EVIDENCE-BASED PUBLIC HEALTH POLICY AND PRACTICE

¹ Department of Internal Medicine, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona
² Ciber Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III
³ Department of Preventive Medicine and Public Health, School of Medicine-Clinica Universitaria, University of Navarra
⁴ Department of Epidemiology, Preventive Medicine and Public Health, School of Medicine, University of Valencia
⁵ Direcció d’Atenció Primària Reus-Tarragona, Institut Català de la Salut, Human Nutrition Unit, School of Medicine, University Rovira i Virgili, Reus (Tarragona)
⁶ Instituto de la Grasa, Consejo Superior de Investigaciones Cientificas, Sevilla
⁷ Cardiovascular Epidemiology Unit, Municipal Institut for Medical Research (IMIM), Barcelona
⁸ Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Palma de Mallorca
⁹ Department of Epidemiology, School of Medicine, University of Malaga
¹⁰ Department of Nutrition and Bromatology, School of Pharmacy, Barcelona
¹¹ Clinical Trial Unit, Fundación LEIA-Hospital Txangorritxu, Vitoria
¹² Arteriosclerosis Unit, Hospital Carlos III, Madrid
¹³ San Pablo Health Center, Sevilla
¹⁴ Department of Biochemistry, School of Medicine, University of Valencia
¹⁵ Lipid Clinic, Endocrinology and Nutrition Service, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain

Dr Ramon Estruch, Dept. of Internal Medicine, Hospital Clinic, Villarroel, 170, 08036 Barcelona, Spain; restruch{at}clinic.ub.es

Background: Epidemiological studies and feeding trials with supplements suggest that fibre intake is associated with a reduction in cardiovascular risk. However, the effects of changes in dietary fibre on risk factor levels have not been evaluated in free-living individuals. Thus, the effects of changes in dietary fibre intake on cardiovascular risk factors were assessed over 3 months in free-living high-risk subjects.

Methods: 772 high-risk subjects (age 69±5 years) were assigned to a low-fat diet or two Mediterranean-style diets. All participants received behavioural and nutritional education, including recommendations for increasing the consumption of vegetables, fruits, and legumes. Changes in food and nutrient intake, body weight, blood pressure, lipid profiles, glucose control and inflammatory markers were evaluated.

Results: Most participants increased consumption of vegetable products, but the increase in dietary fibre exhibited wide between-subject variability (6–65 g/day). Body weight, waist circumference, and mean systolic and diastolic blood pressure decreased across quintiles of fibre intake (p<0.005; all). Reductions in fasting glucose and total cholesterol levels, and increments in HDL cholesterol were highest among participants in the upper 20% of fibre intake (p = 0.04 and 0.02 respectively). Plasma concentrations of C-reactive protein, but not those of inflammatory cytokines, decreased in parallel with increasing dietary fibre (p = 0.04). Significant reductions in LDL cholesterol were observed only among participants with the greatest increases in soluble fibre intake (p = 0.04).

Conclusions: Increasing dietary fibre intake with natural foods is associated with reductions in classical and novel cardiovascular risk factors in a high-risk cohort.

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