Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology

Relationship between carbohydrate and dietary fibre intake and the risk of cardiovascular disease mortality in Japanese: 24-year follow-up of NIPPON DATA80

European Journal of Clinical Nutrition volume 74, pages 67–76 (2020)Cite this article

Subjects

Abstract

Background/Objectives

The association between carbohydrate intake and cardiovascular disease (CVD) risk has been investigated, but whether the quality of carbohydrate is more important than its amount is not known. We examined the associations between intake of dietary fibre (DF), carbohydrate, available carbohydrate, and starch with long-term CVD mortality in a Japanese population.

Subjects/Methods

We prospectively followed 8925 participants (3916 men and 5009 women) aged 30–79 years without CVD at baseline who participated in the National Nutrition Survey in Japan. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) for CVD mortality by quartiles of exposure variables.

Results

During 24 years of follow-up, 823 CVD deaths were observed. In men, the multivariable-adjusted HR for CVD mortality was lower in the highest quartile of DF intake (HR: 0.64; 95% CI: 0.47–0.87; Ptrend = 0.007) compared with the lowest quartile. This association was not significant in women. Multivariable-adjusted HR for total stroke mortality was lower in the highest quartile of DF intake (HR: 0.61; 95% CI: 0.38–0.98; Ptrend = 0.046) compared with the lowest quartile in women. Carbohydrate, available carbohydrate, and starch intake were not associated with CVD mortality.

Conclusions

Higher intake of DF was associated significantly with a lower risk of CVD mortality in men and lower risk of stroke mortality in women. Intake of carbohydrate, available carbohydrate, and starch were not associated with the risk of CVD mortality in men or women.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Mann J, Cummings JH, Englyst HN, Key T, Liu S, Riccardi G, et al. FAO/WHO scientific update on carbohydrates in human nutrition: conclusions. Eur J Clin Nutr. 2007;61(Suppl 1):S132–137. https://doi.org/10.1038/sj.ejcn.1602943

    Article  CAS  PubMed  Google Scholar 

  2. Mann J. Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolism. Eur J Clin Nutr. 2007;61(Suppl 1):S100–111. https://doi.org/10.1038/sj.ejcn.1602940

    Article  CAS  PubMed  Google Scholar 

  3. Yu D, Shu XO, Li H, Xiang YB, Yang G, Gao YT, et al. Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. Am J Epidemiol. 2013;178:1542–9. https://doi.org/10.1093/aje/kwt178

    Article  PubMed  PubMed Central  Google Scholar 

  4. Sieri SKV, Berrino F, Evangelista A, Agnoli C, Brighenti F, Pellegrini N, et al. Dietary glycemic load and index and risk of coronary heart disease in a large italian cohort: the EPICOR study. Arch Intern Med. 2010;170:640–7

    Article  CAS  Google Scholar 

  5. Oh K, Hu FB, Cho E, Rexrode KM, Stampfer MJ, Manson JE, et al. Carbohydrate intake, glycemic index, glycemic load, and dietary fiber in relation to risk of stroke in women. Am J Epidemiol. 2005;161:161–9. https://doi.org/10.1093/aje/kwi026

    Article  PubMed  Google Scholar 

  6. Lagiou P, Sandin S, Weiderpass E, Lagiou A, Mucci L, Trichopoulos D, et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007;261:366–374. https://doi.org/10.1111/j.1365-2796.2007.01774.x

    Article  CAS  PubMed  Google Scholar 

  7. Trichopoulou A, Psaltopoulou T, Orfanos P, Hsieh CC, Trichopoulos D. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007;61:575–81. https://doi.org/10.1038/sj.ejcn.1602557

    Article  CAS  PubMed  Google Scholar 

  8. Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort Studies. Ann Intern Med. 2010;153:289–98. https://doi.org/10.1059/0003-4819-153-5-201009070-00003

    Article  PubMed  PubMed Central  Google Scholar 

  9. Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS ONE. 2013;8:e55030 https://doi.org/10.1371/journal.pone.0055030

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cummings JH, Stephen AM. Carbohydrate terminology and classification. Eur J Clin Nutr. 2007;61(Suppl 1):S5–18. https://doi.org/10.1038/sj.ejcn.1602936

    Article  CAS  PubMed  Google Scholar 

  11. James SL, Muir JG, Curtis SL, Gibson PR. Dietary fibre: a roughage guide. Intern Med J. 2003;33:291–6

    Article  CAS  Google Scholar 

  12. Whelton SP, Hyre AD, Pedersen B, Yi Y, Whelton PK, He J. Effect of dietary fiber intake on blood pressure: a meta-analysis of randomized, controlled clinical trials. J Hypertens. 2005;23:475–81

    Article  CAS  Google Scholar 

  13. Pereira MA, O'Reilly E, Augustsson K, Fraser GE, Goldbourt U, Heitmann BL, et al. Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med. 2004;164:370–6

    Article  Google Scholar 

  14. 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. Brit Med J. 2013;347:f6879 https://doi.org/10.1136/bmj.f6879

    Article  PubMed  Google Scholar 

  15. Threapleton DE, Greenwood DC, Evans CE, Cleghorn CL, Nykjaer C, Woodhead C, et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke. 2013;44:1360–8. https://doi.org/10.1161/STROKEAHA.111.000151

    Article  CAS  PubMed  Google Scholar 

  16. Okamura T, Hayakawa T, Kadowaki T, Kita Y, Okayama A, Elliott P, et al. Resting heart rate and cause-specific death in a 16.5-year cohort study of the Japanese general population. Am Heart J. 2004;147:1024–32. https://doi.org/10.1016/j.ahj.2003.12.020

    Article  PubMed  Google Scholar 

  17. Schakel SF, Dennis BH, Wold AC, Conway R, Zhao L, Okuda N, et al. Enhancing data on nutrient composition of foods eaten by participants in the INTERMAP study in China, Japan, the United Kingdom, and the United States. J Food Compos Anal. 2003;16:395–408. https://doi.org/10.1016/s0889-1575(03)00043-7

    Article  Google Scholar 

  18. Okuda N, Miura K, Yoshita K, Matsumura Y, Okayama A, Nakamura Y, et al. Integration of data from NIPPON DATA80/90 and National Nutrition Survey in Japan: for cohort studies of representative Japanese on nutrition. J Epidemiol. 2010;20(Suppl_III):S506–S514. https://doi.org/10.2188/jea.JE20090218

    Article  PubMed  PubMed Central  Google Scholar 

  19. Iwaoka F, Yoshiike N, Date C, Shimada T, Tanaka H. A validation study on a method to estimate nutrient intake by family members through a household-based food-weighing survey. J Nutr Sci Vitaminol (Tokyo). 2001;47:222–7

    Article  CAS  Google Scholar 

  20. Eshak ES, Iso H, Date C, Kikuchi S, Watanabe Y, Wada Y, et al. Dietary fiber intake is associated with reduced risk of mortality from cardiovascular disease among Japanese men and women. J Nutr. 2010;140:1445–53. https://doi.org/10.3945/jn.110.122358

    Article  CAS  PubMed  Google Scholar 

  21. Kokubo Y, Iso H, Saito I, Yamagishi K, Ishihara J, Inoue M, et al. Dietary fiber intake and risk of cardiovascular disease in the Japanese population: the Japan Public Health Center-based study cohort. Eur J Clin Nutr. 2011;65:1233–41. https://doi.org/10.1038/ejcn.2011.100

    Article  CAS  PubMed  Google Scholar 

  22. AlEssa HB, Bhupathiraju SN, Malik VS, Wedick NM, Campos H, Rosner B, et al. Carbohydrate quality and quantity and risk of type 2 diabetes in US women. Am J Clin Nutr. 2015;102:1543–53. https://doi.org/10.3945/ajcn.115.116558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ministry of Health Labour and Welfare. Overview of dietary reference intakes for Japanese (2015). 2015. p. 14−5. https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/Overview.pdf. Accessed 4 Apr 2019

  24. Nakaji S, Sugawara K, Saito D, Yoshioka Y, MacAuley D, Bradley T, et al. Trends in dietary fiber intake in Japan over the last century. Eur J Nutr. 2002;41:222–7. https://doi.org/10.1007/s00394-002-0379-x

    Article  PubMed  Google Scholar 

  25. The Ministry of Health Labour and Welfare. The National Nutrition Survey of Japan. 2015. p. 17. (Japanese) https://www.mhlw.go.jp/file/04-Houdouhappyou-10904750-Kenkoukyoku-Gantaisakukenkouzoushinka/kekkagaiyou.pdf. Accessed 4 Apr 2019

  26. Okuda N, Miura K, Okayama A, Okamura T, Abbott RD, Nishi N. Fruit and vegetable intake and mortality from cardiovascular disease in Japan: a 24-year follow-up of the NIPPON DATA80 Study. Eur J Clin Nutr. 2015;69:482–8

    Article  CAS  Google Scholar 

  27. Nakamura Y, Okuda N, Okamura T, Kadota A, Miyagawa N, Hayakawa T, et al. Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80. Br J Nutr. 2014;112:916–24. https://doi.org/10.1017/S0007114514001627

    Article  CAS  PubMed  Google Scholar 

  28. Zhou BF, Stamler J, Dennis B, Moag-Stahlberg A, Okuda N, Robertson C, et al. Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens. 2003;17:623–30. https://doi.org/10.1038/sj.jhh.1001605

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, et al. Dietary glycemic index, glycemic load, and intake of carbohydrate and rice in relation to risk of mortality from stroke and its subtypes in Japanese men and women. Metabolism. 2010;59:1574–82. https://doi.org/10.1016/j.metabol.2010.02.004

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all members of the NIPPON DATA80 Research group as listed in the previous article [26]. We thank Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Funding

This study was supported by a Grant-in-Aid from the Ministry of Health, Labour and Welfare under the auspices of the Japanese Association for Cerebro-cardiovascular Disease Control, a Research Grant for Cardiovascular Diseases (7A-2) from the Ministry of Health, Labour and Welfare, and a Health and Labour Sciences Research Grant, Japan (Comprehensive Research on Aging and Health (H11-Chouju-046, H14-Chouju-003, H17-Chouju-012, H19-Chouju-Ippan-014) and Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus (H22-Jyunkankitou-Seisyu-Sitei-017, H25-Jyunkankitou-Seisyu-Sitei-022)).

Author information

Authors and Affiliations

  1. Department of Medicine, Shiga University of Medical Science, Otsu, 520-2192, Japan

    Itsuko Miyazawa

  2. Department of Public Health, Shiga University of Medical Science, Otsu, 520-2192, Japan

    Katsuyuki Miura, Naoko Miyagawa, Keiko Kondo, Aya Kadota, Akira Fujiyoshi & Hirotsugu Ueshima

  3. Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, 520-2192, Japan

    Katsuyuki Miura, Aya Kadota & Hirotsugu Ueshima

  4. International Center for Nutrition and Information, National Institute of Biomedical Innovation, Health and Nutrition, Tokyo, 162-8636, Japan

    Naoko Miyagawa

  5. Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, 339-8539, Japan

    Nagako Okuda

  6. Department of Hygiene, School of Medicine Wakayama Medical University, Wakayama, 641-8509, Japan

    Akira Fujiyoshi

  7. Department of Public Health, Jichi Medical University, Shimotsuke, 329-0498, Japan

    Izumi Chihara & Yosikazu Nakamura

  8. Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, 980-8573, Japan

    Atsushi Hozawa

  9. Department of Food Science and Human Nutrition, Faculty of Agriculture, Ryukoku University, Otsu, 520-2194, Japan

    Yasuyuki Nakamura

  10. Science of Nursing, Tsuruga Nursing University, Tsuruga, 914-0814, Japan

    Yoshikuni Kita

  11. Department of Food Science and Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, 558-8585, Japan

    Katsushi Yoshita

  12. Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, 160-8582, Japan

    Tomonori Okamura

  13. Research Institute of Strategy for Prevention, Tokyo, 104-0033, Japan

    Akira Okayama

Authors
  1. Itsuko Miyazawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katsuyuki Miura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoko Miyagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keiko Kondo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aya Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nagako Okuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akira Fujiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Izumi Chihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yosikazu Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Atsushi Hozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yasuyuki Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yoshikuni Kita
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Katsushi Yoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Tomonori Okamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Akira Okayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Hirotsugu Ueshima
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the NIPPON DATA80 Research group

Corresponding author

Correspondence to Itsuko Miyazawa.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miyazawa, I., Miura, K., Miyagawa, N. et al. Relationship between carbohydrate and dietary fibre intake and the risk of cardiovascular disease mortality in Japanese: 24-year follow-up of NIPPON DATA80. Eur J Clin Nutr 74, 67–76 (2020). https://doi.org/10.1038/s41430-019-0424-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-019-0424-y

This article is cited by

Search

Advanced search

Quick links