Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  1. 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.

  2. 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.

    PubMed  Article  Google Scholar 

  3. 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.

    PubMed  Article  Google Scholar 

  4. 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.

  5. 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.

    PubMed  Article  Google Scholar 

  6. 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.

    PubMed  Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  8. 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  Google Scholar 

  9. 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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

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

    Article  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  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  CAS  Google Scholar 

  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  CAS  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Google Scholar 

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

    Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

  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.

    Book  Google Scholar 

  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.

    Google Scholar 

  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.

    Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  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.

    Chapter  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

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

    PubMed  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgments

We thank participants who took part in the UK Women’s Cohort Study, Mr. James Thomas for his contributions towards data management for the cohort and other cohort team members who have previously contributed to data collection and processing. The cohort was supported by funding from the World Cancer Research Fund. This work was conducted by DET, who is in receipt of a studentship from Kellogg Marketing and Sales Company (UK) Ltd. Funders played no part in data analysis, interpretation of findings, writing or decision to publish.

Conflict of interest

One author (DET) is in receipt of a studentship from Kellogg Marketing and Sales Company (UK) Ltd. One author is in receipt of an unrelated project grant from Danone (DCG). No other competing interests declared.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Diane E. Threapleton.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Threapleton, D.E., Greenwood, D.C., Burley, V.J. et al. Dietary fibre and cardiovascular disease mortality in the UK Women’s Cohort Study. Eur J Epidemiol 28, 335–346 (2013). https://doi.org/10.1007/s10654-013-9799-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-013-9799-6

Keywords

  • Cardiovascular diseases
  • Coronary heart disease
  • Stroke
  • Diet
  • Fibre
  • Epidemiology