Top

Published in:

01-04-2013 | NUTRITIONAL EPIDEMIOLOGY

Dietary fibre and cardiovascular disease mortality in the UK Women’s Cohort Study

Authors: Diane E. Threapleton, Darren C. Greenwood, Victoria J. Burley, Maryam Aldwairji, Janet E. Cade

Published in: European Journal of Epidemiology | Issue 4/2013

Abstract

Dietary fibre has been associated with improvements in key risk factors for cardiovascular disease (CVD). Prior research has focussed more on CVD development in men and our aim was therefore to explore the association between dietary fibre intake and CVD mortality using data from the United Kingdom Women’s Cohort Study (UKWCS). Dietary fibre intake from 31,036 women was calculated both as non-starch polysaccharide (NSP) and using the Association of Official Analytical Chemist (AOAC) method from food-frequency questionnaires. Participants were free from history of CVD at baseline and mean age at recruitment was 51.8 years (standard deviation 9.2). Mortality records for participants were linked from national registry data and 258 fatal CVD cases [130 stroke, 128 coronary heart disease (CHD)] were observed over an average follow-up period of 14.3 years. Total dietary fibre (NSP/AOAC) and fibre from different food sources were not associated with fatal CHD, stroke or CVD risk in the full sample. For every 6 g/day increase in NSP, the hazard ratio (HR) was 0.91 (95 % confidence interval (CI) 0.76–1.08) or for every 11 g/day increase in fibre assessed as AOAC, the HR was 0.92 (95 % CI 0.80–1.05). Sensitivity analyses suggest a possible protective association for cereal sources of fibre on fatal stroke risk in overweight women, HR 0.80 (95 % CI 0.65–0.93) p < 0.01. In the UKWCS, a sample of health-conscious women, greater dietary fibre intake may confer no additional cardiovascular benefit, in terms of mortality, but may contribute to lower fatal stroke risk in some subgroups such as overweight women.

Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R et al. European cardiovascular disease statistics. Available online http://www.heartstats.org/datapage.asp?id=7683 2008.

Vaidya D, Becker DM, Bittner V, Mathias RA, Ouyang P. Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data. BMJ. 2011;343:d5170.PubMedCrossRef

Worrall-Carter L, Ski C, Scruth E, Campbell M, Page K. Systematic review of cardiovascular disease in women: assessing the risk. Nurs Health Sci. 2011;13(4):529–35. doi:10.1111/j.1442-2018.2011.00645.x.PubMedCrossRef

Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P et al. European cardiovascular disease statistics. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis. 2012.

Gale CP, Cattle BA, Woolston A, Baxter PD, West TH, Simms AD, et al. Resolving inequalities in care? Reduced mortality in the elderly after acute coronary syndromes. The Myocardial Ischaemia National Audit Project 2003–2010. Eur Heart J. 2012;33(5):630–9. doi:10.1093/eurheartj/ehr381.PubMedCrossRef

Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation. 2004;109(9):1101–7. doi:10.1161/01.cir.0000118498.35499.b2.PubMedCrossRef

Trowell H. Ischemic heart disease and dietary fiber. Am J Clin Nutr. 1972;25(9):926–32.PubMed

Erkkila AT, Lichtenstein AH, Erkkila AT, Lichtenstein AH. Fiber and cardiovascular disease risk: how strong is the evidence? J Cardiovasc Nurs. 2006;21(1):3–8.PubMed

Mente A, de Koning L, Shannon HS, Anand SS, Mente A, de Koning L, et al. A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med. 2009;169(7):659–69.PubMedCrossRef

10.

Pereira MA, O’Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, et al. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004;164(4):370–6.PubMedCrossRef

11.

Crowe FL, Key TJ, Appleby PN, Overvad K, Schmidt EB, Egeberg R, et al. Dietary fibre intake and ischaemic heart disease mortality: the European Prospective Investigation into Cancer and Nutrition-Heart study. Eur J Clin Nutr. 2012;66(8):950–6. doi:10.1038/ejcn.2012.51.PubMedCrossRef

12.

Lunn J, Buttriss JL. Carbohydrates and dietary fibre. Br Nutr Found Nutr Bull. 2007;32:21–64.CrossRef

13.

James SL, Muir JG, Curtis SL, Gibson PR. Dietary fibre: a roughage guide. Intern Med J. 2003;33(7):291–6.PubMedCrossRef

14.

Slavin JL, Martini MC, Jacobs DR Jr, Marquart L. Plausible mechanisms for the protectiveness of whole grains. Am J Clin Nutr. 1999;70(3 Suppl):459S–63S.PubMed

15.

Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. 1999;69(1):30–42.PubMed

16.

Coultate TP. Chapter 3 polysaccharides. In: Coultate TP, editor. Food the chemistry of its components. Cambridge: The Royal Society of Chemistry; 2009. p. 75.

17.

Rimm EB, Ascherio A, Giovannucci E, Spiegelman D, Stampfer MJ, Willett WC. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease among men. J Am Med Assoc. 1996;275(6):447–51.CrossRef

18.

Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK. National Health Nutrition Examination Survey. Dietary fiber intake and reduced risk of coronary heart disease in US men and women: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med. 2003;163(16):1897–904.PubMedCrossRef

19.

Akbaraly TN, Ferrie JE, Berr C, Brunner EJ, Head J, Marmot MG, et al. Alternative healthy eating index and mortality over 18 y of follow-up: results from the Whitehall II cohort. Am J Clin Nutr. 2011;94(1):247–53. doi:10.3945/ajcn.111.013128.PubMedCrossRef

20.

Kokubo Y, Iso H, Saito I, Yamagishi K, Ishihara J, Inoue M, et al. Dietary fiber intake and risk of cardiovascular disease in the Japanese population: the Japan Public Health Center-based study cohort. Eur J Clin Nutr. 2011;65(11):1233–41. doi:10.1038/ejcn.2011.100.PubMedCrossRef

21.

Streppel MT, Ocke MC, Boshuizen HC, Kok FJ, Kromhout D. Dietary fiber intake in relation to coronary heart disease and all-cause mortality over 40 y: the Zutphen Study. Am J Clin Nutr. 2008;88(4):1119–25.PubMed

22.

Cade JE, Burley VJ, Greenwood DC. The UK Women’s Cohort Study: comparison of vegetarians, fish-eaters and meat-eaters. Public Health Nutr. 2004;7(7):871–8.PubMedCrossRef

23.

Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25:71–80.PubMedCrossRef

24.

Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT. McCance & Widdowson’s the composition of foods. 5th ed. London: Royal Society of Chemistry and Ministry of Agriculture, Fisheries and Food; 1991.

25.

Food Standards Agency. McCance and Widdowson’s the composition of foods. 6th Summary ed. Cambridge: Royal Society of Chemistry; 2002.

26.

EuroFIR. European Food Information Resource. EuroFIR eSearch Prototype. 2010. Available from http://esearch.eurofir.org/. Accessed 11 May 2011.

27.

USDA. Unites States Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 23. Nutrient Data Laboratory Home Page [online]. 2010. Available from: http://www.ars.usda.gov/ba/bhnrc/ndl. Accessed 11 May 2011.

28.

Holland B, Unwin ID, Buss DH. Cereals and cereal products: third supplement to McCance and Widdowson’s the composition of foods. Cambridge: Royal Society of Chemistry; 1988.

29.

Holland B, Unwin ID, Buss DH. Milk products and eggs: fourth supplement to McCance and Widdowson’s the composition of foods. Cambridge: Royal Society of Chemistry; 1989.

30.

Holland B, Unwin ID, Buss DH. Vegetables, herbs and spices: fifth supplement to McCance and Widdowson’s the composition of foods. Cambridge: Royal Society of Chemistry; 1991.CrossRef

31.

Holland B, Unwin ID, Buss DH. Fruit and nuts: first supplement to 5th edition of McCance and Widdowson’s the composition of foods. Cambridge: Royal Society of Chemistry; 1992.

32.

Holland B, Welch AA, Buss DH. Vegetable dishes: second supplement to 5th edition of McCance and Widdowson’s the composition of foods. Cambridge: Royal Society of Chemistry; 1992.

33.

Greenland S, Pearl J, Robins JM. Causal diagrams for epidemiologic research. Epidemiology. 1999;10(1):37–48.PubMedCrossRef

34.

Willett WW, Stampfer MJ. Implications of total energy intake for epidemiologic analyses. In: Willett WW, editor. Nutritional epidemiology. Oxford: Oxford University Press; 1998. p. 273–300.CrossRef

35.

Nordestgaard BG, Palmer TM, Benn M, Zacho J, Tybjaerg-Hansen A, Davey SG, et al. The effect of elevated body mass index on ischemic heart disease risk: causal estimates from a Mendelian randomisation approach. PLoS Med. 2012;9(5):e1001212. doi:10.1371/journal.pmed.1001212.PubMedCrossRef

36.

Logue J, Murray HM, Welsh P, Shepherd J, Packard C, Macfarlane P, et al. Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation. Heart. 2011;97(7):564–8. doi:10.1136/hrt.2010.211201.PubMedCrossRef

37.

Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B, et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol. 2009;54(25):2366–73. doi:10.1016/j.jacc.2009.10.009.PubMedCrossRef

38.

Stata. Stata Statistical Software: Release 11. College Station, TX: StataCorp LP. 2009.

39.

Ward HA, Keogh R, Lentjes M, Luben RN, Wareham NJ, Khaw KT. Fibre intake in relation to serum total cholesterol levels and CHD risk: a comparison of dietary assessment methods. Eur J Clin Nutr. 2012;66(3):296–304. doi:10.1038/ejcn.2011.184.PubMedCrossRef

40.

Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J. Dietary fiber and fiber-rich food intake in relation to risk of stroke in male smokers. Eur J Clin Nutr. 2009;63(8):1016–24.PubMedCrossRef

41.

Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE, et al. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol. 2005;161(2):161–9.PubMedCrossRef

42.

Chuang S-C, Norat T, Murphy N, Olsen A, Tjønneland A, Overvad K, et al. Fiber intake and total and cause-specific mortality in the European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr. 2012;96(1):164–74.PubMedCrossRef

43.

Ye EQ, Chacko SA, Chou EL, Kugizaki M, Liu S. Greater whole-grain intake is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. J Nutr. 2012;142(7):1304–13. doi:10.3945/jn.111.155325.PubMedCrossRef

44.

Eshak ES, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Dietary fiber intake is associated with reduced risk of mortality from cardiovascular disease among Japanese men and women. J Nutr. 2010;140(8):1445–53.PubMedCrossRef

45.

Park Y, Subar AF, Hollenbeck A, Schatzkin A. Dietary fiber intake and mortality in the NIH-AARP diet and health study. Arch Intern Med. 2011;171(12):1061–8. doi:10.1001/archinternmed.2011.18.PubMedCrossRef

46.

Pietinen P, Rimm EB, Korhonen P, Hartman AM, Willett WC, Albanes D, et al. Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Circulation. 1996;94(11):2720–7.PubMedCrossRef

47.

Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, et al. Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. J Am Med Assoc. 1999;281(21):1998–2004.CrossRef

48.

Buyken AE, Flood V, Empson M, Rochtchina E, Barclay AW, Brand-Miller J, et al. Carbohydrate nutrition and inflammatory disease mortality in older adults. Am J Clin Nutr. 2010;92(3):634–43.PubMedCrossRef

49.

Ascherio A, Rimm EB, Hernan MA, Giovannucci EL, Kawachi I, Stampfer MJ, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98(12):1198–204.PubMedCrossRef

50.

Kaushik S, Wang JJ, Wong TY, Flood V, Barclay A, Brand-Miller J, et al. Glycemic index, retinal vascular caliber, and stroke mortality. Stroke. 2009;40(1):206–12.PubMedCrossRef

51.

Barrett-Connor E. Menopause, atherosclerosis, and coronary artery disease. Curr Opin Pharmacol. 2013;. doi:10.1016/j.coph.2013.01.005.PubMed

52.

Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006;13(2):265–79. doi:10.1097/01.gme.0000218683.97338.ea.PubMedCrossRef

53.

Greenwood DC, Gilthorpe MS, Golding C, Cade JE. Stability over time of dietary patterns in the UK Women’s Cohort Study. Proc Nutr Soc. 2003;62:89A.

54.

Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires—a review. Public Health Nutr. 2002;5(4):567–87. doi:10.1079/phn2001318.PubMedCrossRef

55.

Willett WW. Diet and coronary heart disease. In: Willett WW, editor. Nutritional epidemiology. Second Edition ed. monographs in epidemiology and biostatistics, vol. 30. Oxford: Oxford University Press; 1998. p. 414–66.

56.

Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT, et al. Comparison of dietary assessment methods in nutritional epidemiology: weighed records vs. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr. 1994;72(4):619–43.PubMedCrossRef

Title: Dietary fibre and cardiovascular disease mortality in the UK Women’s Cohort Study
Authors: Diane E. Threapleton
Darren C. Greenwood
Victoria J. Burley
Maryam Aldwairji
Janet E. Cade
Publication date: 01-04-2013
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 4/2013
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-013-9799-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Dietary fibre and cardiovascular disease mortality in the UK Women’s Cohort Study

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2013

The role of milk protein in increasing risk of Parkinson’s disease

Gout and the risk of Parkinson’s disease in Denmark

Time-dependent propensity score and collider-stratification bias: an example of beta2-agonist use and the risk of coronary heart disease

Serum cystatin C and prediabetes in non-obese US adults

Mediterranean diet and colorectal cancer risk: results from a European cohort

Screening, case finding or primary cancer prevention in the developing world?