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Acta Sci. Pol., Technol. Aliment. 13(2) 2014, 191-202
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pISSN 1644-0730 eISSN 1889-9594 www.food.actapol.net/

HEALTH EFFECTS OF DIETARY FIBER

Semih Ötles, Selin Ozgoz
Department of Food Engineering, Engineering Faculty, Ege University of Izmir
35100 Bornova Izmir, Turkey

ABSTRACT
Dietary fibre is a group of food components which is resistant to digestive enzymes and found mainly in ce-
reals, fruits and vegetables. Dietary fiber and whole grains contain a unique blend of bioactive components
including resistant starches, vitamins, minerals, phytochemicals and antioxidants. Dietary fiber which indi-
gestible in human small intestinal, on the other hand digested completely or partially fermented in the large
intestine, is examined in two groups: water-soluble and water insoluble organic compounds. Dietary fiber
can be separated into many different fractions. These fractions include arabinoxylan, inulin, pectin, bran,
cellulose, β-glucan and resistant starch. Dietary fibres compose the major component of products with low
energy value that have had an increasing importance in recent years. Dietary fibres also have technological
and functional properties that can be used in the formulation of foods, as well as numerous beneficial effects
on human health. Dietary fibre components organise functions of large intestine and have important physi-
ological effects on glucose, lipid metabolism and mineral bioavailability. Today, dietary fibers are known to
be protective effect against certain gastrointestinal diseases, constipation, hemorrhoids, colon cancer, gas-
troesophageal reflux disease, duodenal ulcer, diverticulitis, obesity, diabetes, stroke, hypertension and car-
diovascular diseases. In this review the physicochemical and biological properties of dietary fibers and their
important implications on human health will be investigated.

Key words: digestion, absorption, obesity, prebiotic, coronary heart disease

INTRODUCTION

Dietary fiber intake provides many health benefits. loss [Birketvedt et al. 2005] and appears to improve
A generous intake of dietary fiber reduces risk for de- immune function [Watzl et al. 2005].
veloping the diseases including coronary heart disease Traditionally, dietary fiber was defined as the por-
[Liu et al. 1999], stroke [Steffen et al. 2003], hyperten- tions of plant foods that were resistant to digestion by
sion [Whelton et al. 2005], diabetes [Montonen et al. human digestive enzyme; this included polysaccha-
2003], obesity [Lairon et al. 2005] and certain gas- rides and lignin. More recently, the definition has been
trointestinal disorders [Petruzziello et al. 2006]. Fur- expanded to include oligosaccharides, such as inulin,
thermore, increased consumption of dietary fiber im- and resistant starches [Jones et al. 2006]. As simple,
proves serum lipid concentrations [Brown et al. 1999], fibers have been classified as soluble, such as vis-
lowers blood pressure [Keenan et al. 2002], improves cous or fermentable fibers (such as pectin) that are
blood glucose, control in diabetes [Anderson 2004], fermented in the colon, and insoluble fibers, such as
promotes regularity [Cummings 2001], aids in weight wheat bran, that have bulking action but may only be

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

fermented to a limited extent in the colon [Anderson water soluble. They do not form gels due to their wa-
et al. 2009]. ter insolubility and fermentation is severally limited.
Some examples of insoluble fiber are of lignin, cellu-
DEFINING DIETARY FIBER lose and some hemicelluloses [James and Mark 2010].
A recent description, as suggested by the American
In the simplest form, carbohydrates can be sepa- Association of Cereal Chemists, terms dietary fiber as
rated into two basic groups based upon their digestibil- carbohydrate polymers with more than a three degree
ity in the Gastro Intestinal (GI) tract. The first group polymerization which are neither digested nor ab-
(i.e. starch, simple sugars, and fructans) is easily hy- sorbed in the small intestine. The greater than three de-
drolysed by enzymatic reactions and absorbed in the gree polymer rule was designed to exclude mono and
small intestine. These compounds can be referred to disaccharides [AACC 2010]. The World Health Or-
as non-structural carbohydrates, non-fibrous polysac- ganization (WHO) and Food and Agriculture Organi-
charides (NFC) or simple carbohydrates. The second zation (FAO) agree with the American Association of
group (i.e. cellulose, hemicellulose, lignin, pectin and Cereal Chemists (AACC) definition but with a slight
beta-glucans) are resistant to digestion in the small variation. They state that dietary fiber is a polysac-
intestine and require bacterial fermentation located charide with ten or more monomeric units which is
in the large intestine. These compounds can be re- not hydrolyzed by endogenous hormones in the small
ferred to as complex carbohydrates, non-starch poly- intestine [Codex... 2010]. The known constituents of
saccharide (NSP) or structural carbohydrates and are dietary fiber are listed in Table 1.
reflective in Neutral Detergent Fiber (NDF) and Acid Non Starch Polysaccharides (NSP) can be further
Detergent Fiber (ADF) analysis. NSP can be further subdivided into the two general groups of soluble
subdivided into the two general groups of soluble and and insoluble. This grouping is based on chemical,
insoluble. This grouping is based on chemical, physi- physical, and functional properties [Sizer and Whit-
cal, and functional properties. Soluble fiber dissolves ney 2008]. Soluble fiber dissolves in water forming
in water forming viscous gels. They bypass the diges- viscous gels. They bypass the digestion in the small
tion of the small intestine and are easily fermented by intestine and are easily fermented by the microflora of
the microflora of the large intestine. They consist of the large intestine. In the human GI tract, insoluble fib-
pectins, gums, inulin-type fructans and some hemicel- ers are not water soluble. They do not form gels due to
luloses. In the human GI tract, insoluble fibers are not their water insolubility and fermentation is severally

Table 1. Components of dietary fiber according to the American Association of Cereal Chemists [Jones 2000]

Non Starch polysaccharides Lignin substances associated

Analagous carbohydrates
and oligosaccharides with the NSP and lignin complex
Cellulose indigestible dextrins waxes
Hemicellulose resistant maltodextrins phytate
Arabinoxylans resistant potato dextrins cutin
Arabinogalactans synthesized carbohydrates compounds saponins
Polyfructoses polydextrose suberin
Inulin methyl cellulose tannin
Oligofructans hydroxypropylmethyl cellulose
Galacto-oligosaccharides resistant starches
Gums, mucilages, pectins

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

Table 2. Content in dietary fibre of some seaweeds, fruits, HEALTH BENEFITS OF DIETARY FIBER
vegetables, legumes and cereals expressed in percentage of
dry matter [Escrig and Muniz 2000] Cardiovascular
Cardiovascular diseases, including coronary heart
Insoluble Soluble Total
fibre fibre fibre
disease (CHD), stroke, and hypertension, affect more
than 80 million people and are the leading causes of
Nori 16.8 17.9 34.7 morbidity and mortality in the United States. In 2005,
Hijiki 16.3 32.9 49.2 CHD was the leading cause of death and strokes were
the third leading cause of death in the United States
Wakame 5.3 30.0 35.3
[American... 2008]. While CHD is the most prevalent
Ulva lactuta 16.8 21.3 38.1 cause of death, it is probably the most modifiable; an
Enteromorpha spp. 16.2 17.2 33.4 estimated 82% of CHD is attributed to lifestyle prac-
tices such as diet, physical activity, and cigarette abuse
Himantalia elongata 7.0 25.7 32.7 [Stampfer et al. 2000] and 60% is attributed to dietary
Eisenia byciclis 14.9 59.7 74.6 patterns [Kris-Etherton et al. 2002].
High levels of dietary fiber intake are associated
Whole soy 65.24 7.08 72.32
with meaningfully lower prevalence rates for coroner
Whole wheat 41.59 2.87 44.46 heart disease, stroke, and peripheral vascular disease
Whole corn 87.47 0.40 87.87 [Merchant et al. 2003]; major risk factors, such as hy-
pertension, diabetes, obesity, and dyslipidemia, are
Rice 0.75 0.19 0.94
also less common in individuals with the highest lev-
Beans 25.64 10.85 36.49 els of fiber consumption [Lairon et al. 2005].
Brussels sprouts 30.23 6.16 36.39
The impact of dietary fiber or whole grain con-
sumption on the prevalence of these conditions is sum-
Chickpeas 16.69 1.35 18.04 marized in Table 3. In the analyses of prospective co-
Onions 13.32 3.59 16.89 hort studies, the observed protective effect of dietary
fiber intake was very similar to the effects of whole
Potatoes 4.85 2.14 6.99
grains but “fellow travelers” with fiber, such as mag-
Apricots 44.92 26.43 71.35 nesium, other minerals, vitamins, and antioxidants,
Peaches 39.53 27.30 66.83 may have significant complementary beneficial effects
[Anderson 2004, Anderson et al. 2007].
Apples 55.57 18.56 74.13 Seven cohort studies presenting observations for
over 158,000 individuals indicate that CHD disease
prevalence is significantly lower (29%) in individuals
limited. Most fiber containing foods include approxi- with the highest intake of dietary fiber compared to
mately one-third soluble and two-third insoluble fiber those with the lowest intake (Table 3). Specifically, the
[Wong and Jenkins 2007]. relative risk, computed by variance weighting (fixed-
Current recommendations for dietary fiber intake effect metaanalysis) is 0.71 for individuals in the high-
are related to age, gender, and energy intake, and the est quintile for dietary fiber intake compared to those
general recommendation for adequate intake (AI) is in the lowest quintile [Anderson et al. 2009].
14 g/1000 kcal [USDA 2005]. This AI includes non- In the United States, CVD affects approximately
starch polysaccharides, analogous carbohydrates (e.g., one-third of the adult US population and CHD is the
resistant starches), lignin, and associated substances leading cause of death. Higher intakes of dietary fiber
[Witwer 2008]. Using the energy guideline of 2000 compared to lower consumption levels are associat-
kcal/day for women and 2600 kcal/day for men, the ed with significantly lower rates of CVD and lower
recommended daily dietary fiber intake is 28 g/day for prevalence of CVD risk factors. Persons with the high-
adult women and 36 g/day for adult men. est levels of fiber consumption have a 29% lower risk

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

Table 3. Dietary fiber intake related to relative risk for dis- enhancing weight loss or maintenance of a healthier
ease based on estimates from prospective cohort studies body weight. Fourth, either through glycemic control
[Anderson et al. 2009] or reduced energy intake, dietary fiber has been shown
to lower the risk for type two diabetes. Fifth, DF has
Number of
Disease subjects
Relative
95% CI
been shown to decrease pro-inflammatory cytokines
risk* such as interleukin-18 which may have an effect on
(studies)
plaque stability. Sixth, increasing DF intake has been
Coronary heart 158,327 (7) 0.71 0.47-0.95
shown to decrease circulating levels of C-Reactive
disease
protein (CRP), a marker of inflammation and a predic-
Stroke** 134,787 (4) 0.74 0.63-0.86 tor for CHD [James and Mark 2010].
Diabetes 239,485 (5) 0.81 0.70-0.93 In a long term clinical study, Jensen et al. [2004]
reported that an increased daily consumption of bran
Obesity 115,789 (4) 0.70 0.62-0.78
significantly decreased the risk of coronary heart dis-
*Relative risks adjusted for demographic, dietary, and non- ease in healthy adult men. This is most likely due to
dietary factors. the data reported by Qureshi et al. [2002] who found
**Estimates related to whole-grain consumption, total dietary that 10 g of rice bran consumed for eight weeks was
fiber and cereal fiber. able to decrease serum total cholesterol, LDL choles-
terol and triglycerides. The mechanisms behind these
for CHD than those with the lowest intakes. Soluble effects may be twofold. The reduction in cholesterol
fiber intake of about 6 g/day is accompanied by reduc- levels is likely due to an increase in bile acid synthesis.
tions in serum LDL-cholesterol values of around 5.4% Andersson et al. [2002] found that oat bran doubled the
and estimated risk for CHD of about 9%. Increased serum concentration of 7α-hydroxy-4-cholesten-3-one
fiber intake modestly lowers the blood pressure of the (α-HC), which is a metabolite in the synthesis of bile
general population but is accompanied by reductions acids that is oxidized from 7α-hydroxycholesterol.
of systolic and diastolic blood pressure, respectively, The reduction in serum triglyceride levels may be
of –6 mmHg and –4 mmHg for hypertensive individu- a result of a decreased absorption of fat from the small
als. Higher fiber intakes are associated with improved intestine.
measures for body weight, visceral adiposity, insulin Theuwissen and Mensink [2008] found that, many
sensitivity, and inflammatory markers. Moderate in- well-controlled intervention studies have shown that
creases in fiber intake, especially soluble fiber, are four major water-soluble fiber types β-glucan, psylli-
likely to have significant favourable effects on risk and um, pectin and guar gum effectively lower serum LDL
progression of CVD [Anderson et al. 2009]. cholesterol concentrations, without affecting HDL
Many studies support the inverse relationship of cholesterol or triacylglycerol concentrations. Further-
dietary fiber and risk for CHD. However, more recent more, epidemiological studies suggest that a diet high
studies found interesting data illustrating that for eve- in water-soluble fiber protects against CVD. These
ry 10 g of additional fiber added to a diet the mortal- findings underlie current dietary recommendations to
ity risk of CHD decreased by 17-35%. Risk factors further increase water-soluble fiber intake.
for CHD include hypercholesterolemia, hypertension,
obesity and type two diabetes. It is speculated that Obesity
the control and treatment of these risk factors under- Nearly 66% of U.S. adults are overweight or obese
lie the mechanisms behind DF and CHD prevention. resulting in an increased risk of health problems in-
First, soluble fibers have been shown to increase the cluding; diabetes, CVD, and certain types of cancer.
rate of bile excretion therefore reducing serum total Although there are multiple factors that could con-
and LDL cholesterol. Second, short chain fatty acid tribute to obesity, the primary cause is due to an in-
production, specifically propionate, has been shown crease in the energy absorption, energy expenditure
to inhibit cholesterol synthesis. Third, dietary fiber ratio. Therefore, limiting energy absorption is critical
demonstrates the ability to regulate energy intake thus when treating obesity. Scientists have taken this a step

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

further and studied the effect of other dietary aspects Both soluble and insoluble fiber may lead to
that may serve in weight regulation, including dietary weight loss. However, there seems to be a relationship
fiber. Increasing dietary fiber consumption may de- between the type of diet (high or low fat) and the type
crease energy absorption by way of diluting a diet’s of fiber consumed. Insoluble fiber may play a more
energy availability while maintaining other important important role for weight loss during consumption of
nutrients [Lattimer and Haub 2010]. a high fat diet. Since resistant starch is a constituent
Substantial research has been conducted to evalu- of dietary fiber and undergoes the same digestion as
ate the effect of dietary fiber and body weight, most insoluble fiber, comparing resistant starch and insolu-
of all which show an inverse relationship between di- ble fiber may give us a better understanding of how
etary fiber intake and change in body weight. Tucker dietary fiber can be used to treat and prevent obesity.
and Thomas [2009] supported this statement in a study Adding resistant starch to a diet dilutes its ME, but
consisting of 252 middle aged women. They observed not to the degree of insoluble fiber. Numerous studies
that over a 20 month period participants lost an aver- have found the same inverse relationship between di-
age of 4.4 lbs due to an 8 g increase in dietary fiber per etary fiber and weight gain [Koh- Banerjee et al. 2004,
1000 kcal. This weight loss was primarily due to de- Du et al. 2010].
creased body fat. It should be recognized that the cor-
relation between dietary fiber and weight change was Diabetes
independent of many other potential factors including Type two diabetes has increased exponentially over
age, baseline fiber and fat intakes, activity level, and the past several years. Since 1990, self reported diabe-
baseline energy intake. tes increased by 61% [Mokdad et al. 2003]. Although
Koh-Banerjee et al. [2004] concur with the above other risk factors such as obesity, lack of physical ac-
findings and also suggest a dose-response relationship. tivity and smoking are precursors for the disease, di-
They reported that for every 40 g/d increase in whole etary factors also seem to play a significant role. Type
grain intake, weight gain decreased by 1.1 lbs. Moreo- two diabetes results from decreased insulin sensitivity
ver, bran seemed to play an important role in the re- and hyperglycemia. For that reason, a primary dietary
duction of weight gain by 0.8 lbs per 20 g/d intake. factor of particular concern is carbohydrate intake
Dietary fiber’s ability to decrease body weight or [Lattimer and Haub 2010].
attenuate weight gain could be contributed to several Meyer et al. [2000] observed that total carbohy-
factors. First, soluble fiber, when fermented in the large drates had no effect on the risk of diabetes. However,
intestine, produces glucagon-like peptide (GLP-1) and the type of carbohydrate (non structural carbohydrates
peptide YY (PYY). These two gut hormones play a role and dietary fiber) was significantly related. Therefore,
inducing satiety. Second, dietary fiber may significant- it is important to understand a foods glycemic index
ly decrease energy intake [Tucker and Thomas 2009]. or load. Glycemic index ranks total carbohydrate in-
Women who consumed increased levels of fiber tend- take according to their immediate postprandial glu-
ed to also have a decreased consumption of dietary fat. cose response in comparison to a reference group such
Third, dietary fiber may decrease a diet metabolizable as glucose or white bread. Carbohydrates with a low
energy (ME), which is gross energy minus the energy glycemic index result in a smaller glucose/insulin re-
lost in the feces, urine and combustible gases. Baer et sponse. Simple small chain carbohydrates would be
al. [1997] observed that an increased consumption of considered to have a higher glycemic index since it
dietary fiber resulted in a decrease in the ME of the produces higher blood glucose concentrations.
diet. This may be attributed to the fact that fat digest- Hu et al. [2001] found that excess body fat was
ibility decreased as dietary fiber increased. Also, as the single most important determinant of type two
dietary fiber intake increases, the intake of simple car- diabetes, poor nutrition was also a large influential
bohydrates tends to decrease. Although, dietary fiber factor. Moreover, women consuming a poor diet sig-
still contributes to the total caloric content of a diet, it nificantly increased their risk of developing type two
is much more resistant to digestion by the small intes- diabetes. Poor diet was classified as a diet high in sat-
tine and even somewhat resistant in the large intestine. urated fat, low dietary fiber and high non structural

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

carbohydrates. This diet would be consistent with a peripheral and not limited to nutrient absorption. First,
high glycemic load being higher in easily digestible an accelerated secretion of glucose-dependent insulin-
and rapidly absorbable carbohydrates [Hu et al. 2001]. tropic polypeptide (GIP) was observed directly after
In a supportive, long term (eight year) study of over the ingestion of an insoluble fiber in healthy women.
90,000 female nurses, Schulze et al. [2004] found a GIP is an incretin hormone which stimulates postpran-
positive correlation between glycemic index and risk dial insulin release. Second, insoluble fiber can result
of type two diabetes. This association was significant in a reduced appetite and food intake [Samra and An-
even after adjusting for age, body mass index (BMI) derson 2007] and this may lead to a decreased caloric
and family history. Several means have been proposed intake and BMI. Third, short chain fatty acids, via fer-
to understand the physiology behind the relationship mentation, have been shown to reduce postprandrial
of glycemic index and diabetes. First, carbohydrates glucose response [Ostman et al. 2002]. Early research
with a higher glycemic index produce higher blood demonstrated that lipid infusions impaired glucose uti-
glucose levels. This chronic hyperglycemia is sug- lization and oral acetate could decrease free fatty acids
gested to lead to the dysfunction of beta cells in the (FFA) in the blood. According to Kelley and Mandari-
pancreas thus decreasing insulin release. Second, due no [2000] increases in FFA in the blood can inhibit
to an over abundance of energy (i.e., high glycemic glucose metabolism through the inhibition of GLUT
load) tissues such as skeletal muscle, liver and adipose 4 transporters. Therefore, short chain fatty acids, by
become resistant to insulin. It is important to note that way of decreasing serum free fatty acids, may reduce
the inverse relationship between dietary fiber and di- blood glucose levels through competition in insulin-
abetes observed by Meyer et al. [2000] and Schulze sensitive tissues.
et al. [2004] was independent of age and body weight. The inverse relationship between cereal grains and
Hu et al. [2001] supported these findings while cor- diabetes may also be attributed to an increased con-
recting for age, fat intake, smoking, alcohol, family sumption of magnesium. Increased intake of magne-
history, exercise, and body weight. Therefore, it seems sium has been shown to decrease the incidence of type
that dietary fiber is associated with type two diabetes, two diabetes [Meyer et al. 2000]. Hypomagnesemia
independent of other compounding factors. is common among diabetics and has been associated
Meyer et al. [2000] using healthy middle aged with a reduction of tyrosine kinase at the insulin recep-
women, observed a strong (P = 0.0012) inverse re- tor. This may impair the action of insulin thus leading
lationship between insoluble fiber and the risk of to insulin resistance [Paolisso and Barbagallo 1997].
type two diabetes while soluble fiber had no effect.
Montonen et al. [2003] also found the same results Gastrointestinal
in healthy middle aged men and women consuming Dietary fibers affect the entire gastrointestinal tract
increased levels of whole rye bread. Interestingly, from the mouth to the anus. High-fiber foods usual-
fiber from fruits and vegetables had no effect on the ly have lower energy density and take longer to eat
risk of developing type two diabetes. Earlier studies [Haber et al. 1977]. Soluble fibers usually delay gas-
have agreed with these findings. A large epidemiologi- tric emptying. Soluble fibers may act to slow transit
cal study of 42,000 men found that dietary fiber from of food materials through the small intestine while
fruits or vegetables had no effect on the risk of diabe- insoluble fibers tend to create “intestinal hurry” [Cum-
tes. However, dietary fiber from whole cereal grains mings 2001]. In the small intestine, dietary fibers can
showed a significant decrease in diabetes occurrence. reveal responses of a wide variety of gastrointestinal
Daily intakes of fiber among all groups were similar hormones that serve as incretins to stimulate insulin
[Salmeron et al. 1997]. release and affect appetite [Anderson 2008]. Some fib-
Weickert and Pfeifer [2008] found that an in- ers bind bile acids and impede micelle formation, thus
creased intake of cereal fiber significantly improved increasing fecal excretion of bile acids and cholesterol
whole body glucose disposal resulting in an 8% im- [Kirby et al. 1981]. In the colon, fermentable fibers
provement of insulin sensitivity. This suggests that increase bacterial mass with some acting as prebiot-
the mechanisms behind insoluble fiber are more ics to promote health-promoting bacteria such as

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

Lactobacilli and Bifidobacteria [Roberfroid 2005]. In- the epidemiological evidence is moderately well sup-
soluble fibers are especially effective in increasing fe- ported by clinical trials [Ryan-Harshman and Aldoori
cal mass and promoting regularity [Cummings 2001]. 2004].
Recently Drzikova et al. [2005] found that the in Irritable bowel syndrome is one of the most com-
vitro binding of bile acids increased with increasing mon gastrointestinal functional disorders worldwide.
proportions of oat bran, total and insoluble dietary It is a complex disorder and includes the following
fibre, as well as b-glucan, in pre-digested oat-based ex- symptoms: abdominal pain or discomfort, bloating,
trudates. The results of the study show, that the source, and diarrhea and/or constipation. While wheat bran of-
the chemical composition and the pre-treatment of di- ten increases symptoms other fiber supplements such
etary fibre preparations strongly influence their ability as methylcellulose, partially hydrolysed guar gum,
to interact with bile acids. and psyllium have been reported to alleviate symp-
The consumption of b-glucan and resistant starch- toms [Anderson et al. 2009]. In clinical trials, reduc-
rich diets results in several beneficial physiological tions in symptoms in groups receiving placebo, as well
effects. Thus, b-glucan lowers the postprandial blood as those receiving fiber are usually dramatic and statis-
glucose and insulin responses in normal individual. tically significant, thus confounding the assessment of
Serum cholesterol and lipoprotein concentrations can the therapeutic intervention. The sympathetic support
be reduced in humans and animals by b-glucans from of the primary care provider combined with highly se-
oat and barley or by cereal products. A reason for the lective therapeutic interventions with dietary fiber in
cholesterol-lowering effects of b-glucan-rich diets foods or supplements can often be very effective in re-
may be the greater excretion of bile acids [Drzikova ducing symptoms [Giannini et al. 2006]. Judicious use
et al. 2005]. of soluble fibers may offer benefits for persons with
Early observers suggested that dietary fiber intake ulcerative colitis in remission [Seidner et al. 2005].
decreased the prevalence of hiatal hernias and gas- Diverticular disease is the fifth most common gastro-
troesophageal reflux disease (GERD), peptic ulcer intestinal condition in Western countries and is one
disease, gallbladder disease, appendicitis, diverticular of the classical fiber-deficiency diseases. A generous
disease, colorectal cancer, and hemorrhoids [Burkitt intake of dietary fiber is considered to be protective,
and Trowell 1975]. Rigorous evaluation of the prev- ameliorative, and preventive of recurrences [Frieri et
alence of these diseases suggests that high levels of al. 2006]. Increased intake of dietary fiber is common-
dietary fiber intake, compared to low levels, may be ly used for the prevention and management of consti-
associated with a decreased prevalence of the follow- pation or hemorrhoids. Wheat bran, high-fiber cereals,
ing conditions: esophageal cancer [Wu et al. 2007], and fiber supplements are widely used by consumers,
GERD [El-Serag et al. 2005], gastric cancer [Wu et al. which represents common knowledge of their benefi-
2007], peptic ulcer disease [Aldoori et al. 1997], gall- cial effects [Anderson et al. 2009].
bladder disease [Tsai et al. 2004], diverticular disease Inulin has demonstrated the ability to contribute to
[Aldoori et al. 1997], constipation and hemorrhoids the health of the human large intestine as a prebiotic.
[Cummings 2001]. They demonstrated that inulin stimulated the growth
Limited data suggest that individuals with high- of Bifidobacteria while restricting the growth of po-
er fiber intakes have a lower prevalence of GERD tential pathogenic bacteria such as E. coli, Salmonella,
[El-Serag et al. 2005]. Guar gum and, possibly, other and Listeria. This could prove to be beneficial in such
soluble fibers are associated with low levels of gas- disorders as ulcerative colitis and C. difficile infec-
tric acid production, which may protect from GERD tions. Rafter et al. [2007] agreed with these findings
and duodenal ulcer disease. The available evidence and suggested they were the underlying mechanisms
strongly indicates that high fiber intakes are associ- behind the observation that inulin decreased biological
ated with lower prevalence of duodenal ulcer disease. compounds associated with colonic cancer, including
The available evidence strongly indicates that high reduced colorectal cell proliferation and water induced
fiber intakes are associated with lower prevalence of necrosis, decreased exposure to genotoxins, and de-
duodenal ulcer disease than lower fiber intakes, and creased interleukin-2 release.

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Several recent clinical studies showed that oral the leading causes of cancer morbidity and mortality
pectin supplementation to children and infants reduced among both men and women in the Western countries,
acute intestinal infections and significantly slowed di- including the U.S.A. Historical observational and
arrhea. This is thought to be due to a reduction in path- epidemiological studies from around the world have
ogenic bacteria such as Shigella, Salmonella, Kleb- long supported that increased consumption of fruits
siella, Enterobacter, Proteus and Citrobacter. This is and vegetables and high fiber intake provide a protec-
supported by Olano-Martin et al. [2002] who observed tive relationship between dietary fiber intake and co-
that pectin stimulated the growth of certain strains of lon cancer incidence. Early results from a European
Bifidobacteria and Lactobacillus in vitro. These bac- investigation, the European Prospective Investigation
teria are considered to be directly related to the health of Cancer (EPIC), involving more than half a million
of the large intestine and their concentrations depict people in 10 European countries, indicates that dietary
a healthy microflora population. fiber provides strong protective effects against colon
Kahlon et al. [2001] found that high-fiber diets fed and rectal cancers. Poorly fermented fiber, such as that
to rats resulted in significantly greater wet and dry fe- in cereal brans, has direct effects in the colon by pro-
cal weights than low-fiber diets. Bran diets resulted in moting laxation, decreasing transit time, and binding
significantly higher fecal moisture than cellulose di- substances such as bile acids and carcinogens. How-
ets. Cecum lengths increased significantly with bran ever, evidence to date is insufficient to determine if de-
diets compared with cellulose diets. The wheat bran creased colon cancer risk is a beneficial effect of this
diet resulted in significantly higher stomach weights type of fiber. Of particular interest is the utilization of
than with cellulose diets. Stomachs were heavier and fermentable fiber by the colonic microbiota that can
cecal lengths were greater with bran diets than with result in changes to the numbers and types of bacteria
cellulose diets; however, a high-cellulose diet resulted and, more importantly, changes to their metabolic ac-
in increased colon weight. Except for higher fiber di- tivities in terms of the formation of genotoxins, carcin-
gestibility of coarse bran, bran particle size had no sig- ogens, and tumor promoters. Selective prebiotic fiber
nificant effects. Healthful effects of wheat bran may sources, such as inulin, resistant starches, and some
be associated with gastrointestinal morphology and oligosaccharides, act as selective substrate for bacteria
function. Fecal bulking and decreased intestinal transit that produce specific short-chain fatty acids (SCFA)
time can prevent constipation and may dilute or reduce and can lower the intestinal pH. The SCFA butyrate
absorption of toxic or carcinogenic metabolites, thus has been shown to increase apoptosis in human colon-
improving gastrointestinal health and lowering the ic tumor cell lines. Apoptosis is a mechanism where
risk of tumor development and cancer. excess or redundant cells are removed during develop-
Ferguson and Harris [1996] found that two groups ment and restricted tissue size is maintained. The apo-
of mechanisms have been proposed for the way die- ptosis process is thus an innate cellular defense against
tary fibres may protect against colorectal cancer: those carcinogenesis. Evidence suggests that increasing the
in which the dietary fibre may act directly and those in numbers of Bifidobacteria in the colon and reducing
which the dietary fibre may have an indirect effect as intestinal pH has a direct impact on carcinogenesis in
a consequence of it being degraded by colonic bacte- the large intestine. Possible mechanisms for the anti-
rial enzymes and the products fermented. carcinogenic and antitumorigenic effect of highly fer-
mentable fibers are not completely understood and re-
Cancer quire further research. However, it is likely that some
Cancer continues to be one of the number one or all are involved in a metabolic chain reaction for
health concerns of populations worldwide. Most can- the inhibitory effect to ocur. The primary mechanisms
cers strike both men and women at about the same involved with these effects are proposed to be: a re-
rate, with exception of cancers of the reproductive duction in the production of carcinogenic substances
system. Of particular concern is cancer of the colon, by decreasing the amount of pathogenic bacteria in
ranking among the top 3 forms of cancer in the U.S.A., the colon [Rumney and Rowland 1995]; and/or lower-
for both men and women. Colon cancer is also one of ing the colonic pH to affect pH-dependent enzymatic

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Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

reactions; for example, secondary bile acid formation fibers have been demonstrated for oat b-glucan, gu-
[Rowland et al. 1998]; and/or reducing the amount of mArabic, and others.
carcinogenic substances available to colonic mucosa The role of prebiotic fibers in infant nutrition and
by adsorption of the substances to the cell wall of the health, especially for non-breastfed infants, is generat-
microbiota, by speeding up the intestinal transit time ing a great deal of interest. The studies suggest that
and by increasing colonic contents and thus diluting supplementation with a prebiotic fiber mixture has the
all components; and/or exerting inhibiting effects on following benefits: promotes postnatal immune devel-
initiation and promotionstages in colon cancer forma- opment, decreases respiratory infections and atopic
tion in which SCFA, particularly butyric acid, may dermatitis and improves bowel function.
play a key role [Tungland and Meyer 2006]. The therapeutic potential for using prebiotic fib-
ers in the treatment of inflammatory bowel disease
Immune system is being examined. In animal studies, prebiotic fibers
Inulin and other oligofructoses have been the most have reduced gut inflammation in a number of animal
extensively studied dietary fibers. They act, to stimu- experimental models. Early studies also indicate that
late growth of bifidobacteria in the colon. Bifidobac- prebiotic fibers significantly reduce the risk of infec-
teria and lactobacilli are healthpromoting bacteria that tion in liver transplant patients. Preliminary human
generate short-chain fatty acids and stimulate the im- studies have shown favourable responses for individu-
mune system. Fairly extensive animal studies have als with ulcerative colitis, Crohn’s disease, or pouchi-
documented the favourable effect of inulin on the im- tis [Anderson et al. 2009].
mune system and preliminary studies in humans sup-
port the hypotheses generated from animal studies. Mineral bioavailability
Inulin and oligofructoses are not digested by pancre- Certain fiber sources from fruits and vegetables
atic enzymes thus, they enter the colon virtually intact. that have cation exchange capacity from unmethylated
In the colon, inulin is fermented completely by the mi- galacturonic acid residues and phytic acid from cereal
crobacteria and it promotes the growth of bifidobac- fibers, have been found to depress the absorption and
teria. Short-chain fatty acids (SCFA) result from this retention of several minerals. However, certain highly
fermentation process. Other fibers are also fermented fermentable fibers have resulted in improved meta-
to generate SCFA, but the bifidobacteria effects of bolic absorption of certain minerals, such as calcium,
non-oligofructose fibers are not as well characterised. magnesium, and iron, even when phytic acid is present
The proposed health benefits of bifidobacteria include at lower concentrations. These compounds include
the following: pectin, various gums, resistant starches, cellulose,
• protection from intestinal infection certain oligosaccharides like soy and fructooligosac-
• lowering of intestinal pH for formation of acids af- charides, inulin, lactulose, and related sugars. Mineral
ter assimilation of carbohydrates absorption has generally been accepted as stemming
• reduction of the number of potentially harmful from diffusion in the small intestine. However, studies
bacteria; production of vitamins and antioxidants now indicate that highly fermentable fibers, such as in-
• activation of intestinal function and assistance in ulin and fructooligosaccharides, also promote mineral
digestion and absorption, especially of calcium absorption in the colon. Through their fermentation by
• bulking activity to prevent and treat constipation colonic microbiota and subsequent SCFA production,
• stimulation of the immune response these fiber components stimulate the proliferation of
• potential reduction in the risk for colorectal cancer. epithelial cells in the cecocolon and reduce the lumi-
Limited studies in humans have indicated that inu- nal pH. Al salts, especially calcium, magnesium, and
lin supplementation increases the fecal bacterial con- iron, in the luminal content and increase their diffusive
tents of bifidobacteria and has favourable effects on absorption via the paracellular route. In particular, the
the types and amounts of circulating lymphocytes. In- accumulation of calcium phosphate in the large intes-
ulin and oligofructoses have been studied most exten- tine and the solubilization of minerals by SCFA are
sively, but favourable effects of fermentable soluble likely to play an essential role in the enhanced mineral

www.food.actapol.net/ 199
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Anderson J.W., 2008. Dietary fiber and associated phyto-
large intestine, as indicated by increased concentra-
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Nutraceuticals, glycemic health and type 2 diabetes. Eds
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Received – Przyjęto: 23.06.2013 Accepted for print – Zaakceptowano do druku: 18.12.2013

For citation – Do cytowania

Ötles S., Ozgoz S., 2014. Health effects of dietary fiber. Acta Sci. Pol., Technol. Aliment. 13(2), 191-202.

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