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Title: Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study
Authors: Buil-Cosiales, Pilar
Zazpe, Itziar
Toledo, Estefania
Corella, Dolores
Salas-Salvadó, Jordi
Diez-Espino, Javier
Ros, Emilio
Navajas, Joaquin Fernandez Creuet
Santos-Lozano, José Manuel
Arós, Fernando
Fiol, Miquel
Castaner, Olga
Serra-Majem, Lluis 
Pintó, Xavier
Lamuela-Raventós, Rosa M.
Marti, Amelia
Basterra-Gortari, F. Javier
Sorli, José V.
Verdú-Rotellar, Jose Ma
Basora, Josep
Ruiz-Gutierrez, Valentina
Estruch, Ramón
Martínez-González, Miguel A.
Keywords: Coronary-Heart-Disease
Total-Energy Intake
Vegetable Consumption
Follow-Up, et al
Issue Date: 2014
Publisher: 0002-9165
Journal: The American journal of clinical nutrition 
Abstract: 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 Prevencion con Dieta Mediterranea (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% Cl: 0.46, 0.86; P = 0.015) and 0.59 (95% Cl: 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 as ISRCTN35739639.
ISSN: 0002-9165
DOI: 10.3945/ajcn.114.093757
Source: American Journal of Clinical Nutrition[ISSN 0002-9165],v. 100, p. 1498-1507
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