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Health James benefits W Anderson, Belinda ABSTRACT as Over a leading chronic dietary diseases. serum High control, improved gastrointestinal for fiber. plant fiber grains, meet foods are of ample and these dried coronary heart (LDL) control, better body of cancer, can be good and servings guidelines. peas Am C/in heart disease, dietary blood fiber, serum Serum Elevated fiber, the indigestible cell wall component of plant several take Western diseases. has been shown cardiovascular cancers The zations dried and the health aspects of (5), consensus increased beans dietary fiber in- hyperlipidemia obesity (3), (6), certain twice the amount of fiber that Amer( I 1 ). To help people meet this recom- consume advises high or treat disorders (8), and diabetes (9). fiber intake for healthy adults is 20- an overwhelming reviews tical hypertension approximately currently time, (4), disease mendation, that prevent (7), gastrointestinal recommended dietary 35 g/d (10), icans Since to help among consumption peas, and whole benefits of fruits grains of dietary implementing health and (12-14). fiber and a high-fiber This then are of dietary fiber such Although high the National evidence that 1242S diseases” reductions and fiber cereal with states rather ‘ than products ‘there the that reduces lower report Clin Nutr also and change (16). for particularly coronary LDL heart Education disease Program rec- in fiber, evidence augment suggests that high the cholesterol-lowering ef- (3, diets enriched (20, in serum terol concentrations sumed with a typical I diet, research with 22) ward soluble indicate fiber from oat can cholesterol concentrations concentrations indicate that fiber, lowers by 15% American recommended mucilloid over 24% wk (23). re- psyllium mucilloid, a suppleserum total and LDL-choles- by the American 9% and 24 and 20%. respectively, diet (24). When used decreased an additional heart (26). serum Heart when conto augment Association, LDL-cholesterol concentra- (25). of have lipid evidence risk I From Affairs components the risk disease a lower Although serum incidence dietary fiber concentrations, suggests of CHD may alter hypertension. that diet may than CHD nonvegetar- risk factors obesity, also and independently such diabeaffect (4). the Metabolic Medical Center, Research Group, University of Medical Kentucky Services, College Veterans’ of Medicine Affairs Medical Lexington. of 2 Address Center, i antioxidants con- risk (13). Am high in LDL-cholesterol Coronary prac- is no conclusive other saturated Cholesterol or beans Vegetarians a recent changes, as factors may Additional studies ment rich in soluble diet. diseases, diet such report outlines is associated of Sciences it is dietary fruits, intake of the concentrations, risk American 26% ductions tes, chronic lower ( 1 ). In produce net reductions in serum cholesterol concentrations of 1 5% and LDL-cholesterol concentrations of 16% over 3 wk (Table 1.) Serum lipid improvements with such diets were sustained over the long-term, with tions fiber fiber in several Academy of vegetables, those dietary pressure, nonvegetarians 5, 18). studies in a metabolic diets clinical (19-21) CHD or improvements blood than heart hipoprotein low-cholesterol diet as a primary treatment ( 17). Although diets low in fat and cho- usually bran as benefits low-density content and National also average ians Health nonvegetar- coronary components cholesterol of soluble psyllium vegetables, fiber major The (4). a Step organi- and lower dietary minerals, are of that materials, plays an important role in human health (I). In the 1970s, Burkitt and Trowell (2) linked how dietary fiber intake to total lifestyles dietary serum cholesterol, Careful Introduction serum than of lipids intake pressure rates although some studies document specific effects of dietary effects ofthe entire high-fiber diet must also be considered. fects Dietary the other fats, lesterol cholesterol, intakes lower healthier ommends a low-fat, for hypercholesterolemia Diabetes. fiber have concentrations, of (CHD) Nutr 12425-75. WORDS Thus, fiber, and help lower and when unsaturated will J addition, dietary also cholesterol Dried arc good of higher cancer, weights, centrations of fruits and diets1’2 Vegetarians and catego- sources have (15). disease form of insoluble of dietary fiber in- beans ians lower components. vegetables bran is a concentrated advise a doubling Inclusion whole coronary Most of forms Dietary Vegetarians of with weight certain emerged treatment associated risk of high-fiber J Gustafson has and and water-insoluble and certain fruits and Americans. 1994;59(suppl): of Nancy fiber enhanced risk and wheat guidelines individuals KEY are aspects 1994;59(suppl):1242S-7S. reprint Cooper Printed Drive in USA. requests to JW Anderson, Division (IIIC), © American 1994 Veterans’ Lexington, Society KY 40511. for Clinical Nutrition Downloaded from www.ajcn.org by on December 29, 2009 take intakes function. soluble vegetables, y dietary prevention lower reduced insoluble fiber fiber. Current and the pressure, into water-soluble oat products, of 20 in fiber blood glycemic sources past Smith, concentrations, reduced rized beans, the practical M factor cholesterol disease, and HIGH TABLE 1 Percent change in serum lipids of hypercholesterolemic metabolic ward to oat bran, bean, and control diets’ Serum Study and fiber amount - 13.0 Recent Triglyceride -9.3 -19.3 -12.8 -15.0 -21.6 -12.1 -5.6 -18.7 -7.4 -10.2 -15.8 -5.0 -12.7 -18.7 -23.1 -12.7 -11.6 -10.0 -11.7 -14.5 -15.2 -16.7 -12.2 -8.8 -0.9 -0.6 -2.3 average reports cers that of the respiratory the human body and that cancer references be related to serum Barrett-Conner (28) effect ment concentrations. that a 6-g Khaw increase in dietary with a 25% reduction in CHD of other dietary variables. The and fiber mortality protective mortality from CHD multivariate was fourfold lower fiber fiber intakes. adjustment higher in Dutch intakes than in males This effect remained for other CHD risk males whose contribute to 35% of all cancers; energy, fat, higher fiber high cancer (30, and fiber 31). A critical and in individuals intakes. intake review low attracted An odds in the highest the observational ratio fiber of 0.57 group was was cancer deaths deaths were intakes greatest studies attention computed when compared with recently re- the majority of for colonectal the prevalence that in the lowest group, suggesting, only 57% of the simplistically, that chance of developing the high-fiber group had colonectal cancer as the low-fiber Lanza results group. (32) tabulated from 48 epidemi- ologic studies on dietary fiber and colorectal cancer that 38 reported an inverse relationship, 7 reported tion, and dominant foods 3 reported data protects a direct available the body association. suggest from that development Thus, the and found no associa- although intake of of colorectal the prehigh-fiber cancer, maladaptation and fruits. blood several to blood pressure pressures diet than and lifestyle differences that changing is accompanied (1). from an omnivby a significant interpnetation or more of of the control group, loss (38-41). these following lower fat intakes, Rouse, Mangetts, and colleagues (42-45) critically studied the effects of a vegetarian diet on blood pressure and attempted to determine the independent effects of dietary fiber. Vegetarian diets compared blood pressure sion. However, with omnivorous in individuals with an independent could diets significantly decrease mild on moderate hyperten- effect not be ascertained of dietary fiber on blood statistically. Obesity The routine use of high-fiber foods reduces and assists in weight loss and weight maintenance fiber foods tend to be high in carbohydrate and the foods may through decrease of peptides enhance adherence that to weight impact, diet thought (1, 46). diabetic studies ument the weight loss. has may eating rates such they may behavior; of constimwhich of dietary as short-chain stimulate and the they hong-term as an adjunct may theoretical potential weight management, benefits. have may high-fiber as Several china significant to a weight-reducing have particular benefits individuals (47). Because of encouraging (48-50), further clinical studies are needed effectiveness in- insulin insulin (1). and diets increases thereby of nutrients, increase considerable to be small, which decrease serum intake because not documented these that fiber supplements High-fiber obese mary emptying, intake; modify loss clinical studies have ical studies document to eat, products, food to the diet fiber longer absorption fermentation long-term weight of the following gastric they decrease dietary adjunct the risk for obesity because highlow in fat (1, 6). loss and of some they food availability; may Although slow of fullness; decreasing their acids, take they they energy release an foods of satiety; appetite; fatty promote weight the interactions high-fiber feeling ulates studies was indicated that were protective colon (37) postulates of plant foods from lower However, thermogenesis; compared between epidemiologic of 23 case-control (31). Both types of analyses suggest that fiber-rich diets cancer. fiber the relationship has of 37 a meta-analysis ported studies with However, to total cancer studies as vegetables subjects, of one decreases threefold to have because noted that fiber to a surprising was inversely related in The Netherlands; foods, These Potter intake results pressure. and fiber intake are more closely linked to overall cancer deaths than other individual dietary factors (13, 29). Kromhout et al (7) with tend be related creasing the feeling centrations, thereby intake degree between (34-36). such in blood mechanisms: factors that foods is hampered High-fiber maintenance factors. Cancer Dietary be a disease control could pressure whose diets insignificant after relationship of higher amounts of vegetables and but not universally, with reduced and particularly with epithehial can- of plant sex-matched reduction was still statistically significant after multivaniate adjustfor other CHD risk factors. Knomhout et al (7) reported that diets included cluded higher cancer concerns: lack of an appropriate lower sodium intakes, or weight cholesterol reported intake was associated that was independent the relationship and Several clinical studies document orous diet to a vegetarian diet Morris et al (27) reported that men with a high intake of cereal fiber have a lower rate of CHD than men with a low cereal-fiber intake. The protective effects of cereal fiber in this study could not may vegetarians and differences 19-22. this foods as an for prelimto doc- adjunct to fiber in- Diabetes Diabetes takes than is more in those prevalent in populations with fiber high intakes with (51). low Recent studies Downloaded from www.ajcn.org by on December 29, 2009 from examined and alimentary tract. is adapted to a high intake Although age- -12.7 before pressure studies Adapted have ingredients, concluded that consumption fruit is associated consistently, risk for cancer at most sites Blood -3.0 to be answered (33). of food to a reduced -2.0 remain be clarified instead HDL cholesterol 13.6 - questions can % change Oat bran 94 g/d 96g/d 106g/d 99g/d Bean 101 g/d 67g/d 83 g/d Control 1243S DIETS many men in a lipids LDL cholesterol Cholesterol FIBER 1244S ANDERSON further support the concept that individuals whose diets are high in fiber are less likely to develop diabetes than those whose diets arc low in fiber. Since 1976 extensive clinical studies have documented individuals offer with persuasive intakes lower (6, 9, 52, 53). that supplements glycemic of 53 of fiber Two intakes types for fiber sensitivity blood improved and not report and the glycemic that fiber subjects. 8 (15%) assist high-fiber diets no change, Of these 53 2 (4%) studies, or long-term these effects 33 control, indicate that, to improvement in diabetic worsening of gly- cholesterol was de- diets betic the quickly the for decrease benefits that hong-term fiber weight low-fat diets diets provides for facilitating obese agents (1, 6, 55). Because of loss and weight high-carbohydrate, especially suited for dia- promptly hypoglycemic lipids has many (56). fecal high-fiber, obese health-promoting Fiber Madar weight and Odes diabetic effects maintains and (8) individ- normal stool and pro- fiber, such as oat products, satiety (57). Foods rich in decrease transit time and number recently on the gastro- function (57, and other fibers reviewed the effects or bowel for individuals prevention syndrome of is still of fruits, and six to eleven whereas whole-grain that serving have and breads with constipation. They also other under conditions such as adequate a high-fiber consensus in the study. servings countries Currently Id) (10). g/4l86 (63, 64) Americans States arc some high-fiber of fruit, 4-8 2 U (10). a 50- consume Consistent of breads, which content provide 2 7- should intake conserv- cereals, rice nuts in the and 1 g fiber g fiber provide group fiber provide beans 2-5 cereals of breads, recommend two to four per serving per serving. Cc- 2-5 per g fiber 1 1 g per provide per day. g per serving, serving. one-half to Two to four should provide g fiber/d. Three to five servings of vegetables, g fiber per serving, should provide another this sensible To tailor high-fiber food diets lipidemia, and other (high-carbohydrate, guide, an individual intakes with 59-62) 100% 10-23 are health and increase g flben/d from 6- would which 12 g adopt to individuals metabolic high-fiber) a high-fiber with conditions exchange eating plan diabetes, hyper- we developed the HCF system to help individAs shown in Table the HCF exchange system consists of eight food that are grouped according to nutrient and fiber content. categories By using the exchange (68, 69). groups, meal plans may be adapted to a variety of taste preferences and lifestyles. The HCF diet is particularly applicable for vegetarian meal planning. Tables 3 and 4 illustrate a sample HCF vegetarian meal plan and menu and a sample HCF meal plan and TABLE menu. We typically recommend a daily intake of 2 High-carbohydrate, Exchange and high-fiber serving size 20 to 35 the recommendations organiza- other Western in fiber intake. (6-10 g/4l86 g/d or 10-13 to increase (HCF) Energy exchange Protein list’ Fat kcal skim (245 mL / cup) g or 1 -2 I oz) or ‘/ (122 g or Fats (5 g or I tsp) /2 Fiber g oz) 85 8 12 0 25 1 0 5 2 95 7 0 17 5 50 8 2 0 0 90 3 0 20 4 2 .5 cup: 28 g or I slice) Fruits Carbohydrate or (80 g or ‘/ cup) Beans (90 g or Proteins (28-57 Cereals (28 g or Starches (100 g of leading (12-14, for Recommended servings from 25 to 50 g fiber/d. Milk, diet recommendations United servings fiber irritable Recommendations The or more food guides of vegetables, provide Six to 1 1 servings from this two-thirds of the recommended Vegetables tions adof and pasta; this food pyramid also includes protein-rich group (65). White bread, rice, and pasta provide icup) Implementing low Academy of Sciences of five or more servings of dietary presented the rationale for including fiber in the diet to protect against diverticulosis of the colon. The role of dietary fiber in the treatment six veg- and 58). fiber on gastrointestinal function and diseases. They summarized the literature and indicated the clear benefits of wheat bran, psylhum, and fruits, 2, motes regularity. Foods rich in soluble delay gastric emptying and enhance insoluble fiber, such as wheat bran, increase vegetables and legumes (13). Current of three to five servings grains, in carbohydrate ingest oral and fiber as whole high by following high-fiber or glucose tract such de- for disorders Dietary and cereals, sumption uals intestinal in fiber, are naturally and advantages uals. Gastrointestinal high 5 g Fiber Thus, maintenance, seem are legumes, fiber/d. Three servings of beans per week, which provide per serving, would contribute another 2 g fiber, on average. values are estimated from our published sources (66, 67). special insulin serum that and have Weight-reducing need Foods another provide may individuals. crease of com- in most instances, an increase in dietary in glycemic control and serum lipids individuals. High-fiber deintake of fiber reals creased in 22 and unchanged in 4 whereas serum triglycerides were decreased in 12 and unchanged or increased in 5. Both sets of studies fiber leads Sources ings choalso studies, glycemic serum consumption daily 53 studies, noted recommend of energy cup) 70 2 0 15 60 0 0 15 45 0 5 0 2.5 0 I Cereal exchanges include cold and hot cereals. Starch exchanges include breads. muffins, crackers, pasta. rice, and starchy vegetables. For more detailed food descriptions and serving sizes, see reference 69. Downloaded from www.ajcn.org by on December 29, 2009 control. and increasing intake, foods fruits sup- Of these improved while (13). etables, recently fiber no change, Of to 30% of energy phex carbohydrate were decreased serum review article (54) individuals. that 37% or long-term noted the short- in diabetic that noted responses. guidelines the current of the National cat a minimum that 12 (22%) supplements The same that examined diets reported control, reported dietary from in fat. A recent report vises that Americans short- individuals 36 (67%) glycemic 53 studies of high-fiber studies, fiber intake arc current creasing fat consumption to in- pressure, the in diabetic Of these 36 (67%) reported lesterol in diabetic discussed examined supplements plements 6 did that AL of studies or high increase decrease studies (54). cemic control, lipids, reviewed (62%) fiber fiber management. Results effects of high diabetes serum in weight benefits evidence improve sulin, the ET HIGH at least three at least six servings servings each from from the vegetable a combination and fruit of cereals and and one serving of beans daily to ensure adequate intake and to make the combining of complementary proteins groups, starches, soluble-fiber vegetable DIETS TABLE increase tially following diabetes their a more reinforcement lemic men fiber or hyperlipidemia intakes. nutritious men The and for continued maintained fiber 40 diabetic 8372 are rapid able benefits fiben-nich diet fiber intakes derived provide from of > 40 g/d for an in our experience, healthy individuals who are free of disease are often not able to achieve these high intakes. healthy After individuals as participants g/d intensive instruction with increased their fiber in a clinical trial (72). 12 weekly intake from classes, 19 to 25 (2000 Kcal/8372 high- fiber (HCF) vegetarian meal plan and menu Id) Menu /2 Milk 1 Cereal 1 Fruit 122 mL (‘/2 cup) Skim milk 37 g (3/4 cup) Oat-bran flakes 84 g (‘/2 cup) Sliced peach 1 Fat 6 Almonds 1 Starch Bagel (28 g) 5 g (1 pat) Margarine 240 mL (1 cup) Coffee 1 Vitamin-mineral supplement exchanges Menu Breakfast 1 Cereal 1 Milk 1 Fruit I Shredded-wheat biscuit (24 g) 184 mL (3/4 cup) Skim milk /2 Banana (60 g) 2 Starch 1 (60 1 Fat 5 g (1 pat) Margarine 240 mL (1 cup) Herb tea 1 Vitamin-mineral supplement Snack 1 Cereal 1 Fruit Lunch 1 Garden g) Cinnamon oat-bran 1 Fat Snack 1 Starch Lunch 1 Free vegetable 1 Garden vegetable I Garden vegetable 18 g (3 cups) vegetable 55 g (1 cup) Mixed salad greens 26 g (V4 cup) Cucumber slices 16 g (1 tablespoon) Light, creamy Starch Bean Fruit Milk 6 Rye crackers 1 fat 248 Caesar dressing (40 g) g (1 cup) Cream of asparagus soup 1 1 1 g (3/4 cup) Strawberries Iced water with lemon 80 g (‘/2 cup) Refried beans 28 g (1 oz) Roast chicken 2 Stanch 2 Flour 1 Fat 1 Garden 2 Starch 5 g (1 pat) Margarine 60 g (‘/2 cup) Green pepper and onion 1 Baked potato (160 g) topped with vegetable tortillas (80 g) salsa 28 g (1 oz) Imitation 173 g (1 cup) Melon Iced tea sour cream balls vegetable vegetable I fruit, 1 fat 1 fat 55 g (1 cup) Raw spinach 17 g (‘/4 cup) Fresh sliced mushrooms 16 g (1 tablespoon) Low-fat ranch dressing 210 g (1 /2 cup) Spaghetti noodles 122 g Cl2 cup) Tofu-tomato sauce 6 g (1 tablespoon) Parmesan cheese 90 g (‘/2 cup) Asparagus spears 28 g (1 slice) Garlic bread 5 g (1 pat) Margarine 150 g (V2 cup) Apple-oat crisp dessert Iced coffee 1 Seasoned roast ear of corn 1 Starch 4 Graham 1 Sweet 28 g (1 oz) Marshmallows crackers (28 g) italian Snack 2 Starch, 16 g (1 tablespoon) 1 Starch 1 Starch, 1 Fruit 2 tablespoons 28 g (1 slice) Whole-wheat bread 226 g (8 oz) Nine-bean soup 122 g (‘/2 cup) Chunky fruit salad 142 g (5 oz) Low-fat vanilla yogurt Spring water 3 Starch Protein Fat Garden Starch Fat Cereal, corn Snack 1 Fat 1 1 1 1 1 1 1 Fat 1 Fat 1 Fruit dressing Supper 1 Garden Air-popped 55 g (1 cup) Iceberg lettuce 80 g (‘/2 cup) Artichoke hearts 100 g total (2 tablespoons each) Bean sprouts, chopped onion, mushrooms and tomato 8 Small black olives (24 g) muffin 23 g (‘/2 cup) Oat squares 85 g (3 oz) Figs 1 Fat 1 1 1 1 (7 g) /2 Supper 1 Bean, 1 fat 1 Protein Meal plan and Kcal/ (229 g) Practical considerations Almost foods intake all individuals penience, problems As can adapt increase to the diet. With individuals fluid increase intake. on diabetes their augments Low-fat grains > fiber Medications intake of fiber-rich effect which of high fiber subsides as patient-years 10 000 may need diets the health that are appropriate are intake, for they of cx- also in on discontinued of high fruits, for all individuals fiber under to cx- intake. vegetables, aged in- hyperten- should also be encouraged such as walking, because benefits rich no major should hyperhipidemia, to be reduced a physician’s direction. Individuals engage in regular aerobic activity encise their The major side gas production, our metabolic research group has encountered using high-fiber, high-carbohydrate diets. crease sion, individuals if they do so gradually. is increased intestinal > and whole 2 y (73). Thus, such a diet can become a lifetime eating plan for an entire family. Nutrition counselors should emphasize those positive eating habits that are already developed and foster change of less desirable Downloaded from www.ajcn.org by on December 29, 2009 3 High-carbohydrate, (2000 plan exchanges 1 Fat TABLE meal plan and menu Breakfast positive struction. fiber (HCF) to substan- adherence. Nine hypencholesterointakes of 51 g/d for 24-99 wk (70) maintained high-fiber Id) Meal average of 100 wk (71). One of our typical diabetic patients continued to follow the HCF guidelines, consuming 27% of energy from fat and 40 g fiben/d for 18 y after the initial inpatient inHowever, of symptoms 4 and with 1245S High-carbohydrate, convenient. Patients and FIBER 12465 ones ANDERSON gradually. not daily A healthy perfection, balance should of high-fiber be the goal foods of nutrition over ET time, AL 16. Margetts BM, Beihin U, izcd trial counseling. controlled Vandongen of the effects R, Armstrong of dietary BK. A random- fibre on blood pressure. Chin Sci l987;72:343-50. 17. Conclusions fiber reduces the risk for predominant diseases people. Clinical evidence has established the Dietary Western high-fiber intakes in reducing dividuals, improving serum glycemic control diabetic individuals, facilitating for insulin or oral agents in obese taming a healthy fiber-rich are also pressure sion, an High to have with independent fiber in of fiber not yet the mounting evidence in nutrition guidelines for that is generous in fruits, a practical nutrition plan overall health benefits be made to incorporate for metabolic conditions Anderson JW, health promotion. vegetables, beans, and to adopt for a lifetime. whole 22. 23. grains effects JW, JW, human health. Hort Science beans. JW, DP, Trowell HC. Refined carbohydrate foods implications of dietary fibre. London: Academic Burkitt Some 3. Anderson 4. bean products. Anderson JW, etary JW, fiber Gustafson NJ. Hypocholesterolemic effects Am J Clin Nutr 1988:48:749-53. Deakins DA, Fboore TL, Smith and coronary heart disease. Crit blood pressure. 25. and disease. Press, 1975. studies with Whitis Rev Food SE. JW, Sci Anderson JW. Plant fiber and Ann 7. Kromhout D, Bosschieter ben and 10-year all causes: 8. the Madar Z, EB, mortality diabetes de Lezenne 27. Study. HS. Dietary heart Lancet Am C. Dietary disease, and l982;2:5l8-22. fiber research. Basel, Switzerland: Karger. 1990. 9. Anderson JW, Akanji AO. Dietary fiber-an overview. Diabetes Care 1991:14:1126-31. 10. Pilch SM. Physiologic effects and health consequences of dietary fiber. Life Sciences Research Office, Bethesda, MD: Federation of American Societies for Experimental Biology, 1987. 28. JW, content 12. 15. Tietyen 1989;49:352-7. of Health Department The Surgeon DC: US 29. 30. report Government National Academy Press, Department DC: Kritchevsky D, Tepper metabolism in populations relationship of diet 6. Public on nutrition and Office, Diet and health. fiber 5cr- Washington, US Dietary guidelines Government Printing at high lipids. for 34. DC: G. Diet, nutrition and low for Am J Clin risk Nutr 35. Americans. Office, intake and 36. cancer: l984;40:921 to single 1990:5 of Am J J. Serum and Diet lipid divided doses 1 : I 013-9. W-JL. Assoc N, Feldman Hypocholesterolemic plant fibers: diets long- for hyper- l984;45:l40-9. T, Tietyen-Clark effects J, Oeltgen of psylhium men. TL, Geil P. hydrophilic Arch PB, O’Neal of different Intern Med DS, Balm bulk-forming in mild Med TK. Hypo- hydrophilic to moderate fibers hypercholestcro- 1991:151:1597-602. RL, Snowdon DA, Choi mortality: Seventh-Day W. Association twenty-one-year Adventist. JN, Marr JW, Clayton l977;2:1307-14. Khaw K-T, Barrett-Connor heart disease mortality study. Am between follow-up on l984;l 19: J Epidemiol Am Willet WC, 1984:310:633-703. MacMahan Burkitt DP. 1971;28:3- The Lanza E. B. Diet heart: fiber and a postscript. Br reduced ischemic a 12-year prospec- and cancer-an of cancer overview. of the colon N Engl and rectum. 13. E, Grcenwald critical and 1987:126:1093-102. epidemiology B, Lanza Diet E. Dietary J Epidemiol Cancer DG. rates in men and women: J Med Potter JD. Why don’t review P. Dietary and fiber, meta-analysis vegetables, and of epidemiologic colon evidence. Inst 1990;82:650-61. National Cancer The Institute - 37. epidemiology the analytical Satellite Cancer Stcinmctz KA, Cancer Potter Ziegler RG. Vegetables, cancer. Am Potter JD. maladaptation. C, Anderson Symposium J Clin fiber Control JD. JW, on Fiber Nutr Epidemiology In: Micozzi colorectal eds. fruit, better New and cancer. sense? York: In: Plenum cancer. I. Epide- 199 1:2:325-57. fruit, Vegetables, Control and data make JD. Vegetables, Causes Causes of epidemiology D, Bonfield Press, 1990:431-45. Steinmetz KA, Potter nisms. 1990. colon DB, Tietyen in water-soluble therapy Intern Phillips miology. SA, Goodman to serum to dietary Kritchevsky Wash- 1988. health. responses intake. bran and Colon Cancer. In: Kritchevsky D, Bonfield C, Anderson JW, ed. Dietary fiber: chemistry, physiology, and health benefits. New York: Plenum Press, 1990:383-7. diets. Health et al. Lipid wheat and bean-supplemented J Can effects J Nath Cancer 1989. of Agriculture. Washington, Dietary research J. hyper- and B, Chen rich diet and all-cause cancer: 32. (publication NJ. selected Services, Printing of Sciences. ed. and Human General’s Academy 3rd diet diets Fboore adult 3 1 . Trock 33. and National US J, Gustafson American US ington, 14. SR. Am J Clin Nutr vice. 13. Bridges of a simulated Story for DA, hypercholesterolemic JW, HA, Morris tive no. 36.) 1 1. Anderson MS. intake 1984:40:1146-55. bran Cholesterol-lowering Arch Kahn MedJ fi- cancer, l981;34:824- 775-87. Med and obesity. Coulander from coronary Zutphen Odes fiber: Anderson 27,530 1983:98:843-846. 6. Anderson JW, Bryant CA. Dietary J Gastroenterol 1986:81:898-906. Nuts men oat-bran for reported Nuts Intern selec- concentra- 148:292-6. lemia. 26. 1990:29:95-147. 5. Petro or bean NJ, Spencer Zettwoch CW. as adjuncts Di- W-JL, Deakins L, Siding men. Anderson cholesterolemic of oat and BM, B, Chen Am J Clin Nutr Story of high-fiber 1988; 1990:25:1488-95. 2. Nuts to oat Gustafson Anderson mucilloid and intake J Clin of hypercholesterolemic Bishop fiber hy- Gastroenterol cholesterol Am J Clin NH, men of canned term El References Dietary J B, et al. Oat-bran of oat-bran Am Gilinsky cholesterolemic JW. in 199l;54:678-83. Anderson effects is 24. 1. Anderson L, Siding men. Anderson response diet Panel cholesterol hyperhipidemia, Am lipoprotein men. hypercholesterolemic fiber inas well A high-fiber Story chohesterolemic 21. of fiber: disease. Siding of the Expert and cancer. II. Mecha- 1991:2:427-442. fruits, and the carotenoids and the risk of 1991;53(Suppl):251S-95. of diet MS. and Moon cancer: TE, evidence eds. for Macronutrients. human In- Downloaded from www.ajcn.org by on December 29, 2009 as of the should therapy JW, of hypercholesterolemic Clin Nutr With heart low-density Hypocholesterohemic established. fiber, aggressive efforts take goals in nutrition J. Dietary coronary serum Report of high blood 9. 20. been Program. and treatment 1988;148:36-69. Tietyen-Clark and lowers tions in hyperten- has JW, tively of lipid to reduce to moderate Anderson Education evaluation, Intern Med 1986;8l :907-19. 19. Kirby RW, Anderson and effects Cholesterol pertension need main- intakes independent been shown mild effect sensitivity protective and CHD, diets have in individuals although insulin 18. in- loss and reducing individuals, and tract. suggested the prevention of colon cancer alterations. Fiber-rich vegetarian blood of hyperlipidemic and weight diabetic gastrointestinal foods lipids among role of National on detection, adults. Arch HIGH vestigating their role in cancer. New York: Marcel FIBER 55. Dekker, I992:55-84. 38. Dobson The PM, Pacy effects PJ, Beevers of a high fibre, on diabetic hypertensive Med J 1983:59:641-4. 39. Dobson PM, Pacy A controlled mild 40. Dobson PM, dietary 41. 42. PJ. Bal 0, EV. of different ethnic groups. Postgrad AJ, Fletcher RF, Hum Nutr Br J Nutr IL, Armstrong and 56. KG. 57. Rouse IL, Record Clin reduced pa- 58. Nuts and 59. low-sodium l985:39C:2l3-20. A, Stenram A, Ockerman in the PA. treatment A of hyper- 60. 1 1-20. BK, Beilin lifestyle of the treatment how-fat medication 1984:52: in two U. The relationship religious of blood populations. pres- trial 1986:4:241 -50. Margetts 45. 46. 47. controlled Sci Exp Armstrong Beilin with dietary fibre izcd studies. 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