An association is indicated between higher consumption of dietary fibre and a reduced incidence of cardiovascular disease Dietary fibre (g/day) and cardiovascular disease • Association • Moderate evidence • The direction of the association indicates higher consumption of dietary fibre is beneficial to health • The association is biologically relevant. SACN CARBOHYDRATES AND HEALTH REPORT PAGE 105 8.6
Given the association between dietary fibre with favourable insulin sensitivity, body composition, appetite regulation and diversity and viability of the gut microflora, it is important to address whether these associations also translate into an effect on overall rates of cardiovascular disease (CVD). Threapleton and colleagues published a systematic review and meta-analysis of the available literature on this topic, with inclusion of 22 prospective cohort studies reporting on associations between dietary fibre intake and coronary heart disease or CVD, with a minimum follow-up period of 3 years. There was an inverse association between total dietary fibre intake (including insoluble fibre and fibre from cereal and vegetable sources) and risk of CVD (risk ratio 0.91 per 7 g/day (95% CI 0.88–0.94)), and coronary heart disease (risk ratio 0.91 per 7 g/day (CI 0.87–0.94)) [75]. Fruit fibre was only associated inversely with risk for CVD.
Consistent with a beneficial effect of dietary fibre on overall risk for CVD, data from a more recent study have shown an association between consumption of ultra-processed foods (with typical impoverishment of dietary fibre) and increased CVD risk. Srour and colleagues reported on a large prospective population-based study from France (the ‘NutriNet-Santé cohort’), with >105,000 adult participants reporting repeated 24-h dietary records. Over a median follow up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall CVD, coronary heart disease and cerebrovascular disease. Interestingly, these associations remained statistically significant following adjustment for intake of other macronutrients, including dietary fibre.
Finally, Kim et al. reported a meta-analysis from 15 prospective cohort studies on the association between dietary fibre intake and mortality from CVD and all cancers. Pooled risk ratio for CVD mortality (based on the highest versus the lowest categories of dietary fibre intake) was 0.77 (95% CI: 0.71–0.84). There were also associations between increased dietary fibre intake and lower risk of mortality from coronary heart disease and all cancers. A dose–response meta-analysis also revealed a pooled relative risk reduction by 9% for CVD mortality for an increment of 10g/day of dietary fibre intake [77]. Based on the available published literature, including meta-analyses and large population-based studies, there does appear to be an association between dietary fibre intake and both risk and mortality from CVD (including coronary heart disease and cerebrovascular disease). Evidence also suggests an association of dietary fibre with reduced mortality from cancer. As with other human-based studies on dietary fibre, there remains a question regarding causality, and other healthy lifestyle factors that associate with increased intake of dietary fibre may mediate at least some of the apparent benefits of dietary fibre on CVD risk. Neither, however, is it possible to disprove an important role for dietary fibre as a direct causal factor for improved CVD outlook. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589116/#sec5-nutrients-12-03209title (5.7 CARDIOVASCULAR DISEASE)
FIBRE AND CORONARY EVENTS
An association is indicated between higher consumption of dietary fibre and a reduced incidence of coronary events.
Dietary fibre (g/day) and coronary events • Association • Adequate evidence • The direction of the association indicates higher consumption of dietary fibre is beneficial to health • The association is biologically relevant SACN Carbohydrates and Health Report page 105 8.7