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Alicja Wolk, DMSc, JoAnn E. Manson, MD, Meir J. Stampfer, MD, Graham A. Colditz, MD, Frank B. Hu, MD, Frank E. Speizer, MD, Charles H. Hennekens, MD, Walter C. Willett, MD
CORONARY HEART DISEASE (CHD) is the leading cause of death among women.
Epidemiological studies of men suggest that dietary fiber or foods rich in fiber protect against CHD but data on women are sparse. High intake of dietary fiber, especially soluble fiber, decreases low density lipoprotein cholesterol. Diets high in dietary fiber also may have other beneficial physiological effects, such as increased insulin sensitivity, lower triglyceride levels, and favorable effects on plasminogen activator type I and factor VII activity.Objective: To examine the association between long-term intake of total dietary fiber as well as fiber from different sources and risk of CHD in women.
Design and Setting: The Nurses' Health Study, a large, prospective cohort study of US women followed up for 10 years from 1984. Dietary data were collected in 1984, 1986, and 1990, using a validated semiquantitative food frequency questionnaire.
Participants: A total of 68,782 women aged 37 to 64 years without previously diagnosed angina, myocardial infarction (MI), stroke, cancer, hypercholesterolemia, or diabetes at baseline.
Main Outcome Measure: Incidence of acute MI or death due to CHD by amount of fiber intake.
Results: Response rate averaged 80% to 90% during the 10-year follow-up. We documented 591 major CHD events (429 nonfatal MIs and 162 CHD deaths). The age adjusted relative risk (RR) for major CHD events was 0.53 (95% confidence interval [CI
], 0.40-0.69) for women in the highest quintile of total dietary fiber intake (median, 22.9 g/d) compared with women in the lowest quintile (median, 11.5 g/d). After controlling for age, cardiovascular risk factors, dietary factors, and multivitamin supplement use, the RR was 0.77 (95% Cl, 0.57-1.04). For a 10-g/d increase in total fiber intake (the difference between the lowest and highest quintiles), the multivariate RR of total CHD events was 0.81 (95% Cl, 0.66-0.99). Among different sources of dietary fiber (eg, cereal, vegetables, fruit), only cereal fiber was strongly associated with a reduced risk of CHD (multivariate RR, 0.63; 95% Cl, 0.49-0.81 for each 5-g/d increase in cereal fiber).Conclusions: Our findings in women
support the hypothesis that higher fiber intake, particularly from cereal sources, reduces
the risk of CHD.