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Dietary fiber consumption and risk of stroke

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Abstract

Observational studies suggest an association between dietary fiber consumption and risk of stroke, but the results are inconclusive. The authors conducted a meta-analysis of prospective cohort studies to evaluate the relation between dietary fiber consumption and stroke risk and mortality. Relevant studies were identified by searching PubMed, Embase, and ISI Web of Science through February 2013. We included prospective studies that reported relative risks (RRs) with 95 % confidence intervals (CIs) for the association between dietary fiber consumption and stroke risk and mortality. Both fixed- and random-effects models were used to calculate the summary risk estimates. Eleven prospective studies involving 325,627 participants were included in the meta-analysis. The pooled RR of stroke for the highest compared with the lowest dietary fiber consumption was 0.83 (95 % CI 0.74, 0.93). In addition, the increment in dietary fiber consumption was associated with decreased stroke risk in a dose–response manner. Sensitivity analysis restricted to studies with control for conventional risk factors yielded similar results, and omission of any single study had little effect on the combined risk estimate. Moreover, there was a trend toward an inverse association between higher fiber consumption and stroke mortality (RR 0.85; 95 % CI 0.60, 1.20), although it is not significant. This meta-analysis indicated that dietary fiber consumption is inversely associated with stroke risk, and the effect is probably independent of conventional risk factors. Our results support recommendations for higher consumption of fiber-rich foods to prevent stroke.

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References

  1. Bonita R, Mendis S, Truelsen T, Bogousslavsky J, Toole J, Yatsu F. The global stroke initiative. Lancet Neurol. 2004;3:391–3.

    Article  PubMed  Google Scholar 

  2. Anderson JW, Baird P, Davis RH Jr, Ferreri S, Knudtson M, Koraym A, Waters V, Williams CL. Health benefits of dietary fiber. Nutr Rev. 2009;67:188–205.

    Article  PubMed  Google Scholar 

  3. Ignarro LJ, Balestrieri ML, Napoli C. Nutrition, physical activity, and cardiovascular disease: an update. Cardiovasc Res. 2007;73:326–40.

    Article  PubMed  CAS  Google Scholar 

  4. Streppel MT, Arends LR, van ‘t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med. 2005;165:150–6.

    Article  PubMed  Google Scholar 

  5. Jenkins DJ, Kendall CW, Vuksan V, Vidgen E, Parker T, Faulkner D, Mehling CC, Garsetti M, Testolin G, Cunnane SC, Ryan MA, Corey PN. Soluble fiber intake at a dose approved by the US food and drug administration for a claim of health benefits: serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. Am J Clin Nutr. 2002;75:834–9.

    PubMed  CAS  Google Scholar 

  6. Pereira MA, Jacobs DR Jr, Pins JJ, Raatz SK, Gross MD, Slavin JL, Seaquist ER. Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr. 2002;75:848–55.

    PubMed  CAS  Google Scholar 

  7. Marlett JA, McBurney MI, Slavin JL. Position of the American dietetic association: health implications of dietary fiber. J Am Diet Assoc. 2002;102:993–1000.

    Article  PubMed  Google Scholar 

  8. Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. N Engl J Med. 1987;316:235–40.

    Article  PubMed  CAS  Google Scholar 

  9. Ascherio A, Rimm EB, Hernan MA, Giovannucci EL, Kawachi I, Stampfer MJ, Willett WC. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98:1198–204.

    Article  PubMed  CAS  Google Scholar 

  10. Mozaffarian D, Kumanyika SK, Lemaitre RN, Olson JL, Burke GL, Siscovick DS. Cereal, fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals. JAMA. 2003;289:1659–66.

    Article  PubMed  Google Scholar 

  11. Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE, Liu S, Willett WC. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol. 2005;161:161–9.

    Article  PubMed  Google Scholar 

  12. Weng LC, Yeh WT, Bai CH, Chen HJ, Chuang SY, Chang HY, Lin BF, Chen KJ, Pan WH. Is ischemic stroke risk related to folate status or other nutrients correlated with folate intake? Stroke. 2008;39:3152–8.

    Article  PubMed  CAS  Google Scholar 

  13. 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;63:1016–24.

    Article  PubMed  CAS  Google Scholar 

  14. Kaushik S, Wang JJ, Wong TY, Flood V, Barclay A, Brand-Miller J, Mitchell P. Glycemic index, retinal vascular caliber, and stroke mortality. Stroke. 2009;40:206–12.

    Article  PubMed  Google Scholar 

  15. Eshak ES, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, Wakai K, Tamakoshi A. Dietary fiber intake is associated with reduced risk of mortality from cardiovascular disease among Japanese men and women. J Nutr. 2010;140:1445–53.

    Article  PubMed  CAS  Google Scholar 

  16. Kokubo Y, Iso H, Saito I, Yamagishi K, Ishihara J, Inoue M, Tsugane S. 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;65:1233–41.

    Article  PubMed  CAS  Google Scholar 

  17. Wallstrom P, Sonestedt E, Hlebowicz J, Ericson U, Drake I, Persson M, Gullberg B, Hedblad B, Wirfalt E. Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the malmo diet and cancer cohort: a prospective study. PLoS ONE. 2012;7:e31637.

    Article  PubMed  Google Scholar 

  18. Casiglia E, Tikhonoff V, Caffi S, Boschetti G, Grasselli C, Saugo M, Giordano N, Rapisarda V, Spinella P. Palatini P. Clin Nutr: High dietary fiber intake prevents stroke at a population level; 2013.

    Google Scholar 

  19. Chen GC, Lv DB, Pang Z, Dong JY, Liu QF. Dietary fiber intake and stroke risk: a meta-analysis of prospective cohort studies. Eur J Clin Nutr. 2013;67:96–100.

    Google Scholar 

  20. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  PubMed  CAS  Google Scholar 

  21. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  22. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.

    Article  PubMed  Google Scholar 

  23. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  PubMed  CAS  Google Scholar 

  24. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301–9.

    PubMed  CAS  Google Scholar 

  25. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6:40–57.

    Google Scholar 

  26. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012;175:66–73.

    Article  PubMed  Google Scholar 

  27. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  PubMed  CAS  Google Scholar 

  28. Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, Hennekens CH, Willett WC. Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA. 1999;281:1998–2004.

    Article  PubMed  CAS  Google Scholar 

  29. Liu S, Buring JE, Sesso HD, Rimm EB, Willett WC, Manson JE. A prospective study of dietary fiber intake and risk of cardiovascular disease among women. J Am Coll Cardiol. 2002;39:49–56.

    Article  PubMed  Google Scholar 

  30. Belin RJ, Greenland P, Allison M, Martin L, Shikany JM, Larson J, Tinker L, Howard BV, Lloyd-Jones D, Van Horn L. Diet quality and the risk of cardiovascular disease: the Women’s health initiative (WHI). Am J Clin Nutr. 2011;94:49–57.

    Article  PubMed  CAS  Google Scholar 

  31. Liu S, Manson JE, Stampfer MJ, Rexrode KM, Hu FB, Rimm EB, Willett WC. Whole grain consumption and risk of ischemic stroke in women: a prospective study. JAMA. 2000;284:1534–40.

    Article  PubMed  CAS  Google Scholar 

  32. Steffen LM, Jacobs DR Jr, Stevens J, Shahar E, Carithers T, Folsom AR. Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the atherosclerosis risk in communities (ARIC) study. Am J Clin Nutr. 2003;78:383–90.

    PubMed  CAS  Google Scholar 

  33. Katz DL, Nawaz H, Boukhalil J, Chan W, Ahmadi R, Giannamore V, Sarrel PM. Effects of oat and wheat cereals on endothelial responses. Prev Med. 2001;33:476–84.

    Article  PubMed  CAS  Google Scholar 

  34. Marlett JA, Hosig KB, Vollendorf NW, Shinnick FL, Haack VS, Story JA. Mechanism of serum cholesterol reduction by oat bran. Hepatology. 1994;20:1450–7.

    Article  PubMed  CAS  Google Scholar 

  35. Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342:1392–8.

    Article  PubMed  CAS  Google Scholar 

  36. Leinonen KS, Poutanen KS, Mykkanen HM. Rye bread decreases serum total and LDL cholesterol in men with moderately elevated serum cholesterol. J Nutr. 2000;130:164–70.

    PubMed  CAS  Google Scholar 

  37. Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. J Fam Pract. 2002;51:369.

    PubMed  Google Scholar 

  38. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6:182–7.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by National Natural Science Foundation of China (31200938, 81000501, 81220108008); Natural Science Foundation of Jiangsu Province (BK2011021); Natural Science Foundation of Jinling Hospital (2012009). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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  1. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

    Zhizhong Zhang, Gelin Xu, Dezhi Liu, Wusheng Zhu, Xinying Fan & Xinfeng Liu

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  1. Zhizhong Zhang
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Correspondence to Xinfeng Liu.

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Zhang, Z., Xu, G., Liu, D. et al. Dietary fiber consumption and risk of stroke. Eur J Epidemiol 28, 119–130 (2013). https://doi.org/10.1007/s10654-013-9783-1

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