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Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis

BMJ 2013; 347 doi: (Published 19 December 2013) Cite this as: BMJ 2013;347:f6879
  1. Diane E Threapleton, doctoral student1,
  2. Darren C Greenwood, senior lecturer in biostatistics2,
  3. Charlotte E L Evans, lecturer in nutritional epidemiology1,
  4. Christine L Cleghorn, research fellow1,
  5. Camilla Nykjaer, research assistant1,
  6. Charlotte Woodhead, research assistant1,
  7. Janet E Cade, professor of nutritional epidemiology group1,
  8. Christopher P Gale, associate professor of cardiovascular health sciences 2,
  9. Victoria J Burley, senior lecturer in nutritional epidemiology1
  1. 1Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK
  2. 2Centre for Epidemiology and Biostatistics, University of Leeds, UK
  1. Correspondence to: V J Burley v.j.burley{at}
  • Accepted 11 November 2013


Objective To investigate dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease.

Design Systematic review of available literature and dose-response meta-analysis of cohort studies using random effects models.

Data sources The Cochrane Library, Medline, Medline in-process, Embase, CAB Abstracts, ISI Web of Science, BIOSIS, and hand searching.

Eligibility criteria for studies Prospective studies reporting associations between fibre intake and coronary heart disease or cardiovascular disease, with a minimum follow-up of three years and published in English between 1 January 1990 and 6 August 2013.

Results 22 cohort study publications met inclusion criteria and reported total dietary fibre intake, fibre subtypes, or fibre from food sources and primary events of cardiovascular disease or coronary heart disease. Total dietary fibre intake was inversely associated with risk of cardiovascular disease (risk ratio 0.91 per 7 g/day (95% confidence intervals 0.88 to 0.94)) and coronary heart disease (0.91 (0.87 to 0.94)). There was evidence of some heterogeneity between pooled studies for cardiovascular disease (I2=45% (0% to 74%)) and coronary heart disease (I2=33% (0% to 66%)). Insoluble fibre and fibre from cereal and vegetable sources were inversely associated with risk of coronary heart disease and cardiovascular disease. Fruit fibre intake was inversely associated with risk of cardiovascular disease.

Conclusions Greater dietary fibre intake is associated with a lower risk of both cardiovascular disease and coronary heart disease. Findings are aligned with general recommendations to increase fibre intake. The differing strengths of association by fibre type or source highlight the need for a better understanding of the mode of action of fibre components.


  • We thank Iris Gordon for search strategy development and James Thomas for his work developing the database into which all articles were extracted.

  • Contributors: VJB was the project lead for the main systematic review concerning dietary carbohydrates and cardiometabolic health outcomes. VJB, DET, and CLC searched databases. CPG helped develop search strategies. Article screening was undertaken by VJB, DET, CLC, CELE, and CN. Data extraction was carried out by VJB, DET, DCG, CLC, CELE, and CN. Quality of data extraction and checking was carried out by DET, CN, CLC, and CW. Statistical analysis was undertaken by DCG. DET wrote the manuscript. All authors reviewed the manuscript and contributed to manuscript revisions. VJB is the guarantor for this study.

  • Funding sources: The main systematic review was funded by the Department of Health for England. The update review was conducted primarily by DET, whose PhD studentship is sponsored by Kellogg Marketing and Sales Company (UK). Funding bodies played no part in article selection, analysis, interpretation; or decision to publish. Kellogg Marketing and Sales Company (UK) sponsored the main author studentship. One author is in receipt of an unrelated project grant from Danone. Funders played no part in article selection, analysis, interpretation, or decision to publish.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: support from the Department of Health for England and support for DET from Kellogg Marketing and Sales Company (UK) for the submitted work; DCG, CELC, CLC, CN, CW, JEC, CPG, and VJB have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Ethical approval was not required for this work.

  • Data sharing: Details of how to obtain additional data from the study can be obtained from VJB (v.j.burley{at}

  • The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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