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Alicja Wolk, DMSc; JoAnn E. Manson, MD; Meir J. Stampfer, MD; Graham A. Colditz, MD; Frank B. Hu, MD; Frank E. Speizer, MD; Charles H. Hennekens, MD; Walter C. Willett, MD

JAMA. 1999;281:1998-2004.

Context  Epidemiological studies of men suggest that dietary fiber intake protects against coronary heart disease (CHD), but data on this association in women are sparse.

Objective  To examine the association between long-term intake of total dietary fiber as well as fiber from different sources and risk of CHD in women.

Design and Setting  The Nurses' Health Study, a large, prospective cohort study of US women followed up for 10 years from 1984. Dietary data were collected in 1984, 1986, and 1990, using a validated semiquantitative food frequency questionnaire.

Participants  A total of 68,782 women aged 37 to 64 years without previously diagnosed angina, myocardial infarction (MI), stroke, cancer, hypercholesterolemia, or diabetes at baseline.

Main Outcome Measure  Incidence of acute MI or death due to CHD by amount of fiber intake.

Results  Response rate averaged 80% to 90% during the 10-year follow-up. We documented 591 major CHD events (429 nonfatal MIs and 162 CHD deaths). The age-adjusted relative risk (RR) for major CHD events was 0.53 (95% confidence interval [CI], 0.40-0.69) for women in the highest quintile of total dietary fiber intake (median, 22.9 g/d) compared with women in the lowest quintile (median, 11.5 g/d). After controlling for age, cardiovascular risk factors, dietary factors, and multivitamin supplement use, the RR was 0.77 (95% CI, 0.57-1.04). For a 10-g/d increase in total fiber intake (the difference between the lowest and highest quintiles), the multivariate RR of total CHD events was 0.81 (95% CI, 0.66-0.99). Among different sources of dietary fiber (eg, cereal, vegetables, fruit), only cereal fiber was strongly associated with a reduced risk of CHD (multivariate RR, 0.63; 95% CI, 0.49-0.81 for each 5-g/d increase in cereal fiber).

Conclusions  Our findings in women support the hypothesis that higher fiber intake, particularly from cereal sources, reduces the risk of CHD.

Author Affiliations: Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden (Dr Wolk); the Channing Laboratory (Drs Manson, Stampfer, Colditz, Speizer, Hennekens, and Willett) and the Division of Preventive Medicine (Drs Manson and Hennekens), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, the Departments of Environmental Science (Dr Speizer), Epidemiology (Drs Manson, Stampfer, Colditz, Hennekens, and Willett), and Nutrition (Drs Stampfer, Hu, and Willett), Harvard School of Public Health, and the Department of Ambulatory Care and Prevention (Dr Hennekens), Harvard Medical School, Boston, Mass.

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