Fiber intake and total and cause-specific mortality in the European Prospective Investigation into Cancer and Nutrition cohort

Shu Chun Chuang, Teresa Norat, Neil Murphy, Anja Olsen, Anne Tjønneland, Kim Overvad, Marie Christine Boutron-Ruault, Florence Perquier, Laureen Dartois, Rudolf Kaaks, Birgit Teucher, Manuela M. Bergmann, Heiner Boeing, Antonia Trichopoulou, Pagona Lagiou, Dimitrios Trichopoulos, Sara Grioni, Carlotta Sacerdote, Salvatore Panico, Domenico PalliRosario Tumino, Petra H M Peeters, Bas Bueno-de-Mesquita, Martine M. Ros, Magritt Brustad, Lene Angell Åsli, Guri Skeie, J. Ramón Quirós, Carlos A. González, María José Sánchez, Carmen Navarro, Eva Ardanaz Aicua, Miren Dorronsoro, Isabel Drake, Emily Sonestedt, Ingegerd Johansson, Göran Hallmans, Timothy Key, Francesca Crowe, Kay Tee Khaw, Nicholas Wareham, Pietro Ferrari, Nadia Slimani, Isabelle Romieu, Valentina Gallo, Elio Riboli, Paolo Vineis

Research output: Contribution to journalArticlepeer-review


Background: Previous studies have shown that high fiber intake is associated with lower mortality. However, little is known about the association of dietary fiber with specific causes of death other than cardiovascular disease (CVD). Objective: The aim of this study was to assess the relation between fiber intake, mortality, and cause-specific mortality in a large European prospective study of 452,717 men and women. Design: HRs and 95% CIs were estimated by using Cox proportional hazards models, stratified by age, sex, and center and adjusted for education, smoking, alcohol consumption, BMI, physical activity, total energy intake, and, in women, ever use of menopausal hormone therapy. Results: During a mean follow-up of 12.7 y, a total of 23,582 deaths were recorded. Fiber intake was inversely associated with total mortality (HRper 10-g/d increase: 0.90; 95% CI: 0.88, 0.92); with mortality from circulatory (HRper 10-g/d increase: 0.90 and 0.88 for men and women, respectively), digestive (HR: 0.61 and 0.64), respiratory (HR: 0.77 and 0.62), and non-CVD noncancer inflammatory (HR: 0.85 and 0.80) diseases; and with smoking-related cancers (HR: 0.86 and 0.89) but not with non-smoking-related cancers (HR: 1.05 and 0.97). The associations were more evident for fiber from cereals and vegetables than from fruit. The associations were similar across BMI and physical activity categories but were stronger in smokers and participants who consumed >18 g alcohol/d. Conclusions: Higher fiber intake is associated with lower mortality, particularly from circulatory, digestive, and non-CVD noncancer inflammatory diseases. Our results support current recommendations of high dietary fiber intake for health maintenance.

Original languageEnglish
Pages (from-to)164-174
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Issue number1
Publication statusPublished - Jul 2012

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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