Dietary fibre and incidence of type 2 diabetes in eight European countries: the EPIC-InterAct Study and a meta-analysis of prospective studies

Anneleen Kuijsten*, Dagfinn Aune, Matthias B. Schulze, Teresa Norat, Geertruida J. van Woudenbergh, Joline W.J. Beulens, Ivonne Sluijs, Annemieke M.W. Spijkerman, Daphne L. van der A, Domenico Palli, Tilman Kühn, Andrea Wendt, Brian Buijsse, Heiner Boeing, Valeria Pala, Pilar Amiano, Genevieve Buckland, José María Huerta Castaño, Anne Tjønneland, Cecilie KyrøMaria Luisa Redondo, Carlotta Sacerdote, María José Sánchez, Guy Fagherazzi, Beverley Balkau, Martin Lajous, Salvatore Panico, Paul W. Franks, Olov Rolandsson, Peter Nilsson, Marju Orho-Melander, Kim Overvad, Inge Huybrechts, Nadia Slimani, Rosario Tumino, Aurelio Barricarte, Timothy J. Key, Edith J.M. Feskens, Claudia Langenberg, Stephen Sharp, Nita G. Forouhi, Elio Riboli, Nicholas J. Wareham, The InterAct Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

229 Citations (Scopus)


Aims/hypothesis: Intake of dietary fibre has been associated with a reduced risk of type 2 diabetes, but few European studies have been published on this. We evaluated the association between intake of dietary fibre and type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study and in a meta-analysis of prospective studies. Methods: During 10.8 years of follow-up, 11,559 participants with type 2 diabetes were identified and a subcohort of 15,258 participants was selected for the case-cohort study. Country-specific HRs were estimated using Prentice-weighted Cox proportional hazards models and were pooled using a random effects meta-analysis. Eighteen other cohort studies were identified for the meta-analysis. Results: In the EPIC-InterAct Study, dietary fibre intake was associated with a lower risk of diabetes (HRQ4 vs Q1 0.82; 95% CI 0.69, 0.97) after adjustment for lifestyle and dietary factors. Similar inverse associations were observed for the intake of cereal fibre and vegetable fibre, but not fruit fibre. The associations were attenuated and no longer statistically significant after adjustment for BMI. In the meta-analysis (19 cohorts), the summary RRs per 10 g/day increase in intake were 0.91 (95% CI 0.87, 0.96) for total fibre, 0.75 (95% CI 0.65, 0.86) for cereal fibre, 0.95 (95% CI 0.87, 1.03) for fruit fibre and 0.93 (95% CI 0.82, 1.05) for vegetable fibre. Conclusions/interpretation: The overall evidence indicates that the intake of total and cereal fibre is inversely related to the risk of type 2 diabetes. The results of the EPIC-InterAct Study suggest that the association may be partially explained by body weight.

Original languageEnglish
Pages (from-to)1394-1408
Number of pages15
Issue number7
Publication statusPublished - 20 Jul 2015
Externally publishedYes


  • Case-cohort
  • Dietary fibre
  • EPIC-InterAct
  • Meta-analysis
  • Type 2 diabetes


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