Introduction
Methods
Study population
Population for current analysis
Incidence of diabetes
Fibre intake and other dietary variables
Lifestyle variables
Statistical analysis
Meta-analysis
Results
The EPIC-InterAct Study
Variable |
n
| Q1 | Q2 | Q3 | Q4 |
---|---|---|---|---|---|
Cutoffs (g/day) | <18.9 | 18.9–<22.4 | 22.4–26.4 | >26.4 | |
Median (g/day) | 16.3 | 20.7 | 24.2 | 29.7 | |
Age (years) | 15,258 | 52.0 ± 9.4 | 52.2 ± 9.1 | 52.6 ± 9.0 | 52.8 ± 8.7 |
Men (%) | 15,258 | 50 | 35 | 31 | 35 |
Follow-up (years) | 15,258 | 12.0 ± 2.5 | 12.0 ± 2.3 | 11.9 ± 2.4 | 12.0 ± 2.2 |
BMI (kg/m2) | 15,258 | 25.8 ± 4.0 | 26.0 ± 4.2 | 26.2 ± 4.2 | 26.2 ± 4.3 |
BMI (% obese) | 15,258 | 14 | 16 | 17 | 16 |
Waist circumference (cm) | |||||
Men | 5,282 | 94.8 ± 10.2 | 94.9 ± 9.9 | 95.9 ± 9.6 | 95.1 ± 9.8 |
Women | 8,963 | 80.1 ± 11.4 | 81.0 ± 10.9 | 81.7 ± 11.0 | 81.9 ± 11.3 |
First-degree relatives with diabetes (% yes)a
| 7,615 | 17 | 19 | 21 | 19 |
Smoking (% current) | 15,258 | 37 | 26 | 23 | 18 |
Hypertension (% yes) | 14,930 | 18 | 19 | 20 | 19 |
Hyperlipidaemia (% yes) | 11,389 | 18 | 19 | 19 | 19 |
Myocardial infarction (% yes) | 15,007 | 1.4 | 1.3 | 1.5 | 1.4 |
Angina (% yes) | 10,078 | 1.7 | 1.8 | 2.3 | 2.4 |
Stroke (% yes) | 14,036 | 0.9 | 0.9 | 0.8 | 0.8 |
Educational level (% high) | 15,258 | 21 | 21 | 20 | 21 |
Physical activity (% inactive) | 15,258 | 25 | 24 | 23 | 22 |
Postmenopausal women (%) | 9,484 | 44 | 46 | 47 | 51 |
Dietary factors | |||||
Energy (kJ/day) | 15,258 | 9,320 ± 2,834 | 8,579 ± 2,562 | 8,629 ± 2,516 | 9,286 ± 2,617 |
Fat (en%) | 15,258 | 36.7 | 35.4 | 34.3 | 32.7 |
Saturated fatty acids | 14.8 | 13.6 | 12.8 | 11.7 | |
Monounsaturated fatty acids | 13.8 | 13.5 | 13.0 | 12.4 | |
Polyunsaturated fatty acid | 5.4 | 5.6 | 5.7 | 5.7 | |
Protein (en%) | 15,258 | 16.5 | 17.0 | 17.3 | 17.4 |
Carbohydrates (en%) | 15,258 | 40.6 | 43.35 | 45.1 | 47.0 |
Starch | 21.6 | 23.7 | 24.5 | 25.4 | |
Sugars | 18.4 | 19.1 | 20.0 | 20.9 | |
Magnesium (mg/day) | 15,258 | 313 ± 64 | 337 ± 59 | 362 ± 61 | 398 ± 65 |
Cholesterol (mg/day) | 15,258 | 373 ± 125 | 352 ± 105 | 337 ± 104 | 314 ± 113 |
Vitamin B1 (mg/day) | 15,258 | 1.2 ± 0.3 | 1.3 ± 0.3 | 1.4 ± 0.3 | 1.5 ± 0.4 |
β-Carotene (mg/day) | 15,258 | 1.9 ± 1.3 | 2.6 ± 1.6 | 3.1 ± 1.9 | 4.4 ± 3.8 |
Vitamin C (mg/day) | 15,258 | 88 ± 44 | 111 ± 45 | 131 ± 52 | 167 ± 83 |
Vitamin E (mg/day) | 15,258 | 10.1 ± 4.1 | 11.5 ± 3.9 | 12.0 ± 4.1 | 13.1 ± 4.9 |
GI (not energy adjusted) | 15,258 | 56.6 ± 4.1 | 55.9 ± 3.8 | 55.9 ± 3.8 | 55.8 ± 3.9 |
GL (not energy adjusted) | 15,258 | 128 ± 47 | 124 ± 44 | 130 ± 43 | 145 ± 47 |
Alcohol (g/day) median (P10; P90), not energy adjusted | 15,258 | 12 (0; 58) | 7 (0; 37) | 5 (0; 31) | 4 (0; 30) |
Alcohol (% non-drinkers) | 15,258 | 19 | 26 | 29 | 31 |
Variable | Q1 | Q2 | Q3 | Q4 |
p
|
---|---|---|---|---|---|
Total fibre, g/day (median) | <18.9 (16.3) | 18.9–22.4 (20.7) | 22.4–26.4 (24.2) | >26.4 (29.7) | |
Model 1 ‘age, sex’ | 1.00 | 0.91 (0.82, 1.02) | 0.90 (0.79, 1.02) | 0.93 (0.78, 1.11) | 0.08 |
Model 2 ‘lifestyle’ | 1.00 | 0.92 (0.82, 1.04) | 0.91 (0.81, 1.02) | 0.84 (0.69, 1.02) | 0.07 |
Model 3 ‘lifestyle and diet’ | 1.00 | 0.92 (0.83, 1.02) | 0.91 (0.82, 1.01) | 0.82 (0.69, 0.97) | 0.02 |
Model 4 ‘lifestyle, diet and BMI’ | 1.00 | 0.93 (0.84, 1.03) | 0.98 (0.89, 1.08) | 0.91 (0.81, 1.03) | 0.28 |
Cereal fibre, g/day (median) | <5.7 (4.3) | 5.7–7.9 (6.8) | 7.9–10.9 (9.3) | >10.9 (13.7) | |
Model 1 ‘age, sex’ | 1.00 | 0.89 (0.80, 0.99) | 0.88 (0.77, 1.00) | 0.85 (0.72, 1.00) | 0.03 |
Model 2 ‘lifestyle’ | 1.00 | 0.89 (0.80, 0.98) | 0.89 (0.80, 0.99) | 0.82 (0.72, 0.93) | <0.01 |
Model 3 ‘lifestyle and diet’ | 1.00 | 0.90 (0.80, 1.00) | 0.91 (0.82, 1.00) | 0.81 (0.70, 0.93) | <0.01 |
Model 4 ‘lifestyle, diet, and BMI’ | 1.00 | 0.90 (0.80, 1.02) | 1.00 (0.90, 1.10) | 0.95 (0.83, 1.08) | 0.49 |
Fruit fibre, g/day (median) | <2.3 (1.4) | 2.3–4.0 (3.1) | 4.0–6.6 (5.1) | >6.3 (8.4) | |
Model 1 ‘age, sex’ | 1.00 | 0.88 (0.82, 0.95) | 0.91 (0.83, 1.00) | 0.89 (0.81, 0.98) | 0.17 |
Model 2 ‘lifestyle’ | 1.00 | 0.91 (0.84, 0.98) | 0.96 (0.88, 1.04) | 0.93 (0.85, 1.01) | 0.41 |
Model 3 ‘lifestyle and diet’ | 1.00 | 0.93 (0.86, 1.00) | 0.98 (0.90, 1.06) | 0.98 (0.89, 1.08) | 0.74 |
Model 4 ‘lifestyle, diet, and BMI’ | 1.00 | 0.91 (0.82, 1.00) | 0.93 (0.84, 1.03) | 0.96 (0.83, 1.10) | 0.76 |
Vegetable fibre, g/day (median) | <2.4 (1.6) | 2.4–3.6 (3.0) | 3.6–5.3 (4.4) | >5.3 (6.9) | |
Model 1 ‘age, sex’ | 1.00 | 0.95 (0.88, 1.02) | 0.87 (0.76, 0.98) | 0.93 (0.78, 1.11) | 0.57 |
Model 2 ‘lifestyle’ | 1.00 | 0.98 (0.91, 1.06) | 0.91 (0.81, 1.03) | 0.98 (0.85, 1.14) | 0.92 |
Model 3 ‘lifestyle and diet’ | 1.00 | 0.94 (0.87, 1.01) | 0.82 (0.71, 0.94) | 0.84 (0.74, 0.96) | <0.01 |
Model 4 ‘lifestyle, diet, and BMI’ | 1.00 | 0.91 (0.84, 0.99) | 0.83 (0.71, 0.97) | 0.93 (0.84, 1.03) | 0.11 |
Meta-analysis
Author, publication year, country/ region | Study name | Population | Follow-up (years) | Age at baseline (range in years) | No. of cases | Dietary assessment | Exposure | Quantity | RR (95% CI) | Adjustment for confounders |
---|---|---|---|---|---|---|---|---|---|---|
Hodge et al, 1993, Australia [39] | NA | 350 M/W | 5 | >20 | 7 | 24 h dietary recall | Total fibre | Per 10 g/day | 0.69 (0.16, 2.96) | Age, sex, BMI, energy |
Salmeron et al, 1997, USA [8] | Nurses’ Health Study | 85,173 W | 6 | 40–65 | 915 | Validated FFQ, 134 food items | Total fibre | 24.1 vs 11.8 g/day | 0.78 (0.62, 0.98) | Age, BMI, alcohol, smoking, physical activity, family history of diabetes, energy |
Cereal fibre | 7.5 vs 2.0 g/day | 0.72 (0.58, 0.90) | ||||||||
Fruit fibre | 7.6 vs 1.4 g/day | 0.87 (0.70, 1.08) | ||||||||
Vegetable fibre | 9.6 vs 3.4 g/day | 1.17 (0.93, 1.46) | ||||||||
Salmeron et al, 1997, USA [26] | Health Professionals Follow-up Study | 42,759 M | 6 | 40–75 | 523 | Validated FFQ, 131 food items | Total fibre | 29.7 vs 13.4 g/day | 0.98 (0.73, 1.33) | Age, BMI, alcohol, smoking, physical activity, family history of diabetes, energy |
Cereal fibre | 10.2 vs 2.5 g/day | 0.70 (0.51, 0.96) | ||||||||
Fruit fibre | 8.3 vs 1.2 g/day | 1.01 (0.76, 1.36) | ||||||||
Vegetable fibre | 11.3 vs 3.5 g/day | 1.12 (0.84, 1.49) | ||||||||
Meyer et al, 2000, USA [10] | Iowa Women’s Health | 35,988 W | 6 | 55–69 | 1,141 | Validated FFQ, 127 food items | Total fibre | 26.5 vs 13.27 g/day | 0.78 (0.64, 0.96) | Age, BMI, WHR, alcohol, smoking, physical activity, education level, energy intake |
Cereal fibre | 9.43 vs 2.66 g/day | 0.64 (0.53, 0.79) | ||||||||
Fruit fibre | 8.72 vs 1.71 g/day | 1.17 (0.96, 1.42) | ||||||||
Vegetable fibre | 11.74 vs 4.71 g/day | 0.97 (0.80, 1.18) | ||||||||
Soluble fibre | 8.01 vs 4.19 g/day | 0.89 (0.73, 1.08) | ||||||||
Insoluble fibre | 19.84 vs 9.93 g/day | 0.75 (0.61, 0.91) | ||||||||
Hu et al, 2001, USA [27] | Nurses’ Health Study | 84,941 W | 16 | 34–59 | 3,300 | Validated FFQ, 61–120 food items | Cereal fibre | Quintile 5 vs 1 | 0.59 (0.52, 0.68) | Age, time, family history of diabetes, menopausal status, HT, smoking status, BMI, moderate-to-vigorous exercise, alcohol, TFA, PUFA/SFA ratio, GL |
Stevens et al, 2002, USA [28] | Atherosclerosis Risk in Communities Study | 9,529 M/W white participants, 2,722 M/W AA participants | 9 | 45–64 | 971 and 478 | Validated FFQ, 66 food items | Total fibre, whites | Per 1 g/day | 0.999 (0.987, 1.012) | Age, sex, BMI, smoking, physical activity, education level, field centre, energy |
Cereal fibre, whites | Per 1 g/day | 0.956 (0.925, 0.987) | ||||||||
Fruit fibre, whites | Per 1 g/day | 1.002 (0.983, 1.021) | ||||||||
Total fibre, AA | Per 1 g/day | 0.998 (0.980, 1.017) | ||||||||
Cereal fibre, AA | Per 1 g/day | 0.982 (0.927, 1.039) | ||||||||
Fruit fibre, AA | Per 1 g/day | 1.009 (0.985, 1.033) | ||||||||
Cereal fibre, whites | Quintile 5 vs 1 | 0.75 (0.60, 0.92) | ||||||||
Cereal fibre, AA | Quintile 5 vs 1 | 0.86 (0.65, 1.15) | ||||||||
Montonen et al, 2003, Finland [6] | Finnish Mobile Clinic Health Examination Survey | 4,318 M/W | 10 | 40–69 | 156 | FFQ, 100 food items | Total fibre | ≥33.2 vs ≤19.2 g/day | 0.51 (0.26, 1.00) | Age, sex, geographical area, smoking BMI, intakes of energy, fruit and berries, vegetables |
Cereal fibre | ≥24.5 vs ≤12.0 g/day | 0.39 (0.20, 0.77) | ||||||||
Fruit fibre | ≥3.4 vs ≤0.99 g/day | 0.92 (0.40, 2.13) | ||||||||
Vegetable fibre | ≥26.5 vs ≤3.7 g/day | 1.19 (0.46, 3.04) | ||||||||
Soluble fibre | ≥7.4 vs ≤4.5 g/day | 0.57 (0.29, 1.12) | ||||||||
Insoluble fibre | ≥16.6 vs ≤8.7 g/day | 0.47 (0.25, 0.91) | ||||||||
Schulze et al, 2004, USA [9] | Nurses’ Health Study II | 91,249 W | 8 | 26–46 | 741 | Validated FFQ, 133 food items | Total fibre | 24.9 vs 12.5 g/day | 1.00 (0.75, 1.34) | Age, BMI, alcohol, smoking, physical activity, family history of diabetes, high blood pressure, high blood cholesterol, HT, OC use, energy intake, Mg, and caffeine, GL, mutual adjustment between fibre types |
Cereal fibre | 8.8 vs 3.1 g/day | 0.64 (0.48, 0.86) | ||||||||
Fruit fibre | 6.2 vs 1.1 g/day | 0.79 (0.60, 1.02) | ||||||||
Vegetable fibre | 10.4 vs 3.4 g/day | 1.12 (0.87, 1.46) | ||||||||
Hodge et al, 2004, Australia [29] | Melbourne Collaborative Cohort Study | 31,641 M/W | 4 | 40–69 | 365 | FFQ, 121 food items | Fibre | Per 20 g/day | 1.02 (0.81, 1.30) | Age, sex, BMI, WHR, weight change, alcohol, smoking, physical activity, family history of diabetes, education, country of birth, energy intake |
Cereal fibre | Per 10 g/day | 1.08 (0.88, 1.32) | ||||||||
Fruit fibre | Per 10 g/day | 0.97 (0.81, 1.16) | ||||||||
Vegetable fibre | Per 5 g/day | 1.00 (0.86, 1.17) | ||||||||
Lindström et al, 2006, Finland [7] | The Finnish Diabetes Prevention Study | 172 M, 350 W | 4.1 | 40–64 | 114 | 3 day food record | Fibre | >15.55 vs <10.85 g/4.1868 MJ/day | 0.38 (0.19, 0.77) | Age, sex, baseline weight, baseline 2 h glucose, physical activity, weight change, energy |
Barclay et al, 2007, Australia [30] | Blue Mountains Eye Study | 1,833 M/W | 10 | ≥49 | 138 | Validated FFQ, 145 food items | Fibre | Per 5 g/day | 0.90 (0.79, 1.02) | Age, sex, smoking, physical activity, family history of diabetes, triacylglycerols, HDL cholesterol |
Cereal fibre | Per 5 g/day | 0.96 (0.78, 1.20) | ||||||||
Fruit fibre | Per 5 g/day | 0.94 (0.78, 1.15) | ||||||||
Vegetable fibre | Per 5 g/day | 0.76 (0.57, 0.99) | ||||||||
Krishnan et al, 2007, USA [31] | Black Women’s Health Study | 40,078 W | 8 | 21–69 | 1,938 | Validated FFQ, 68 food items | Cereal fibre | 7.6 vs 1.7 g/day | 0.82 (0.70, 0.96) | Age, BMI, smoking, physical activity, family history of diabetes, total fat, protein intake, GI, energy intake |
Schulze et al, 2007, Germany [5] | EPIC-Potsdam | 9,702 M, 15,365 W | 7 | 35–65 | 844 | Validated FFQ | Soluble fibre | 9.6 vs 5.3 g/day | 0.83 (0.57, 1.22) | Age, sex, BMI, sports activities, education, cycling, occupational activity, smoking, alcohol, total energy intake, waist circumference, PUFA:SFA ratio, MUFA:SFA ratio, carbohydrate, Mg |
Insoluble fibre | 18.4 vs 10.3 g/day | 0.93 (0.62, 1.40) | ||||||||
Wannamethee et al, 2009, UK [32] | British Regional Heart Study | 3,428 M | 7 | 60–79 | 162 | Validated 7 day recall FFQ | Total fibre | ≥31.0 vs ≤20 g/day | 0.82 (0.51, 1.32) | Age, waist circumference, alcohol, smoking, physical activity, social class, pre-existing MI or stroke, statin use, energy intake |
Cereal fibre | Quartile 4 vs 1 | 0.70 (0.44, 1.12) | ||||||||
Vegetable fibre | Quartile 4 vs 1 | 0.74 (0.46, 1.19) | ||||||||
Hopping et al, 2010, USA [33] | Multiethnic cohort | 36,256 M, 39,256 W | 14 | 45–75 | 4,555 and 4,032 | Validated FFQ | Total fibre, M | 14.2 vs 7.4 g/4.1868 MJ/day | 0.75 (0.67, 0.84) | Age, BMI, physical activity, education, ethnicity, energy intake |
Cereal fibre, M | 4.8 vs <1.9 g/4.1868 MJ/day | 0.91 (0.82, 1.00) | ||||||||
Fruit fibre, M | 3.9 vs <0.8 g/4.1868 MJ/day | 0.93 (0.84, 1.02) | ||||||||
Vegetable fibre, M | 5.3 vs <2.2 g/4.1868 MJ/day | 0.78 (0.69, 0.88) | ||||||||
Total fibre, W | 16.2 vs <8.9 g/4.1868 MJ/day | 0.95 (0.85, 1.06) | ||||||||
Cereal fibre, W | 5.1 vs <2.1 g/4.1868 MJ/day | 0.88 (0.79, 0.97) | ||||||||
Fruit fibre, W | 5.1 vs <2.1 g/4.1868 MJ/day | 0.95 (0.85, 1.06) | ||||||||
Vegetable fibre, W | 5.2 vs <1.3 g/4.1868 MJ/day | 0.96 (0.87, 1.08) | ||||||||
Sakurai et al, 2012, Japan [34] | NA | 1,995 M | 6 | 35–55 | 133 | DHQ, 147 items | Fibre | >6.0 vs <3.7 g/day | 0.99 (0.59, 1.66) | Age, BMI, family history of diabetes, exercise, hypertension, hyperlipidaemia, total energy, GI, GL |
Wirström et al, 2013, Sweden [35] | NA | 5,477 M/W | 8–10 | 35–56 | 165 | Validated FFQ, NA | Cereal fibre | Per 10 g/day | 0.97 (0.82, 1.14) | Age, family history of diabetes, BMI, leisure-time physical activity, smoking, education, blood pressure |
>11.6 vs <7.7 g/day | 1.02 (0.68, 1.52) | |||||||||
Liu et al, 2012, China [37] | NA | 3,461 M/W | >5 | 35–74 | 162 | NA | Total fibre | High vs low | 0.38 (0.17, 0.87) | Age, sex, family history of diabetes, blood pressure, triacylglycerols, fasting glucose |
Weng et al, 2012, Taiwan [36] | CardioVascular Disease risk FACtor Two-township Study | 1,604 M/W | 4.6 | >30 | 141 | Validated FFQ, 49 food items | Total fibre | 43.3 vs 20.4 g/day | 0.49 (0.28, 0.85)a
| Age, sex, age–sex interaction, calories, residential area, family history of diabetes, BMI, central obesity, smoking, drinking, physical activity, hypertension, hypercholesterolaemia, hypertriacylglycerolaemia, low HDL-cholesterol |
Fruit fibre | 20.6 vs 3.1 g/day | 0.55 (0.32, 0.95)a
| ||||||||
Vegetable fibre | 15.8 vs 3.2 g/day | 0.45 (0.25, 0.82)a
| ||||||||
Qiao et al, 2014, USA [38] | Women’s Health Initiative | 154,493 W | 7.6 | 50–79 | 10,285 | Validated FFQ | Total fibre | ≥13.14 vs <13.14 g/day | 0.98 (0.93, 1.04) | Age, education, cigarette smoking, BMI, WHR, physical activity, family history of diabetes, study arms, HT use |
Present study, Europe | EPIC-InterAct | 26,088 M/W | 10.8 | 20–79 | 11,559 | Validated FFQs, diet history, 7 day food diaries | Total fibre | >26.4 vs <18.9 g/day | 0.91 (0.81, 1.03) | Age, sex, smoking status, physical activity, education level, alcohol, energy intake, carbohydrates, Mg, vitamin B1, SFA, BMI |
Cereal fibre | >10.9 vs <5.7 g/day | 0.95 (0.83, 1.08) | ||||||||
Fruit fibre | >6.3 vs <2.3 g/day | 0.96 (0.83, 1.10) | ||||||||
Vegetable fibre | >5.3 vs <2.4 g/day | 0.93 (0.84, 1.03) |