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Eric B. Rimm, ScD; Alberto Ascherio, MD; Edward Giovannucci, MD; Donna Spiegelman, ScD; Meir J. Stampfer, MD; Walter C. Willett, MD

JAMA. 1996;275(6):447-451.

Abstract
Objective.
—To examine prospectively the relationship between dietary fiber and risk of coronary heart disease.

Design.
—Cohort study.

Setting.
—In 1986, a total of 43 757 US male health professionals 40 to 75 years of age and free from diagnosed cardiovascular disease and diabetes completed a detailed 131 -item dietary questionnaire used to measure usual intake of total dietary fiber and specific food sources of fiber.

Main Outcome Measure.
—Fatal and nonfatal myocardial infarction (Ml).

Results.
—During 6 years of follow-up, we documented 734 cases of Ml (229 were fatal coronary heart disease). The age-adjusted relative risk (RR) for total Ml was 0.59 (95% confidence interval [CI], 0.46 to 0.76) among men in the highest quintile of total dietary fiber intake (median, 28.9 g/d) compared with men in the lowest quartile (median, 12.4 g/d). The inverse association was strongest for fatal coronary disease (RR, 0.45; 95% CI, 0.28 to 0.72). After controlling for smoking, physical activity and other known nondietary cardiovascular risk factors, dietary saturated fat, vitamin E, total energy intake, and alcohol intake, the RRs were only modestly attenuated. A 10-g increase in total dietary fiber corresponded to an RR for total Ml of 0.81 (95% CI, 0.70 to 0.93). Within the three main food contributors to total fiber intake (vegetable, fruit, and cereal), cereal fiber was most strongly associated with a reduced risk of total Ml (RR, 071; 95% CI, 0.55 to 0.91 for each 10-g increase in cereal fiber per day).

Conclusions.
—Our results suggest an inverse association between fiber intake and Ml. These results support current national dietary guidelines to increase dietary fiber intake and suggest that fiber, independent of fat intake, is an important dietary component for the prevention of coronary disease.

(JAMA. 1996;275:447-451)

Author Affiliations
From the Departments of Epidemiology (Drs Rimm, Ascherio, Spiegelman, Stampfer, and Willett), Nutrition (Drs Rimm, Ascherio, Stampfer, and Willett), and Biostatistics (Dr Spiegelman), Harvard School of Public Health, Boston, Mass; and the Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass (Drs Giovannucci, Stampfer, and Willett).

Footnotes
Reprint requests to the Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115 (Dr Rimm).

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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

History of Recommendations to the Public about Dietary Fat
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ABSTRACT | FULL TEXT  

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ABSTRACT | FULL TEXT  

Fiber, Lipids, and Coronary Heart Disease : A Statement for Healthcare Professionals From the Nutrition Committee, American Heart Association
Van Horn
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FULL TEXT  

Dietary Fiber: Further Epidemiological Support for a High-Intake Dietary Pattern
Labarthe
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FULL TEXT  

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ABSTRACT | FULL TEXT  

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Joshipura et al.
JDR 1996;75:1631-1636.
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