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Original Contribution
April 2, 2003

Cereal, Fruit, and Vegetable Fiber Intake and the Risk of Cardiovascular Disease in Elderly Individuals

Author Affiliations

Author Affiliations: Cardiovascular Health Research Unit, Departments of Medicine (Drs Lemaitre and Siscovick) and Epidemiology (Dr Siscovick) and Division of Cardiology (Dr Mozaffarian), University of Washington, and the Veterans Affairs Puget Sound Health Care System (Dr Mozaffarian), Seattle, Wash; the Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania School of Medicine, Philadelphia (Dr Kumanyika); the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Dr Olson); and the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (Dr Burke).

JAMA. 2003;289(13):1659-1666. doi:10.1001/jama.289.13.1659

Context People older than 65 years are the fastest-growing segment of the population and account for the majority of cardiovascular disease (CVD) morbidity, mortality, and health care expenditures. Additionally, the influence of dietary habits on risk may be less pronounced in elderly persons, when atherosclerosis is more advanced. However, few data address the influence of diet on CVD risk in this population.

Objective To determine whether fiber consumption from fruit, vegetable, and cereal sources (including whole grains and bran) is associated with incident CVD in elderly persons.

Design Prospective cohort study conducted from 1989 to June 2000.

Setting and Participants Population-based, multicenter study among 3588 men and women aged 65 years or older and free of known CVD at baseline in 1989-1990. Usual dietary fiber consumption was assessed at baseline (mean participant age, 72 years) using a 99-item food frequency questionnaire.

Main Outcome Measure Incident CVD (combined stroke, ischemic heart disease death, and nonfatal myocardial infarction).

Results During 8.6 years mean follow-up, there were 811 incident CVD events. After adjustment for age, sex, education, diabetes, ever smoking, pack-years of smoking, daily physical activity, exercise intensity, alcohol intake, and fruit and vegetable fiber consumption, cereal fiber consumption was inversely associated with incident CVD (P for trend = .02), with 21% lower risk (hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.62-0.99) in the highest quintile of intake, compared with the lowest quintile. In similar analyses, neither fruit fiber intake (P for trend = .98) nor vegetable fiber intake (P for trend = .95) were associated with incident CVD. When CVD events were separately evaluated, higher cereal fiber intake was associated with lower risk of total stroke and ischemic stroke and a trend toward lower risk of ischemic heart disease death. In a post hoc analysis, dark breads such as wheat, rye, or pumpernickel were associated with a lower risk of incident CVD (HR, 0.76; 95% CI, 0.64-0.90) rather than cereal fiber from other sources.

Conclusions Cereal fiber consumption late in life is associated with lower risk of incident CVD, supporting recommendations for elderly individuals to increase consumption of dietary cereal fiber.