title: Dietary fiber intake modifies the association between secondhand smoke exposure and coronary heart disease mortality among Chinese non-smokers in Singapore.
abstract: OBJECTIVE
  Secondhand smoke (SHS) exposure increases the risk for coronary heart disease (CHD) by an estimated 25% to 30% via oxidative stress and inflammatory mechanisms that may be ameliorated by dietary components. The aim of this study was to evaluate the hypothesized modifying role of nutrients with known antioxidant and/or anti-inflammatory properties on the relationship between SHS exposure and CHD mortality.
  
  
  METHODS
  Detailed SHS exposure and dietary information was collected among 29,579 non-smokers in the Singapore Chinese Health Study, a prospective population-based cohort. The evaluation of whether or not dietary factors (β-cryptoxanthin, lutein, ω-3 polyunsaturated fatty acids, fiber, isothiocyanates, and soy isoflavones) modified the relationship between SHS exposure and CHD mortality was conducted within multivariable Cox proportional hazards models by creating an interaction term between the potential dietary effect modifier (lowest quartile of intake versus the second through fourth quartiles of intake) and the SHS exposure (none versus living with at least one smoker[s]).
  
  
  RESULTS
  Evidence for a main-effects association between SHS exposure and risk for CHD mortality was not observed. In stratified analyses by levels of selected dietary nutrient intake, fiber modified the effects of SHS exposure on risk for CHD mortality (P for interaction = 0.02). The adjusted hazards ratio for SHS exposure (living with at least one smoker[s] versus living with no smokers) and CHD mortality was 1.62 (95% confidence interval, 1.00-2.63) for those with low-fiber intake. In contrast, among those with high-fiber intake, there was no association with SHS exposure.
  
  
  CONCLUSIONS
  We provide evidence that a diet high in fiber may ameliorate the harmful effects of SHS exposure on risk for CHD mortality.
authors.affiliation: Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA. Electronic address: maggie.clark@colostate.edu.
authors.forename: Maggie L
authors.initials: ML
authors.lastname: Clark
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Butler
authors.forename: Woon-Puay
authors.initials: WP
authors.lastname: Koh
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality*; D065366:Cryptoxanthins; D004043:Dietary Fiber / Q000008:administration & dosage*; D004781:Environmental Exposure / Q000009:adverse effects*; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007529:Isoflavones / Q000008:administration & dosage / Q000097:blood; D017879:Isothiocyanates / Q000008:administration & dosage / Q000097:blood; D014975:Lutein / Q000008:administration & dosage / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D024341:Xanthophylls / Q000008:administration & dosage / Q000097:blood; D047071:beta-Glucans / Q000008:administration & dosage / Q000097:blood
chemical_list: D065366:Cryptoxanthins; D004043:Dietary Fiber; D015525:Fatty Acids, Omega-3; D007529:Isoflavones; D017879:Isothiocyanates; D014028:Tobacco Smoke Pollution; D024341:Xanthophylls; D047071:beta-Glucans; C508230:soy isoflavone aglycone; D014975:Lutein
keywords: Coronary heart disease; Dietary fiber; Environmental tobacco smoke pollution; Indoor air pollution; Mortality; Secondhand smoke; Singapore
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