Legumes as a Substitute for Red and Processed Meat, Poultry or Fish, and the Risk of Non‐Alcoholic Fatty Liver Disease in a Large Cohort

BACKGROUND: Dietary recommendations have globally shifted towards promoting the consumption of legumes as an environmentally friendly and healthy source of protein. This study investigated the replacement of red and processed meat, poultry or fish for equal amounts of legumes on the risk of non-alcoholic fatty liver disease (NAFLD). METHODS: UK Biobank participants who completed ≥ 2 dietary assessments and had complete covariate information were included in the analyses (N = 124,546). Information on dietary intake was collected using two to five 24-h dietary assessments. Incident cases of NAFLD were determined through linkage to the National Health Service registries. The rate of developing NAFLD when replacing 80 g/week of red and processed meat, poultry or fish with legumes was estimated using multivariable-adjusted Cox proportional hazards regression. RESULTS: During follow-up (median 10.49, IQR: 10.4-10.9 years), 1205 individuals developed NAFLD. Replacing 80 g/week of red and processed meat or poultry with legumes was associated with 4% and 3% lower rates of NAFLD, respectively (red and processed meat HR: 0.96, 95% CI: 0.94; 0.98; poultry HR: 0.97, 95% CI: 0.95; 0.99). Replacing 80 g/week of fish with legumes was not associated with NAFLD (fish HR: 0.98, 95% CI: 0.96; 1.00). Results did not change markedly after adjustment for BMI. CONCLUSIONS: Consuming one serving of legumes weekly instead of red and processed meat or poultry was associated with a slightly lower rate of NAFLD, while consuming legumes instead of fish did not show an association with NAFLD. Further research in cohorts with higher legume consumption is needed to confirm these findings.