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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

Rapid Response:

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

Reconfirm the Importance of Therapeutic Life Style Changes

Threapleton DE, et al investigated dietary fibre intake and any potential dose-response association with coronary heart disease and cardiovascular disease. They included 22 cohort study publications met inclusion criteria and observed that total dietary fibre intake was inversely associated with risk of cardiovascular disease (risk ratio 0.91 per 7 g/day) and coronary heart disease (0.91). Further, 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.1

Cardiovascular disease and coronary heart disease are leading cause of death in developed countries. Effective therapies to prevent these are very important in the public health. To aligned with its paramount importance, general recommendations with a confirmed evidence have been released. Nonetheless, pretty many dietary supplements are widespread and many people are taking them. Money spent for them is uncountable. In this regard, the current study is very important even though it reconfirms the current nutritional guidelines.

Recent three studies reported no effectiveness of supplementation with a multivitamin. The first study systematically reviewed trial evidence to update the U.S. Preventive Services Task Force recommendation on the efficacy of vitamin supplements for primary prevention in community-dwelling adults with no nutritional deficiencies. After reviewing 3 trials of multivitamin supplements and 24 trials of single or paired vitamins that randomly assigned more than 400 000 participants, the authors concluded that there was no clear evidence of a beneficial effect of supplements on all-cause mortality, cardiovascular disease, or cancer.2 The second study investigated the potential benefits of a high-dose, 28-component multivitamin supplement in 1708 men and women with a previous myocardial infarction. After a median follow-up of 4.6 years, there was no significant difference in recurrent cardiovascular events with multivitamins compared with placebo.3 The last one evaluated the efficacy of a daily multivitamin to prevent cognitive decline among 5947 men aged 65 years or older participating in the Physicians’ Health Study II. After 12 years of follow-up. There were no differences between the multivitamin and placebo groups in overall cognitive performance or verbal memory.4 In an editorial related to this topic, authors concluded that supplementing the diet of well-nourished adults with (most) mineral or vitamin supplements has no clear benefit and might even be harmful and therefore, these vitamins should not be used for chronic disease prevention.5

On the other hand, Naci H, et al investigated to determine the comparative effectiveness of exercise, another component of therapeutic life style changes versus drug interventions on mortality outcomes. They included 16 (four exercise and 12 drug) meta-analyses and included 305 randomised controlled trials with 339 274 participants. They observed that no statistically detectable differences were evident between exercise and drug interventions in the secondary prevention of coronary heart disease and prediabetes. They concluded that although limited in quantity, existing randomised trial evidence on exercise interventions suggests that exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.6

All these studies points the importance of therapeutic life style changes mostly consisting of healthy diet and regular exercise compared with drugs intervention. All physicians should think about this message in time of many drugs and mineral or multivitamin supplementation being prescribed while elderly population is increasing fast and life expectancy is longer.

Funding: None, Disclosures: None

1. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 2013;347:f6879.

2. Fortmann SP, Burda BU, Senger CA, Lin JS, Whitlock EP. Vitamin and mineral supplements in the primary prevention of cardiovascular disease and cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2013; 159:824-834.

3. Lamas GA, Boineau R, Goertz C, Mark DB, Rosenberg Y, Stylianou M, et al, for the TACT (Trial to Assess Chelation Therapy) Investigators. Oral high-dose multivitamins and minerals after myocardial infarction: a randomized trial. Ann Intern Med 2013;159:797-805.

4. Grodstein F, O’Brien J, Kang JH, Dushkes R, Cook NR, Okereke O, et al. Long-term multivitamin supplementation and cognitive function in men: a randomized trial Ann Intern Med 2013;159:806-814.

5. Guallar E, Stranges S, Mulrow C, Appel LJ, Miller ER, III. Enough is enough: stop wasting money on vitamin and mineral supplements. Ann Intern Med 2013;159:850-851.

6. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577.

Competing interests: No competing interests

01 January 2014
Kwang K. Koh
Gachon University Gil Medical Center
1198 Kuwol-dong, Namdong-gu, Incheon, Korea