- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01594567
Meta-analyses of Dietary Pulses and Cardiometabolic Risk
Effect of Dietary Pulses on Cardiometabolic Risk in Humans: A Series of Systematic Reviews and Meta-analyses to Provide Evidence-based Guidance for Nutrition Guidelines Development
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Dietary non-oil-seed pulses (chick peas, beans, lentils, peas) are a source of slowly digestible carbohydrate, vegetable protein, and fibre. Canada's Food Guide encourages consumption of meat alternatives, such as beans, "more often", and the dietary guidelines for Americans recommend 3-cups of legumes per week. The American Heart Association (AHA) recommends the consumption of legumes at least twice a week for cardiovascular health, while the European (EASD), Canadian (CDA), and American (ADA) Diabetes Associations recommend the consumption of dietary pulses as a means of improving diabetes control. The evidence on which these recommendations are based, however, has been graded as low. The evidence to support cardiovascular risk reduction health claims for pulses has also been deemed insufficient, and obesity, blood pressure, and dyslipidemia guidelines have not addressed pulses in their recommendations.
Need for a review: The low-grade of evidence on which heart and diabetes association recommendations are based and the lack of data to support health claims and other cardiometabolic recommendations represent an urgent call for stronger evidence. A systematic review and meta-analysis of controlled feeding trials remains the "Gold Standard" of evidence for nutrition guidelines development.
Objectives: To provide evidence-based guidance for public health policy, health claims, and nutrition guidelines relating to dietary pulses, we will conduct a series of systematic reviews and meta-analyses (knowledge synthesis) of controlled feeding trials to assess the effect of pulses on markers of cardiometabolic risk in humans, specifically lipid endpoints with therapeutic targets, glycemia, blood pressure and body weight.
Design: The planning and conduct of the proposed meta-analyses will follow the Cochrane handbook for systematic reviews of interventions. The reporting will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
Data sources: MEDLINE, EMBASE, CINAHL and The Cochrane Central Register of Controlled Trials will be searched using appropriate search terms.
Study selection: Intervention trials that investigate the effect of exchanging dietary pulses for other diets on cardiometabolic risk outcomes in humans will be included. Studies that are <3-wks duration, lack a control, or report non-isocaloric comparisons will be excluded.
Data extraction: Independent investigators (≥2) will extract information about study design, sample size, subject characteristics, pulse form, dose, follow-up, and the composition of the background diets. Mean±SEM values will be extracted for all outcomes. Standard computations and imputations will be used to derive missing variance data. Risk of bias and study quality will be assessed using the risk of bias tool and the Heyland Methodological Quality Score (MQS), respectively.
Outcomes: The 4 proposed analyses will each assess a set of outcomes related to a different area of cardiometabolic control: (1) lipid control (LDL-C, ApoB, TC:HDL, non-HDL-C, ApoB:ApoA-1), (2) glycemic control (fasting glucose and insulin, HOMA-IR, glycated blood proteins), (3) body weight control, and (4) blood pressure control. Where data for both change-from-baseline differences and end differences are equally available, we will use the difference in change from baseline as the primary end point for analyses.
Data synthesis: Separate pooled analyses stratified by underlying disease status will be conducted for each area of metabolic control using the Generic Inverse Variance method with random effects models. Random-effects models will be used even in the absence of statistically significant between-study heterogeneity, as they yield more conservative summary effect estimates in the presence of residual heterogeneity. Paired analyses will be applied to all crossover trials. Heterogeneity will be tested by Cochrane's Q and quantified by I2. Sources of heterogeneity will be explored by sensitivity and subgroup analyses. A priori subgroup analyses will include pulse type, pulse dose, duration of follow-up, absolute and change in saturated fat intake, absolute and change in dietary fibre intake, design (crossover, parallel), study quality, and baseline endpoint values. An a priori subgroup analysis for absolute and change in sodium intake will replace that for absolute and change in saturated fat intake in the blood pressure analysis. Significant unexplained heterogeneity will be investigated by additional post hoc subgroup analyses (e.g. age, sex, level of feeding control [metabolic, supplemented, dietary advice], washout in crossover trials, energy balance of the background diet, composition of the background diet [total % energy from fat, carbohydrate, protein], change in cholesterol intake, absolute and change in glycemic index, etc.). Meta-regression analyses will assess the significance of subgroups analyses. Publication bias will be investigated by the inspection of funnel plots and application of Egger's and Begg's tests.
Knowledge translation plan: Results will be disseminated through traditional means such as interactive presentations at local, national, and international scientific meetings and publication in high impact factor journals. Innovative means such as webcasts with e-mail feedback mechanisms will also be used. Knowledge Users will act as knowledge brokers networking among opinion leaders and different adopter groups to increase awareness at each stage. Four Knowledge Users will also participate directly as members of nutrition guidelines committees. Target adopters will include the clinical practice, public health, industry, research communities, and patient groups. Feedback will be incorporated and used to guide analyses and improve key messages at each stage.
Preliminary findings: We conducted a systematic review and meta-analysis of the effect of dietary pulses on glycemic control in 41 controlled feeding trials. We found that pulses alone or in low-glycemic index or high-fibre diets improved markers of glycemic control. Although the improvement was clinically significant, it came at the expense of substantial inter-study heterogeneity. Knowledge translation from this preliminary project has already begun. It has provided a rationale for a large trial of the effect of pulses in type 2 diabetes to address some of the identified sources of heterogeneity and is being used in the development of the 2013 CDA Clinical Practice Guidelines (CPG) for Nutrition Therapy.
Significance: The proposed project will aid in knowledge translation related to the effects of dietary pulses on cardiometabolic risk, strengthening the evidence-base for dietary recommendations and health claims and improving health outcomes through informing healthcare providers and patients, stimulating industry innovation, and guiding future research.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Locations
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Ontario
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Toronto, Ontario, Canada, M5C 2T2
- The Toronto 3D (Diet, Digestive tract and Disease) Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Dietary trials in humans
- Randomized treatment allocation
- >=3-weeks
- Suitable control (i.e. isocaloric exchange of other dietary components for dietary pulses)
- viable endpoint data
Exclusion Criteria:
- Non-human studies
- Nonrandomized treatment allocation
- <3-weeks
- Lack of a suitable control (non-isocaloric)
- no viable endpoint data
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Lipid Analysis
Time Frame: Up to 2-years
|
Lipid endpoints with established therapeutic targets (LDL-C, apoB, TC:HDL-C, non-HDL-C, ApoB:ApoA1)
|
Up to 2-years
|
Glycemic Control Analysis
Time Frame: Up to 2-years
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Glycated blood proteins (HbA1c, fructosamine, glycated albumin), fasting blood glucose (FBG) and insulin (FBI), and the homeostasis model assessment for insulin resistance (HOMA-IR)
|
Up to 2-years
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Body Weight Analysis
Time Frame: Up to 2-years
|
body weight
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Up to 2-years
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Blood Pressure (BP) Analysis
Time Frame: Up to 2-years
|
Systolic BP, diastolic BP, mean arterial pressure (MAP)
|
Up to 2-years
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Joseph Beyene, PhD, Department of Epidemiology and Biostatistics, McMaster University
Publications and helpful links
General Publications
- Sievenpiper JL, Kendall CW, Esfahani A, Wong JM, Carleton AJ, Jiang HY, Bazinet RP, Vidgen E, Jenkins DJ. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia. 2009 Aug;52(8):1479-95. doi: 10.1007/s00125-009-1395-7. Epub 2009 Jun 13.
- Ha V, Sievenpiper JL, de Souza RJ, Jayalath VH, Mirrahimi A, Agarwal A, Chiavaroli L, Mejia SB, Sacks FM, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Bazinet RP, Josse RG, Beyene J, Kendall CW, Jenkins DJ. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2014 May 13;186(8):E252-62. doi: 10.1503/cmaj.131727. Epub 2014 Apr 7.
- Jayalath VH, de Souza RJ, Sievenpiper JL, Ha V, Chiavaroli L, Mirrahimi A, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ. Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials. Am J Hypertens. 2014 Jan;27(1):56-64. doi: 10.1093/ajh/hpt155. Epub 2013 Sep 7.
- Kim SJ, de Souza RJ, Choo VL, Ha V, Cozma AI, Chiavaroli L, Mirrahimi A, Blanco Mejia S, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ, Sievenpiper JL. Effects of dietary pulse consumption on body weight: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2016 May;103(5):1213-23. doi: 10.3945/ajcn.115.124677. Epub 2016 Mar 30.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
- Insulin resistance
- Cholesterol
- Blood pressure
- Uric acid
- Evidence-based nutrition (EBN)
- Body weight
- Triglycerides
- Systematic review and meta-analysis
- Evidence-based medicine (EBM)
- Clinical practice guidelines
- Clinical trials
- Glycemic control
- Cardiometabolic risk factors
- legumes
- Dietary pulses
- Beans, peas, chickpeas, lentils
Additional Relevant MeSH Terms
Other Study ID Numbers
- CIHR-KRS-2011-263052
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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