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Meta-Analysis

Dietary Fibre and Incidence of Type 2 Diabetes in Eight European Countries: The EPIC-InterAct Study and a Meta-Analysis of Prospective Studies

InterAct Consortium. Diabetologia. .
Free PMC article

Abstract

Aims/hypothesis: Intake of dietary fibre has been associated with a reduced risk of type 2 diabetes, but few European studies have been published on this. We evaluated the association between intake of dietary fibre and type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study and in a meta-analysis of prospective studies.

Methods: During 10.8 years of follow-up, 11,559 participants with type 2 diabetes were identified and a subcohort of 15,258 participants was selected for the case-cohort study. Country-specific HRs were estimated using Prentice-weighted Cox proportional hazards models and were pooled using a random effects meta-analysis. Eighteen other cohort studies were identified for the meta-analysis.

Results: In the EPIC-InterAct Study, dietary fibre intake was associated with a lower risk of diabetes (HRQ4 vs Q1 0.82; 95% CI 0.69, 0.97) after adjustment for lifestyle and dietary factors. Similar inverse associations were observed for the intake of cereal fibre and vegetable fibre, but not fruit fibre. The associations were attenuated and no longer statistically significant after adjustment for BMI. In the meta-analysis (19 cohorts), the summary RRs per 10 g/day increase in intake were 0.91 (95% CI 0.87, 0.96) for total fibre, 0.75 (95% CI 0.65, 0.86) for cereal fibre, 0.95 (95% CI 0.87, 1.03) for fruit fibre and 0.93 (95% CI 0.82, 1.05) for vegetable fibre.

Conclusions/interpretation: The overall evidence indicates that the intake of total and cereal fibre is inversely related to the risk of type 2 diabetes. The results of the EPIC-InterAct Study suggest that the association may be partially explained by body weight.

Figures

Fig. 1
Fig. 1
Association between cereal fibre, fruit fibre and vegetable fibre consumption and risk of type 2 diabetes in the EPIC-InterAct study (n = 26,088). Country-specific HRQ4 vs Q1 (95% CIs) were pooled using random effects meta-analysis. HRs were adjusted for sex, smoking status, physical activity, education level, sex-specific alcohol categories, energy, energy-adjusted carbohydrate, magnesium intake, vitamin B1 intake, saturated fatty acids and BMI. The x-axis is on a log scale
Fig. 2
Fig. 2
Dietary total fibre (a, b) and cereal fibre (c, d) and type 2 diabetes, linear dose–response meta-analyses per 10 g/day (a, c) and non-linear dose–response meta-analyses (b, d). In (a) and (c), the RR of each study is represented by a square, and the size of the square represents the weight of each study to the overall estimate. The 95% CIs are represented by horizontal lines, and the diamond represents the overall estimate and its 95% CI. The x-axis is on a log scale. In (b) and (d), the solid lines represent the best-fitting fractional polynomial, and the dashed lines represent 95% CIs
Fig. 3
Fig. 3
Fruit fibre (a, b) and vegetable fibre (c, d) and type 2 diabetes, linear dose–response meta-analyses per 10 g/day (a, c) and non-linear dose–response meta-analyses (b, d). In (a) and (c), the RR of each study is represented by a square and the size of the square represents the weight of each study to the overall estimate. The 95% CIs are represented by horizontal lines, and the diamond represents the overall estimate and its 95% CI. The x-axis is on a log scale. In (b) and (d), the solid lines represent the best-fitting fractional polynomial, and the dashed lines represent 95% CIs

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