2004)⁶¹
Isoflavones and lignans	Affect energy metabolism	Bhathena and Velasquez (2002)¹¹⁷
Isoflavones; formononetin, biochanin A, genistein, and daidzein (chickpeas, soybeans)	Act as PPARα and PPARγ activators; active compounds are used to correct dyslipidemia and to restore glycaemia balance, respectively	Shen et al. (2006);⁵⁰ Rochfort and Panozzo (2007)⁴⁸

Legume phenolic compounds have been reported to reduce the risk of diabetes. Many of these benefits result from the antioxidant characteristics.¹¹⁹ Antioxidants refer to compounds possessing free radical-scavenging activity, transition metal-chelating activity, and/or singlet oxygen-quenching capacity.^120,121

Several studies suggest that cells of diabetic patients are under oxidative stress with an imbalance between free radical-generating and radical-scavenging capacities. The increased free radical production and reduced antioxidant defense may partially mediate the initiation and progression of diabetes-associated complications.^122,123

Phytoestrogens have been shown to have a beneficial effect, by improving serum lipids and modifying LDL oxidation, the basal metabolic rate and insulin-stimulated glucose oxidation. Isoflavones and lignans also affect energy metabolism. These observations suggest that the consumption of foods rich in phytoestrogens has a beneficial effect on diabetes (Table 4).¹¹⁷

Antioxidant phytochemicals in legumes and their antiobesity effect

In a review of the literature, the role of legume phytochemicals in weight loss was assessed (Table 4). Data have shown that weight loss was achievable with energy-controlled diets that were high in cereals and pulses.⁹⁴

Dietary phytochemicals might be employed as antiobesity agents because they may suppress growth of adipose tissue, inhibit differentiation of preadipocytes, stimulate lipolysis, and induce apoptosis of existing adipocytes, thereby reducing adipose tissue mass.¹⁰⁹ Their potential role in weight management is unclear,¹²⁴ although studies indicate that certain phenolics interfere with enterocyte glucose absorption through interference with the glucose transporters.^125,126 Moreover, dietary polyphenols may suppress growth of adipose tissue through their antiangiogenic activity and by modulating adipocyte metabolism.^127,128

Phytosterols with potential effects on obesity are diosgenin, campesterol, brassicasterol, sitosterol, stigmasterol, and guggulsterone.¹²⁹ Phytate has been shown to reduce the in vitro rate of starch digestion and delay postprandial glucose absorption in humans,¹³⁰ which could contribute to satiety and delay the return of hunger. Kawano-Takahashi et al. ¹³¹ reported that saponins in soy have an antiobesity effect induced by gold thioglucose in mice.

Antioxidant phytochemicals in legumes and their cardiovascular effect

Vegetarians consume high levels of flavonoids and other phytochemicals compared to omnivores. These antioxidants provide beneficial cardiovascular protection^{13,132

–135} (Table 5) by reducing platelet aggregation and blood clotting, acting as anti-inflammatory agents, and improving vascular endothelial function.^136,137

Table 5.

Phytochemicals in Legumes and Their Cardiovascular Effect

Phytochemicals in legumes	Health benefits and brief description of mechanism	References
Isoflavones	Role in treatment of metabolic disorders by preventing and treating cardiovascular disease	Rochfort and Panozzo (2007)⁴⁸
Isoflavonoids or soy products	Beneficial effects on cardiovascular system protect against atherosclerosis; altered tumor biomarkers associated with angiogenesis.	Zulet et al. (1999);⁷¹ Schonfeld (2010)⁵¹
Flavonoids	Capacity to exert both estrogenic and antiestrogenic effects and provide possible protection against heart diseases	Schonfeld (2010);⁵¹ Sharma et al. (2011)¹⁸
Phytosterols	Protect against atherosclerosis	Schonfeld (2010)⁵¹
	Protective actions on many pathological conditions particularly those triggered by oxidative stress, such as cardiovascular disease (CVD) and metabolic disorders; protect against DNA damage	Kris-Etherton et al. (2002);¹¹² Bhathena and Velasquez (2002);¹¹⁷ Scalbert et al. (2005)¹¹¹
Phenolic compounds (lentils, chickpeas, green peas, soybeans)	Block the angiotensin converting enzyme (ACE) that raises blood pressure; they inhibit cyclooxygenase, which forms prostaglandins; and they block enzymes that produce estrogen.	Sharma et al. (2011)¹⁸
Polyphenols containing azukibean seed coats (ABSC)	Anti-inflammatory responses for example, regulate cyclooxygenase-2 (COX-2)	Mukai and Sato (2009)¹⁴²
Flavonoids, isoflavonoids (soybeans)	Strong natural antioxidants with free radical scavenging activity; exert synergistic actions in scavenging free radicals	Sharma et al. (2011);¹⁸ Prakash and Gupta (2011)¹⁹
Phytostrogens; soy isoflavone metabolite	Increase in bioavailability of nitric oxide (NO)	Hwang et al. (2003)¹¹⁸
Isoflavones	Capacity to exert both estrogenic and antiestrogenic effects and provide possible protection against heart diseases	Sharma et al. (2011)¹⁸
Isoflavonoides (genistein and daidzein) (soybeans)	Potentially preventing and treating osteoporosis; protect against cardiovascular diseases; inhibit angiogenesis	Braquet et al. (1986);¹⁴³ Sharma et al. (2011)¹⁸
	Have also been reported to inhibit angiogenesis, cell cycle progression, aromatase enzyme inhibition, stimulation of sex hormone binding globulin (SHBG); synthesis and digitalis-like activity	Braquet et al. (1986)¹⁴³

Legumes are good natural sources of phytosterols. Additionally, they contain appreciable amounts of squalene, α- and β+γ-tocopherol, and generally their FA profile is favorable for a cardioprotective perspective.³¹

Legume isoflavonoids or soy products/soy protein and flaxseed have the ability to lower cholesterol and LDL-C and raise HDL-C, resulting in a reduced risk of CVD.^138
–140 Genistein and daidzein also lower the insulin response to an oral glucose load. These results indicate the beneficial effects of isoflavones on excess body weight, hyperinsulinemia, and hyperlipidemia, which are the major cardiovascular risk factors, commonly associated with obesity.

Dietary polyphenols and phytoestrogens may provide cardioprotective benefits via direct effect on lipids, inhibition of platelet aggregation, and antioxidant effects (Table 5).^{19,105,141
–143}

Conclusion

Legumes, as functional food ingredients, have gained a great interest. Indeed, legumes are a rich source of proteins, dietary fibers, micronutrients, and bioactive compounds. These health benefits are known to be associated with phytochemicals like polyphenols present in legumes, but also other bioactive compounds (phytoestrogens, saponins, etc.). Evidently, with such a wide variety of protective phytochemicals in legumes, the regular consumption of these foods is essential to ensure a healthy population with low rates of heart disease. Effectively, this review reports the nutritional quality of legumes and the beneficial effects of their phytochemicals on the excess body weight, hyperinsulinemia, hyperlipidemia, inflammation, and the oxidative stress, which are the major cardiovascular risk factors, commonly associated with obesity and diabetes.

It can, therefore, be concluded that these legumes (considered as an ideal complement to cereals in vegetarian diets) may contribute greatly in the management and/or prevention of cardiometabolic risk.

Author Disclosure Statement

No competing financial interests exist.

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