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Benefits of Dietary Fibre to Human Health: Study from a Multi-Country
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Platform
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Raquel P. F. Guiné
1,*
, João Duarte
1
, Manuela Ferreira
1
, Paula Correia
1
, Marcela Leal
2
, Ivana 6
Rumbak
3
, Irena C. Barić
3
, Drazenka Komes
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, Zvonimir Satalić
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, Marijana M. Sarić
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, Monica 7
Tarcea
5
, Zita Fazakas
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, Dijana Jovanoska
6
, Dragoljub Vanevski
6
, Elena Vittadini
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, Nicoletta 8
Pellegrini
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, Viktória Szűcs
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, Júlia Harangozó
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, Ayman EL-Kenawy
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, Omnia EL-Shenawy
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, Erkan 9
Yalçın
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, Cem Kösemeci
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, Dace Klava
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, Evita Straumite
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CI&DETS, Polytechnic Institute of Viseu, Portugal.
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2
Faculty of Health Sciences, Maimonides University, Argentina.
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Faculty of Food Technology and Biotechnology, University of Zagreb, Croatia.
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Department of Health Studies, University of Zadar, Croatia.
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University of Medicine and Pharmacy from Tirgu-Mures, Romania.
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Public Health Institute, Centre for Public Health, Tetovo, Macedonia.
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Department of Food Science, University of Parma, Italy.
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National Agricultural Research and Innovation Centre, Budapest, Hungary.
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9
Genetic Engineering Institute, University of Sadat City, Egypt.
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Department of Psychology, Faculty of Arts, Menofiya University, Egypt.
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Department of Food Engineering, Abant İzzet Baysal University, Turkey.
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LUA Latvia University of Agriculture, Latvia.
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*
Corresponding author:
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Raquel P. F. Guiné
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Escola Superior Agrária de Viseu, Quinta da Alagoa, Estrada de Nelas, Ranhados, 3500-606 Viseu, Portugal.
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Tel: + 351 232 446 640; Fax: +351 232 426 536
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E-mail: raquelguine@esav.ipv.pt
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Published article.
Citation:
Guiné R, Duarte J, Ferreira M, Correia P, Leal M, Rumbak I, Baric I,
Komes D, Satalic Z, Saric MM, Tarcea M, Fazakas Z, Jovanoska D,
Vanevski D, Vittadini E, Pellegrini N, Szucs V, Harangozó J, EL-
Kenawy A, EL-Shenawy O, Yalçin E, Kösemeci C, Klava D, Straumite
E. (2017) Benefits of dietary fibre to human health: study from a
multi-country platform. Nutrition & Food Science, 47(5), 688-699.
Author version
Abstract 32
Purpose: Because dietary fibre has been recognized as a major ally to the maintenance of a healthy 33
body as well as to help against the development of some chronic diseases, this work aimed at 34
studying the level of knowledge of a relatively wide range of people about the health effects related 35
to the ingestion of dietary fibre in appropriate dosages. 36
Methodology: A descriptive cross-sectional study was undertaken on a non-probabilistic sample of 37
6010 participants. The data were collected from 10 countries in 3 different continents (Europe, 38
Africa and America) and measured the level of knowledge regarding different health benefits from 39
dietary fibre. The questionnaires were applied by direct interview after verbal informed consent. 40
Findings: The results obtained considering the general level of knowledge revealed a considerable 41
degree of information about the benefits of fibre (average score of 3.54±0.5, on a scale from 1 to 5). 42
There were significant differences between genders (p<0.001), with higher average score for women, 43
and also for level of education (p<0.001), with higher score for university level. The living 44
environment also showed significant differences (p<0.001), with people living in urban areas 45
showing a higher degree of knowledge. Also for countries the differences were significant (p<0.001), 46
with the highest score obtained for Portugal (3.7), and the lowest for Croatia, Italy, Latvia, 47
Macedonia and Romania (3.5). However, despite these differences, the results showed that for all the 48
countries the degree of knowledge was good (above 3.5), corresponding to a minimum level of 49
knowledge of 70%. 50
Originality/Value: This work is considered important due to the wide coverage, including so many 51
countries inclusive with different social and cultural settings. The study allowed concluding that, in 52
general, the participants in the study were quite well informed about the benefits of dietary fibre for 53
the improvement of human health, regardless of gender, level of education, living environment or 54
country. This finding is very relevant considering the diversity of people that composed the sample 55
and reinforces the necessity of continuing with educational policies aimed at providing the general 56
population with the knowledge that might help them make appropriate food choices. 57
58
Keywords: Dietary fibre, health effect, cardiovascular disease, diabetes, obesity, survey. 59
60
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62
I
NTRODUCTION
63
Dietary fibre comprises a category of non-digestible food ingredients originating from vegetable 64
products and includes, among other polysaccharides, non-starch polysaccharides, oligosaccharides, 65
and lignin. Dietary fibre can be classified into water soluble (pectins, some hemicelluloses, gums) or 66
insoluble (cellulose, lignin and some hemicelluloses) (Chylińska et al., 2016; Guiné et al., 2014; 67
Kaczmarczyk et al., 2012; Martinho et al., 2013). 68
Various health benefits are related to an adequate intake of dietary fibre, which is a pivotal 69
element of a healthy diet. The positive relationship between dietary fibre intake and human health 70
has been scientifically established (Macagnan et al., 2015). 71
The benefits associated with an adequate intake of dietary fibre are numerous, and include the 72
improvement of bowel functions such as regulation of the transit and prevention of constipation; 73
prevention of diverticular disease; prevention of inflammatory bowel disease (Crohn's disease); 74
prevention or treatment diabetes, cardiovascular disease and gastro-intestinal related types of cancer. 75
Furthermore, it reduces the risk of obesity, hyperlipidaemia, hypercholesterolaemia and 76
hyperglycaemia (Kaczmarczyk et al., 2012; Kendall et al., 2010). 77
Some nondigestible carbohydrates like fructo-oligosaccharides are easily and rapidly fermented, 78
and they have been associated with an increase in the number of bifidobacteria in feces, being thus 79
beneficial for the colonic health. Yen et al. (2011) evaluated the long-term effects of isomalto-80
oligosaccharide supplementation on fecal microbiota, bowel function, and biochemical indicators of 81
nutritional status in constipated elderly subjects and observed a positive effect of fibre intake in 82
improving the colonic microbiota profile and bowel movement. 83
High-fibre diets, particularly those with insoluble fibre, help to increase stool bulk and moisture 84
and reduce travel time through the gastrointestinal tract, thus providing considerable defense against 85
the development of diverticulosis. A low-fibre diet can increase the risk for developing diverticula 86
because of the resulting reduction in colon lumen size, resulting in the diffusion of muscular 87
contraction forces to the colon wall, thus increasing pressure and producing herniation (Mulligan, 88
2015). 89
Scientific research suggests a possible protective effect of dietary fibre against the development 90
of oesophageal and gastric types of cancer (Gonzalez and Riboli, 2010; Jessri et al., 2011; Navarro 91
Silvera et al., 2014; Zhang et al., 2013). There is also evidence that there is a relationship between 92
dietary fibre ingestion and colorectal cancer prevention (Azuma et al., 2013; Ben et al., 2014; Khalid 93
et al., 2014; Ma et al., 2013). 94
O’Neil et al. (2010) investigated the association of whole grain consumption with prevalence of 95
overweight and obesity in adults, and their results confirmed that those who consumed higher 96
amounts of whole grains, and hence higher fibre dosages, had lower body weight. Experimental 97
studies have further associated dietary fibre with a favourable influence on cardiovascular risk 98
factors, reduced risk of coronary heart disease, and significant lowering of total and LDL cholesterol 99
(Mann and Cummings, 2009). 100
Despite the positive effects mentioned above, there is also evidence of some possible negative 101
effects resulting from the intake of fibre, such as some slight interference with the absorption of 102
some vitamins and minerals (Hernández et al., 1995). However, it is unlikely that healthy adults who 103
consume dietary fibre within the recommended dosages have problems relatively to nutrient 104
absorption (Slavin, 2008). 105
The aims of the present work were to investigate to what extent the population is aware of the 106
positive health effects associated with the ingestion of dietary fibre, and also in what way factors 107
such as gender, level of education, living environment or country can influence the perceptions of 108
people about the relations between fibre and health. 109
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M
ATERIALS AND METHODS
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112
Instrument 113
The questionnaire was designed to access on one hand the socio-demographic characteristics like 114
age, gender, level of education, country and living environment, and on the other hand the 115
knowledge about the relation between dietary fibre and possible beneficial effects to treat and 116
prevent diseases. For this, a group of questions were included and the respondents were asked to 117
state their accordance measured on a 5-point Likert scale varying from 1 (totally disagree) to 5 118
(totally agree). Hence, the respondents were asked to indicate their extent of agreement towards the 119
following statements: “Eating dietary fibres in appropriate amounts can prevent and/or treat 120
diseases”, “Fibres can prevent and/or treat cardiovascular diseases”, “Fibres can prevent and/or treat 121
cholesterol”, “Fibres can prevent and/or treat bowel cancer”, “Fibres can prevent and/or treat 122
obesity”, “Fibres can prevent and/or treat breast cancer”, “Fibres can prevent and/or treat 123
constipation”, “Fibres can prevent and/or treat vision problems”, “Fibres can prevent and/or treat the 124
deficiency of vitamins and minerals” and “Fibres can prevent and/or treat diabetes”. 125
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Data collection 127
Before application of the questionnaire to the participants in the study, it was submitted for approval 128
by the Ethics Committee for use in human subjects. The participation in the survey was voluntary, 129
and the questionnaire was applied by direct interview only to adult citizens, after verbal informed 130
consent was obtained. All answers were anonymous, so as to protect the participants and all ethical 131
issues were strictly fulfilled when preparing and and applying the questionnaire. The questionnaire 132
was applied in 10 different countries simultaneously, after the translation to the native languages in 133
each country. 134
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Statistical Analysis 136
For the analysis of the data, several basic descriptive statistical tools were used. Also the crosstabs 137
and the chi square test were used to assess the relations between some of the variables under study. 138
For all data analysis the SPSS software, from IBM Inc. (version 22), was used. The level of 139
considered significance was 5%. 140
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R
ESULTS AND DISCUSSION
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Sample Characterization 143
This study was undertaken simultaneously in 10 different countries originating from 3 different 144
continents (Europe, America, Africa). This study accounted for a global participation of 6010 145
individuals. The number of participants from Argentina was 847, from Croatia was 2530, from Egypt 146
281, from Hungary 296, from Italy 312, from Latvia 180, from Macedonia 312, from Portugal 382, 147
from Romania 670 and from Turkey was 200. 148
Regarding gender, 65.7% were female and 34.3% were male. 149
The average age of the participants was 34.5±13.7 years, ranging from 17 to 84 years. The 150
average age of the female participants was slightly lower (33.5±13.3 years) when compared to the 151
average age of the male participants (36.5±14.4 years). 152
The majority of the participants, 55%, had a university degree, while 42% had competed 153
secondary school and just 3% had the lowest level of education (primary school). 154
Most of the participants lived in an urban environment (79.7%), while 19.6% lived in rural 155
areas. 156
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Knowledge about Health Benefits of Dietary Fibre 158
According to Anderson et al. (2009) dietary fibre intake provides many health benefits. Table 1 159
reveals the statistics and results of the chi-square test relating to the knowledge about the health 160
benefits of ingesting dietary fibre. It was observed that the women were more aware of these benefits 161
than men (average 4.1 against 3.9), and this difference was statistically significant (P<0.001), 162
although the relation between the variables was low (Cramer’s V = 0.081). Typically, values of 163
Cramer’s V coefficient around 0.1 are small, meaning that the association between the variables is 164
weak, values around 0.3 are medium and of 0.5 or over are large, and in that case the association 165
between the variables is strong (Maroco, 2012). Also significant differences were observed 166
according to educational level, so that people with a university degree showed a higher level of 167
knowledge about the benefits of dietary fibre for human health. These variables were significantly 168
related but also with a low degree of association (P<0.001and Cramer’s V = 0.076). Regarding the 169
living environment, people residing in urban areas tended to be more informed than those living in 170
rural areas, being these differences significat (P<0.001 and Cramer’s V = 0.094). 171
Because this study was undertaken in 10 different countries, it was interesting to see the 172
differences among them. Hungary showed the highest average score (4.1) for knowledge about the 173
fibre benefits, while Egypt, Latvia and Macedonia presented the lowest values (3.8). These 174
differences were statistically significant (P<0.001) and the Cramer’s V indicated the degree of 175
association between these variables to be 13%, and therefore also weak. 176
Anderson & Jhaveri (2012) presented epidemiological studies about dietary fibre and 177
cardiovascular diseases. The relation between fibre and cardiovascular diseases was also investigated 178
in the present study and the results are shown in Table 1. Significant differences were found between 179
genders, levels of education, living environments and countries. The women were more aware of the 180
effects of fibre on cardiovascular diseases, and so were those with a university degree and those 181
living in urban areas. Participants from Argentina and Portugal showed the highest average scores 182
for this effect of fibre (3.9, for both) while participants from Italy showed the lowest score (3.4). 183
Although these difference were significant (P<0.001) the association between the variables was weak 184
(Cramer’s V = 0.129). 185
Solá et al. (2010) demonstrated the influence of dietary fibre in lowering plasma low-density 186
lipoprotein (LDL) cholesterol, triglycerides, insulin, oxidised LDL and systolic blood pressure. Table 187
1 shows that the participants in this study were generally aware of these effects of dietay fibre, with 188
average scores above 3.6 on a scale from 1 to 5. Again statistically significant differences were 189
encountered between all the demographic variables studied (Gender, Level of Education, Living 190
Environment or Country). The participants from Argentina and Portugal showed once more the 191
highest level of knowledge about this fact (4.0), against Italy with a score of 3.6. 192
Many studies have shown that colorectal cancers can be attributable to insufficient fibre intake 193
(Azuma et al., 2013; Ben et al., 2014; Khalid et al., 2014; Ma et al., 2013; Nagle et al., 2015). Table 194
2 reveals the results obtained for the knowledge about this effect of fibre. Gender, level of education, 195
living environment and country all influenced significantly the knowledge of the respondents. For 196
this case, Portugal and Turkey appeared with the highest scores (4.1) while Egypt and Latvia 197
evidenced the lowest awareness of this fact (3.5). Although there were significant differences for all 198
demographic variables, the association was slightly less weak for the variable country, with the 199
highest Cramer’s coefficient (0.139). 200
Adam et al.(2015) demonstrated that increasing the amount of fibre in the diet proportionately 201
decreased food intake, body weight gain and body fat content. The participants in this study revealed 202
a considerable knowledge about this effect, although with significant differences between women 203
and men, among levels of education, living environments or countries (Table 2). While in Egypt the 204
knowledge was good but not very high (3.4), in Turkey and Portugal the scores obtained were higher 205
(4.1, in both cases). 206
Low fibre intake constitutes a risk factor for developing breast cancer, according to many studies 207
(van Gemert et al., 2015; Peltzer and Pengpid, 2014). Table 2 shows that, on average, the participants 208
were informed about this, with a general score of 3.0±1.0, on a scale up to 5. Again the women got a 209
higher score (3.0) when compared to men (2.9), with statistically significant differences. The same 210
happened for level of education, with higher education corresponding to the highest score (3.1), and 211
hence the highest knowledge. For the relation between fibre and breast cancer no significant 212
differences were found for living environments. However, the country of residence exerted a 213
statistically significant influence over the level of knowledge, with Egypt showing the highest score 214
(3.5) contrarily to Italy, with only 2.7. 215
Dietary fibre has an important role against constipation (Collins and O’Brien, 2015; Rao et al., 216
2015). According to the results in Table 3, women revealed a higher knowledge of this when 217
compared to men (average scores of 4.2 and 3.9, respectively), with significant differences among 218
genders. The level of education also revealed a significant influence, so that the participants with 219
higher education showed higher score (4.2). The people in urban areas showed again a significantly 220
higher degree of information when compared to those living in rural areas. Regarding the influence 221
of country, Hungary and Portugal showed the highest scores (4.4) contrarily to Egypt with 3.7, being 222
these differences statistically significant. 223
There is no evidence whatsoever about any benefits of ingesting dietary fibre and improvement 224
of vision. Hence, this question was aimed at accessing the knowledge of the population about this, 225
and in this case the lowest score would mean the highest degree of knowledge. Although with an 226
average overall score lower than in other cases, still the value was high, 2.9±1.0, meaning that people 227
had a wrong idea about the effect of fibre to treat vision problems (Table 3). There were statistically 228
significant differences for all demographic variables considered: women with higher score in 229
comparison to men, and, surprisingly, higher level of education also corresponding to the highest 230
score, and therefore to a lowest level of knowledge. Regarding the differences between countries, 231
they were also statistically significant (P<0.001) and the lowest score was for Latvia (2.6) contrarily 232
to Egypt that got the highest score (3.3). In this case, the most informed would be the participants 233
from Latvia. Again the association between these variables was weak, given the low value of 234
Cramer’s V (0.115). 235
Several in vitro studies have shown that both insoluble and soluble fibres have mineral-binding 236
properties, thus potentially interfering with mineral absorption (Baye et al., 2015). Hence, the results 237
in Table 3 suggest that the respondents are not aware of this fact, because the overall score obtained 238
was 3.3±1.1, thus indicating agreement with the false statement evaluated. The differences were 239
statistically significant among genders (P<0.001) or countries (P<0.001), but not between different 240
education levels or living environments (p > 0.05). 241
The type as well as quantity of dietary fibre ingested have shown to play an important role in the 242
management of diabetes and improvement of insulin sensitivity (Li and Uppal, 2010). According to 243
the results in Table 3, the degree of information about this positive effect of fibre on diabetes was 244
relatively elevated (3.4±1.0). There were significant differences among genders, with higher average 245
score for women, and also among education levels, for which those with a university degree showed 246
a higher knowledge. The living environment also induced significant differences, being those who 247
lived in urban areas slightly more informed when compared to those from rural areas. Regarding the 248
differences between the countries, they were also significant, with Turkey showing the highest score 249
(3.8) and Italy the lowest (3.1). 250
To assess the global knowledge about the effect of dietary fibre on human health, a new variable 251
was created as the average value considering all the ten statements, but after inverting the scores for 252
the two statements that were false. In this way the new variable would be on a scale from 1, 253
corresponding to the lowest degree of knowledge, to 5, corresponding to the highest degree of 254
knowledge. From the obtained data (Table 11) it was observed that the global knowledge varied from 255
a minimum value of 1.7 to a maximum of 5.0, with an average of 3.5±0.5. 256
The results in Table 4 indicated significant differences for all demographic variables considered 257
and the values of Cramers’s V indicate that when the global degree of knowledge was considered, 258
the association between the variables was in general higher than for the knowledge about a specific 259
topic. The highest score for overall knowledge was obtained for the participants from Portugal (3.7), 260
whereas the lowest score was for Croatia, Italy, Latvia, Macedonia and Romania (3.5, in all cases). 261
However, the differences were quite small, and the results showed that for all the countries at study 262
the degree of knowledge was good (above 3.5), corresponding to a minimum level of knowledge of 263
70%. 264
Another aspect evaluated was the possible differences among regions of the globe. For that the 265
average knowledge was considered for 4 regions, according to the geographical disposition of the 266
countries, in this way: Mediterranean countries (Croatia, Egypt, Italy, Portugal, Turkey), Central 267
Europe (Hungary, Macedonia, Romania), North Europe (Latvia) and Latin America (Argentina). The 268
results presented in Table 4 indicate that the general level of knowledge about the health benefits of 269
dietary fibre showed statistically significant differences among the regions considered, being the 270
knowledge higher for Latin America and lower for Central Europe. Mediterranean and Northern 271
Europe countries showed a similar level of knowledge. However, it is worth noticing that in some of 272
these regions the number of countries was not entirely representative of the region considered. Only 273
one country was considered in Latin America and also in Northern Europe. 274
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C
ONCLUSION
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The results obtained in this work allowed concluding that there were in general differences in the 277
level of knowledge about the health benefits of dietary fibre regarding gender, for which the women 278
showed a higher level of knowledge; regarding the level of education, with the higher education 279
corresponding to a higher level of knowledge; and also regarding living environment, with urban 280
residents showing more knowledge about these matters in relation to rural residents. 281
In relation to the differences among the countries, the results for each of the particular topics 282
addressed varied, but when the overall level of knowledge was accessed, the highest score was 283
obtained for the participants from Portugal, although the countries with the lowest score (Croatia, 284
Italy, Latvia, Macedonia and Romania) also showed a high level of knowledge. Some differences 285
were also observed for different regions of the globe, with Latin America showing the highest global 286
level of knowledge as compared to the other regions considered. 287
In general, the results allowed concluding that the participants in the study were well informed 288
about the benefits of dietary fibre to the general wellbeing and for improved health conditions. 289
This study provided valuable information regarding the level of information of a wide range of 290
people about the health benefits of an adequate intake of dietary fibre. The fact that the study was 291
undertaken in several countries, including North, Central and South Europe, North Africa and Latin 292
America, is a positive indicator of the globally accepted benefits of fibre. However, interventions 293
should be planed so as to address those groups who revealed a slightly lower level of knowledge, 294
such as the men, the people with lowest levels of education or those living in rural areas. 295
There are, however, some limitations of the present work, namely: although the number of 296
participants was high, over 6 thousand, there were some countries with a lower representation. Also, 297
and in view of the obtained results, a wider distribution of the participating countries would be 298
advisable in future works. 299
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A
CKNOWLEDGMENT
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This work was prepared in the ambit of the multinational project from CI&DETS Research 302
Centre (IPV - Viseu, Portugal) with reference PROJ/CI&DETS/2014/0001. 303
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395
396
Table 1. Relation between demographic characteristics and knowledge and beliefs towards dietary 397
fibre and health. 398
Statement (A)
1
Statement (B)
2
Statement (C)
3
Variable Score
4
Statistic
5
p-value
Score
4
Statistic
5
p-value
Score
4
Statistic
5
p-value
Gender Female
4.1±0.8
<0.001 3.7±0.9
<0.001 3.9±0.8
<0.001
Male
3.9±0.9
3.6±1.0
3.7±1.0
Level of
Education
Primary
3.9±0.9
<0.001 3.6±0.9
<0.001 3.7±0.8
<0.001
Secondary
3.9±0.9
3.6±1.0
3.7±0.9
University
4.1±0.8
3.7±0.9
3.9±0.9
Living
Environment
Rural
3.9±0.9
<0.001 3.6±0.9
0.001 3.7±0.9
<0.001
Urban
4.0±0.9
3.7±0.9
3.8±0.9
Country Argentina
4.0±0.9
<0.001 3.9±0.9
<0.001 4.0±0.8
<0.001
Croatia
4.0±0.8
3.6±0.9
3.7±0.8
Egypt
3.8±1.0
3.7±0.8
3.6±0.9
Hungary
4.2±0.9
3.8±0.9
3.9±1.0
Italy
3.9±0.8
3.4±0.9
3.6±0.9
Latvia
3.8±0.7
3.6±0.8
3.9±0.7
Macedonia
3.8±0.9
3.6±0.9
3.9±0.9
Portugal
4.3±0.6
3.9±0.8
4.0±0.8
Romania
4.0±1.1
3.5±1.2
3.7±1.2
Turkey
3.9±0.8
3.8±0.8
3.9±0.8
Total
4.0±0.9
3.7±0.9
3.8±0.9
1
(A) Eating dietary fibres in appropriate amounts can prevent and/or treat diseases. 399
2
(B) Fibres can prevent and/or treat cardiovascular diseases. 400
3
(C) Fibres can prevent and/or treat cholesterol. 401
4
Score: Mean ± Standard deviation; Scale from 1= totally disagree to 5= totally agree. 402
5
Statistical information: p-value corresponding to the chi square test with a level of significance 403 of 5%. Sample size = 6010 participants. 404
405
Table 2. Relation between demographic characteristics and knowledge and beliefs towards dietary 406
fibre and health. 407
Statement (D)
1
Statement (E)
2
Statement (F)
3
Variable Score
4
Statistic
5
p-value
Score
4
Statistic
5
p-value
Score
4
Statistic
5
p-value
Gender Female
3.9±0.9
<0.001 3.0±1.0
<0.001 3.9±0.9
<0.001
Male
3.7±1.0
2.9±1.0
3.7±1.0
Level of
Education
Primary
3.6±1.0
<0.001 3.0±0.9
0.013 3.7±0.9
<0.001
Secondary
3.7±1.0
3.0±1.0
3.7±0.9
University
3.9±0.9
3.1±1.0
3.9±0.9
Living
Environment
Rural
3.6±1.0
<0.001 3.0±1.0
0.387 3.7±0.9
<0.001
Urban
3.8±1.0
3.0±1.0
3.9±0.9
Country Argentina
3.8±0.9
<0.001 3.0±1.0
<0.001 3.9±0.9
<0.001
Croatia
3.7±0.9
3.0±0.9
3.8±0.9
Egypt
3.5±0.9
3.5±1.2
3.3±0.9
Hungary
4.0±0.9
2.8±1.1
4.0±1.0
Italy
3.6±1.0
2.7±0.7
3.7±0.9
Latvia
3.5±0.9
2.8±0.8
4.0±0.8
Macedonia
3.7±1.0
3.3±1.0
3.7±1.0
Portugal
4.1±0.8
3.0±0.8
4.1±0.7
Romania
3.9±1.3
3.0±1.1
3.8±1.2
Turkey
4.1±0.8
3.2±0.9
4.1±0.8
Total
3.8±1.0
3.0±1.0
3.8±0.9
1
(D) Fibres can prevent and/or treat bowel cancer. 408
2
(E) Fibres can prevent and/or treat breast cancer 409
3
(F) Fibres can prevent and/or treat obesity 410
4
Score: Mean ± Standard deviation. Scale from 1= totally disagree to 5= totally agree. 411
5
Statistical information: p-value corresponding to the chi square test with a level of significance 412 of 5%. Sample size = 6010 participants. 413 414
415
Table 3. Relation between demographic characteristics and knowledge and beliefs towards dietary 416
febre and health. 417
Statement (G)
1
Statement (H)
2
Statement (I)
3
Statement (J)
4
Variable Score
5
Statistic
6
p-value
Score
5
Statistic
6
p-value
Score
5
Statistic
6
p-value
Score
5
Statistic
6
p-value
Gender Female
4.2±0.9
<0.001 3.9±1.0
0.005 3.3±1.1
<0.001 3.4±1.0
<0.001
Male
3.9±1.0
2.8±1.0
3.2±1.1
3.3±1.0
Level of
Education
Primary
3.9±0.9
<0.001 2.8±1.0
0.032 3.2±1.1
0.097 3.4±0.9
<0.001
Secondary
4.0±1.0
2.9±1.0
3.3±1.0
3.3±1.0
University
4.2±0.9
2.9±1.0
3.3±1.1
3.5±1.0
Living
Environment
Rural
4.0±0.9
<0.001 3.0±1.0
0.002 3.3±1.1
0.864 3.3±1.0
0.003
Urban
4.1±0.9
2.9±1.0
3.3±1.1
3.4±1.0
Country Argentina
4.1±1.0
<0.001 2.9±1.0
<0.001 3.2±1.1
<0.001 3.6±1.0
0.121
Croatia
4.1±0.8
2.9±1.0
3.2±1.0
3.3±0.9
Egypt
3.7±1.0
3.3±1.0
3.8±0.9
3.4±0.9
Hungary
4.4±1.0
2.8±1.1
3.6±1.2
3.6±1.1
Italy
4.3±0.9
2.8±0.8
3.1±1.0
3.1±0.9
Latvia
4.1±0.8
6.6±0.8
3.1±1.0
3.3±0.8
Macedonia
3.8±1.0
3.1±1.0
3.4±1.1
3.3±1.1
Portugal
4.4±0.7
2.9±0.8
4.1±1.0
3.5±0.9
Romania
3.9±1.1
2.9±1.2
3.4±1.2
3.4±1.2
Turkey
4.3±0.9
3.1±0.9
3.5±0.7
3.8±0.8
Total
4.1±0.9
2.9±1.0
3.3±1.1
3.4±1.0
1
(G) Fibres can prevent and/or treat constipation. 418
2
(H) Fibres can prevent and/or treat vision problems 419
3
(I) Fibres can prevent and/or treat the deficiency of vitamins and minerals. 420
4
(J) Fibres can prevent and/or treat diabetes. 421
5
Score: Mean ± Standard deviation. Scale from 1= totally disagree to 5= totally agree. 422
6
Statistical information: p-value corresponding to the chi square test with a level of significance 423 of 5%. Sample size = 6010 participants. 424 425
426
Table 4. Measurement of the general level of knowledge. 427
General level of knowledge
Variable Score
1
Statistic
2
p-value
Gender Female
3.6±0.5 <0.001
Male
3.5±0.5
Level of Education Primary
3.5±0.4 <0.001
Secondary
3.5±0.5
University
3.6±0.5
Living Environment Rural
3.5±0.5 <0.001
Urban
3.6±0.5
Country Argentina
3.6±0.5 <0.001
Croatia
3.5±0.4
Egypt
3.3±0.4
Hungary
3.6±0.5
Italy
3.5±0.4
Latvia
3.5±0.4
Macedonia
3.5±0.5
Portugal
3.7±0.4
Romania
3.5±0.7
Turkey
3.6±0.4
Total
3.5±0.5
World region Mediterranean countries
3.53±0.43 <0.001
Central Europe countries
3.52±0.59
Northern Europe countries
3.53±0.41
Latin American countries
3.62±0.49
1
Score: Mean ± Standard deviation. Scale from 1= totally disagree to 5= totally agree. 428
2
Statistical information: p-value corresponding to the chi square test with a level of significance 429 of 5%. Sample size = 6010 participants. 430 431
432