Skip to main content
SpringerLink
Log in

Dietary fiber intake and risk of type 2 diabetes: a dose–response analysis of prospective studies

  • META-ANALYSIS
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Observational studies suggest an association between dietary fiber intake and risk of type 2 diabetes, but the results are inconclusive. We conducted a meta-analysis of prospective studies evaluating the associations of dietary fiber intake and risk of type 2 diabetes. Relevant studies were identified by searching EMBASE (from 1974 to April 2013) and PubMed (from 1966 to April 2013). The fixed or random-effect model was selected based on the homogeneity test among studies. In addition, a 2-stage random-effects dose–response meta-analysis was performed. We identified 17 prospective cohort studies of dietary fiber intake and risk of type 2 diabetes involving 19,033 cases and 488,293 participants. The combined RR (95 % CI) of type 2 diabetes for intake of total dietary fiber, cereal fiber, fruit fiber and insoluble fiber was 0.81 (0.73–0.90), 0.77 (0.69–0.85), 0.94 (0.88–0.99) and 0.75 (0.63–0.89), respectively. A nonlinear relationship was found of total dietary fiber intake with risk of type 2 diabetes (P for nonlinearity < 0.01), and the RRs (95 % CI) of type 2 diabetes were 0.98 (0.90–1.06), 0.97 (0.87–1.07), 0.89 (0.80–0.99), 0.76 (0.65–0.88), and 0.66 (0.53–0.82) for 15, 20, 25, 30, and 35 g/day. The departure from nonlinear relationship was not significant (P for nonlinearity = 0.72), and the risk of type 2 diabetes decreased by 6 % (RR 0.94, 95 % CI 0.93–0.96) for 2 g/day increment in cereal fiber intake. Findings from this meta-analysis indicate that the intakes of dietary fiber may be inversely associated with risk of type 2 diabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011;378(9785):31–40.

    Article  CAS  PubMed  Google Scholar 

  2. American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033–46.

    Article  Google Scholar 

  3. Waldeyer R, Brinks R, Rathmann W, Giani G, Icks A. Projection of the burden of type 2 diabetes mellitus in Germany: a demographic modelling approach to estimate the direct medical excess costs from 2010 to 2040. Diabetes Med. 2013;30(8):999–1008.

    Article  CAS  Google Scholar 

  4. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362(12):1090–101.

    Article  CAS  PubMed  Google Scholar 

  5. Johnson JA, Carstensen B, Witte D, Bowker SL, Lipscombe L, Renehan AG. Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence. Diabetologia. 2012;55(6):1607–18.

    Article  CAS  PubMed  Google Scholar 

  6. Parillo M, Riccardi G. Diet composition and the risk of type 2 diabetes: epidemiological and clinical evidence. Br J Nutr. 2004;92(1):7–19.

    Article  CAS  PubMed  Google Scholar 

  7. Meyer KA, Kushi LH, Jacobs DR Jr, Slavin J, Sellers TA, Folsom AR. Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr. 2000;71(4):921–30.

    CAS  PubMed  Google Scholar 

  8. Weng LC, Lee NJ, Yeh WT, Ho LT, Pan WH. Lower intake of magnesium and dietary fiber increases the incidence of type 2 diabetes in Taiwnese. J Formos Med Assoc. 2012;111(11):651–9.

    Article  CAS  PubMed  Google Scholar 

  9. Salmerón J, Ascherio A, Rimm EB, Colditz GA, Spiegelman D, Jenkins DJ, et al. Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care. 1997;20(4):545–50.

    Article  PubMed  Google Scholar 

  10. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004;80(2):348–56.

    CAS  PubMed  Google Scholar 

  11. Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Stat Med. 2010;29(9):1037–57.

    PubMed  Google Scholar 

  12. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  13. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Tobias A. Assessing the influence of a single study in the meta-analysis estimate. Stata Tech Bull. 1999;47:15–7.

    Google Scholar 

  16. 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(1):66–73.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8(5):551–61.

    Article  CAS  PubMed  Google Scholar 

  18. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stat J. 2006;6(1):40–57.

    Google Scholar 

  19. Jackson D, White IR, Thompson SG. Extending DerSimonian and Laird’s methodology to perform multivariate random effects meta-analyses. Stat Med. 2010;29(12):1282–97.

    Article  PubMed  Google Scholar 

  20. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135(11):1301–9.

    CAS  PubMed  Google Scholar 

  21. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA. 1997;277(6):472–7.

    Article  PubMed  Google Scholar 

  22. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–7.

    Article  CAS  PubMed  Google Scholar 

  23. Stevens J, Ahn K, Juhaeri J, Houston D, Steffan L, Couper D. Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Diabetes Care. 2002;25(10):1715–21.

    Article  CAS  PubMed  Google Scholar 

  24. Montonen J, Knekt P, Järvinen R, Aromaa A, Reunanen A. Whole-grain and fiber intake and the incidence of type 2 diabetes. Am J Clin Nutr. 2003;77(3):622–9.

    CAS  PubMed  Google Scholar 

  25. Hodge AM, English DR, O’Dea K, Giles GG. Glycemic index and dietary fiber and the risk of type 2 diabetes. Diabetes Care. 2004;27(11):2701–6.

    Article  PubMed  Google Scholar 

  26. Lindström J, Peltonen M, Eriksson JG, Louheranta A, Fogelholm M, Uusitupa M, Tuomilehto J. High-fibre, low-fat diet predicts long-term weight loss and decreased type 2 diabetes risk: the Finnish diabetes prevention study. Diabetologia. 2006;49(5):912–20.

    Article  PubMed  Google Scholar 

  27. Schulze MB, Schulz M, Heidemann C, Schienkiewitz A, Hoffmann K, Boeing H. Fiber and magnesium intake and incidence of type 2 diabetes: a prospective study and meta-analysis. Arch Intern Med. 2007;167(9):956–65.

    Article  CAS  PubMed  Google Scholar 

  28. Barclay AW, Flood VM, Rochtchina E, Mitchell P, Brand-Miller JC. Glycemic index, dietary fiber, and risk of type 2 diabetes in a cohort of older Australians. Diabetes Care. 2007;30(11):2811–3.

    Article  PubMed  Google Scholar 

  29. Krishnan S, Rosenberg L, Singer M, Hu FB, Djoussé L, Cupples LA, Palmer JR. Glycemic index, glycemic load, and cereal fiber intake and risk of type 2 diabetes in US black women. Arch Intern Med. 2007;167(21):2304–9.

    Article  PubMed  Google Scholar 

  30. Wannamethee SG, Whincup PH, Thomas MC, Sattar N. Associations between dietary fiber and inflammation, hepatic function, and risk of type 2 diabetes in older men: potential mechanisms for the benefits of fiber on diabetes risk. Diabetes Care. 2009;32(10):1823–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Sluijs I, van der Schouw YT, van der A DL, Spijkerman AM, Hu FB, Grobbee DE, Beulens JW. Carbohydrate quantity and quality and risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition–Netherlands (EPIC-NL) study. Am J Clin Nutr. 2010; 92(4): 905–911

  32. Hopping BN, Erber E, Grandinetti A, Verheus M, Kolonel LN, Maskarinec G. Dietary fiber, magnesium, and glycemic load alter risk of type 2 diabetes in a Multiethnic Cohort in Hawaii. J Nutr. 2010;140(1):68–74.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  33. Hindy G, Sonestedt E, Ericson U, Jing XJ, Zhou Y, Hansson O, et al. Role of TCF7L2 risk variant and dietary fibre intake on incident type 2 diabetes. Diabetologia. 2012;55(10):2646–54.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Sonestedt E, Lyssenko V, Ericson U, Gullberg B, Wirfält E, Groop L, Orho-Melander M. Genetic variation in the glucose-dependent insulino tropic polypeptide receptor modifies the association between carbohydrate and fat intake and risk of type 2 diabetes in the Malmo Diet and Cancer Cohort. J Clin Endocrinol Metab. 2012;97(5):E810–8.

    Article  CAS  PubMed  Google Scholar 

  35. Wirström T, Hilding A, Gu HF, Östenson CG, Björklund A. Consumption of whole grain reduces risk of deteriorating glucose tolerance, including progression to prediabetes. Am J Clin Nutr. 2013;97(1):179–87.

    Article  PubMed  Google Scholar 

  36. Carlson JJ, Eisenmann JC, Norman GJ, Ortiz KA, Young PC. Dietary fiber and nutrient density are inversely associated with the metabolic syndrome in US adolescents. J Am Diet Assoc. 2011;111(11):1688–95.

    Article  PubMed  Google Scholar 

  37. Hosseinpour-Niazi S, Mirmiran P, Sohrab G, Hosseini-Esfahani F, Azizi F. Inverse association between fruit, legume, and cereal fiber and the risk of metabolic syndrome: Tehran Lipid and Glucose Study. Diabetes Res Clin Pract. 2011;94(2):276–83.

    Article  PubMed  Google Scholar 

  38. Mozaffarian D, Kamineni A, Carnethon M, Djoussé L, Mukamal KJ, Siscovick D. Lifestyle risk factors and new-onset diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2009;169(8):798–807.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Sahyoun NR, Anderson AL, Tylavsky FA, Lee JS, Sellmeyer DE, Harris TB. Dietary glycemic index and glycemic load and the risk of type 2 diabetes in older adults. Am J Clin Nutr. 2008;87(1):126–31.

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Mosdøl A, Witte DR, Frost G, Marmot MG, Brunner EJ. Dietary glycemic index and glycemic load are associated with high-density-lipoprotein cholesterol at baseline but not with increased risk of diabetes in the Whitehall II study. Am J Clin Nutr. 2007;86(4):988–94.

    PubMed  Google Scholar 

  41. US Department of Agriculture and US Department of Health and Human Services. Dietary guidelines for Americans, 2010 7th Edition

  42. Wen W, Shu XO, Li H, Yang G, Ji BT, Cai H, Gao YT, Zheng W. Dietary carbohydrates, fiber, and breast cancer risk in Chinese women. Am J Clin Nutr. 2009;89(1):283–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  43. Liu S, Willett WC, Manson JE, Hu FB, Rosner B, Colditz G. Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. Am J Clin Nutr. 2003;78(5):920–7.

    CAS  PubMed  Google Scholar 

  44. Lattimer JM, Haub MD. Effects of dietary fiber and its components on metabolic health. Nutrients. 2010;2(12):1266–89.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Pi-Sunyer X. Do glycemic index, glycemic load, and fiber play a role in insulin sensitivity, disposition index, and type 2 diabetes? Diabetes Care. 2005;28(12):2978–9.

    Article  PubMed  Google Scholar 

  46. Weickert MO, Pfeiffer AFH. Metabolic effects of dietary fiber consumption and prevention of diabetes. J Nutr. 2008;138(3):439–42.

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Conflict of interest

No conflict of interest existed for any of the authors.

Author information

Authors and Affiliations

  1. Shanghai Minhang Center for Disease Control and Prevention, 965 Zhongyi Road, Shanghai, 201101, China

    Baodong Yao, Hong Fang, Yujie Yan, Huilin Xu, Yinan Liu & Yanping Zhao

  2. The Key Laboratory of Public Health Safety of Ministry of Education, Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China

    Wanghong Xu, Miao Mo & Hua Zhang

Authors
  1. Baodong Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wanghong Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yujie Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huilin Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yinan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miao Mo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yanping Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yanping Zhao.

Additional information

Baodong Yao and Hong Fang have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yao, B., Fang, H., Xu, W. et al. Dietary fiber intake and risk of type 2 diabetes: a dose–response analysis of prospective studies. Eur J Epidemiol 29, 79–88 (2014). https://doi.org/10.1007/s10654-013-9876-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-013-9876-x

Keywords

Search

Navigation