Canadian Potential Healthcare and Societal Cost Savings from Consumption of Pulses: A Cost-Of-Illness Analysis

Incorporation of Whole or Milled Dry Edible Beans into a High-Fat Diet Improves Bone Structure in Obese Mice

BACKGROUND

Pulses, a healthy diet component, have many bone-beneficial nutrients.

OBJECTIVES

This study investigated whether incorporation of dried pulses to a high-fat diet improves bone metabolism in obese mice.

METHODS

Male C57BL/6 mice at 4-wk-old were randomly assigned to 4 diet groups (n = 22-24/group) for 12 wk: a normal-fat (NF; 4.1 kcal/g and 16% energy as fat), a HF (4.9 kcal/g and 48% energy as fat), or a HF containing either whole beans (HFWB) or milled bean flour (HFMB) at 15% wt/wt. Diets containing beans had similar total energy, protein, and fiber content as the HF without beans. Bone structure and related biomarkers were measured. Data were analyzed using a 1-way analysis of variance followed by Tukey-Kramer post hoc contrasts.

RESULTS

Mice fed the HFWB or HFMB but not the HF had higher lean mass than those fed the NF (P < 0.05, 9.1% and 8.7%, for HFWB and HFMB, respectively). Mice fed the HF, HFWB, or HFMB had 23%, 14%, and 12% lower tibial bone volume/total volume (P < 0.05), respectively, than those on the NF. Mice fed the HF but not the HFWB or HFMB had 9.2% lower bone volume/total volume in the second lumbar vertebrae than those fed the NF (P < 0.05). Pooled HF with bean groups had 18%, 14%, 27%, 17%, and 15% greater body weight, fat mass, plasma concentrations of tartrate-resistant acid phosphatase, C-terminal telopeptide of type 1 collagen, blood glucose than the HF alone, respectively (P < 0.05). Milled bean flour had a greater impact on body weight, fat mass, tibial structural model index, circulating leptin, and glucose than whole bean relative to the HF alone.

CONCLUSIONS

These data indicate that the incorporation of dry edible beans into a HF mitigates but does not fully prevent bone deterioration in obese mice.

Nutritional Quality, Safety and Environmental Benefits of Alternative Protein Sources-An Overview

Protein is a fundamental macronutrient in the human diet. It supplies our organisms with essential amino acids, which are needed for the growth and maintenance of cells and tissues. Conventional protein sources, despite their complete amino acid profiles and excellent digestibility, have a proven negative impact on the environment. Furthermore, their production poses many ethical challenges. This review aims to present nutritional, more ethical, and environmentally friendly alternatives that could serve as potential protein sources for the population. The available literature on alternative protein sources has been analyzed. Based on the research conducted, various products have been identified and described, including plant-based protein sources such as soybeans, peas, faba beans, lupins, and hemp seeds; aquatic sources such as algae, microalgae, and water lentils; as well as insect-based and microbial protein sources, and cell-cultured meat. Despite numerous advantages, such as a lower environmental impact, higher ethical standards of production, and beneficial nutritional profiles, alternative protein sources are not without limitations. These include lower bioavailability of certain amino acids, the presence of antinutritional compounds, technological challenges, and issues related to consumer acceptance. Nevertheless, with proper dietary composition, optimization of production processes, and further technological advancements, presented alternatives can constitute valuable and sustainable protein sources for the growing global population.

Dietary Patterns and Nutritional Status in Bariatric Surgery Candidates-A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Observing a patient's dietary behaviour before bariatric surgery may help to predict their diet (and indirectly, the rate of weight loss) after the procedure. Consequently, the aim of this study was to identify dietary patterns (DPs) in bariatric surgery candidates, as well as to assess the relationship between DPs, degree of obesity, and body composition.

METHODS

The participants were comprised of 117 bariatric surgery candidates. Data concerning their diet, lifestyle, and socioeconomic status was collected using the KomPAN® questionnaire. The following three DPs were identified using a principal component analysis: 'Sandwiches & Sweets', 'Fast Food, Convenience Food & Alcohol' and 'Prudent'. Baseline nutritional status and body composition using electric bioimpedance were assessed.

RESULTS

Differences were found between the DPs, degree of obesity, and body composition. The Prudent DP primarily involved a high consumption of healthy products. Following the Prudent DP, differentiated the degree of obesity and the patient's body composition the most. In turn, the Fast Food, Convenience Food & Alcohol DP was associated with a higher likelihood of Degree III obesity and a very high visceral fat level (VFL). The Sandwiches & Sweets DP included the most participants with a very high VFL.

CONCLUSIONS

The bariatric surgery candidates were shown to follow different diets, and different DPs could be identified. Patients with a higher degree of obesity followed a more beneficial DP, which was likely due to their higher awareness of the risks of morbidity in obesity and of post-surgical complications. Socioeconomic factors may attenuate the association between diet and the degree of obesity and body composition in bariatric surgery candidates.

Estimating the Potential Health Care Cost-Savings from a Flax-Based Treatment for Hypertension

Hypertension contributes to the increase in health care spending in Canada through two primary mechanisms. First, it directly increases costs, as individuals with hypertension require medical care to manage the condition. Second, it indirectly raises expenses by serving as a risk factor for numerous chronic diseases, leading to increased health care utilization among those affected. Therefore, reducing hypertension prevalence could alleviate its resulting strain on the Canadian health care system. Clinical trials have demonstrated that daily flaxseed consumption effectively lowers both systolic and diastolic blood pressure. This study employs a four-step cost-of-illness analysis to estimate the potential health care cost-savings from a flaxseed-based treatment for hypertension. The analysis begins by assessing the proportion of individuals with hypertension likely to adopt the flaxseed regimen. It then evaluates the impact of flaxseed consumption on systolic and diastolic blood pressure. Next, data from the Canadian Health Measures Survey, Cycles 5 and 6, are used to estimate the prevalence of hypertension and the expected reduction in prevalence due to the flaxseed treatment. Finally, the potential reduction in health care spending is calculated. To incorporate uncertainty, partial sensitivity analysis and Monte Carlo simulations were utilized, varying the intake success rate and other model parameters, respectively. The most conservative estimate suggests a potential health care cost-savings of CAD 96,284,344 in Canada for the year 2020.

A Translational Approach to Increase Pulse Intake and Promote Public Health through Developing an Extension Bean Toolkit

Practical, affordable solutions need to be implemented to address global challenges confronting human and environmental health. Despite a myriad of benefits for people and the planet, beans and other pulses (e.g., chickpeas, cowpeas, dry peas, lentils) are under-consumed. To better understand consumer concerns and interests, a Food Habits Survey was conducted and the findings were incorporated into the Colorado State University Extension Bean Toolkit. Guided by the Information-Motivation-Behavioral Skills model, the toolkit included informational social media posts, cooking guidance, and an online class. A convenience sample of participants was recruited through Extension and university networks. After class participation, significant gains in knowledge of pulse nutrition, versatility, and cooking were observed, with an average increase of 1.5 points on a 5-point Likert scale (p < 0.001). Moreover, participants (n = 86) perceived a greater importance of motivators (e.g., nutrition, versatility, environmental benefits) and found barriers (e.g., flatulence, long cooking times, unfamiliarity) to be less discouraging. Most participants reported an intention to eat more pulses, and among those who completed the 1-month follow-up survey, pulse intake frequency increased (p = 0.004). Emphasizing motivating factors while simultaneously mitigating barriers to consumption can help reverse insufficient intake and promote healthy behavior change. Leveraging Extension or similar networks is one way to adopt a translational approach to better reach the public with this information.

Plant Proteins: Methods of Quality Assessment and the Human Health Benefits of Pulses

As countries increase their standard of living and individual income levels rise, there is a concomitant increase in the demand for animal-based protein. However, there are alternative sources. One of the alternatives available is that of increased direct human consumption of plant proteins. The quality of a dietary protein is an important consideration when discussing the merits of one protein source over another. The three most commonly used methods to express protein quality are the protein efficiency ratio (PER), a weight gain measurement; protein digestibility-corrected amino acid score (PDCAAS); and the digestible indispensable amino acid score (DIAAS). The possibility that alterations in the quality and quantity of protein in the diet could generate specific health outcomes is one being actively researched. Plant-based proteins may have additional beneficial properties for human health when compared to animal protein sources, including reductions in risk factors for cardiovascular disease and contributions to increased satiety. In this paper, the methods for the determination of protein quality and the potential beneficial qualities of plant proteins to human health will be described.

Comparison of the effects of six-week time-restricted eating on weight loss, body composition, and visceral fat in overweight older men and women

The aim of this study was to determine the effectiveness of a six-week time-restricted eating (TRE) intervention in reducing body weight, fat loss, and visceral fat in overweight, older adult men and women (age range = 65-74 years). Another objective was to determine the feasibility of widespread use of TRE in older women and men. The study randomly assigned 116 healthy, non-smoking participants to one of two conditions: TRE or educational control participants. Participants in the TRE group were instructed to not consume calorie containing beverages or food for 16 h per day, from 8:00 pm to 12:00 pm. Participants in the control group were instructed to follow a meal plan based on their previous habits. The changes in body weight and body composition were determined using a SECA mBCA 515 analyzer. The six-week TRE intervention resulted in a significant decrease in body weight in both men and women (-1.8 kg and-1.3 kg, respectively; p = 0.03). In men, a significant decrease in visceral fat mass (-0.54 l; p ≤ 0.001) and waist circumference (-2.9 cm; p ≤ 0.015) was observed. No significant changes in either visceral fat or waist circumference were observed in women. Additionally, no change in skeletal muscle mass was observed in either the control or TRE group. More than 99 % of female and 98 % of male participants were able to adhere to the prescribed time-restricted eating (16/8) plan, suggesting that this dietary approach could have beneficial effects on the body composition of overweight older men and may also reduce body weight in overweight, older women.

Theoretical attributable risk analysis and Disability Adjusted Life Years (DALYs) based on increased dairy consumption

BACKGROUND

Identification of modifiable risk factors that may impact chronic disease risk is critical to public health. Our study objective was to conduct a theoretical population attributable risk analysis to estimate the burden of disease from low dairy intake and to estimate the impact of increased dairy intake on United States (US)-based disability adjusted life years (DALYs).

METHODS

We conducted a comprehensive literature review to identify statistically significant summary relative risk estimates (SRREs) from recent meta-analyses of dairy consumption and key chronic disease outcomes. The SRREs were applied to preventive fractions using a range of categories (low to high) for population consumption of dairy products. The preventive fraction estimates were then applied to the number of DALYs for each health outcome in the US based on 2019 WHO estimates. The population attributable risk proportion estimates were calculated using the inverse of the SRRE from each meta-analysis using the same range of categories of consumption. These values were subsequently applied to the DALYs estimates to estimate the theoretical burden of disease attributable to low dairy intake.

RESULTS

Statistically significant SRREs were identified in recent meta-analyses of total dairy consumption in relation to breast cancer, colorectal cancer, cardiovascular disease (CVD), type 2 diabetes (T2D), stroke, and hypertension. In this theoretical analysis, nearly 850,000 DALYs (or 5.0% of estimated years of healthy life lost) due to CVD and 200,000 DALYs (4.5%) due to T2D may be prevented by increased dairy consumption. Approximately 100,000 DALYs due to breast cancer (7.5%) and approximately 120,000 DALYs (8.5%) due to colorectal cancer may be prevented by high dairy intake. The numbers of DALYs for stroke and hypertension that may be prevented by increased dairy consumption were approximately 210,000 (6.0%) and 74,000 (5.5%), respectively.

CONCLUSIONS

Consumption of dairy products has been associated with decreased risk of multiple chronic diseases of significant public health importance. The burden of disease that may potentially be prevented by increasing dairy consumption is substantial, and population-wide improvement in meeting recommended daily dairy intake goals could have a notable public health impact. However, this analysis is theoretical, and thus additional studies providing empirical evidence are needed to further clarify potential relationships between dairy intake and various health outcomes.

The Special Issue on “The Nutritional Value of Pulses and Whole Grains”: A Continued Endeavor to Delineate Their Benefits for Today and Addressing the Challenges of the Future

Dietary patterns are increasingly focusing on the interplay between nutritional adequacy, reduction of chronic disease, and environmental sustainability [...]

Legumes—A Comprehensive Exploration of Global Food-Based Dietary Guidelines and Consumption

Despite the well-known human and planetary health benefits of legumes, consumption is often low. This scoping review aimed to evaluate the inclusion of legumes in global food-based dietary guidelines (FBDG), and to review consumption data against global food group classifications for legumes. The review of FBDG from 94 countries identified legume-based key messaging, the key terms used to define legumes, recommended serving size and frequency of consumption and the classification of legumes into food groups as depicted by food guides. The 2018 Global Dietary Database isolated consumption data of legumes and beans using individual-level, nationally representative dietary survey data for matched countries. Food-based dietary guidelines from 40/94 countries most often identified legumes utilising the term legumes, followed by beans (n = 13), pulses (n = 10), or as beans, peas and lentils (n = 5). The serving size recommendations for legume consumption varied widely, and there was no consistency in the suggested frequency of consumption. Median bean and legume consumption for countries with FBDG ranged from 1.2 g/d (Norway) to 122.7 g/d (Afghanistan). Classification of legumes into food groups varied, with 38% of countries categorising legumes in the protein-rich food group, 20% were in a group on their own and 15% were in the starchy staples group. In countries where legumes were together with either nuts or seeds had the greatest range in intake (11.6–122.7 g/day), followed by those that grouped legumes together with protein-rich foods (4.0–104.7 g/day), while countries that grouped legumes into two food groups, in an attempt to promote consumption, tended to have a lower consumption. Greater emphasis and perhaps repositioning of legumes in dietary guidelines may be required to encourage consumption for health, environmental and economic benefits.

Legume Intake Is Associated with Potential Savings in Coronary Heart Disease-Related Health Care Costs in Australia

Legume intake has been associated with lower risk for a number of chronic disorders of high financial burden, and is advocated by dietary guidelines as an important part of healthy dietary patterns. Still, the intake of legumes generally falls short of the recommended levels in most countries around the world despite their role as an alternative protein source. The aim of this study was to assess the potential savings in costs of health care services that would follow the reduction in incidences of coronary heart disease (CHD) when adult consumers achieve a targeted level of 50 g/day of legumes intake in Australia. A cost-of-illness analysis was developed using estimates of current and targeted legumes intake in adults (age 25+ y), the estimated percent reduction in relative risk (95% CI) of CHD following legumes intake, and recent data on health care costs related to CHD in Australia. A sensitivity analysis of ‘very pessimistic’ through to ‘universal’ scenarios suggested savings in CHD-related health care costs equal to AUD 4.3 (95% CI 1.2–7.4) to AUD 85.5 (95% CI 23.3–147.7) million annually. Findings of the study suggest an economic value of incorporating attainable levels of legumes within the dietary behaviors of Australians. Greater prominence of legumes in dietary guidelines could assist with achieving broader sustainability measures in relation to diet, helping to bring together the environment and health as an important pillar in relation to sustainability.

Consumer Understanding of the Australian Dietary Guidelines: Recommendations for Legumes and Whole Grains

Dietary guidelines provide evidence-based guidance for healthy individuals to improve dietary patterns, although they are most often based on individual foods or food groups. Legumes are a class of food included in current Australian Dietary Guidelines (ADG), mentioned in two of the five food groups, as a vegetable and as an alternative to meat. Whole grain consumption is encouraged in ADG via the statement focused on cereal grains due to their health-promoting properties. Despite their prominence in guidelines, average legume and whole grain consumption in Australia remains lower than recommendations outlined in the ADG. This exploratory study aimed to understand consumer perspectives of wording utilised in dietary guidelines specifically focused on legumes and whole grains. Based on the analysis, there was a significant preference for the statement “each day, consume at least one serve of legumes either as a serve of vegetables or as an alternative to meat” (p < 0.05), which provides a specific frequency and quantification for legume consumption. For whole grain, the significantly preferred statement was “choose whole grain products over refined grains/white flour products whenever you can” indicating a less prescriptive option. Effective messaging in guidelines could consider greater specificity regarding frequency, quantity and quality of foods recommended. This exploratory study suggests an improvement in the adoption and consumption of legumes and whole grains in the Australian diet may be better facilitated through consumer-tested messaging.

Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Many dietary guidelines emphasise "mostly" whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the recommended DTI in Australia; 2) relative reductions in risk of T2DM and CVD associated with specific whole grain consumption, as reported in meta-analysis studies; and 3) data on costs of healthcare and productivity loss based on monetary figures by national healthcare authorities. A very pessimistic (5% of the population) through to universal (100% of the population) adoption of the recommended DTI was shown to potentially yield AUD 37.5 (95% CI 22.3-49.3) to AUD 750.7 (95% CI 445.7-985.2) million, and AUD 35.9 (95% CI 8.3-60.7) to AUD 717.4 (95% CI 165.5-1214.1) million in savings on annual healthcare and lost productivity costs for T2DM and CVD, respectively. Given such economic benefits of the recommended consumption of whole grains, in exchange for refined grains, there is a real opportunity to facilitate relevant socioeconomic cost-savings for Australia and reductions in disease. These results are suggestive of a much greater opportunity to communicate the need for dietary change at all levels, but particularly through food-based dietary guidelines and front-of-pack labelling initiatives.

Motivating Pulse-Centric Eating Patterns to Benefit Human and Environmental Well-Being

Pulses (e.g., lentil, common bean, chickpea, and dry pea) are linked to a myriad of positive human and environmental health impacts, making them an ideal food for wise and conscientious global citizens. In addition, pulses are affordable and shelf-stable. The combination of these factors, an elevated consumer interest in plant-based diets, and the COVID-19 pandemic resulted in increased purchasing of pulses and even empty grocery store shelves. Although pulses have many associated benefits, some consumers are hesitant to regularly eat pulses, claiming concerns of abdominal discomfort or a lack of knowledge on how to best prepare pulses. To capitalize on increased consumer interest and purchasing of pulses, now is the time for outreach efforts that address these concerns and the positive outcomes associated with pulses, thereby promoting public and environmental health. Consumers must actively decide to add pulses to their grocery lists and incorporate them into their regular eating patterns. Motivation to adopt new eating habits is essential because knowledge alone does not result in behavior change. Thus, to mitigate perceived barriers and drive consumption, we suggest application of the Information-Motivation-Behavioral Skills Model and emphasis of three main benefits of pulses as motivators: (1) culinary versatility, (2) sustainability, and (3) healthfulness.

Historical Reflection of Food Processing and the Role of Legumes as Part of a Healthy Balanced Diet

The purpose of food processing has changed over time. High-intensity industrially processed food often exhibits higher concentrations of added sugar, salt, higher energy, and lower micronutrient density than does similar food or meals prepared at home from raw or minimally processed food. Viewing the evolution of food processing from history, one could make out three major transitions related to human socioeconomic changes. The first transition was marked by the change from hunting and gathering to settled societies with agriculture and livestock farming. The second and third transitions were associated with the Industrial Revolution and with market liberalization, global trade and automation, respectively. The next major transition that will influence food processing and shape human nutrition may include the exploitation of sustainable and efficient protein and food sources that will ensure high-quality food production for the growing world population. Apart from novel food sources, traditional food such as legumes and pulses likewise exhibit great potential to contribute to a healthy balanced diet. The promotion of legumes should be intensified in public dietary guidelines because their consumption is rather low in high-income countries and increasingly displaced as a traditional staple by industrially processed food in low- to middle-income countries.

Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

High Temperature Rotational Rheology of the Seed Flour to Predict the Texture of Canned Red Kidney Beans (Phaseolus vulgaris)

The pasting profile of starchy tissues is conventionally measured by recording the apparent viscosity (η) in heating/cooling cycles. However, conventional rheometers show critical limitations when the starch is embedded in compact protein-rich cotyledon matrices, as occurs in pulses. In this work, the pasting profile of 13 red kidney beans (Phaseolus vulgaris) from the same cultivar but different growing locations was investigated using a heating/cooling cycle at higher temperature (130 °C) and pressurized conditions, using both water and brine as cooking solvents. It was hypothesized that the continuous measure of η at these conditions of flours from the dry seed would correlate with the texture, as determined by the mini-Kramer cell, of the beans after the entire process of soaking and canning. Furthermore, mechanistic answers were obtained by investigating their composition (starch, protein, and ash content) and physical properties (water holding capacity, seed ratio and weight). Interestingly, as opposed to the pasting profile at 95 °C, pasting indicators at 130 °C, including trough and final viscosity, strongly correlated with starch and protein content, seed coat ratio and, remarkably, with the firmness of the beans after canning when brine was incorporated. These results clearly show that small beans with a high protein content would bring about a more compact matrix that restricts starch from swelling and results in canned beans with a hard texture, which can be predicted by a lower pasting profile of the whole bean flour.

Dietitians vary by counseling status in bean promotion with type 2 diabetes clients: A pilot study

Beans are noted for their beneficial effects on blood glucose for persons with type 2 diabetes mellitus (T2DM). However, little is known about dietitian attitudes and perceptions, self-efficacy, or counseling practices about beans in T2DM management. Through an online survey, the attitudes and perceptions dietitians have toward the role of beans in managing T2DM were examined. The practice intentions for advising T2DM clients about beans, perceived self-efficacy for counseling on general nutrition topics and specifically on beans, were evaluated. While the target population was dietitians, all persons on the Arizona Dietetic Association and the Arizona School Nutrition Association listservs received a direct email invitation for an online survey on foods and chronic disease. There was no mention of beans or pulses to reduce bias toward bean advocates. Of the 302 dietitian respondents, over 66% counseled clients with T2DM. Fewer clinical counseling dietitians recommended beans to control blood glucose (p = .041) or to increase fiber (p < .05), and more of them promoted beans as being the same as other carbohydrates (p = .002). Higher mean self-efficacy scores for general nutrition counseling were observed for T2DM counseling RDs (p < .001). Counseling dietitians in nonclinical settings had the highest bean self-efficacy score (p < .001). Findings suggest clinical counseling dietitians are aware of bean health benefits, but do not consistently suggest beans to improve nutrition for those with T2DM in contrast to dietitians who counsel in other settings.

Associations between Dietary Pulses Alone or with Other Legumes and Cardiometabolic Disease Outcomes: An Umbrella Review and Updated Systematic Review and Meta-analysis of Prospective Cohort Studies

To update the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy, we conducted an umbrella review and updated systematic review and meta-analysis (SRMA) of prospective cohort studies of the association between dietary pulses with or without other legumes and cardiometabolic disease outcomes. We searched the PubMed, MEDLINE, EMBASE, and Cochrane databases through March 2019. We included the most recent SRMAs of prospective cohort studies and new prospective cohort studies published after the census dates of the included SRMAs assessing the relation between dietary pulses with or without other legumes and incidence and mortality of cardiovascular diseases (CVDs) [including coronary heart disease (CHD), myocardial infarction (MI), and stroke], diabetes, hypertension, and/or obesity. Two independent reviewers extracted data and assessed risk of bias. Risk estimates were pooled using the generic inverse variance method and expressed as risk ratios (RRs) with 95% CIs. The overall certainty of the evidence was assessed using the GRADE approach. Six SRMAs were identified and updated to include 28 unique prospective cohort studies with the following number of cases for each outcome: CVD incidence, 10,261; CVD mortality, 16,168; CHD incidence, 7786; CHD mortality, 3331; MI incidence, 2585; stroke incidence, 8570; stroke mortality, 2384; diabetes incidence, 10,457; hypertension incidence, 83,284; obesity incidence, 8125. Comparing the highest with the lowest level of intake, dietary pulses with or without other legumes were associated with significant decreases in CVD (RR: 0.92; 95% CI: 0.85, 0.99), CHD (RR: 0.90; 95% CI: 0.83, 0.99), hypertension (RR: 0.91; 95% CI: 0.86, 0.97), and obesity (RR: 0.87; 95% CI: 0.81, 0.94) incidence. There was no association with MI, stroke, and diabetes incidence or CVD, CHD, and stroke mortality. The overall certainty of the evidence was graded as "low" for CVD incidence and "very low" for all other outcomes. Current evidence shows that dietary pulses with or without other legumes are associated with reduced CVD incidence with low certainty and reduced CHD, hypertension, and obesity incidence with very low certainty. More research is needed to improve our estimates. This trial was registered at clinicaltrials.gov as NCT03555734.

Economic modeling for improved prediction of saving estimates in healthcare costs from consumption of healthy foods: the Mediterranean-style diet case study

Background

By design, existing scenario-based nutrition economics studies on the financial benefits of healthy dietary behaviors generally report uncertainty in inputs and wide ranges of outcome estimates.

Objectives

This modeling exercise aimed to establish precision in prediction of the potential healthcare cost savings that would follow a reduction in the incidence of cardiovascular disease (CVD) consistent with an increase in adherence to a Mediterranean-style diet (MedDiet).

Design

Using a Monte Carlo simulation model on a cost-of-illness analysis assessing MedDiet adherence, CVD incidence reduction, and healthcare cost savings in the United States and Canada, short- and long-term cost savings that are likely to accrue to the American and Canadian healthcare systems were estimated using 20 and 80% increases in MedDiet adherence scenarios.

Results

Increasing percentage of population adhering to a MedDiet by 20% beyond the current adherence level produced annual savings in CVD-related costs of US$8.2 billion (95% confidence interval [CI], $7.5-$8.8 billion) in the United States and Can$0.32 billion (95% CI, $0.29-$0.34 billion) in Canada. An 80% increase in adherence resulted in savings equal to US$31 billion (95% CI, $28.6-$33.3 billion) and Can$1.2 billion (95% CI, $1.11-$1.30 billion) in each respective country.

Conclusion

Computational techniques with stochastic parameter inputs, such as the Monte Carlo simulation, could be an effective way of incorporating variability of modeling parameters in nutrition economics studies for improved precision in estimating the monetary value of healthy eating habits.

Consumer Understanding and Culinary Use of Legumes in Australia

While health benefits of legume consumption are well documented, intake is well below recommendations in many Western cultures, and little is known regarding culinary use and consumer understanding of these foods. This study aimed to investigate consumption, knowledge, attitudes, and culinary use of legumes in a convenience sample of Australians. An online computer-based survey was used to gather data and demographic characteristics. Respondents (505 individuals answered in full or in part) were regular consumers of legumes (177/376 consumed legumes 2–4 times weekly). Chickpeas, green peas, and kidney beans were most often consumed, and were made into most commonly Mexican, then Indian and Middle Eastern meals. Consumers correctly identified protein and dietary fibre (37%) as key nutritional attributes. For non-consumers (7%; 34/463), taste, a lack of knowledge of how to prepare and include legumes, and the time taken to prepare, along with family preferences, hindered consumption. Participants identified the food category as “beans” rather than “legumes”, and this may have implications for dietary guidance at an individual and policy level. Addressing barriers to consumption, perhaps through food innovation, emphasizing positive health attributes, and clarification within dietary guidelines, are important considerations for increasing consumption of legumes.

Temporal changes in diet quality and the associated economic burden in Canada

A high-quality diet is associated with a reduced of risk of chronic disease and all-cause mortality. In this study, we assessed changes in diet quality and the associated economic burden in the Canadian population between 2004 and 2015. We used a prevalence-based cost-of-illness approach. We first calculated the diet quality using the Healthy Eating Index-Canada-2010 (HEI-C-2010) and 24-hour recall data from the Canadian Community Health Surveys (CCHS) on nutrition (CCHS 2004 cycle 2.2 and the CCHS-NU 2015). We then retrieved relative risks of HEI-2010 quintiles for chronic diseases from meta-analyses. Based on the proportions of the population following diets of varying qualities and these relative risks, we computed the population-attributable fractions and attributable costs (direct health care and indirect costs) by survey year (2004 and 2015) as well as by age and sex group. Costs were estimated in 2017 Canadian dollars for comparison purposes. We observed that on average the diet quality of Canadians improved between 2004 and 2015: the proportion of the Canadian population that did not eat a diet of high quality decreased from 83% to 76%. This improvement in diet quality translated in a decrease in economic burden of $133 million, down from $13.21 billion in 2004 to $13.08 billion in 2015. The economic burden decreased by $219 million among males but increased by $86 million among females. It also decreased among people under the age of 65 years ($333 million) but increased among those over 65 years ($ 200 million). Our findings suggest that, despite some temporal improvements, the diet of the majority of Canadians is of poor quality resulting in a high attributable economic burden. Policy and decision makers are encouraged to expand nutrition programs and policies and to specifically target the elderly in order to prevent chronic diseases and reduce health care costs.

Nutritional Combined Greenhouse Gas Life Cycle Analysis for Incorporating Canadian Yellow Pea into Cereal-Based Food Products

Incorporating low cost pulses, such as yellow peas, that are rich in nutrients and low in fertilizer requirements, into daily food items, can improve the nutritional and sustainability profile of national diets. This paper systematically characterized the effect of using Canadian grown whole yellow pea and refined wheat flours on nutritional density and carbon footprint in cereal-based food products. Canada-specific production data and the levels of 27 macro- and micronutrients were used to calculate the carbon footprint and nutrient balance score (NBS), respectively, for traditional and reformulated pan bread, breakfast cereal, and pasta. Results showed that partial replacement of refined wheat flour with yellow pea flour increased the NBS of pan bread, breakfast cereal, and pasta by 11%, 70%, and 18%, and decreased the life cycle carbon footprint (kg CO₂ eq/kg) by 4%, 11%, and 13%, respectively. The cultivation stage of wheat and yellow peas, and the electricity used during the manufacturing stage of food production, were the hotspots in the life cycle. The nutritional and greenhouse gas (GHG) data were combined as the nutrition carbon footprint score (NCFS) (NBS/g CO₂ per serving), a novel indicator that reflects product-level nutritional quality per unit environmental impact. Results showed that yellow pea flour increased the NCFS by 15% for pan bread, 90% for breakfast cereal, and 35% for pasta. The results and framework of this study are relevant for food industry, consumers, as well as global and national policy-makers evaluating the effect of dietary change and food reformulation on nutritional and climate change targets.

Glycemic Response to Black Beans and Chickpeas as Part of a Rice Meal: A Randomized Cross-Over Trial

Legumes, such as black beans (Phaseolus vulgaris L.) and chickpeas (Cicer arietinum L.), have a low glycemic index, and may reduce the glycemic load of meals in which they are included. Although the low glycemic response of beans consumed alone has been documented, few studies have examined the glycemic response to traditional food combinations such as black beans and rice or chickpeas and rice. This randomized cross-over study examined the glycemic and insulinemic impact of 50 grams of available carbohydrate from three test meals: plain white rice (control), black beans with rice, and chickpeas with rice among healthy adult women (n = 12, 18-65 years). Treatments were consumed on different mornings, a minimum of 7 days apart. Blood samples were collected at time 0 (fasting), and at 30, 60, 90, and 120 min postprandial, and were subsequently analyzed for glucose and insulin concentrations. Glucose response based on the incremental area under the curve showed a significant difference by treatment (p = 0.027). Changes in blood glucose concentrations were significantly different for the black bean meal and the chickpea meal in comparison to rice alone at 60 min (p = 0.026 and p = 0.024), 90 min (p = 0.001 and p = 0.012) and 120 min post prandial (p = 0.024; black bean meal). Findings indicate that combinations of black beans and chickpeas with white rice improve glycemic response, providing evidence that has promising implications for dietary guidance to reduce postprandial glucose and related health risks through traditional food patterns.