title: Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the Malmö Diet and Cancer Cohort: a prospective study.
abstract: BACKGROUND
  The aim of the study was to examine associations between intake of macronutrients and dietary fiber and incident ischemic cardiovascular disease (iCVD) in men and women.
  
  
  METHODS
  We used data from 8,139 male and 12,535 female participants (aged 44-73 y) of the Swedish population-based Malmö Diet and Cancer cohort. The participants were without history of CVD and diabetes mellitus, and had reported stable dietary habits in the study questionnaire. Diet was assessed by a validated modified diet history method, combining a 7-d registration of cooked meals and cold beverages, a 168-item food questionnaire (covering other foods and meal patterns), and a 1-hour diet interview. Sociodemographic and lifestyle data were collected by questionnaire. iCVD cases, which included coronary events (myocardial infarctions or deaths from chronic ischemic heart disease) and ischemic strokes, were ascertained via national and local registries. Nutrient-disease associations were examined by multivariate Cox regressions.
  
  
  RESULTS
  During a mean follow-up of 13.5 years, we identified 1,089 male and 687 female iCVD cases. High fiber intakes were associated with lower incidence rates of iCVD in women and of ischemic stroke in men. In post-hoc analysis, we discovered statistically significant interactions between intake of fiber and saturated fat; these interactions also differed between men and women (p<0.001).
  
  
  CONCLUSIONS
  In this well-defined population, a high fiber intake was associated with lower risk of iCVD, but there were no robust associations between other macronutrients and iCVD risk. Judging from this study, gender-specific nutrient analysis may be preferable in epidemiology.
authors.affiliation: Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden. peter.wallstrom@med.lu.se
authors.forename: Peter
authors.initials: P
authors.lastname: Wallström
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.forename: Joanna
authors.initials: J
authors.lastname: Hlebowicz
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ericson
authors.forename: Isabel
authors.initials: I
authors.lastname: Drake
authors.forename: Margaretha
authors.initials: M
authors.lastname: Persson
authors.forename: Bo
authors.initials: B
authors.lastname: Gullberg
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Elisabet
authors.initials: E
authors.lastname: Wirfält
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications* / Q000378:metabolism; D015331:Cohort Studies; D004032:Diet; D004041:Dietary Fats / Q000378:metabolism*; D004043:Dietary Fiber / Q000378:metabolism*; D005260:Female; D005502:Food; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000378:metabolism; D052756:Nutritional Sciences; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012044:Regression Analysis; D012737:Sex Factors; D012907:Smoking; D020521:Stroke / Q000473:pathology
chemical_list: D004041:Dietary Fats; D004043:Dietary Fiber