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Nutrition Epidemiology Highlights Original Article

Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women’s Cohort Study

Subjects

Abstract

Background:

Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types.

Methods:

A total of 27 373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake.

Results:

A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6 g/day total fibre intake was 0.89 (95% confidence intervals: 0.81–0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk.

Conclusions:

Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.

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References

  1. Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P et al European Cardiovascular Disease Statistics. European Society of Cardiology, Sophia Antipolis: European Heart Network, Brussels, 2012.

    Google Scholar 

  2. Townsend N, Wickramasinghe K, Bhatnagar P, Smolina K, Nichols M, Leal J et al Coronary heart disease statistics. A conpendium of health statistics. British Heart Foundation Health Promotion Research Group. Department of Public Health, University of Oxford. [Online]. Available at http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002097 [Accessed 2013]. 2012.

  3. Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42: 517–584.

    Article  PubMed  Google Scholar 

  4. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010; 376: 112–123.

    Article  PubMed  Google Scholar 

  5. Frizzell JP . Acute stroke: pathophysiology, diagnosis, and treatment. AACN Clin Issues 2005; 16: 421–440.

    Article  PubMed  Google Scholar 

  6. Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP . Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke 2009; 40: 2068–2072.

    Article  PubMed  Google Scholar 

  7. James SL, Muir JG, Curtis SL, Gibson PR . Dietary fibre: a roughage guide. Int Med J 2003; 33: 291–296.

    Article  CAS  Google Scholar 

  8. British Nutrition Foundation. Cardiovascular Disease: Diet, Nutrition and Emerging Risk Factors. Report of the British Nutrition Foundation Task Force. Stanner S (ed). Blackwell Publishing Ltd: Oxford, 2005.

  9. Lunn J, Buttriss JL . Carbohydrates and dietary fibre. Brit Nutr Found Nutr Bull 2007; 32: 21–64.

    Article  Google Scholar 

  10. Coultate TP . Polysaccharides. In: Coultate TP ed. Food The Chemistry of its components. The Royal Society of Chemistry: Cambridge. p Chapter 3: 75, 2009.

    Google Scholar 

  11. Wanders AJ, van den Borne JJ, de Graaf C, Hulshof T, Jonathan MC, Kristensen M et al. Effects of dietary fibre on subjective appetite, energy intake and body weight: a systematic review of randomized controlled trials. Obes Rev 2011; 12: 724–739.

    CAS  PubMed  Google Scholar 

  12. King DE . Dietary fiber, inflammation, and cardiovascular disease. Mol Nutr Food Res 2005; 49: 594–600.

    Article  PubMed  Google Scholar 

  13. George SJ, Lyon C . Pathogenesis of Atherosclerosis. In: Johnson J, George SJ eds. Atherosclerosis: molecular and cellular mechanisms. Wiley-VCH, 2010.

    Chapter  Google Scholar 

  14. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke 2013; 44: 1360–1368.

    Article  CAS  PubMed  Google Scholar 

  15. Zhang Z, Xu G, Liu D, Zhu W, Fan X, Liu X . Dietary fiber consumption and risk of stroke. Eur J Epidemiol 2013; 28: 119–130.

    Article  PubMed  Google Scholar 

  16. Cade JE, Burley VJ, Greenwood DC . The UK Women's Cohort Study: comparison of vegetarians, fish-eaters and meat-eaters. Public Health Nutr 2004; 7: 871–878.

    Article  CAS  PubMed  Google Scholar 

  17. Threapleton DE, Greenwood DC, Burley VJ, Aldwairji M, Cade JE . Dietary fibre and cardiovascular disease mortality in the UK Women's Cohort Study. Eur J Epidemiol 2013; 28: 335–346.

    Article  CAS  PubMed  Google Scholar 

  18. Cox DR, Oakes D . Analysis of Survival Data. Chapman & Hall/CRC: London, 1984.

    Google Scholar 

  19. Kohler U, Kreuter F . Data Analysis Using StataThird ed.Stata Press: Texas, 2012.

    Google Scholar 

  20. Greenland S, Pearl J, Robins JM . Causal diagrams for epidemiologic research. Epidemiology 1999; 10: 37–48.

    Article  CAS  PubMed  Google Scholar 

  21. Willett WW, Stampfer MJ . Implications of total energy intake for epidemiologic analyses. In: Nutritional Epidemiology Willett WW ed. Second ed. Oxford University Press: Oxford. p 273–300, 1998.

    Chapter  Google Scholar 

  22. Matthews KA, Crawford SL, Chae CU, Everson-Rose SA, Sowers MF, Sternfeld B et al. Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am Coll Cardiol 2009; 54: 2366–2373.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Nordestgaard BG, Palmer TM, Benn M, Zacho J, Tybjaerg-Hansen A, Davey Smith G et al. The effect of elevated body mass index on ischemic heart disease risk: causal estimates from a Mendelian randomisation approach. PLoS Med 2012; 9: e1001212.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Logue J, Murray HM, Welsh P, Shepherd J, Packard C, Macfarlane P et al. Obesity is associated with fatal coronary heart disease independently of traditional risk factors and deprivation. Heart 2011; 97: 564–568.

    Article  PubMed  Google Scholar 

  25. StataCorp Stata Statistical Software: Release 12. StataCorp LP: College Station, TX, 2011.

  26. Slavin J . Why whole grains are protective: biological mechanisms. Proc Nutr Soc 2003; 62: 129–134.

    Article  CAS  PubMed  Google Scholar 

  27. Bingham SA, Gill C, Welch A, Cassidy A, Runswick SA, Oakes S et al. Validation of dietary assessment methods in the UK arm of EPIC using weighed records, and 24-hour urinary nitrogen and potassium and serum vitamin C and carotenoids as biomarkers. Int J Epidemiol 1997; 26: S137–S151.

    Article  PubMed  Google Scholar 

  28. Brunner E, Stallone D, Juneja M, Bingham S, Marmot M . Dietary assessment in Whitehall II: comparison of 7 d diet diary and food-frequency questionnaire and validity against biomarkers. Brit J Nutr 2001; 86: 405–414.

    Article  CAS  PubMed  Google Scholar 

  29. Berg AH, Scherer PE . Adipose tissue, inflammation, and cardiovascular disease. Circ Res 2005; 96: 939–949.

    Article  CAS  PubMed  Google Scholar 

  30. Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE et al. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol 2005; 161: 161–169.

    Article  PubMed  Google Scholar 

  31. Larsson SC, Mannisto S, Virtanen MJ, Kontto J, Albanes D, Virtamo J . Dietary fiber and fiber-rich food intake in relation to risk of stroke in male smokers. Eur J Clin Nutr 2009; 63: 1016–1024.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Wallstrom P, Sonestedt E, Hlebowicz J, Ericson U, Drake I, Persson M et al. Dietary fiber and saturated fat intake associations with cardiovascular disease differ by sex in the Malmo diet and cancer cohort: A prospective study. PLoS ONE 2012; 7: e31637.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kokubo Y, Iso H, Saito I, Yamagishi K, Ishihara J, Inoue M et al. Dietary fiber intake and risk of cardiovascular disease in the Japanese population: The Japan Public Health Center-based study cohort. Eur J Clin Nutr 2011; 65: 1233–1241.

    Article  CAS  PubMed  Google Scholar 

  34. Greenwood DC, Gilthorpe MS, Golding C, Cade JE . Stability over time of dietary patterns in the UK Women's Cohort Study. Proc Nutr Soc 2003; 62: 89A.

    Google Scholar 

  35. Cade J, Thompson R, Burley V, Warm D . Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr 2002; 5: 567–587.

    Article  PubMed  Google Scholar 

  36. Willett W, Lenart E . Reproducibility and validity of Food Frequency Questionnaires. In: Nutritional Epidemiology Hofman A, Marmot M, Samet J, Savitz DZ eds. Third edn. Oxford University Press: Oxford, 2013.

    Google Scholar 

  37. Bingham SA, Gill C, Welch A, Day K, Cassidy A, Khaw KT et al. Comparison of dietary assessment methods in nutritional epidemiology: weighed records v. 24h recalls, food-frequency questionnaires and estimated-diet records. Brit J Nutr 1994; 72: 619–643.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank the participants of the UKWCS and all those who have previously contributed to the initiation, data collection, management and processing of information for the cohort.

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Correspondence to D E Threapleton.

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Competing interests

The PhD studentship for D Threapleton was sponsored by Kellogg Sales and Marketing UK Ltd. DCG has held an unrelated research grant (a study of infant diet) funded by Danone and has received personal fees from American Institute for Cancer Research/World Cancer Research Fund, outside the submitted work. Funding bodies played no part in data collection, analysis, interpretation or decision to publish.

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Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

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Threapleton, D., Burley, V., Greenwood, D. et al. Dietary fibre intake and risk of ischaemic and haemorrhagic stroke in the UK Women’s Cohort Study. Eur J Clin Nutr 69, 467–474 (2015). https://doi.org/10.1038/ejcn.2014.260

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