The Relationship between Whole-Grain Intake and Measures of Cognitive Decline, Mood, and Anxiety—A Systematic Review
Open accessAbstract
Greater intake of whole grains, compared to refined grains, is consistently associated with a reduced risk of cardiovascular disease and type 2 diabetes, both of which are associated with cognitive decline. To better understand the relationship between whole-grain intake, cognition, mood, and anxiety, a systematic review was conducted to synthesize available evidence linking whole grains to these outcomes. Four electronic databases were searched from inception to August 2021 for potentially relevant observational and interventional studies. Risk of bias (RoB) assessments were performed using the newly developed Nutrition Quality Evaluation Strengthening Tools, and the Grades of Recommendation, Assessment, Development, and Evaluation approach was used to determine the strength of evidence for each outcome. In total, 23 studies [4 randomized controlled trials (RCTs) and 19 observational studies] met the predefined eligibility criteria. Of these,12 studies included analysis of whole-grain intake and cognitive decline, 9 included mood outcomes, and 2 included both cognition and mood outcomes. The overall evidence for an association between whole-grain intake and cognition is inconclusive. With respect to mood outcomes, evidence from RCTs prospective cohort and case-control studies suggest that higher intake is linked to improved outcomes for mood and depression although the evidence is mixed for cross-sectional studies. Reporting of whole-grain intake fell short of suggested standards, and the strength of available evidence was low or very low for all outcomes. A high RoB toward studies reporting results was also noted, complicating both the interpretation of some studies and the combined evidence. Of note, few well-designed RCTs assessing the effect of whole-grain intake on measures of cognition, mood, and anxiety were identified, highlighting the need for more studies in this area. The available, although limited, evidence suggests that greater whole-grain intake is associated with better mood and anxiety-related scores and is inconclusive regarding cognitive outcomes. PROSPERO registration: CRD42021266355.
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A systematic review showed an association between reduced anxiety and higher whole-grain intake.
“A systematic review showed that there was an association between reduced anxiety and a higher whole-grain intake [52]”
From The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes. (2025) · cites this paper as [52]
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Dietary intake and cognitive function: evidence from the Bogalusa Heart Study
Fortune, N. C., Harville, E. W., Guralnik, J. M., Gustat, J., Chen, W., Qi, L., & Bazzano, L. (2019) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqz026 · Cited by 32 · see citing works
Musa‐Veloso, K., Noori, D., Venditti, C. C., Poon, T. H., Johnson, J., Harkness, L. S., O’Shea, M., & Chu, Y. (2020) · Journal of Nutrition · doi:10.1093/jn/nxaa349 · Cited by 32 · see citing works
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Koecher, K. J., McKeown, N. M., Sawicki, C. M., Menon, R. S., & Slavin, J. L. (2019) · Nutrition Reviews · doi:10.1093/nutrit/nuz008 · Cited by 28 · cited 1× · see citing works
“665 microbiota populations is mixed, with most studies finding no or limited changes to fecal microbiota relative to refined grains, possibly explained by a high degree of heterogeneity in study design and intervention foods [65,66], a reoccurring theme in whole-grain intervention studies.”
BackgroundSelf-citationXu, D., Fu, L., Pan, D., Lu, Y., Yang, C., Wang, Y., Wang, S., & Sun, G. (2021) · Nutrients · doi:10.3390/nu14010109 · Cited by 27 · see citing works
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Kelly, S., Greene-Finestone, L. S., Yetley, E. A. D., Benkhedda, K., Brooks, S. P. J., Wells, G. A., & MacFarlane, A. J. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab335 · Cited by 24 · see citing works
Homocysteine, antioxidant micronutrients and late onset dementia
Whalley, L. J., Duthie, S. J., Collins, A. R., Starr, J. M., Deary, I. J., Lemmon, H. A., Duthie, A. C., Murray, A. D., & Staff, R. T. (2013) · European Journal of Nutrition · doi:10.1007/s00394-013-0526-6 · Cited by 23 · see citing works
Esmaeilpour, M., Ghasemian, S., & Alizadeh, M. (2019) · British Journal Of Nutrition · doi:10.1017/s0007114519000333 · Cited by 23 · see citing works
Whole grains beyond fibre: what can metabolomics tell us about mechanisms?
Ross, A. B. (2014) · Proceedings of The Nutrition Society · doi:10.1017/s0029665114001542 · Cited by 21 · see citing works
Self-citationSavitz, D. A., & Forastiere, F. (2021) · Occupational and Environmental Medicine · doi:10.1136/oemed-2021-107702 · Cited by 21 · see citing works
Kleppang, A. L., Ridder, K. D., Haugland, S. H., & Stea, T. H. (2021) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-021-01215-7 · Cited by 21 · see citing works
Kuroda, Y., Matsuzaki, K., Wakatsuki, H., Shido, O., Harauma, A., Moriguchi, T., Sugimoto, H., Yamaguchi, S., Yoshino, K., & Hashimoto, M. (2019) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.65.s80 · Cited by 17 · see citing works
Impact of a Nordic diet on psychological function in young students
Abbaszadeh, A., Saharkhiz, M., Khorasanchi, Z., Karbasi, S., Askari, M., Hoseini, Z. S., Ayadilord, M., Mahmoudzadeh, S., Rezapour, H., Enayati, H., et al. (2020) · Nutrition and Health · doi:10.1177/0260106020964981 · Cited by 17 · see citing works
Assessment of dietary habits of patients with recurrent depressive disorders
Stefańska, E., Wendołowicz, A., Cwalina, U., Kowzan, U., Konarzewska, B., Szulc, A., & Ostrowska, L. (2014) · Archives of Psychiatry and Psychotherapy · doi:10.12740/app/31780 · Cited by 11 · see citing works
Food consumption and mild cognitive impairment in Qingdao rural elderly: A cross-sectional study.
Xu, R. P., Gao, T., Cai, J., Zhang, H., Zhou, H. P., Ding, K., Chen, L., Zhong, F., & Ma, A. (2020) · PubMed · doi:10.6133/apjcn.202012_29(4).0023 · Cited by 11 · see citing works
Lanuza, F., Petermann-Rocha, F. E., Celis-Morales, C. A., Concha‐Cisternas, Y., Nazar, G., Troncoso-Pantoja, C., Lassere-Laso, N., Martínez-Sangüinetti, M. A., Parra-Soto, S. L., Zamora‐Ros, R., et al. (2021) · Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) · Cited by 11 · see citing works
Effect of Continuous Dewaxed Brown Rice Ingestion on the Cognitive Function of Elderly Individuals
Uenobe, M., Saika, T., Waku, N., Ohno, M., & Inagawa, H. (2019) · Journal of Nutritional Science and Vitaminology · doi:10.3177/jnsv.65.s122 · Cited by 9 · cited 6× · see citing works
“Neither study found a change to the Hasegawa Dementia Scale (HDS), although one found an improvement in HDS score in a low cognitive function subgroup associated with improved cognition [30] (Table 2, Supplemental Table 6), whereas a 2-y intervention found that daily intake of preprocessed brown rice improved changes…”
BackgroundMethodResultInfluentialKurkinen, K., Kärkkäinen, O. K., Lehto, S. M., Luoma, I., Kraav, S., Nieminen, A. I., Kivimäki, P., Therman, S., & Tolmunen, T. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100261 · Cited by 9 · see citing works
Lanuza, F., Petermann-Rocha, F., Celis-Morales, C., Concha-Cisternas, Y., Nazar, G., Troncoso-Pantoja, C., Lassere-Laso, N., Martínez-Sanguinetti, M. A., Parra-Soto, S., Zamora-Ros, R., et al. (2021) · Public Health Nutrition · doi:10.1017/s1368980021004869 · Cited by 9 · cited 1× · see citing works
“B.R oss et al. A dvances in N utrition 14 (2023) 652 –670 658 Mood, anxiety, and depression Lanuza, 2021 [45] Chile 2031 65.9 [NR] 48.2 NR Generally healthy14 FFQ (whole-grain bread, whole-grain cereal, or any food product that contains whole-grain flour) Composite International Diagnostic…”
BackgroundInfluentialStefańska, E., Wendołowicz, A., Cwalina, U., Kowzan, U., Konarzewska, B., Szulc, A., & Ostrowska, L. (2017) · Annals of Agricultural and Environmental Medicine · doi:10.5604/12321966.1233554 · Cited by 7 · see citing works
Jones, J. M., Korczak, R., Peña, R. J., & Braun, H. J. (2017) · Cereal Foods World · doi:10.1094/cfw-62-3-0104 · Cited by 5 · see citing works
Jones, J. M., Peña, R. J., Korczak, R., & Braun, H. J. (2017) · Cereal Foods World · doi:10.1094/cfw-62-4-0162 · Cited by 2 · see citing works
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Research works printed but not linked: 1
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Cited by
Sorted by citations
Enriching the Mediterranean diet could nourish the brain more effectively
Picone, P., Girgenti, A., Buttacavoli, M., & Nuzzo, D. (2024) · Frontiers in Nutrition · doi:10.3389/fnut.2024.1489489 · Cited by 44 · see citing works
Nutrition for dementia prevention: a state of the art update for clinicians
Townsend, R. F., McGrattan, A., Gregory, S., Ritchie, C. W., Stevenson, E., & Shannon, O. M. (2024) · Age and Ageing · doi:10.1093/ageing/afae030 · Cited by 28 · see citing works
Kelly, S., Brooks, S. P. J., Benkhedda, K., MacFarlane, A. J., Greene-Finestone, L. S., Skidmore, B., Clifford, T., & Wells, G. A. (2024) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2024.111408 · Cited by 28 · see citing works
Jian, Y., Cheng, L., Hong, Y., Li, Z., Li, C., Ban, X., Zhu, L., & Gu, Z. (2023) · Nutrients · doi:10.3390/nu15245080 · Cited by 23 · see citing works
“SDS, RS, and many whole grains could reduce the risks of these metabolic diseases through a smooth postprandial glucose response and positive regulation of the gut microenvironment, thus hindering and delaying the related cognitive decline [158,159].”
BackgroundAssociation of Whole Grain Consumption and Cognitive Decline
Liu, X.-R., Beck, T., Dhana, K., Desai, P., Krueger, K. R., Tangney, C., Holland, T., Agarwal, P., Evans, D. A., & Rajan, K. (2023) · Neurology · doi:10.1212/wnl.0000000000207938 · Cited by 17 · see citing works
“13 In addition, there is limited evidence on how whole grain consumption relates to cognitive function, particularly, among di ff erent racial groups.”
BackgroundRelationship between triglyceride-glucose index and endometriosis: a cross-sectional analysis
Cao, Y., Yang, Q., Mai, Q., Wuliu, J., & Deng, K. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03287-6 · Cited by 15 · see citing works
“Insulin resistance may induce an inflammatory response, creating a vicious cycle that disrupts endometrial tissue function [51, 52], facilitating the attachment and spread of ectopic endometrial tissue [53, 54].”
BackgroundWang, H., Guan, Y., Du, H., Dai, P., Zhong, J., Yu, M., & Li, N. (2025) · Nutrients · doi:10.3390/nu17071271 · Cited by 14 · see citing works
“Whole grains exert protective effects on mental health [48].”
Lu, L., Cai, S., Xiao, Q., Peng, J., Li, F., Li, Y., Li, B., Li, T., & Rong, S. (2024) · European Journal of Nutrition · doi:10.1007/s00394-024-03522-8 · Cited by 12 · see citing works
Dietary Patterns and Indicators of Cognitive Function
Chen, H., Cortese, M., Flores‐Torres, M. H., Tessier, A., Wang, D. D., Kang, J. H., Eliassen, A. H., Stampfer, M. J., Ascherio, A., Willett, W. C., et al. (2026) · JAMA Neurology · doi:10.1001/jamaneurol.2026.0062 · Cited by 12 · see citing works
Godos, J., Micek, A., Carota, G., Venuta, C. D., Mauro, A. D., Furnari, F., Balzano, R., Giorgio, J. D., Leonardi, A., Caruso, G., et al. (2025) · Mediterranean Journal of Nutrition and Metabolism · doi:10.1177/1973798x251360765 · Cited by 11 · see citing works
“122 Taken together, these fi ndings underscore the mechanistic basis by which (poly)phenolic compounds in whole grains contribute to brain health preservation, providing a compelling rationale for their inclusion in dietary strategies aimed at promoting cognitive resilience and neuroprotection.”
InfluentialLi, Z., Ye, K. X., Yang, M., Lee, T.-S. W., John Suckling, A., Feng, L., Wang, Z., & Chen, C. (2025) · Food Research International · doi:10.1016/j.foodres.2025.116977 · Cited by 8 · see citing works
The Effect of Anxiety and Nutritional Habits on the Body Distortion of Athletes.
Ramírez-Goerke, M. I., Tornero-Aguilera, J. F., Martín-Rodríguez, A., & Clemente-Suárez, V. J. (2025) · Nutrients · doi:10.3390/nu17040682 · Cited by 6 · see citing works
“A systematic review showed that there was an association between reduced anxiety and a higher whole-grain intake [52], which agrees with our results.”
Zapawi, M. M. M., You, Y. X., Shahar, S., Shahril, M. R., Rivan, N. F. M., Fakhruddin, N. N. I. N. M., & Yap, A. X. W. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04966-7 · Cited by 6 · see citing works
“A systematic review by Ross et al. (2023) highlighted that most studies reported a positive relationship between whole-grain consumption and measures of cognitive decline, anxiety, and mood.”
BackgroundExploring the therapeutic potential of barley grain in type 2 diabetes management: a review
Gebre, B. A., Liu, X., Zhang, C., Ma, M., Abate, S., Yao, T., & Sui, Z. (2024) · International Journal of Food Science & Technology · doi:10.1111/ijfs.17205 · Cited by 6 · see citing works
Li, S., Ma, Y., Wang, J., Zhang, M., Zhang, W., Xu, Y., & Chen, Z. (2026) · Foods · doi:10.3390/foods15040791 · Cited by 5 · see citing works
The quality of spring common wheat varieties for making bread from whole grain flour
Askhadullin, D. F., Askhadullin, D. F., Василова, Н. З., Kirillova, E. S., Saubanova, G., Gaifullina, G. R., Хусаинова, И. И., & Tazutdinova, M. R. (2025) · Agrarian science · doi:10.32634/0869-8155-2025-398-09-125-133 · Cited by 3 · see citing works
Soldevila‐Domenech, N., Ayala‐García, A., Zhou, X., Yi, S.-Y. Y., Ros, E., Sala‐Vila, A., Lehtisalo, J., Steffen, L. M., de la Torre, R., Blackwell, C. K., et al. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101694 · Cited by 3 · see citing works
Miyake, H., Nanri, A., Okazaki, H., Miyamoto, T., Kochi, T., Kabe, I., Tomizawa, A., Yamamoto, S., Konishi, M., Dohi, S., et al. (2025) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13842 · Cited by 3 · see citing works
“28,29 This has prompted us to also create a modi fi ed score by incorporating these foods into the traditional diet.”
Shen, M., Yu, X., Wu, S., Qiu, J., Wang, R., Li, K., & Zhang, Q. (2025) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2025.105182 · Cited by 2 · see citing works
Betaine: A Promising Natural Product for Neurological and Psychiatric Diseases
Zhang, Y., Ke, Z., Luo, J., Chen, Q., Jiang, X., Xiong, J., & Deng, L. (2025) · Current Neuropharmacology · doi:10.2174/011570159x375540250718094903 · Cited by 2 · see citing works
“Novel medicinal agents are being explored, and the beneficial roles of druggable nutraceuticals in preventing and/or treating these diseases have been emphasized [6].”
Guo, S., Feng, J., Wang, Y., & Li, H. (2024) · International Journal of Food Sciences and Nutrition · doi:10.1080/09637486.2024.2420265 · Cited by 2 · see citing works
“Studies have shown that higher whole grain intake is associated with improved emotional state, and increased whole grain intake can help reduce anxiety and depression mood scores (Ross et al. 2023).”
Gouhari, F., Zandi, R., Talebi, S., Mehrvar, A., & Shariatpanahi, Z. V. (2024) · Journal of Functional Foods · doi:10.1016/j.jff.2024.106325 · Cited by 1 · see citing works
Exploring the relationship between dietary index for gut microbiota and cognitive function
Sun, C., Tan, T., & Chen, Z. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1618220 · Cited by 1 · see citing works
Diet, brain, and mental health
Melaku, Y. A., Mekonnen, T. C., Abebe, Z., & Shi, Z. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-33841-0.00018-x · Cited by 1 · see citing works
Chen, Y., Cao, Y., Fang, W., Sannoh, M., Zhang, H., Ni, R., & Pan, G. (2024) · European Journal of Clinical Nutrition · doi:10.1038/s41430-024-01499-5 · Cited by 1 · see citing works
“The detrimental effects of plant-derived foods (such as re fi ned grains, sugars, and salt-preserved vegetables) on cognition have been widely observed [10 – 13].”
Takahashi, M., Kokubun, K., Yoda, M., Kawaoka, S., Nakase, T., Ohara, T., & Taki, Y. (2024) · Research Square · doi:10.21203/rs.3.rs-4719225/v1
Effects of different intake levels of brown rice and whole wheat on the mental state of mice
Zhi, L., Wu, T., Zhu, Y., Zhao, Q., Xue, Y., & Shen, Q. (2025) · Food Chemistry · doi:10.1016/j.foodchem.2025.146664
Hezaveh, Z. S., Moodi, M., Fakhrzadeh, H., Arzaghi, S. M., Esmaeili, A., Khodabakhshi, H., Shadman, Z., Khorashadizadeh, M., Ejtahed, H., & Sharifi, F. (2025) · Nutrire · doi:10.1186/s41110-025-00408-5
“…symptoms consumed almost as much bread as those with minimal case-control study showing higher whole-grain intake among non-depressed individuals [30] as well as studies from Chile [ 31 ] and a recent systematic review [ 15 ] linking greater whole-grain intake to better mood in older adults.”
Bot, M., & Penninx, B. W. J. H. (2026) · medRxiv · doi:10.64898/2026.02.05.26345645
Ageing, Wealth, and Diet: A Global Cross-National Analysis of Cereal Consumption and Dementia Risk
You, W., Garcia, L. R., Ratnayake, S. G. K., Sumar, B., Henneberg, M., Feng, S., & Chang, H.-C. (2026) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000551241
Wang, Z., & Wang, S. (2026) · European Journal of Nutrition · doi:10.1007/s00394-026-03959-z
Masood, F., Minó, A., Sadiq, F., Mahmood, R., Costanzo, A. D., & Angiolillo, A. (2026) · Nutrients · doi:10.3390/nu18071135
“…common among healthier populations, while more refined and less varied dietary pattern are frequently observed among individuals with cognitive decline [6–8 Furthermore, both the HLT group and individuals with dementia were asked why they preferred a specific type of flour for preparing chapati.”
Takahashi, M., Kokubun, K., Yoda, M., Kawaoka, S., Nakase, T., Tadashi, O., & Taki, Y. (2026) · BMC Complementary Medicine and Therapies · doi:10.1186/s12906-026-05384-5
Whole and refined grains consumption and social interaction in children: a cross-sectional study
Aliakbari, M., Lari, M. M. H., Nouri, P., Mollaei, M., Jamkarani, Z. K., Nematolahi, F., & Milajerdi, A. (2026) · BMC Nutrition · doi:10.1186/s40795-026-01350-z
“A systematic review by Ross et al. on adults concluded that higher intake of whole grains was associated with better mood and anxiety-related scores [11].”
Brain Foods: A Narrative Review of Food Items and Their Impact on Cognition over the Life Course
Hardaway, C., Tiwari, C., Bonna, A. S., Adesogan, A. T., & McKune, S. L. (2026) · Nutrients · doi:10.3390/nu18111779
“Whole grains provide steady glucose, B vitamins, and fiber that support energy metabolism and gut/brain signaling [72].”
InfluentialChakraborty, A., & Guha, S. (2026) · Recent Progress in Nutrition · doi:10.21926/rpn.2602008
Mirjalili, F. S., Jambarsang, S., Yazd, E. F., Dianatinasab, M., Eussen, S. J. P. M., Schram, M. T., Koster, A., Salehi‐Abargouei, A., Yu, E. Y.-W., Zeegers, M. P., et al. (2026) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2026.101415
Ren, Y., Li, Y., Wang, L., Fan, M., & Ren, Y. (2026) · Food Bioscience · doi:10.1016/j.fbio.2026.109591
Dietary factors and cognitive aging: Mapping epidemiological evidence and the role of gut microbiota
Chen, H., Shen, J., Liu, X., Ni, J., Rong, S., Zheng, J.-S., Xu, W., Huang, G., Luo, B., Zheng, Y., et al. (2026) · The Innovation Nutrition · doi:10.59717/j.xinn-nutri.2026.100030
van Vuren, E. J., O'Neil, A. E., Ashtree, D. N., Lane, M. M., Orr, R., Pieters, M., & van Zyl, T. (2026) · Depression and Anxiety · doi:10.1155/da/2938819
The MIND Diet and Physical Activity in Cognitive Ageing: From Mechanisms to Multidomain Trials
Lim, Y. L., Tan, X., Heng, L. C., & Cheong, C. Y. (2026) · Nutrients · doi:10.3390/nu18213579
- Authors
- Ross, A. B., Shertukde, S. P., Livingston Staffier, K., Chung, M., Jacques, P. F., & McKeown, N. M.
- Affiliations
- AgResearch (NZ)
- Tufts University (US)
- Boston University (US)
- Corresponding author
- Ross, Alastair B.
- Venue
- Advances in Nutrition
- Publisher
- Elsevier BV
- Published
- 2023-07
- Volume
- 14
- Issue
- 4
- Pages
- 652-670
- ISSN
- 2156-5376 (ISSN-L)
- 2161-8313
- PMC
- PMC10334137
- OpenAlex
- W4366438784
- Cited by
- 41
- References
- 104
- Citations by year
- 2026: 17 · 2025: 11 · 2024: 11 · 2023: 2
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Advances in Nutrition (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by-nc-nd)
- AgResearch
- Funders
- General Mills
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- whole grains, refined grains, cognitive decline, mood, depression, anxiety, diet and cognition, risk of bias
- MeSH terms
- Whole Grains, Anxiety, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Cognitive Dysfunction
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