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Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study
Open accessAbstract
Background Recent epidemiologic study results showed that subjects who had high intakes of whole-grain foods had lower risks of death and heart disease than did subjects who had low intakes. However, the findings were inconsistent for fruit and vegetable intake. Objective The relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of total mortality and the incidence of coronary artery disease (CAD) and ischemic stroke were studied in the Atherosclerosis Risk in Communities (ARIC) cohort (baseline: age 45-64 y, n = 15,792). Design Proportional hazards regression analyses were used to assess the relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of death and the incidence of CAD and ischemic stroke, with adjustment for age, sex, ethnicity, energy intake, and cardiovascular disease risk factors. Dietary intakes were assessed by using a food-frequency questionnaire. Results Over an 11-y follow-up period, whole-grain intake was inversely associated with total mortality and incident CAD. The relative hazards of death for quintiles 2-5 of fruit and vegetable intake were 1.08 (95% CI: 0.88, 1.33), 0.94 (0.75, 1.17), 0.87 (0.68, 1.10), and 0.78 (0.61, 1.01), respectively; P for trend = 0.02. An inverse association between fruit and vegetable intake and CAD was observed among African Americans but not among whites (P for interaction = 0.01). The risk of ischemic stroke was not significantly related to whole-grain, refined-grain, or fruit and vegetable consumption. Conclusion These observational findings suggest a beneficial effect of whole-grain and fruit and vegetable consumption on the risks of total mortality and incident CAD but not on the risk of ischemic stroke.
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“Of the cohort studies on whole grains and cardiovascular disease or all cause mortality, some16 20 22 but not all4 15 17 21 29 studies reported a possible plateau effect, with most of the benefit observed at relatively low levels of intake.”
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“Global estimates, mostly derived from high-income countries, show that 3% of total health system resources are devoted to stroke.[10]”
BackgroundKim, J. S., Lim, J. H., & Cho, S. K. (2023) · Applied Biological Chemistry · doi:10.1186/s13765-023-00786-2 · Cited by 24
“Previous studies have shown that increased fruit and vegetable intake is associated with reduced mortality [3, 4].”
BackgroundWhole Grain Intake and Survival Among Scandinavian Colorectal Cancer Patients
Skeie, G., Braaten, T., Olsen, A., Kyrø, C., Tjønneland, A. M., Nilsson, L. M., Landberg, R., & Lund, E. (2013) · Nutrition and Cancer · doi:10.1080/01635581.2014.847472 · Cited by 22
O’Sullivan, A. M., Armstrong, P., Schuster, G. U., Pedersen, T. L., Allayee, H., Stephensen, C. B., & Newman, J. W. I. (2013) · Journal of Nutrition · doi:10.3945/jn.113.181875 · Cited by 22
Foods, Dietary Patterns and Occupational Class and Leukocyte Telomere Length in the Male Population
Karimi, B., Nabizadeh, R., Yunesian, M., Mehdipour, P., Rastkari, N., & Aghaie, A. (2017) · American Journal of Men s Health · doi:10.1177/1557988317743385 · Cited by 24
“Per other studies, whole grains, vegetables, and nuts were inversely associated with age and total mortality-related diseases (Jaiswal McEligot, Largent, Ziogas, Peel, & Anton-Culver, 2006; Knoops et al., 2004; Steffen et al., 2003).”
BackgroundIntake of fruit and vegetables and risk of stroke: an overview
Johnsen, S. P. (2004) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/00075197-200411000-00012 · Cited by 23
Stroke Risk among Chinese Immigrants in New York City
Fang, J., Foo, S. H., Fung, C., Wylie‐Rosett, J., & Alderman, M. H. (2006) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-006-9009-7 · Cited by 22
“The association of food intake and stroke has been widely reported in the United States [16–19] as well as in Japan [20, 21], but not among Chinese in the United States.”
BackgroundSteffen, L. M., & Hootman, K. C. (2016) · Current Nutrition Reports · doi:10.1007/s13668-016-0176-4 · Cited by 24
Self-citationRecovery and utilization of bioactives from food processing waste
Kumar, S., Kushwaha, R., & Verma, M. L. (2019) · Elsevier eBooks · doi:10.1016/b978-0-444-64323-0.00002-3 · Cited by 22
Dietary intake and coronary heart disease: A variety of nutrients and phytochemicals are important
Tucker, K. L. (2004) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-004-0031-6 · Cited by 22
Kim, J., Jia, Y., Lee, J., Nam, B., Lee, J. H., Shin, K., Hurh, B. S., Choi, Y. H., & Lee, S. (2014) · Phytotherapy Research · doi:10.1002/ptr.5134 · Cited by 20
“001) (Liu et al., 1999; Steffen et al., 2003).”
BackgroundInfluentialThe Mediterranean Diet: Socio-cultural Relevance for Contemporary Health Promotion
Phull, S. (2015) · The Open Public Health Journal · doi:10.2174/1874944501508010035 · Cited by 25
“the most part, has taken a reductionist approach to the analysis of various foods consumed in the region in order to validate adherence to the whole diet model [2, 7, 8].”
BackgroundAzuma, K., Osaki, T., Ifuku, S., Maeda, H., Morimoto, M., Takashima, O., Tsuka, T., Imagawa, T., Okamoto, Y., Saimoto, H., et al. (2013) · Bioactive Carbohydrates and Dietary Fibre · doi:10.1016/j.bcdf.2013.09.006 · Cited by 20
Noori, N., Nafar, M., Pour-Reza-Gholi, F., Ahmadpoor, P., Samadian, F., Firouzan, A., & Einollahi, B. (2009) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2009.06.001 · Cited by 20
Lim, C. G. Y., Tai, E. S., & van Dam, R. M. (2021) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqab403 · Cited by 19
Association of Total Energy Intake with 29-Year Mortality in the Japanese: NIPPON DATA80
Nagai, M., Ohkubo, T., Miura, K., Fujiyoshi, A., Okuda, N., Hayakawa, T., Yoshita, K., Arai, Y., Nakagawa, H., Nakamura, K., et al. (2015) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.29991 · Cited by 19
Teixeira, F., Nunes, G., Santos, M. M. R., Cândido, C. J., dos Santos, E. F., & Novello, D. (2017) · Revista da Universidade Vale do Rio Verde · doi:10.5892/ruvrd.v15i1.2765 · Cited by 18
Barrett, E. M., Batterham, M. J., & Beck, E. J. (2020) · Public Health Nutrition · doi:10.1017/s1368980019004233 · Cited by 19
Kissock, K., Neale, E. P., & Beck, E. J. (2020) · Public Health Nutrition · doi:10.1017/s1368980019004452 · Cited by 18
“Therefore notably, some studies include any amount of whole grain from any foods(22,26), some specify a minimum whole grain proportion in foods and only count contributions from those foods(17,19) and”
BackgroundPozzo, L., Vizzarri, F., Ciardi, M., Nardoia, M., Palazzo, M., CASAMASSIMA, D., & Longo, V. G. (2015) · Food and Chemical Toxicology · doi:10.1016/j.fct.2015.07.004 · Cited by 18
Brownlee, I. A., Kuznesof, S. A., Moore, C. S., Jebb, S. A., & Seal, C. J. (2013) · British Journal Of Nutrition · doi:10.1017/s0007114512006034 · Cited by 18
Murphy, K. J., Marques-Lopes, I., & Sánchez‐Tainta, A. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-811259-5.00007-x · Cited by 18
Zhang, Z., Chen, B., Zeng, J., Fan, M., Xu, W., Li, X., Xing, Y., & Xu, S. (2022) · Nutrients · doi:10.3390/nu14132650 · Cited by 17
Association between whole grain intake and stroke risk: evidence from a meta-analysis.
Fang, L., Wen, L., Zhang, W., Wang, Y., & Fu, S. (2015) · PubMed · Cited by 17
The whole grain content of foods consumed in the UK
Jones, A. R., Mann, K. D., Kuznesof, S. A., Richardson, D. P., & Seal, C. J. (2016) · Food Chemistry · doi:10.1016/j.foodchem.2016.07.063 · Cited by 17
“However, previous studies have also included non-whole-grain ingredients such as wheat germ and bran in analyses of whole grain intake (Jacobs, Meyer, Kushi, & Folsom, 1998; Liu et al., 1999, 2000; Steffen et al., 2003).”
ResultBiological mechanisms of glycan- and glycosaminoglycan-based nutraceuticals
Tang, Y., Cui, Y., de Agostini, A. I., & Zhang, L. (2019) · Progress in molecular biology and translational science · doi:10.1016/bs.pmbts.2019.02.012 · Cited by 17
Metadata
- Authors
- Steffen, L. M., Jacobs, D. R., Stevens, J., Shahar, E., Carithers, T., & Folsom, A. R.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Steffen, Lyn M
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2003-09
- Volume
- 78
- Issue
- 3
- Pages
- 383-390
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W2100700568
- Cited by
- 538
- References
- 34
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 11 · 2023: 13 · 2022: 24 · 2021: 25 · 2020: 19 · 2019: 14 · 2018: 12 · 2017: 22 · 2016: 30 · 2015: 29 · 2014: 33 · 2013: 36 · 2012: 35
- FWCI
- 22.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc55021-47-0-1, n01hc55020-39-0-0, n01hc55016-37-0-0, n01hc055022-024, n01hc55019-35-0-1, n01hc55018-38-0-1, n01hc55015-48-0-1)
- National Heart, Lung, and Blood Institute (N01-HC55022, N01-HC-55018, N01 HC 55020, N01 HC 55019, N01-HC55016, N01‐HC‐55015, N01-HC55021)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- whole grain intake, fruit and vegetable intake, all-cause mortality, coronary artery disease, ischemic stroke, dietary intake, African Americans, cardiovascular risk
- MeSH terms
- Arteriosclerosis, Edible Grain, Coronary Artery Disease, Diet, Female, Follow-Up Studies, Fruit, Humans, Male, Surveys and Questionnaires, Risk, Vegetables, Cohort Studies, Incidence, Proportional Hazards Models, Stroke
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