Epidemiological Studies

Epidemiological evidence suggests that intake of certain fibers may delay glucose uptake and attenuate the insulin response, thus providing a protective effect against diabetes. Evidence for the protective effect of Dietary Fiber intake against type 2 diabetes comes from several prospective studies that have reported on the relationship between food intake and type 2 diabetes (Colditz et al., 1992; Meyer et al., 2000; Salmerón et al., 1997a, 1977b). One study examined the relationship between specific dietary patterns and risk of type 2 diabetes in a cohort of 42,759 men, while controlling for major known risk factors (Salmerón et al., 1997a). The results suggest that diets with a high glycemic load and low cereal fiber content are positively associated with risk of type 2 diabetes, independent of other currently known risk factors (Figure 7-1). In a second study, diet and risk of type 2 diabetes in a cohort of 65,173 women were evaluated (Salmerón et al., 1997b). Again, diets with a high glycemic load and

DIETARY, FUNCTIONAL, AND TOTAL FIBER 381

High Medium Low

Glycemic Load

High Medium Low

Glycemic Load

FIGURE 7-1 Relative risk of type 2 diabetes by different levels of cereal fiber intake and glycemic load. Reprinted, with permission, from Salmerón et al. (1997b). Copyright 1997 by the American Medical Association.

low cereal fiber content were positively associated with risk of type 2 diabetes, independent of other dietary factors and currently known risk factors. Of particular importance is that this combination resulted in a relative risk of 2.17 for men (Salmerón et al., 1997a) and 2.5 for women (Salmerón et al., 1997b), which is more than twofold greater relative to consumption of a diet high in cereal fiber and low in glycemic load (Figure 7-1).

In theory, the hypothesis as to how Dietary Fiber may be protective against type 2 diabetes is that it attenuates the glucose response and decreases insulin concentrations. This theory is supported by results from the Zutphen Elderly Study, where a negative relationship was observed between Dietary Fiber intake and insulin concentrations (Feskens et al., 1994).

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