Fiber intake and total and cause-specific mortality in the European Prospective Investigation into Cancer and Nutrition cohort.
BACKGROUND
Previous studies have shown that high fiber intake is associated with lower mortality. However, little is known about the association of dietary fiber with specific causes of death other than cardiovascular disease (CVD).


OBJECTIVE
The aim of this study was to assess the relation between fiber intake, mortality, and cause-specific mortality in a large European prospective study of 452,717 men and women.


METHODS
HRs and 95% CIs were estimated by using Cox proportional hazards models, stratified by age, sex, and center and adjusted for education, smoking, alcohol consumption, BMI, physical activity, total energy intake, and, in women, ever use of menopausal hormone therapy.


RESULTS
During a mean follow-up of 12.7 y, a total of 23,582 deaths were recorded. Fiber intake was inversely associated with total mortality (HR(per 10-g/d increase): 0.90; 95% CI: 0.88, 0.92); with mortality from circulatory (HR(per 10-g/d increase): 0.90 and 0.88 for men and women, respectively), digestive (HR: 0.61 and 0.64), respiratory (HR: 0.77 and 0.62), and non-CVD noncancer inflammatory (HR: 0.85 and 0.80) diseases; and with smoking-related cancers (HR: 0.86 and 0.89) but not with non-smoking-related cancers (HR: 1.05 and 0.97). The associations were more evident for fiber from cereals and vegetables than from fruit. The associations were similar across BMI and physical activity categories but were stronger in smokers and participants who consumed >18 g alcohol/d.


CONCLUSIONS
Higher fiber intake is associated with lower mortality, particularly from circulatory, digestive, and non-CVD noncancer inflammatory diseases. Our results support current recommendations of high dietary fiber intake for health maintenance.
School of Public Health, Imperial College London, London, United Kingdom.
Shu-Chun
SC
Chuang
Teresa
T
Norat
Neil
N
Murphy
Anja
A
Olsen
Anne
A
Tjønneland
Kim
K
Overvad
Marie Christine
MC
Boutron-Ruault
Florence
F
Perquier
Laureen
L
Dartois
Rudolf
R
Kaaks
Birgit
B
Teucher
Manuela M
MM
Bergmann
Heiner
H
Boeing
Antonia
A
Trichopoulou
Pagona
P
Lagiou
Dimitrios
D
Trichopoulos
Sara
S
Grioni
Carlotta
C
Sacerdote
Salvatore
S
Panico
Domenico
D
Palli
Rosario
R
Tumino
Petra H M
PH
Peeters
Bas
B
Bueno-de-Mesquita
Martine M
MM
Ros
Magritt
M
Brustad
Lene Angell
LA
Åsli
Guri
G
Skeie
J Ramón
JR
Quirós
Carlos A
CA
González
María-José
MJ
Sánchez
Carmen
C
Navarro
Eva
E
Ardanaz Aicua
Miren
M
Dorronsoro
Isabel
I
Drake
Emily
E
Sonestedt
Ingegerd
I
Johansson
Göran
G
Hallmans
Timothy
T
Key
Francesca
F
Crowe
Kay-Tee
KT
Khaw
Nicholas
N
Wareham
Pietro
P
Ferrari
Nadia
N
Slimani
Isabelle
I
Romieu
Valentina
V
Gallo
Elio
E
Riboli
Paolo
P
Vineis
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004043:Dietary Fiber / Q000008:administration & dosage*; D004066:Digestive System Diseases / Q000401:mortality* / Q000517:prevention & control; D002523:Edible Grain / Q000737:chemistry; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005638:Fruit / Q000737:chemistry; D006293:Health Promotion; D006801:Humans; D007154:Immune System Diseases / Q000401:mortality* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009026:Mortality; D018673:Nutrition Policy; D011446:Prospective Studies; D012306:Risk; D014675:Vegetables / Q000737:chemistry