Dietary Fiber and Nutrient Density Are Inversely Associated with the Metabolic Syndrome in US Adolescents

Background There is no consensus as to whether low dietary intakes of saturated fat or cholesterol, or high intakes of dietary fiber are related to a lower prevalence of metabolic syndrome (MetS) in adolescent children. Objective To determine whether a fiber-rich diet as measured by a fiber index (grams fiber/1,000 kcal) is associated with lower rates of MetS among adolescents vs a diet low in saturated fat or cholesterol as measured by a saturated fat index (grams saturated fat/1,000 kcal) and a cholesterol index (milligrams cholesterol/1,000 kcal), respectively. Design/participants/setting Cross-sectional analysis of 12- to 19-year-old boys and girls (N=2,128) who participated in the National Health and Nutrition Examination Survey 1999-2002. Outcomes and statistical analyses The prevalence of MetS (abnormal values of three or more of the following: waist circumference, blood pressure, fasting serum high-density lipoprotein cholesterol, triglycerides, and glucose) was compared across quintiles of the dietary indexes (fiber index, saturated fat index, and cholesterol index) derived from 24-hour recalls. chi(2) tests determined the prevalence across dietary quintiles, and multivariate logistic regression evaluated the association of the dietary indexes with MetS. Weighted analyses were used controlling for sex, age, ethnicity, and family income. Significance was set at P <= 0.05. Results The overall prevalence of MetS was 6.4% (n=138). There vias a graded inverse association between the fiber index and MetS (P<0.001) with a threefold difference between the lowest and highest quintiles (9.2% vs 3.1%). Each quintile increase in the fiber index was associated with a similar to 20% decrease in MetS (adjusted odds ratio 0.83, 95% confidence interval 0.68-1.00; P <= 0.043). Neither the saturated fat index (P=0.87) nor the cholesterol index (P=0.22) was significantly associated with MetS. Conclusions Higher intakes of dietary fiber, but not low intakes of saturated fat or cholesterol are related to the MetS in adolescents. These findings suggest that to reduce the risks for MetS in adolescents, it is more important to emphasize a paradigm that promotes the inclusion of fiber-rich, nutrient-dense, plant-based foods vs what foods to restrict or exclude as is commonly done when the focus is on total fat, cholesterol, or saturated fat intake. J Am Diet Assoc. 2011;111:1688-1695.