Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis

Diane E Threapleton, Darren C Greenwood, Charlotte E L Evans, Christine L Cleghorn, Camilla Nykjaer, Charlotte Woodhead, Janet E Cade, Christopher P Gale, Victoria J Burley, Diane E Threapleton, Darren C Greenwood, Charlotte E L Evans, Christine L Cleghorn, Camilla Nykjaer, Charlotte Woodhead, Janet E Cade, Christopher P Gale, Victoria J Burley

Abstract

Objective: To investigate dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease.

Design: Systematic review of available literature and dose-response meta-analysis of cohort studies using random effects models.

Data sources: The Cochrane Library, Medline, Medline in-process, Embase, CAB Abstracts, ISI Web of Science, BIOSIS, and hand searching.

Eligibility criteria for studies: Prospective studies reporting associations between fibre intake and coronary heart disease or cardiovascular disease, with a minimum follow-up of three years and published in English between 1 January 1990 and 6 August 2013.

Results: 22 cohort study publications met inclusion criteria and reported total dietary fibre intake, fibre subtypes, or fibre from food sources and primary events of cardiovascular disease or coronary heart disease. Total dietary fibre intake was inversely associated with risk of cardiovascular disease (risk ratio 0.91 per 7 g/day (95% confidence intervals 0.88 to 0.94)) and coronary heart disease (0.91 (0.87 to 0.94)). There was evidence of some heterogeneity between pooled studies for cardiovascular disease (I(2)=45% (0% to 74%)) and coronary heart disease (I(2)=33% (0% to 66%)). Insoluble fibre and fibre from cereal and vegetable sources were inversely associated with risk of coronary heart disease and cardiovascular disease. Fruit fibre intake was inversely associated with risk of cardiovascular disease.

Conclusions: Greater dietary fibre intake is associated with a lower risk of both cardiovascular disease and coronary heart disease. Findings are aligned with general recommendations to increase fibre intake. The differing strengths of association by fibre type or source highlight the need for a better understanding of the mode of action of fibre components.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the Department of Health for England and support for DET from Kellogg Marketing and Sales Company (UK) for the submitted work; DCG, CELC, CLC, CN, CW, JEC, CPG, and VJB have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793439/bin/thrd012510.f1_default.jpg
Fig 1 Risk of CHD associated with each 7 g/day increase in total fibre intake. RR=risk ratio
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793439/bin/thrd012510.f2_default.jpg
Fig 2 Risk of CHD across increasing levels of total fibre intake. RR=risk ratio
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793439/bin/thrd012510.f3_default.jpg
Fig 3 Risk of CVD associated with each 7g/day increase in total fibre intake. RR=risk ratio
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793439/bin/thrd012510.f4_default.jpg
Fig 4 Risk of CVD across increasing levels of total fibre intake. RR=risk ratio
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4793439/bin/thrd012510.f5_default.jpg
Fig 5 Combined study risk estimates for CHD and CVD associated with greater intake of total fibre, soluble or insoluble fibre and fibre from different food sources. RR=risk ratio

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