Healthy diet and fiber intake are associated with decreased risk of incident symptomatic peripheral artery disease – A prospective cohort study

Kulezic, Andrea; Bergwall, Sara; Fatemi, Shahab; Sonestedt, Emily; Zarrouk, Moncef; Gottsäter, Anders; Acosta, Stefan

doi:10.1177/1358863x19867393

Cited by 28 publications

(20 citation statements)

References 36 publications

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“…The association between fiber intake and reduced risk of incident peripheral atherosclerotic occlusive disease [6] was further strengthened by the present study finding on the composite endpoint ACVD. Soluble fiber prolongs the emptying of the stomach and food transit time by forming a gel, lowering postprandial blood glucose and lipid increase [21].…”

Section: Discussionsupporting

confidence: 71%

“…A high diet quality was associated with lower incidence of cardiovascular events in terms of myocardial infarction or ischemic stroke with follow up to 2008 in the Malmö Diet and Cancer Study (MDCS) [5]. A healthy diet and adherence to recommended levels of fiber intake were associated with a reduced risk of incident peripheral artery disease in MDCS [6], whereas no association was found between diet quality and incident carotid artery disease [7], but this study was probably underpowered. Current smoking, low diet quality and low physical activity level were associated with atherothrombotic ischemic stroke in MDCS [8].…”

Section: Introductionmentioning

confidence: 82%

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Diet and Lifestyle Factors and Risk of Atherosclerotic Cardiovascular Disease—A Prospective Cohort Study

2021

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Atherosclerotic cardiovascular disease (ACVD) is the leading cause of death worldwide. This study aimed to investigate the association between diet and lifestyle factors, beyond traditional risk factors, and the risk of incident ACVD. The Malmö Diet and Cancer study included 30,446 middle-aged individuals. Baseline examinations including a dietary assessment, questionnaire and interviews, were performed between 1991–1996. After excluding individuals with prevalent cardiovascular disease and atrial fibrillation or flutter, 26,990 participants remained. In a previously developed diet quality index, adherence to recommended intake of saturated fat (SFA), polyunsaturated fat (PUFA), fish and shellfish, fiber, vegetables and fruit, and sucrose results in one point per dietary component, with a maximum diet score of six points. Diagnosis of incident ACVD was based on validated diagnoses of coronary artery disease, atherothrombotic ischemic stroke, carotid artery disease or peripheral artery disease. Multivariable Cox regression analysis adjusting for established risk factors was performed to assess hazard ratios (HR) with 95% confidence intervals (CI). After a median follow-up of 21.1 years, 5858 (21.7%) individuals diagnosed with ACVD unrelated to atrial fibrillation or flutter were identified. Higher diet score (HR 0.94/point increase; 95% CI 0.91–0.97; p < 0.001), intake of fish and shellfish (HR 0.95/standard deviation (SD) increment, 95% CI 0.93–0.98), fiber (HR 0.93/SD increment, 95% CI 0.89–0.98) and SFA (HR 0.96/SD increment, 95% CI 0.92–0.99) consumption were associated with decreased risk for incident ACVD. High leisure-time physical activity (HR 0.82, 95% CI 0.74–0.91) was associated with reduced risk and obesity (HR 1.17, 95% CI 1.08–1.27) with increased risk of incident ACVD. The present study strengthens current recommendations of improving diet quality and increasing physical activity in preventing ACVD.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 82%

Diet and Lifestyle Factors and Risk of Atherosclerotic Cardiovascular Disease—A Prospective Cohort Study

2021

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“…The main finding in this population-based prospective cohort study with a median follow-up of 21.8 years was a trend toward a protective effect of adherence to recommended levels of fruit and vegetable on risk of incident CAD. Similarly, fruit and vegetables have been found to reduce the incidence of peripheral artery disease [12], CV events [13], and abdominal aortic aneurysm [14] in the same cohort. Only one other prospective longitudinal cohort study was found to specifically address the association between intake of vegetables and CAD, which showed an inverse association of vegetable nitrate intake with carotid atherosclerosis and ischemic cerebrovascular disease in older women after a follow-up of 14.5 years [15].…”

Section: Discussionmentioning

confidence: 99%

Diet and Lifestyle as Risk Factors for Carotid Artery Disease: A Prospective Cohort Study

Johansson

Acosta

2020

Cerebrovasc Dis

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Background: Stroke is one of the leading causes of death, and out of all stroke cases, 10–15% originate from a previously asymptomatic stenosis in the internal carotid artery. Aims: The aim of the study was to investigate whether dietary and lifestyle habits were associated with future risk of incident carotid artery disease (CAD). Methods: Baseline examinations on middle-aged individuals (n = 30,447) in the Malmö Diet and Cancer study (MDCS), a prospective cohort study, took place between 1991 and 1996 in Malmö, Sweden. Individuals with cardiovascular disease and diabetes mellitus were excluded at baseline, resulting in a total study population of 25,952 patients. Information on dietary intake was gathered through a 7-day food diary, a detailed questionnaire, and a 1-h interview. A diet quality index was calculated from adherence to recommended intake of 6 dietary components (saturated fat, polyunsaturated fat, fish and shellfish, fiber, vegetables and fruit, and sucrose). Individuals with a first registered diagnosis of CAD were identified from the Swedish National Patient register. Results: During a median follow-up of 21.8 years, 469 participants (1.8%) developed CAD. The diagnosis of incident CAD was validated and confirmed in 99% of a random sample of 100 individuals. Higher intake of vegetables and fruit was associated with a trend of decreased risk of CAD in a Cox regression analysis (hazard ratio of 0.76, 95% confidence interval 0.56–1.03; p = 0.080). Conclusions: In conclusion, the present study found a trend toward a protective effect of higher intake of vegetables and fruit against incident CAD. More prospective studies investigating the association between diet and CAD and stroke are needed in order to give firm recommendations.

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“…This study involved 26 010 middle-aged men and over 20 years of follow-up. The results indicated that individuals who consumed the recommended intakes of fibre, fruit and vegetables had significantly lower risk of developing peripheral artery disease (Kulezic et al 2019). In another study, the association between CVD risk and dietary fibre intake was examined in a cohort of women.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

The public health rationale for increasing dietary fibre: Health benefits with a focus on gut microbiota

et al. 2020

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Dietary fibre can be considered an essential macronutrient which feeds our gut microbiota, thus enabling the optimal functioning of this ‘virtual organ’. Recommended daily intakes range from 25 to 38 g/day. However, most individuals fail to reach this target and may consume <50% of the recommended amount. Poor dietary fibre intake is associated with an imbalanced gut microbiota leading to reduced diversity and increased abundance of non‐beneficial microorganisms at the expense of beneficial ones. Inflammation is a recognised physiological effect of such a microbiome structure and is a common denominator in several non‐communicable diseases associated with the Western lifestyle/developed world including obesity, cardiovascular disease, type 2 diabetes and colorectal cancer. Yet increasing dietary fibre intake can reduce risk factors associated with these diseases and may even improve prognosis. Several food manufacturers have now developed strategies to increase the fibre content of foods. However, research gaps still remain. In particular, dietary fibre is composed of various non‐digestible carbohydrates and the exact effect of each of these on the gut microbiota is currently unknown. The links between dietary fibre and disease risk are generally associative. Understanding the biological mechanisms will require deeper insight into the impact of the gut microbiota on health. Furthermore, gut microbiota research has shown significant inter‐individual variation meaning that some individuals may not respond to certain dietary fibres owing to the absence of specific microorganisms. Understanding how the different fibre types influence the microbiota, combined with knowledge of an individual’s microbiota, should lead to fibre‐led, microbiota‐based dietary advice.

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Healthy diet and fiber intake are associated with decreased risk of incident symptomatic peripheral artery disease – A prospective cohort study

Cited by 28 publications

References 36 publications

Diet and Lifestyle Factors and Risk of Atherosclerotic Cardiovascular Disease—A Prospective Cohort Study

Diet and Lifestyle Factors and Risk of Atherosclerotic Cardiovascular Disease—A Prospective Cohort Study

Diet and Lifestyle as Risk Factors for Carotid Artery Disease: A Prospective Cohort Study

The public health rationale for increasing dietary fibre: Health benefits with a focus on gut microbiota

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