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Running Head: 611 PICO 1 Nurs 611 PICO: Fiber Intake and Cardiovascular Disease Risk Factors Erica Prince University of New Hampshire 611 PICO 2 Abstract This paper reviews three research articles that examine the relationship between fiber intake and cardiovascular risk factors. The three studies all had subjects increase their fiber intake and then measured how the selected risk factors changed in response to this diet. The results showed that increasing fiber intake can decrease certain cardiovascular risk factors like cholesterol and arterial stiffness. Further research should be done, however. No negative effects were noted. 611 PICO 3 Nurs 611 PICO: Fiber Intake and Cardiovascular Disease Risk In patients aged 13-adult, how does increased fiber intake compared with lower fiber intake affect risk for cardiovascular disease? Heart disease is the number one cause of death for Americans. Patient teaching is an important part of nursing practice, so information on how to reduce risk factors of cardiovascular disease is essential information. Evidence based practice is necessary in order to provide support for nursing interventions. Research studies test theories and help provide this evidence. By looking at these articles and considering the specific patient’s needs, nurses can use evidence based practice to teach and intervene about the patient’s health. Instructing a patient to eat a higher fiber diet can be an intervention that reduces risks of cardiovascular disease, which includes elevated blood lipid levels, artery stiffness, and increased weight. To find evidence, CINAHL was accessed through the UNH Library Database search. The key words entered in the search were, “fiber intake, cardiovascular disease.” This resulted in 51 articles, with a majority of them seeming relevant to the topic at hand. The results were then limited to articles that had the full text available, those that had been published within that last 10 years, and those that were in English. This refined the results to 17 articles. Articles were eliminated if they didn’t directly address cardiovascular disease risk. This left seven articles. The final three articles were selected because they allowed examination of a wide variety of risk factors that can be affected by fiber intake. 611 PICO 4 The first study examined whether a lower intake of dietary fiber contributed to arterial stiffness. It was a longitudinal cohort study with 373 participants whose fiber intake was assessed from ages 13-36. Then at age 36, stiffness of 3 large arteries was measured using ultrasonography. Results showed, after accounting for sex, height, total energy intake and other lifestyle factors, those with the lowest fiber intake had stiffer arteries than those with higher fiber intake (Laar et al., 2012). The study boasted a large number of participants which allowed for more accurate data. The researchers also used confidence intervals to assess the accuracy of the data. The participants met with researchers once a month for a face to face interview where they listed what and how much they generally ate. This is not the most accurate measurement of fiber intake and leaves room for error. So, while this study does show that fiber can reduce this certain risk factor, it is still important to take into account other preventative measures like exercise, blood pressure control and low fat diet. The second study examined the effects of a diet supplemented with soluble versus insoluble fiber on plasma lipid levels through a randomized, crossover, controlled, singleblind design. Twenty eight men with cardiovascular disease (CVD), which the authors defined as stable angina or past myocardial infarction, consumed a controlled, low fat diet that was supplemented with either soluble or insoluble fiber over an 8 week period. Results showed that ingestion of either type of fiber resulted in a decreased waist circumference by an average of 2cm. The soluble fiber showed a more favorable effect on the lipid levels than the insoluble fiber did. The soluble fiber reduced plasma 611 PICO 5 triacylglycerol concentrations by 6.7% and apo B:apo A-I by 4.7% and increased the apo A-I concentration by 4.3% in comparison with insoluble fiber. Also those that ate the soluble fiber rather than the insoluble fiber had increased HDL-cholesterol concentrations by 6.7% (P <0.006) and decreased the ratio of LDL to HDL cholesterol by 14.2% (P <0.003) (Solà et al., 2007). While this study did blind its participants and calculate the significance of the data for accuracy, there were a couple limitations. Twenty eight subjects is a small sample size, which could have affected the results. The authors also discussed that different people have varying genes that affect their metabolism of lipids and fiber. So, while this method may be useful for some, it might not be as helpful for others. It will be important to take into account the patient’s history and preferences before suggesting this intervention. The study did not find any significant increase in cardiovascular disease risk by ingesting this diet, so it is a relatively safe intervention patients could try. The third study was a cross sectional study that included 2532 men and 3429 women. Over a period of 8 years, the subjects were instructed to give a 24 hour food recall at least every 2 months. The amount of dietary fiber consumed was extracted and then the subjects were split into fifths based on the amount of fiber consumed. The authors referred to the divided groups quintiles. The 2nd-5th quintiles were compared to the 1st quintile, which was the quintile with the lowest intake, to assess cardiovascular risks. A total increase in dietary fiber by 5 grams per day showed decreases in risk for overweight BMI by 10.6%, elevated hip to waist ratio by 14.7%, high apo B by 9.2%, high homocysteine by 15.4% and hypertension by 11.6% (Lairon et al., 2005). This study 611 PICO 6 boasted a large sample size with provides more effective results. However, again, their method for obtaining dietary fiber measurements left a lot of room for human error. This study also calculated the statistical significance for its data. This study, like the others, shows the potential benefits of a high fiber diet in reducing cardiovascular risks. All together the results show that increased fiber consumption can decrease cardiovascular risks. Cholesterol levels, especially, seem to be lowered with high fiber intake. Soluble fiber seemed to be more effective with this. One study even compared their results to statin use. This intervention could be used as an adjuvant therapy. Arterial stiffness, which can contribute to cardiovascular disease, seems to be minimized with fiber intake. Other risk factors, like weight seem to decrease with this type of diet. Overall, the research as a whole shows that high dietary fiber should be recommended for those at risk for cardiovascular disease. After reviewing the evidence, I would recommend this intervention to a patient. None of the studies I reviewed showed any compelling negative effects. Of course, since foods like fruits, vegetables, and legumes are typically the foods that are high in fiber, this isn’t a particularly risky diet change. It would be important to assess the patient’s diet to make sure that as they increase fiber intake they still receive enough nutrients like protein. It is also important to know that high fiber intake alone has not been proven to prevent cardiovascular disease. Low fat diets, exercise, seeing a doctor regularly and taking medications should still be considered vital pieces. Further research should be done to look into which interventions are most effective when compared to each other. 611 PICO 7 Also, more research may be necessary regarding fiber intake as it is difficult to measure people’s fiber intake long term, so there studies could have errors within them. Overall, the evidence suggests that high fiber can have beneficial effects and when used with other prevention methods, patients will be reducing their risk of having a heart attack. 611 PICO 8 References Laar, R., DA Stehouwer, Bas, Saskia, H Prins, WR Twisk, & Ferreira, I. (2012). Lower lifetime dietary fiber intake is associated with carotid artery stiffness: the Amsterdam Growth and Health Longitudinal Study. American Journal Of Clinical Nutrition, 96(1), 14-23. Lairon, D., Arnault, N., Bertrais, S., Planells, R., Clero, E., Hercberg, S., & BoutronRuault, M. (2005). Dietary fiber intake and risk factors for cardiovascular disease in French adults. American Journal Of Clinical Nutrition, 82(6), 1185-1194. Solà, R., Godàs, G., Ribalta, J., Vallvé, J., Girona, J., Anguera, A., & ... Masana, L. (2007). Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. American Journal Of Clinical Nutrition, 85(4), 1157-1163.