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This study aimed to investigate the association between dietary fber intake and long-term cardiovascular disease (CVD) risk based on the National Health and Nutrition Examination Survey (NHANES) database.
(2022) 22:1076 Zhang et al BMC Public Health https://doi.org/10.1186/s12889-022-13419-y Open Access RESEARCH Association between dietary fiber intake and atherosclerotic cardiovascular disease risk in adults: a cross‑sectional study of 14,947 population based on the National Health and Nutrition Examination Surveys Shutang Zhang1†, Jie Tian1†, Min Lei1, Canye Zhong1 and Yan Zhang2* Abstract Background: This study aimed to investigate the association between dietary fiber intake and long-term cardiovascular disease (CVD) risk based on the National Health and Nutrition Examination Survey (NHANES) database Methods: A total of 14,947 participants aged 20–79 from the NHANES database were included in this study between 2009 and 2018 The atherosclerotic cardiovascular disease (ASCVD) score was utilized to predict the 10-year risk of CVD in individuals (low, borderline, intermediate, and high risk) Weighted univariate and multinomial multivariate logistic regression analyses were used to analyze the association between dietary fiber intake and long-term CVD risk Results: Higher dietary fiber density may be associated with a reduced ASCVD risk in participants with intermediate risk [odds ratio (OR) = 0.76; 95% confidence interval (CI), 0.61–0.94] and high risk (OR = 0.60; 95%CI, 0.45–0.81) compared with those in the group with low risk Higher total dietary fiber intake may also reduce ASCVD risk in participants with high risk (OR = 0.84; 95%CI, 0.75–0.95) Subgroup analyses showed that higher dietary fiber density may be related to reduced ASCVD risk in intermediate-risk participants aged 20–39 (OR = 0.62; 95%CI, 0.43–0.89) and 40–59 (OR = 0.67; 95%CI, 0.49–0.94) In high-risk participants, higher dietary fiber density may reduce ASCVD risk in 20–39-year-old (OR = 0.38; 95%CI, 0.19–0.77), 40–59-year-old (OR = 0.37; 95%CI, 0.20–0.70), male (OR = 0.47; 95%CI, 0.23–0.97) and female (OR = 0.57; 95%CI, 0.38–0.86) participants Conclusion: Higher dietary fiber density and total dietary fiber intake were associated with a lower long-term CVD risk, especially in the 20–39 and 40–59 age groups, where the reduction was most significant Keywords: Dietary fiber intake, Framingham risk score, Cardiovascular disease, 10-year risk † Shutang Zhang and Jie Tian contributed equally to this study and should be considered co-first authors *Correspondence: yanzhangccu@outlook.com Department of Cardiovascular Medicine CCU, Hanzhong People’s Hospital, No.251 North Unity Street, Hantai District, Hanzhong 723000, Shaanxi, People’s Republic of China Full list of author information is available at the end of the article Introduction Cardiovascular diseases (CVD), the world’s leading cause of death, are a group of disorders of the heart and blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease and other diseases, claiming an estimated 17.9 million lives each year [1, 2] CVD presents a heavy burden for the world due to its high treatment cost and extensive preventive © The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data Zhang et al BMC Public Health (2022) 22:1076 interventions [3, 4] Evidence demonstrated that the occurrence of most CVD can be attributed to a series of factors, such as smoking, obesity, diabetes, dyslipidemia, hypertension, diet, excessive alcohol consumption, and mental state [5, 6] Early prevention can effectively reduce the incidence of CVD, but CVD-related deaths still account for a large proportion of all-cause deaths Dietary fiber can affect the cardiometabolic pathways, improve lipid or lipoprotein metabolism, insulin homeostasis, and so on [7] Epidemiologic studies have shown that dietary fiber intake is associated with the CVD risk in short and medium-term follow-up [8–10] Murai et al indicated that seaweed intake was inversely associated with the risk of ischemic heart disease [8] Song et al found that total fruit and whole fruit intake were inversely related to cardiovascular risk factors such as obesity, metabolic syndrome and hypertension [9] Wang et al showed that higher fiber intake and fiber intake density may be associated with a lower risk of major adverse cardiovascular events [10] An in-depth understanding of the role of dietary fiber intake in predicting the long-term CVD risk can help the public identify optimal dietary patterns and improve long-term survival The atherosclerotic cardiovascular disease (ASCVD) score, recommended by the American College of Cardiology (ACC) and American Heart Association (AHA), is a commonly and widely used to evaluate the 10-year CVD [11] In this study, we applied this score to identify people at high risk of CVD over the next ten years and assessed the association between dietary fiber intake and the CVD risk based on the National Health and Nutrition Examination Survey (NHANES) database Methods Study population Data in this study were extracted from the NHANES database between 2009 and 2018, which is a cross-sectional survey of the health and nutrition status of the U.S civilian and non-institutionalized population conducted by the National Center of Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC) Subjects were randomly screened based on a complex, stratified multi-stage cluster sampling design The information collection was carried out through interviews Additional information was available at: https://www. cdc.gov/nchs/tutorials/dietar y/SurveyOrientation/Resou rce Dietary Analysis/intro.htm A total of 14,947 participants with complete data were included in this study Data collection Participants’ information including age (20–79 years old), gender (male and female), body mass index (BMI, kg/ m2), race (Mexican Americans, Hispanics, non-Hispanic Page of whites, non-Hispanic blacks, and others), marital status (married, widowed, divorced/separated, and unmarried), education level ( high school), family income (