Cardiovascular Benefits of Dietary Fiber
- 2.5k Downloads
The relationship between dietary fiber and risk of cardiovascular disease (CVD) has been extensively studied. There is considerable epidemiological evidence indicating an inverse association between dietary fiber intake and CVD risk. The association has been found to be stronger for cereal fiber than for fruit or vegetable fiber, and several studies have also found increased whole grain consumption to be associated with CVD risk reduction. In light of this evidence, recent US dietary guidelines have endorsed increased consumption of fiber rich whole grains. Regular consumption of dietary fiber, particularly fiber from cereal sources, may improve CVD health through multiple mechanisms including lipid reduction, body weight regulation, improved glucose metabolism, blood pressure control, and reduction of chronic inflammation. Future research should focus on various food sources of fiber, including different types of whole grains, legumes, fruits, vegetables, and nuts, as well as resistant starch in relation to CVD risk and weight control; explore the biological mechanisms underlying the cardioprotective effect of fiber-rich diets; and study different ethnic groups and populations with varying sources of dietary fiber.
KeywordsDietary fiber Soluble fiber Insoluble fiber Cereal fiber Whole grains Resistant starch Cardiovascular disease Cardiovascular risk factors
This study is supported by NIH grant HL60712.
No potential conflicts of interest relevant to this article were reported.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance
- 3.FDA. Health claims: fruits, vegetables, and grain products that contain fiber, particularly soluble fiber, and risk of coronary heart disease. In Code of Federal Regulations. Silver Spring: Food and Drug Administration; 2008. Volume 2: [Internet].; cited 5/29/2012]. Available from: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr;sid=502078d8634923edc695b394a357d189;rgn=div8;view=text;node=21:22.214.171.124.126.96.36.199;idno=21;cc=ecfr.Google Scholar
- 5.•• U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010. These are the most recent dietary guidelines endorsed by the USDA, which recommend increased consumption of dietary fiber and whole grains in the context of an overall healthy diet and lifestyle.Google Scholar
- 6.ChooseMyPlate.gov [Internet].; cited 5/29/2012]. Available from: http://www.choosemyplate.gov/.
- 8.A Institute of Food Science and Technology. Information Statement: Dietary Fiber, April 2007: [Internet].; cited 6/12/2012]. Available from: http://www.ifst.org/science_technology_resources/for_food_professionals/information_statements/.
- 9.Institute of Medicine (US). Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Institute of Medicine (US). Panel on the Definition of Dietary Fiber. Dietary reference intakes: Proposed definition of dietary fiber. Natl Academy Pr; 2001. [Internet].; cited 5/29/2012]. Available from: http://books.nap.edu/openbook.php?record_id=10161&page=R1.
- 10.FAO/WHO Codex Alimentarius Commission. Report of the 30th session of the Codex Committee on nutrition and foods for special dietary uses, November 2008: [Internet].; cited 5/29/2012]. Available from http://www.codexalimentarius.net/web/archives.jsp?year=09.
- 26.Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK. National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. 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.PubMedCrossRefGoogle Scholar
- 29.• Eshak ES, Iso H, Date C, et al. Dietary fiber intake is associated with reduced risk of mortality from cardiovascular disease among Japanese men and women. J Nutr. 2010 Aug;140(8):1445–53. This is one of the few prospective studies from outside of USA and Europe, reporting on the association between dietary fiber intake and risk of cardiovascular disease. This study found dietary fiber intake to have a strong inverse association with CVD risk. It also found a stronger effect of insoluble fiber on CVD risk relative to soluble fiber, highlighting the importance of studying this research question in other parts of the world where the main sources of dietary fiber might be different from those most often studied in USA and Europe. PubMedCrossRefGoogle Scholar
- 30.• 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 Nov;65(11):1233–41. This is one of the few prospective studies from outside of USA and Europe, reporting on the association between dietary fiber intake and risk of cardiovascular disease. This study found dietary fiber intake to have a non-significant inverse association with CVD risk. It also found a stronger effect of insoluble fiber on CVD risk relative to soluble fiber, highlighting the importance of studying this research question in other parts of the world where the main sources of dietary fiber might be different from those most often studied in USA and Europe. PubMedCrossRefGoogle Scholar
- 37.• Chuang SC, Norat T, Murphy N, 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 May 30. [Epub ahead of print]. This is one of the most recent investigations of the association between dietary fiber intake and CVD mortality. This multi-center prospective cohort study found a significant, inverse dose-response relationship between consumption of fiber and mortality from cardiovascular causes in a large European population. Google Scholar
- 38.•• Schoenaker DAJM, Toeller M, Chaturvedi N, Fuller JH, Soedamah–Muthu S. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: The EURODIAB prospective complications study. Diabetologia. 2012;55(8):2132–41. This is one of few studies that have found an inverse association between dietary fiber intake and CVD risk in diabetics, a group at high risk of developing CVD. This is particularly important in light of the fact that most studies have found dietary fiber intake to be more strongly associated with CVD risk in low risk groups in sub-group analyses, which could be due to lack of sufficient power to detect a significant effect in high-risk groups. Thus, larger studies such as this one are needed to examine this relationship in high-risk populations. Google Scholar
- 40.•• Bernstein AM, Rosner BA, Willett WC. Cereal fiber and coronary heart disease: A comparison of modeling approaches for repeated dietary measurements, intermediate outcomes, and long follow-up. Eur J Epidemiol. 2011 Nov;26(11):877–86. This is a significant study because it demonstrates the various methodological issues surrounding longitudinal analysis of dietary fiber intake as it relates to cardiovascular risk. It highlights the importance of periodically collecting dietary information and updating it over time. Most importantly, it shows a consistent inverse association of cereal fiber intake with CHD risk across models. PubMedCrossRefGoogle Scholar
- 42.•• Harris KA, Kris-Etherton PM. Effects of whole grains on coronary heart disease risk. Curr Atheroscler Rep. 2010 Nov;12(6):368–76. This is a recent, comprehensive review of whole grain consumption as it relates to CHD risk. It provides an overview of the changing definition of whole grains, and reviews the evidence supporting the inverse association between whole grain consumption and CHD risk, while discussing the effects of different types of grains and processing techniques on cardiovascular health. PubMedCrossRefGoogle Scholar
- 52.• Smith CE, Tucker KL. Health benefits of cereal fibre: A review of clinical trials. Nut Res Rev. 2011;24(1):118–31. This detailed review summarizes the findings of clinical trials that have examined the effect of cereal fiber intake on cardiovascular risk factors, such as obesity and glucose metabolism. CrossRefGoogle Scholar
- 54.• Giacco R, Della Pepa G, Luongo D, Riccardi G. Whole grain intake in relation to body weight: From epidemiological evidence to clinical trials. Nutr Metab Cardiovasc Dis. 2011 Dec;21(12):901–8. This is the most recent review of cross-sectional, prospective and experimental studies examining whole grain intake as it relates to body weight. It concludes that while observational studies have consistently found an inverse association between whole grain intake and BMI, clinical trials have not supported this finding, calling for larger intervention studies that are carried out for longer durations PubMedCrossRefGoogle Scholar
- 62.• North CJ, Venter CS, Jerling JC. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. Eur J Clin Nutr. 2009 Aug;63(8):921–33. Chronic inflammation is being studied more recently as one of the pathways that could potentially explain the protective effect of dietary fiber consumption on cardiovascular risk. This review of clinical trials assessing the association between dietary fiber intake and C-reactive protein, shows that a consistent inverse association has been found between the two, in the presence of weight loss and changes in fat intake. PubMedCrossRefGoogle Scholar
- 66.Sola R, Valls RM, Godas G, Perez–Busquets G, Ribalta J, Girona J, et al. Cocoa, hazelnuts, sterols and soluble fiber cream reduces lipids and inflammation biomarkers in hypertensive patients: A randomized controlled trial. PLoS ONE. 2012;7(2):e31103.Google Scholar
- 67.Mietus–Snyder ML, Shigenaga MK, Suh JH, Shenvi SV, Lal A, McHugh T, et al. A nutrient-dense, high-fiber, fruit-based supplement bar increases HDL cholesterol, particularly large HDL, lowers homocysteine, and raises glutathione in a 2-wk trial. FASEB J. 2012 May 1.Google Scholar
- 70.Li S, Guerin-Deremaux L, Pochat M, Wils D, Reifer C, Miller LE. NUTRIOSE dietary fiber supplementation improves insulin resistance and determinants of metabolic syndrome in overweight men: a double-blind, randomized, placebo-controlled study. Appl Physiol Nutr Metab. 2010;35(6):773–82.PubMedCrossRefGoogle Scholar