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

The InterAct Consortium

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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
Early online date29 May 2015
Publication statusPublished - 20 Jul 2015
Externally publishedYes

Bibliographical note

Funding Information:
The InterAct project was supported by the European Union (LSHM-CT-2006-037197) in the Framework Programme 6; DA was supported by the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU); TN was supported by the World Cancer Research Fund (WCRF); JWJB and IS were supported by the Netherlands Agency grant IGE05012 and Incentive Grant from the Board of the UMC Utrecht; DLVDA and AMWS were supported by the Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF) and Statistics Netherlands; DP was supported by Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy; TK and AW were supported by the German Cancer Aid, German Cancer Research Center (DKFZ Heidelberg) and German Federal Ministry of Education and Research; PA was supported by the Regional Basque Country Government; GB was supported by The Spanish Ministry of Health (ISCIII RETICC RD06/0020/0091) and the Catalan Institute of Oncology; AT and CK were supported by the Danish Cancer Society; MLR was supported by the Government of the Principality of Asturias; SP was supported by Compagnia di San Paolo; PWF was supported by the Swedish Research Council, Novo Nordisk, Swedish Diabetes Association and Swedish Heart-Lung Foundation; OR was supported by the Västerboten County Council; TJK was supported by the Cancer Research UK; NJW, SS, CL and NGF are supported by the Medical Research Council Epidemiology Unit MC_UU_12015/1 and MC_UU_12015/5.

Publisher Copyright:
© 2015, The Author(s).


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

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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