Nutr Res Pract.  2025 Feb;19(1):41-54. 10.4162/nrp.2025.19.1.41.

The association between dietary fiber intake and all-cause mortality and cardiovascular disease mortality in patients with stroke: a retrospective cohort study of NHANES

• Li Y
• Liu L
• Yang Z
• Li M
• Tang T
• Xu J

• KMID: 2565395
• DOI: http://doi.org/10.4162/nrp.2025.19.1.41

Abstract

BACKGROUND/OBJECTIVES
Stroke represents the primary cause of death and persistent disability globally, leading to around 5.5 million annual patient fatalities. The objective was to explore the relationship of dietary fiber with all-cause and cardiovascular disease (CVD) mortality risk in patients with stroke.
SUBJECTS/METHODS
We extracted stroke patients’ data from the National Health and Nutrition Examination Survey (NHANES) database. All-cause and CVD mortality were outcomes. Dietary fiber consists of non-digestible forms of carbohydrates, usually polysaccharides that originate from plant-based foods. Covariates including demographic data, vital signs, comorbidities, laboratory parameters, and medication use were screened using the weighted multivariate Cox regression models with backward elimination. Weighted univariate and multivariate Cox regression models were performed to explore the relationship between dietary fiber intake and all-cause/CVD mortality, with hazard ratios (HRs) and 95% confidence intervals (CIs). The association was further investigated in different subgroups.
RESULTS
A total of 1,578 patients with stroke were included, of whom 688 (43.6%) died. Total fiber and vegetable fiber intake were analyzed as categorical variables, and the lowest intake was considered reference groups. High intake of total fiber (HR, 0.73; 95% CI, 0.57–0.94) and high intake of vegetable fiber (HR, 0.63; 95% CI, 0.48–0.82) were related to lower all-cause mortality risk in individuals with stroke. Similar findings were also observed between higher total fiber (HR, 0.56; 95% CI, 0.37–0.85) and vegetable fiber intake (HR, 0.57; 95% CI, 0.36–0.89) with decreased CVD mortality risk. The relationship between higher total fiber intake and lower all-cause mortality risk was discovered in individuals aged ≥ 60 yrs, smoking, non-CVD, and chronic kidney disease (CKD). High total fiber, or vegetable fiber consumption was linked to lower CVD mortality risk in stroke individuals aged ≥ 60 yrs, females, body mass index ≥ 30 kg/m 2 , non-smoking, and CKD.
CONCLUSION
Dietary fiber intake and vegetable fiber intake may benefit the prognosis of patients with stroke. Increasing dietary fiber consumption, especially vegetable fiber intake, potentially benefits the prognosis of stroke patients.

Keyword

Dietary fiber; mortality; cause of death; stroke

Figure

• 

  Fig. 1 The screening flowchart of stroke patients.NHANES, National Health and Nutrition Examination Survey; BMI, body mass index; WBC, white blood cell; ALT, alanine transaminase; CVD, cardiovascular disease.

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