Background: Dietary recommendations have globally shifted towards promoting consumption of legumes as an environmentally friendly and healthy source of protein. This study investigated 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=124,194). Information on dietary intake was collected using two to five 24-hour 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), 1201 individuals developed NAFLD. Replacing 80 g/week red and processed meat or poultry with legumes was associated with 4% and 3% lower rates of NAFLD, respectively (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; 1.01). 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.

The authors have declared no competing interest.

https://doi.org/10.5281/zenodo.11670547

This study was funded by Aarhus University and the Steno Diabetes Center Aarhus. The Graduate School of Health, Aarhus University funded the salary of Fie Langmann. Access to data and data management was funded by the Steno Diabetes Center Aarhus. Daniel B. Ibsen was funded by the Independent Research Fund Denmark with grant number 1057-00016B and the Danish Diabetes Association. The funding agencies had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript, or the decision to publish the manuscript.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The National Information Governance Board for Health and Social Care and the National Health Service (NHS) North West Multicentre Research Ethics Committee (ref 21/NW/0157) gave ethical approval for this work. This work has been conducted using the UK Biobank Resource under Application Number 81520.

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