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. 2025 Jun 18;17(1):231.
doi: 10.1186/s13098-025-01810-9.

Association of dietary fiber intake with all-cause and cardiovascular mortality in diabetes and prediabetes

Xingxing Chen  1 , Luping Tao  1 , Yunchao Wang  2
Affiliations

Association of dietary fiber intake with all-cause and cardiovascular mortality in diabetes and prediabetes

Xingxing Chen et al. Diabetol Metab Syndr. .

Abstract

Purpose: To examine the association between dietary fiber intake and mortality risks (all-cause and cardiovascular) among U.S. adults with diabetes or prediabetes, and to evaluate the dose-response patterns of these associations.

Materials and methods: This longitudinal cohort study analyzed data from 3259 adults with diabetes or prediabetes from the 2011-2018 National Health and Nutrition Examination Survey (NHANES). Dietary fiber intake was assessed using two 24-hour dietary recall interviews. Mortality data were obtained through December 31, 2019. Multiple Cox proportional hazards models were used to evaluate associations between fiber intake and mortality outcomes, adjusting for demographic and health-related covariates.

Results: Higher dietary fiber intake was significantly associated with reduced all-cause mortality risk (HR = 0.98, 95% CI: 0.97-0.99, P = 0.0039). For cardiovascular mortality, a non-linear relationship was identified with a threshold at 26.2 g/day. Below this threshold, each gram increase in fiber intake was associated with a 3% reduction in cardiovascular mortality risk (HR = 0.97, 95% CI: 0.94-0.99, P = 0.0352), while no significant benefit was observed above this threshold.

Conclusions: Dietary fiber intake shows a protective effect against all-cause mortality in U.S. adults with diabetes or prediabetes. For cardiovascular mortality, moderate fiber intake up to 26.2 g/day appears beneficial, while higher intake may not provide additional cardiovascular benefits. These findings provide important evidence for developing targeted dietary recommendations in diabetes management.

Keywords: All-cause mortality; Cardiovascular mortality; Diabetes/prediabetes; Dietary fiber; Dose-response relationship.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All participants gave their informed agreement, and the project was authorized by the National Center for Health Statistics Research Ethics Review Board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Flow chart of study participants
Fig. 2
Fig. 2
Dose-response relationships between dietary fiber intake and the probability of all-cause (a) and cardiovascular disease (CVD) (B) in participants with diabetes or prediabetes. The solid line and dashed line represent the estimated values and their corresponding 95% confidence intervals. Age, gender, race, education level, income to poverty ratio, body mass index, moderate activity, smoking behavior, and the existence of hypertension and energy intake were adjusted
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