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Dietary Fiber

Many articles have been reported about the relation between insufficient intake of dietary fiber and lifestyle disease, i.e. myocardial infarction, ischemic stroke, cardiovascular disease, diabetes, breast cancer and gastric cancer. Then the target amount has been set. But the reports about the relation between the intake of dietary fiber and colorectal cancer do not match. It’s unclear that which the intake of dietary fiber in daily life has relation with constipation or not.

In the meta-analysis with trial study, negative correlation has been suggested between the intake amount of dietary fiber and blood pressure, LDL cholesterol and fasting plasma glucose.

In 2015 edition, in order to calculate the dietary reference intakes of dietary fiber, they have compromised of ideal value and reality. Based on the National Health and Nutrition Examination Survey in 2010 and 2011, the median is 13.7 g/d. On the other hand, ideal value besed on the pooled analysis is 24 g/d. The intermediate of them is 18.9 g/d. They have extrapolated body surface area from the ratio of reference weight in each the gender and age groups to reference weight in adult and have set the target amount for each gender and age groups. They have not set the additional amount for pregnant and lactation and they have not set the target amount for child between 1 and 5 years old because it’s difficult to quantify the intake. They don’t ensure the effect of dietary fiber by supplements.

$\displaystyle 18.9\ \mathrm{(g/d)}\times [\mathrm{Reference\ Weight\ (kg)}/57.8\ \mathrm{(kg)}]^{0.75}$
The Dietary Reference Intakes of Dietary Fiber (g/d) (2015 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7 ≥ 11 ≥ 10
8-9 ≥ 12 ≥ 12
10-11 ≥ 13 ≥ 13
12-14 ≥ 17 ≥ 16
15-17 ≥ 19 ≥ 17
18-29 ≥ 20 ≥ 18
30-49 ≥ 20 ≥ 18
50-69 ≥ 20 ≥ 18
70- ≥ 19 ≥ 17
Pregnant
Lactation

The Dietary reference Intakes of dietary fiber in 2010 edition is based on the article, Dietary Fiber and Risk of Coronary Heart Disease, in which the reduction of the mortality has been suggested in more than 24 g/d intake group and the increase of mortality has been suggested in less than 12 g/d group. They had set the intermediate value, 18 g/d, as reference. In the National Health and Nutrition Examination Survey in 2005 and 2006, the median intake is 12.3-16.3 g/d in adult male and 11.8-16.1 g/d in adult female, respectively. Then it seems to be determined that the ideal value 24 g/d is not practical for most Japanese.

The Dietary Reference Intakes of Dietary Fiber (g/d) (2010 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7
8-9
10-11
12-14
15-17
18-29 ≥ 19 ≥ 17
30-49 ≥ 19 ≥ 17
50-69 ≥ 19 ≥ 17
70- ≥ 19 ≥ 17
Pregnant
Lactation

Dietary Fiber and Risk of Coronary Heart Disease

This article has reported the association between dietary fiber intakes and the risk of cardiovascular disease, that it has been shown that total fiber intakes, cereal fiber intakes and fruit fiber intakes have inverse association, in contrast, vegetable fiber has no association.

In the Dietary Reference Intakes for Japanese 2015 edition, they have described “If they would intake 24 g/d or greater of dietary fiber, they could avoid the risk of coronary death.”, but I couldn’t find the describe in the original article.

Dietary Fiber and Risk of Coronary Heart Disease

A pooled Analysis of Cohort Studies

Mark A. Pereira, PhD; Eilis O’Reilly, MSc; Katarina Augustsson, PhD; Gary E. Fraser, MBChB, PhD; Uri Goldbourt, PhD; Berit L. Heitmann, PhD; Goran Hallmans, MD, PhD; Paul Knekt, PhD; Simin Liu, MD, ScD; Pirjo Pietinen, DSc; Donna Spiegelman, ScD; June Stevens, MS, PhD; Jarmo Virtamo, MD; Walter C. Willett, MD; Alberto Ascherio, MD

Background Few epidemiologic studies of dietary fiber intake and risk of coronary heart disease have compared fiber types (cereal, fruit, and vegetable) or included sex-specific results. The purpose of this study was to conduct a pooled analysis of dietary fiber and its subtypes and risk of coronary heart disease.

Methods We analyzed the original data from 10 prospective cohort studies from the United States and Europe to estimate the association between dietary fiber intake and the risk of coronary heart disease.

Results Over 6 to 10 years of follow-up, 5249 incident total coronary cases and 2011 coronary deaths occurred among 91 058 men and 245 186 women. After adjustment for demographics, body mass index, and lifestyle factors, each 10-g/d increment of energy-adjusted and measurement error–corrected total dietary fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death. For cereal, fruit, and vegetable fiber intake (not error corrected), RRs corresponding to 10-g/d increments were 0.90 (95% CI, 0.77-1.07), 0.84 (95% CI, 0.70-0.99), and 1.00 (95% CI, 0.88-1.13), respectively, for all coronary events and 0.75 (95% CI, 0.63-0.91), 0.70 (95% CI, 0.55-0.89), and 1.00 (95% CI, 0.82-1.23), respectively, for deaths. Results were similar for men and women.

Conclusion Consumption of dietary fiber from cereals and fruits is inversely associated with risk of coronary heart disease.

Arch Inern Med. 2004; 164: 370-376

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

Outcome of PREDIMED Study has been published in the New England Journal of Medicine that examined primary prevention of cardiovascular disease with Mediterranean diet. The result has been shown that Mediterranean diet with extra-virgin olive oil or mixed nuts has better prognosis than reduction of lipid. It is considered that alpha linolenic acid rich Mediterranean diet, a component of walnuts, influences oxidative stress, inflammation or endothelial dysfunction.

Primary Prevention of Cardiovascular Disease with a Mediterranean Diet

Ramón Estruch, M.D., Ph.D., Emilio Ros, M.D., Ph.D., Jordi Salas-Salvadó, M.D., Ph.D., Maria-Isabel Covas, D.Pharm., Ph.D., Dolores Corella, D.Pharm., Ph.D., Fernando Arós, M.D., Ph.D., Enrique Gómez-Gracia, M.D., Ph.D., Valentina Ruiz-Gutiérrez, Ph.D., Miquel Fiol, M.D., Ph.D., José Lapetra, M.D., Ph.D., Rosa Maria Lamuela-Raventos, D.Pharm., Ph.D., Lluís Serra-Majem, M.D., Ph.D., Xavier Pintó, M.D., Ph.D., Josep Basora, M.D., Ph.D., Miguel Angel Muñoz, M.D., Ph.D., José V. Sorlí, M.D., Ph.D., José Alfredo Martínez, D.Pharm, M.D., Ph.D., and Miguel Angel Martínez-González, M.D., Ph.D., for the PREDIMED Study Investigators

N Engl J Med 2013;368:1279-90

Background

Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events.

Methods

In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years.

Results

A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported.

Conclusions

Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events.