Associations between Consumption of Dietary Fibers and the Risk of Type 2 Diabetes, Hypertension, Obesity, Cardiovascular Diseases, and Mortality in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Abstract

Although many studies have explored the relationship between total dietary fiber intake and the risk of chronic non-communicable diseases, the results are mixed. There is also a lack of research on the association between dietary fiber intake from different food sources and disease. Using data from the China Nutrition and Health Database from 2004 to 2015, Cox proportional risk models were used to explore the associations between total dietary fiber and fiber intake from different food sources and the occurrence of type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality. After multi-factorial adjustment, the hazard ratios (95% confidence interval) of total dietary fiber intake (quartile 4 vs. quartile 1) in type 2 diabetes, hypertension, obesity, cardiovascular disease, and all-cause mortality cohorts were 1.20 (0.93, 1.55), 0.91 (0.75, 1.12), 0.93 (0.64, 1.35), 1.13 (0.60, 2.12), 1.13 (0.60, 2.12), and 1.13 (0.84, 1.52). Whole-grain fiber intake was positively associated with hypertension but not with the occurrence of other diseases. No association was observed between legume fibers, fruit fibers, and vegetable fibers in the cohorts of type 2 diabetes, hypertension, obesity, cardiovascular diseases and all-cause mortality. Our study did not find any association between total dietary fiber and dietary fiber intake from different food sources and type 2 diabetes, obesity, cardiovascular disease, and all-cause mortality in the Chinese population. The role of dietary fiber in the Chinese population may be overestimated. More extraordinary efforts are needed to further confirm the association between dietary fiber and these diseases in the Chinese population.

Dietary intake of total vegetable, fruit, cereal, soluble and insoluble fiber and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose–response meta-analysis of prospective cohort studies

“…The number of participants in these studies ranged from 314 to 452,717, with a mean or median age ranging from 16 to 99 years. Ten studies were from the United States ( 18 , 21 , 35 , 56 , 62 , 64 , 65 , 67 , 72 , 77 ), four from the United Kingdom ( 19 , 70 , 71 , 74 ), three cohorts conducted in Australia ( 58 , 61 , 63 ), two conducted among multiple nations ( 40 , 59 ), two from Spain ( 28 , 57 ), one from Dutch ( 69 ), one from Finland ( 68 ), one from France ( 22 ), one from Israeli ( 66 ), three from Japan ( 20 , 29 , 60 ), one from Korea ( 32 ), one from China ( 75 ), one from Malaysia ( 76 ), and one from Sweden ( 73 ). The follow-up period ranged from 2 to 40 years.…”

“…The follow-up period ranged from 2 to 40 years. Notably, 22 studies assessed dietary fiber intake using the food frequency questionnaire (FFQ) ( 20 , 28 , 32 , 40 , 56 – 63 , 65 – 67 , 70 – 74 ), and 10 using 24-h dietary records ( 18 , 19 , 21 , 22 , 35 , 64 , 69 , 75 – 77 ). A total of 21 studies adjusted for physical activities ( 18 , 20 – 22 , 28 , 32 , 35 , 40 , 56 , 57 , 59 , 60 , 62 , 65 , 67 , 68 , 71 , 72 , 75 ), and others did not adjust for physical activities, and only one study did not adjust for age ( 69 ).…”

Association between the Dietary Inflammatory Index and Hypertension in Middle-Aged and Elderly population in China: Results from a nation-wide cross sectional study

“…The intake of animal, plant, and total proteins exhibited an L-shaped, Jshaped, and U-shaped correlation with hypertension, respectively [46]. Whole grain ber intake positively correlated with hypertension, whereas no signi cant association with hypertension was observed for bean ber, fruit ber, and vegetable ber [47]. The association between total iron or non-heme iron intake and hypertension displayed a U-shaped pattern, whereas heme iron intake showed an L-shaped pattern [48].…”

Dietary Patterns and Nutritional Value in Non-Communicable Diseases

“…Apart from dietary patterns, dietary fiber intake and dietary antioxidant capacity in cardiometabolic diseases have recently been investigated. Zhang and his colleagues [ 6 ] analyzed data from a longitudinal study (the China Nutrition and Health Database), including 24 h recalls from 2004 to 2015, examining 8307 individuals, and they computed dietary fiber intake. Contrary to other similar studies, whole-grain fiber intake was positively associated with hypertension (hazard ratio (95% confidence interval) (quartile 3 vs. quartile 1) was 1.21 (1.04, 1.40)), but not with other cardiometabolic diseases [ 6 ].…”

“…Zhang and his colleagues [ 6 ] analyzed data from a longitudinal study (the China Nutrition and Health Database), including 24 h recalls from 2004 to 2015, examining 8307 individuals, and they computed dietary fiber intake. Contrary to other similar studies, whole-grain fiber intake was positively associated with hypertension (hazard ratio (95% confidence interval) (quartile 3 vs. quartile 1) was 1.21 (1.04, 1.40)), but not with other cardiometabolic diseases [ 6 ]. A Polish study (n = 5690) evaluated the association between dietary total antioxidant capacity (DTAC), healthy diet quality, and the risk of CVDs [ 7 ].…”