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Cited by 191Nutritional Studies and DietFood composition and propertiesNutrition, Health, and Society Studies

Association Between Dietary Whole Grain Intake and Risk of Mortality: Two Large Prospective Studies in US Men and Women

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Wu, Hongyu, Flint, Alan J., Qi, Qibin, van Dam, Rob M., Sampson, Laura A., Rimm, Eric B., Holmes, Michelle D., Willett, Walter C. +2 more·2015·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2014.6283PMC PMC4429593
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Abstract

IMPORTANCE: Higher intake of whole grains has been associated with a lower risk of major chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease (CVD), although limited prospective evidence exists regarding whole grains' association with mortality. OBJECTIVE: To examine the association between dietary whole grain consumption and risk of mortality. DESIGN, SETTING, AND PARTICIPANTS: We investigated 74 341 women from the Nurses' Health Study (1984-2010) and 43 744 men from the Health Professionals Follow-Up Study (1986-2010), 2 large prospective cohort studies. All patients were free of CVD and cancer at baseline. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for total mortality and mortality due to CVD and cancer according to quintiles of whole grain consumption, which was updated every 2 or 4 years by using validated food frequency questionnaires. RESULTS: We documented 26 920 deaths during 2 727 006 person-years of follow-up. After multivariate adjustment for potential confounders, including age, smoking, body mass index, physical activity, and modified Alternate Healthy Eating Index score, higher whole grain intake was associated with lower total and CVD mortality but not cancer mortality: the pooled HRs for quintiles 1 through 5, respectively, of whole grain intake were 1 (reference), 0.99 (95% CI, 0.95-1.02), 0.98 (95% CI, 0.95-1.02), 0.97 (95% CI, 0.93-1.01), and 0.91 (95% CI, 0.88-0.95) for total mortality (P fortrend < .001); 1 (reference), 0.94 (95% CI, 0.88-1.01), 0.94 (95% CI, 0.87-1.01), 0.87 (95% CI, 0.80-0.94), and 0.85 (95% CI, 0.78-0.92) for CVD mortality (P fortrend < .001); and 1 (reference), 1.02 (95% CI, 0.96-1.08), 1.05 (95% CI, 0.99-1.12), 1.04 (95% CI, 0.98-1.11), and 0.97 (95% CI, 0.91-1.04) for cancer mortality (P fortrend = .43). We further estimated that every serving (28 g/d) of whole grain consumption was associated with a 5% (95% CI, 2%-7%) lower total morality or a 9% (95% CI, 4%-13%) lower CVD mortality, whereas the same intake level was nonsignificantly associated with lower cancer mortality (HR, 0.98; 95% CI, 0.94-1.02). Similar inverse associations were observed between bran intake and CVD mortality, with a pooled HR of 0.80 (95% CI, 0.73-0.87; P fortrend < .001), whereas germ intake was not associated with CVD mortality after adjustment for bran intake. CONCLUSIONS AND RELEVANCE: These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.

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References 52 · Cited by 191

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  1. [3]McCarty MF Magnesium may mediate the favorable impact of whole grains on insulin sensitivity by acting as a mild calcium antagonist Med Hypotheses 2005 64 3 619 627 15617878
  2. [4]Juntunen KS Niskanen LK Liukkonen KH Postprandial glucose, insulin, and incretin responses to grain products in healthy subjects Am J Clin Nutr 2002 75 2 254 262 11815315
  3. [5]Pereira MA Jacobs DR Pins JJ Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults Am J Clin Nutr 2002 75 5 848 855 11976158
  4. [6]Jenkins DJA Kendall CWC Axelsen M Augustin LSA Vuksan V Viscous and nonviscous fibres, nonabsorbable and low glycaemic index carbohydrates, blood lipids and coronary heart disease Curr Opin Lipidol 2000 11 1 49 56 10750694
  5. [7]Katz DL Nawaz H Boukhalil J Effects of Oat and Wheat Cereals on Endothelial Responses Preventive Medicine 2001 33 5 476 484 11676590
  6. [8]Adom KK Liu RH Antioxidant Activity of Grains J Agric Food Chem 2002 50 21 6182 6187 12358499
  7. [9]Adlercreutz H Lignans and Human Health Crit Rev Clin Lab Sci 2007 44 5–6 483 525 17943494
  8. [10]Qi L Hu FB Dietary glycemic load, whole grains, and systemic inflammation in diabetes: the epidemiological evidence Curr Opin Lipidol 2007 18 1 3 8 17218824
  9. [12]Ye EQ Chacko SA Chou EL Kugizaki M Liu S Greater Whole-Grain Intake Is Associated with Lower Risk of Type 2 Diabetes, Cardiovascular Disease, and Weight Gain J Nutr 2012 142 7 1304 1313 22649266 PMC6498460
  10. [13]Cho SS Qi L Fahey GC Klurfeld DM Consumption of cereal fiber, mixtures of whole grains and bran, and whole grains and risk reduction in type 2 diabetes, obesity, and cardiovascular disease Am J Clin Nutr 2013 98 2 594 619 23803885
  11. [14]Mellen PB Walsh TF Herrington DM Whole grain intake and cardiovascular disease: A meta-analysis Nutr Metab Cardiovasc Dis 2008 18 4 283 290 17449231
  12. [15]Jacobs DR Jr Andersen LF Blomhoff R Whole-grain consumption is associated with a reduced risk of noncardiovascular, noncancer death attributed to inflammatory diseases in the Iowa Women’s Health Study Am J Clin Nutr 6 2007 85 6 1606 1614 17556700
  13. [16]Jacobs DR Jr Meyer KA Kushi LH Folsom AR Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women’s Health Study Am J Public Health 3 1999 89 3 322 329 10076480 PMC1508593
  14. [18]Jacobs DR Jr Meyer HE Solvoll K Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study Eur J Clin Nutr 2 2001 55 2 137 143 11305627
  15. [19]Sahyoun NR Jacques PF Zhang XL Juan W McKeown NM Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults Am J Clin Nutr 2006 83 1 124 131 16400060
  16. [20]He M van Dam RM Rimm E Hu FB Qi L Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus Circulation 2010 121 20 2162 2168 20458012 PMC2886277
  17. [21]Jacobs DR Jr Meyer KA Kushi LH Folsom AR Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women’s Health Study Am J Clin Nutr 1998 68 2 248 257 9701180
  18. [22]Salvini S Hunter DJ Sampson L Food-Based Validation of a Dietary Questionnaire: The Effects of Week-to-Week Variation in Food Consumption Int J Epidemiol 1989 18 4 858 867 2621022
  19. [23]Feskanich D Rimm EB Giovannucci EL Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire J Am Diet Assoc 1993 93 7 790 796 8320406
  20. [24]Koh-Banerjee P Franz M Sampson L Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men Am J Clin Nutr 2004 80 5 1237 1245 15531671
  21. [25]Jensen MK Koh-Banerjee P Hu FB Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men Am J Clin Nutr 2004 80 6 1492 1499 15585760
  22. [26]Franz M Sampson L Challenges in developing a whole grain database: Definitions, methods and quantification Journal of Food Composition and Analysis 2006 19 Supplement 0 S38 S44
  23. [27]Rich-Edwards JW Corsano KA Stampfer MJ Test of the National Death Index and Equifax Nationwide Death Search Am J Epidemiol 1994 140 11 1016 1019 7985649
  24. [28]Rimm EB Stampfer MJ Colditz GA Validity of self-reported waist and hip circumferences in men and women Epidemiology 1990 1 6 466 473 2090285
  25. [31]Chiuve SE Fung TT Rimm EB Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease J Nutr 2012 142 6 1009 1018 22513989 PMC3738221
  26. [33]Sun Q Spiegelman D van Dam RM White rice, brown rice, and risk of type 2 diabetes in US men and women Arch Intern Med 2010 170 11 961 969 20548009 PMC3024208
  27. [35]Wang L Gaziano JM Liu S Whole- and refined-grain intakes and the risk of hypertension in women Am J Clin Nutr 2007 86 2 472 479 17684221
  28. [36]Flint AJ Hu FB Glynn RJ Whole grains and incident hypertension in men Am J Clin Nutr 2009 90 3 493 498 19571218 PMC2728640
  29. [37]Leinonen KS Poutanen KS Mykkänen HM Rye Bread Decreases Serum Total and LDL Cholesterol in Men with Moderately Elevated Serum Cholesterol J Nutr 2000 130 2 164 170 10720164
  30. [38]Maki KC Beiseigel JM Jonnalagadda SS Whole-Grain Ready-to-Eat Oat Cereal, as Part of a Dietary Program for Weight Loss, Reduces Low-Density Lipoprotein Cholesterol in Adults with Overweight and Obesity More than a Dietary Program Including Low-Fiber Control Foods Journal of the American Dietetic Association 2010 110 2 205 214 20102847
  31. [39]Tighe P Duthie G Vaughan N Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial Am J Clin Nutr 2010 92 4 733 740 20685951
  32. [40]Saltzman E Das SK Lichtenstein AH An Oat-Containing Hypocaloric Diet Reduces Systolic Blood Pressure and Improves Lipid Profile beyond Effects of Weight Loss in Men and Women J Nutr 2001 131 5 1465 1470 11340101
  33. [41]Aune D Chan DSM Lau R Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies BMJ 2011 343 PMC3213242 22074852
  34. [42]Aarestrup J Kyrø C Christensen J Whole Grain, Dietary Fiber, and Incidence of Endometrial Cancer in a Danish Cohort Study Nutrition and Cancer 2012 64 8 1160 1168 23163844
  35. [43]Kasum CM Nicodemus K Harnack LJ Jacobs DR Folsom AR Whole Grain Intake and Incident Endometrial Cancer: The Iowa Women’s Health Study Nutrition and Cancer 2001 39 2 180 186 11759278
  36. [44]Hedelin M Löf M Andersson TM-L Adlercreutz H Weiderpass E Dietary Phytoestrogens and the Risk of Ovarian Cancer in the Women’s Lifestyle and Health Cohort Study Cancer Epidemiology Biomarkers & Prevention 2011 20 2 308 317 21098648
  37. [45]Nicodemus K Jacobs D Jr Folsom A Whole and refined grain intake and risk of incident postmenopausal breast cancer (United States) Cancer Causes & Control 2001 12 10 917 925 11808711
  38. [46]Egeberg R Olsen A Loft S Intake of whole grain products and risk of breast cancer by hormone receptor status and histology among postmenopausal women International Journal of Cancer 2009 124 3 745 750 19004010
  39. [47]Egeberg R Olsen A Christensen J Intake of whole-grain products and risk of prostate cancer among men in the Danish Diet, Cancer and Health cohort study Cancer Causes & Control 2011 22 8 1133 1139 21656162
  40. [48]Slavin J Why whole grains are protective: biological mechanisms Proceedings of the Nutrition Society 2003 62 01 129 134 12740067
  41. [49]Alan P-A Ofelia R-Sn Patricia T Rosario Maribel R-Sn Cereal bran and wholegrain as a source of dietary fibre: technological and health aspects Int J Food Sci Nutr 2013 63 7 882 892 22486424
  42. [50]Lattimer JM Haub MD Effects of Dietary Fiber and Its Components on Metabolic Health Nutrients 2010 2 12 1266 1289 22254008 PMC3257631
  43. [51]Zhou K Su L Yu L Phytochemicals and Antioxidant Properties in Wheat Bran J Agric Food Chem 2004 52 20 6108 6114 15453674
  44. [52]Kawano Y Matsuoka H Takishita S Omae T Effects of Magnesium Supplementation in Hypertensive Patients: Assessment by Office, Home, and Ambulatory Blood Pressures Hypertension 1998 32 2 260 265 9719052
  45. [53]Shechter M Merz CNB Paul-Labrador M Oral magnesium supplementation inhibits platelet-dependent thrombosis in patients with coronary artery disease Am J Cardiol 1999 84 2 152 156 10426331

Authors
Wu, H., Flint, A. J., Qi, Q., van Dam, R. M., Sampson, L. A., Rimm, E. B., Holmes, M. D., Willett, W. C., Hu, F. B., & Sun, Q.
Affiliations
  • Harvard University (US)
  • Albert Einstein College of Medicine (US)
  • Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore4National University Health System, Singapore, Republic of Singapore
  • Brigham and Women's Hospital (US)
Corresponding author
Sun, Qi
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2015-03-01
Volume
175
Issue
3
Pages
373
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2014.6283
PMC
PMC4429593
OpenAlex
W2040582472
Cited by
191
References
52
Citations by year
2026: 3 · 2025: 15 · 2024: 16 · 2023: 13 · 2022: 18 · 2021: 11 · 2020: 18 · 2019: 19 · 2018: 25 · 2017: 19 · 2016: 29 · 2015: 5
FWCI
27.88
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • National University of Singapore (submittedVersion)
Funders
  • State of Connecticut Department of Public Health
  • National Institutes of Health (UM1-CA167552, CA-167552, DK58845, CA 87969, CA055075)
  • National Heart, Lung, and Blood Institute (HL60712, R01HL060712, R01HL035464, HL-034594, R01 HL35464, HL35464, CA167552, R00HL098459, R01HL034594)
  • National Cancer Institute (U19CA055075, CA055075, P01CA087969, U54CA155626, P01CA055075, UM1CA186107, UM1CA167552, [P01 CA87969)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, R01 DK58845)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
Keywords
whole grain intake, mortality, cardiovascular mortality, cancer mortality, all-cause mortality, Nurses' Health Study, Health Professionals Follow-up Study, prospective cohort, diet and longevity, Alternative Healthy Eating Index, dietary habits, cancer risk factors, cardiovascular risk factors, food frequency questionnaire, cardiovascular disease prevention, lifestyle modification
MeSH terms
Adult, Cardiovascular Diseases, Edible Grain, Diet, Female, Humans, Male, Middle Aged, Mortality, Prospective Studies, United States

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