Dietary Fiber Reduces Peripheral Arterial Disease Risk in Men: study

We prospectively evaluated the relationship between dietary fiber and peripheral arterial disease risk (PAD) among 46,032 men, aged 40 to 75 y, in 1986. Subjects answered a vascular disease questionnaire and completed a validated 131-item food frequency questionnaire, and were free of PAD, cardiovascular disease and diabetes. During 12 y of follow-up 308 incident PAD cases were documented.

After adjusting for age, smoking, hypertension, hypercholesterolemia, family history of early coronary heart disease, alcohol consumption, BMI, physical activity and energy intake, PAD risk in each quintile of cereal fiber intake compared with the lowest quintile was 0.69, 95% CI 0.49–0.97 for quintile 2; 0.65, 95% CI 0.45–0.94 for quintile 3; 0.68, 95% CI 0.47–0.98 for quintile 4; and 0.67, 95% CI 0.47–0.97 for quintile 5. In a nonlinear model the overall inverse association (P = 0.02) and nonlinear components (P = 0.03) were significant. Fruit, vegetable and total fiber intakes were not associated with PAD risk. These results suggest an inverse association between cereal fiber intake and PAD risk in men. Increasing cereal fiber intake may prevent PAD.

Peripheral arterial disease (PAD) is a major cause of morbidity, and people with PAD are more than four times as likely to die of any cause over 2 y from diagnosis than those without. Severe disease often requires surgery, including limb amputation, and operative mortality is high. PAD results mainly from atherosclerotic narrowing of the blood vessel lumen and shares some risk factors with coronary heart disease (CHD) and stroke, including diabetes, hypertension and cigarette smoking. There is little direct evidence, however, for the role of diet. An inverse association between fiber and PAD has been suggested in a cross-sectional study, a case-control study and a cohort study conducted among Finnish smokers. This is biologically plausible because soluble fiber reduces LDL. Cereal fiber intake specifically has been inversely associated with the risk of CHD and diabetes, and has been shown to favorably impact total cholesterol, LDL and fasting serum insulin. Therefore, we prospectively examined the association of dietary fiber intake with incident PAD in a large cohort of men followed for 12 y.

The Health Professionals Follow-up Study began in 1986 when 51,529 U.S. male health professionals, aged 40 to 75 y, volunteered to participate in the study (29,683 dentists, 4185 pharmacists, 3745 optometrists, 1600 podiatrists and 10,098 veterinarians; 531 African-American and 877 Asian-American). The participants received questionnaires at baseline and biennially to determine lifestyle and medical conditions, and validated food frequency questionnaires (FFQ) every 4 y to determine diet.

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We excluded men with a history of PAD, CHD, stroke and diabetes, because they may have changed their diets following disease, and men with inadequate dietary data (reported energy intake <3352 or >17598 kJ, or >70 unanswered of 131 items in the FFQ) resulting in 46,032 men in this analysis. The study was approved by the Human Subjects Committee of the Harvard School of Public Health.