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Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study
Pilar Buil-Cosiales1, Itziar Zazpe1, Estefanía Toledo1
1From the Prevención con Dieta Mediterránea Research Network (Red 06/0045) (PB-C, IZ, ET, JS-S, JD-E, FA, LS-M, XP, RML-R, AM, FJB-G, JB, VR-G, RE, and MÁM-G) and the Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (PB-C, IZ, ET, DC, JS-S, JD-E, ER, JF-CN, JMS-L, FA, MF, OC, LS-M, XP, RML-R, AM, FJB-G, JVS, JMV-R, JB, VR-G, RE, and MÁM-G), Instituto de Salud Carlos III, Madrid, Spain; the Servicio Navarro de Salud-Osasunbidea (PB-C, JD-E, and FJB-G), Pamplona, Spain; the Departments of Preventive Medicine and Public Health (IZ, ET, and MÁM-G) and Nutrition (AM), University of Navarra, Pamplona, Spain; the Department of Preventive Medicine, University of Valencia, Valencia, Spain (DC and JVS); the Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain (JS-S and JB); the Lipid Clinic, Department of Endocrinology and Nutrition (ER), the Department of Internal Medicine (RE), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, and the Department of Nutrition and Food Science, School of Pharmacy, Xarxa de Referència en Tecnologia dels Aliments, Instituto de Investigación en Nutrición y Seguridad Alimentaria (RML-R), University of Barcelona, Barcelona, Spain (ER); the Department of Preventive Medicine, University of Malaga, Malaga, Spain (JF-CN); the Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain (JMS); the Department of Cardiology, University Hospital of Alava, Vitoria, Spain (FA); the Institute of Health Sciences, University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain (MF); the Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain (OC); the Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain (LS-M); the Lipids and Vascular Risk Unit, Int
Background:
Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet.
Objective:
We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention.
Design:
We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes.
Results:
In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death.
Conclusion:
Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639.