European Journal of Nutrition

, Volume 58, Issue 8, pp 3009–3022 | Cite as

Dietary fiber intake and mortality in a Mediterranean population: the “Seguimiento Universidad de Navarra” (SUN) project

  • Ligia J. DominguezEmail author
  • Maira Bes-Rastrollo
  • Estefania Toledo
  • Alfredo Gea
  • Ujue Fresán
  • Mario Barbagallo
  • Miguel A. Martínez-González
Original Contribution



To prospectively assess the association of dietary fiber intake (from different dietary sources) with all-cause mortality in a Mediterranean cohort.


We assessed 19,703 participants of the SUN (Seguimiento Universidad de Navarra) cohort (mean follow-up: 10.1 years). A validated 136-item FFQ was administered at baseline. We used Cox proportional hazards models adjusted for multiple socio-demographic, anthropometric, lifestyle factors, and prevalent conditions at baseline.


We observed 323 deaths during 198,341 person-years of follow-up. A significantly inverse linear trend in Cox models was observed for the association of total dietary fiber intake and all-cause mortality after adjustment for confounders (p for trend 0.017). Each additional intake of 5 g/1000 kcal of dietary fiber was associated with a 9% relative reduction in all-cause mortality risk (HR 0.91, 95% CI 0.84–0.99). Considering separate dietary sources in separate models, a significant inverse trend was apparent for fiber derived from vegetables (p for trend 0.001), but it was non-significant for fiber derived from fruit, legumes, cereals, or other sources. Soluble fiber was significantly inversely associated with all-cause mortality in the fully adjusted model (p for trend 0.007), and insoluble fiber was marginally significant (p for trend 0.08).


A higher intake of total dietary fiber, and particularly fiber from vegetables, was related to a reduced all-cause mortality in our Mediterranean cohort. Dietary messages to increase the consumption of dietary patterns rich in fiber-rich foods should be broadly disseminated to decrease the alarming rate of chronic diseases and its derived mortality.


Mortality Fiber Vegetables Diet Cohort Prospective 



The authors thank the participants of the SUN Project for their generous and enthusiastic collaboration.

Author contributions

LJD and MAM-G designed research; MAM-G, MB-R, ET, and AG conducted research; MAM-G, LJD, AG, and UF analysed data and performed statistical analysis; LJD and MAM-G wrote the paper; LJD and MAM-G had primary responsibility for final content. All authors read and approved the final manuscript.


The SUN Project has received funding from the Spanish Government-Instituto de Salud Carlos III, and the European Regional Development Fund (FEDER) (RD 06/0045), CIBER-OBN, Grants PI10/02658, PI10/02293, PI13/00615, PI14/01668, PI14/01798, PI14/01764, and G03/140, the Navarra Regional Government (45/2011, 122/2014), and the University of Navarra. Funding sources had no role in study design, data collection, analysis and interpretation of data, writing the report, and decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The SUN study has been conducted in accordance with the Declaration of Helsinki, with the approval of the Institutional Review Board of the University of Navarra.

Supplementary material

394_2018_1846_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 30 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Ligia J. Dominguez
    • 1
    Email author
  • Maira Bes-Rastrollo
    • 2
    • 3
  • Estefania Toledo
    • 2
    • 3
  • Alfredo Gea
    • 2
    • 3
  • Ujue Fresán
    • 4
  • Mario Barbagallo
    • 1
  • Miguel A. Martínez-González
    • 2
    • 3
    • 5
  1. 1.Geriatric Unit, Department of Internal Medicine and GeriatricsUniversity of PalermoPalermoItaly
  2. 2.Department of Preventive Medicine and Public HealthUniversity of Navarra-IDISNAPamplonaSpain
  3. 3.CIBER Fisiopatologia de la Obesidad y Nutricion (CIBERobn), Instituto de Salud Carlos IIIMadridSpain
  4. 4.Environmental Nutrition Group, School of Public HealthLoma Linda UniversityLoma LindaUSA
  5. 5.Department of NutritionHarvard TH Chan School of Public HealthBostonUSA

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