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Purpose Epidemiological studies have reported the influence of legume consumption on multiple cancers risk, but the association in esophageal cancer (EC) remains unclear. This study aimed to investigated the prospective associations between legume consumption and EC risk, especially among Chinese populations. Methods We conducted a prospective cohort study with 15,184 participants aged 40 to 69 years from two high-risk areas of EC in China between 2005 and 2009, with follow-up until 2022. A validated questionnaire was used to collect the consumption frequency of major food groups at baseline and subsequent resurveys, including legume. The Cox proportional hazard regression was used to evaluate the multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of legume consumption and EC risk. To quantify the linear association of legume consumption and EC risk and to account for regression dilution bias, the mean usual consumption amount for each baseline group was estimated by combining the consumption level at both baseline and the second resurvey. Results The final study sample included 15,184 participants in the cohort (mean [SD] baseline age, 51.8 [7.5] years). During a follow-up of 219,365 person-years, a total of 176 new EC cases were identified. Legume consumption was inversely associated with EC risk, with a 63% reduction in risk for participants who consumed legume regularly compared with nonconsumption (HR: 0.37; 95% CI 0.16, 0.84; p for trend = 0.022). After correction for regression dilution bias, each 10 g/day increased legume consumption was associated with a HR of 0.35 (0.13, 0.96) for esophageal squamous cell carcinoma (ESCC) risk. The associations were consistent across most subgroups and sensitivity analyses. Conclusion Higher frequency of legume consumption was associated with lower risk of EC among Chinese adults, particularly ESCC. Our findings suggest legume consumption may play an important role in preventing the development of EC.

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