Effect of dietary fiber intake on lipoprotein cholesterol levels independent of estradiol in healthy premenopausal women.
ABSTRACT High-fiber diets are associated with improved lipid profiles. However, pre- and postmenopausal women respond differently to fiber intake, suggesting that endogenous estradiol mediates the effect. The authors' objective was to determine the direct effect of fiber intake on lipoprotein cholesterol levels independent of estradiol among premenopausal women. The BioCycle Study, a prospective cohort study conducted at the State University of New York at Buffalo from 2005 to 2007, followed 259 healthy women for up to 2 complete menstrual cycles. Serum lipoprotein and hormone levels were measured at 16 visits timed using fertility monitors. Fiber intake was assessed by 8 24-hour recalls. Marginal structural models with inverse probability weights for both lipoprotein and estradiol levels were used to estimate controlled direct effects of the highest category of fiber intake (≥22 g/day vs. <22 g/day) while accounting for age, body mass index, total energy, vitamin E intake, physical activity, luteinizing hormone, follicle-stimulating hormone, and progesterone. Reductions were observed in total and low density lipoprotein cholesterol in women with higher fiber intakes. Direct effects were greater than total effects. These analyses suggested that estradiol mediates at least part of the association between fiber and cholesterol among premenopausal women. More research is needed to elucidate the biologic mechanisms driving these associations.
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ABSTRACT: We consider the problem of separating the direct effects of an exposure from effects relayed through an intermediate variable (indirect effects). We show that adjustment for the intermediate variable, which is the most common method of estimating direct effects, can be biased. We also show that even in a randomized crossover trial of exposure, direct and indirect effects cannot be separated without special assumptions; in other words, direct and indirect effects are not separately identifiable when only exposure is randomized. If the exposure and intermediate never interact to cause disease and if intermediate effects can be controlled, that is, blocked by a suitable intervention, then a trial randomizing both exposure and the intervention can separate direct from indirect effects. Nonetheless, the estimation must be carried out using the G-computation algorithm. Conventional adjustment methods remain biased. When exposure and the intermediate interact to cause disease, direct and indirect effects will not be separable even in a trial in which both the exposure and the intervention blocking intermediate effects are randomly assigned. Nonetheless, in such a trial, one can still estimate the fraction of exposure-induced disease that could be prevented by control of the intermediate. Even in the absence of an intervention blocking the intermediate effect, the fraction of exposure-induced disease that could be prevented by control of the intermediate can be estimated with the G-computation algorithm if data are obtained on additional confounding variables.Epidemiology 04/1992; 3(2):143-55. · 5.57 Impact Factor
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ABSTRACT: Epidemiologic studies have suggested that dietary fibre protects humans against coronary heart disease, but interpretation of the data is confounded by coexisting differences in both dietary and environmental variables. The hypocholesterolemic action of dietary fibre varies: in general mucilaginous fibres such as pectin and oat bran are more effective than particulate fibres such as wheat bran. Although the mechanism of action of mucilaginous fibres is not completely understood, there is evidence that they induce small increases in the fecal excretion of bile acids and neutral steroids that are not fully compensated for by de novo cholesterol synthesis.Canadian Medical Association journal 01/1981; 123(12):1213-7. · 7.27 Impact Factor
Article: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.Clinical Chemistry 07/1972; 18(6):499-502. · 7.91 Impact Factor