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Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies
Open accessAbstract
OBJECTIVE: To examine the associations between the intake of total and individual whole grain foods and the risk of type 2 diabetes. DESIGN: Prospective cohort studies. SETTING: Nurses' Health Study (1984-2014), Nurses' Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016), United States. PARTICIPANTS: 158 259 women and 36 525 men who did not have type 2 diabetes, cardiovascular disease, or cancer at baseline. MAIN OUTCOME MEASURES: Self-reports of incident type 2 diabetes by participants identified through follow-up questionnaires and confirmed by a validated supplementary questionnaire. RESULTS: During 4 618 796 person years of follow-up, 18 629 participants with type 2 diabetes were identified. Total whole grain consumption was categorized into five equal groups of servings a day for the three cohorts. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole grain consumption had a 29% (95% confidence interval 26% to 33%) lower rate of type 2 diabetes compared with those in the lowest category. For individual whole grain foods, pooled hazard ratios (95% confidence intervals) for type 2 diabetes in participants consuming one or more servings a day compared with those consuming less than one serving a month were 0.81 (0.77 to 0.86) for whole grain cold breakfast cereal, 0.79 (0.75 to 0.83) for dark bread, and 1.08 (1.00 to 1.17) for popcorn. For other individual whole grains with lower average intake levels, comparing consumption of two or more servings a week with less than one serving a month, the pooled hazard ratios (95% confidence intervals) were 0.79 (0.75 to 0.83) for oatmeal, 0.88 (0.82 to 0.94) for brown rice, 0.85 (0.80 to 0.90) for added bran, and 0.88 (0.78 to 0.98) for wheat germ. Spline regression showed a non-linear dose-response association between total whole grain intake and the risk of type 2 diabetes where the rate reduction slightly plateaued at more than two servings a day (P<0.001 for curvature). For whole grain cold breakfast cereal and dark bread, the rate reduction plateaued at about 0.5 servings a day. For consumption of popcorn, a J shaped association was found where the rate of type 2 diabetes was not significantly raised until consumption exceeded about one serving a day. The association between higher total whole grain intake and lower risk of type 2 diabetes was stronger in individuals who were lean than in those who were overweight or obese (P=0.003 for interaction), and the associations did not vary significantly across levels of physical activity, family history of diabetes, or smoking status. CONCLUSION: Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.
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“For example, yogurt and possibly some other forms of dairy, whole grains, and green leafy vegetables reduce the risk of diabetes,42–44”
From Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants (2024) · cites this paper as [43]
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“Regular intake of sufficient dietary fiber is associated with lower all-cause mortality in people with diabetes (173,174), and prospective cohort studies have found dietary fiber intake is inversely associated with risk of type 2 diabetes (175-177).”
From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023 (2023) · cites this paper as [177]
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Li, Z., Yan, H., Chen, L., Wang, Y., Liang, J., Feng, X., Hui, S., & Wang, K. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13866 · Cited by 17
Wang, M., He, Y., Zhao, Y., Zhang, L., Liu, J., Zheng, S., & Bai, Y. (2024) · Environmental Geochemistry and Health · doi:10.1007/s10653-023-01794-3 · Cited by 17
“It has been suggested that the development of T2DM is attributable to poor diet, obesity, unhealthy lifestyle and genetic susceptibility (Hu et al., 2020; Zuo et al., 2014).”
Ficco, D. B. M., Petroni, K., Mistura, L., & D’Addezio, L. (2024) · Nutrients · doi:10.3390/nu16132155 · Cited by 17
“…cardiovascular diseases, total cancer, type 2 diabetes, obesity, and all-cause mortality in several large-scale prospective cohort studies, providing support for the current recommendation of increasing wholegrain consumption as part of a healthy diet for the prevention of chronic diseases [2,3].”
BackgroundNext Generation Health Claims Based on Resilience: The Example of Whole-Grain Wheat
Hoevenaars, F. P. M., van der Kamp, J. W., van den Brink, W., & Wopereis, S. (2020) · Nutrients · doi:10.3390/nu12102945 · Cited by 17
Nasab, S. J., Ghanavati, M., Clark, C. C. T., & Nasirian, M. (2024) · Nutrition and Diabetes · doi:10.1038/s41387-024-00313-2 · Cited by 16
“With respect to whole grains, it is now fully evidenced that total whole grain consumption is associated with a lower risk of type 2 diabetes [32, 33].”
BackgroundMartikainen, J. A., Jalkanen, K., Heiskanen, J., Lavikainen, P., Peltonen, M., Laatikainen, T. K., & Lindström, J. (2021) · Nutrients · doi:10.3390/nu13103583 · Cited by 16
“[10] providing the non-linear marginal effects of an increased number of whole grain servings a day, reducing the risk for T2D.”
BackgroundMethodOutdoor light at night, air pollution and risk of incident type 2 diabetes
Wu, Y., Ye, J., Shen, P., Qiu, J., Wang, Y., Xu, L., Hu, J., Zhang, J., Lin, H., Lin, H., et al. (2024) · Environmental Research · doi:10.1016/j.envres.2024.120055 · Cited by 15
Wu, F., Pahkala, K., Juonala, M., Rovio, S., Sabin, M. A., Rönnemaa, T., Buscot, M., Smith, K. J., Männistö, S., Jula, A., et al. (2021) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgab044 · Cited by 16
“This may be partly explained by the high intake of whole grains, which have been consistently associated with reduced risk of T2D in recent systematic reviews and meta-analyses of observational and intervention studies(31-33).”
BackgroundMicrostructure and viscosity of in vitro-digested rye and wheat food products
Lu, J., Hansson, H., Johansson, D. P., Landberg, R., & Langton, M. (2024) · Food Hydrocolloids · doi:10.1016/j.foodhyd.2024.109990 · Cited by 14
Sun, T., Deng, Y., Geng, X., Fang, Q., Li, X., Chen, L., Zhan, M., Li, D., Zhu, K., Li, H., et al. (2022) · Journal of Nutrition · doi:10.1093/jn/nxab404 · Cited by 13
Genetic trade‐offs between complex diseases and longevity
Hu, D., Li, Y., Zhang, D., Ding, J., Song, Z., Min, J., Zeng, Y., & Nie, C. (2022) · Aging Cell · doi:10.1111/acel.13654 · Cited by 13
“Healthy lifestyles, such as consuming whole grain foods (Hu et al., 2020), physical exercises (Garatachea et al., 2015; Li et al., 2020), and calorie restriction (Hwangbo et al., 2020) are beneficial for promoting healthy aging.”
BackgroundWang, Y., Xie, W., Tian, T., Zhang, J., Zhu, Q., Pan, D., Xu, D., Lü, Y., Sun, G., & Dai, Y. (2022) · Nutrients · doi:10.3390/nu14194111 · Cited by 17
“Results from the latest prospective cohort study also showed that participants with high whole grain intakes had a 29% lower incidence of type 2 diabetes, suggesting further support for the current recommendation to increase whole grain intake as part of a healthy diet to prevent type 2 diabetes [36].”
Road Traffic Noise, Obesity, and the Risk of Incident Type 2 Diabetes: A Cohort Study in UK Biobank
Zuo, L., Chen, X., Liu, M., Chen, L., Xu, W., Chen, H., Dong, S., Wei, Y., Li, L., Peng, S., et al. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1605256 · Cited by 12
Plant-based diets and risk of type 2 diabetes: systematic review and dose–response meta-analysis
Murciano, A., Malavolti, M., Fairweather‐Tait, S. J., Paduano, S., Vinceti, M., & Filippini, T. (2025) · British Journal Of Nutrition · doi:10.1017/s0007114525104157 · Cited by 17
Mete, E., Haszard, J. J., Perry, T., Oey, I., Mann, J. I., & Morenga, L. T. (2021) · Nutrients · doi:10.3390/nu13082579 · Cited by 12
“Wholegrain consumption can improve acute postprandial glycaemia compared with refined grains [1] and is associated with reduced risk of developing type 2 diabetes [2,3] and other non-communicable diseases [3].”
BackgroundMetabolic changes in response to varying whole-grain wheat and rye intake
Koistinen, V., Haldar, S., Tuomainen, M. H., Lehtonen, M., Klåvus, A., Draper, J., Lloyd, A. J., Beckmann, M., Bal, W., Ross, A. B., et al. (2024) · npj Science of Food · doi:10.1038/s41538-024-00247-0 · Cited by 12
Impact of lipase and lipoxygenase activity on the aroma profile of whole wheat bread
Pham, T., Tello, E., & Peterson, D. G. (2025) · Food Research International · doi:10.1016/j.foodres.2025.116191 · Cited by 13
Dietary patterns among Saudis with type 2 diabetes mellitus in Riyadh: A cross-sectional study
Aljahdali, A., & Bawazeer, N. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267977 · Cited by 13
Fisberg, R. M., Fontanelli, M. D. M., Kowalskys, I., Gómez, G., Rigotti, A., Cortés, L. Y., García, M. C. Y., Pareja, R. G., Herrera‐Cuenca, M., Fisberg, M., et al. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02635-8 · Cited by 14
Liu, T., Xu, C. Q., Driban, J. B., Liang, G., Zhang, X., Hu, F. B., McAlindon, T. E., & Lü, B. (2022) · Rheumatology · doi:10.1093/rheumatology/keac517 · Cited by 12
Impact of Daily Consumption of Whole-Grain Quinoa-Enriched Bread on Gut Microbiome in Males
Li, L., Houghton, D., Lietz, G., Watson, A., Stewart, C. J., Bal, W., & Seal, C. J. (2022) · Nutrients · doi:10.3390/nu14224888 · Cited by 11
Liu, H.-P., Zhu, J., Gao, R., Ding, L., Yang, Y., Zhao, W.-X., Cui, X.-N., Lu, W., Wang, J., & Li, Y.-J. (2024) · Nutrix Journal · doi:10.1186/s12937-024-00957-x · Cited by 10
“Of 28 included publications in the BPRF analysis, a total of eight studies investigated the association between whole grains and T2D [10, 28, 29, 32, 33, 37, 46, 47], seven for CRC [19–21, 30, 42–44], six for both IHD and stroke [23, 26, 39–41, 48 All included publications used dietary records or…”
BackgroundMethodInfluentialWang, Y., Feng, J., Liu, T., Gong, Z., & Zhuo, Q. (2024) · Nutrients · doi:10.3390/nu16142373 · Cited by 10
Yılmaz, B., Sîrbu, A., Başar, H. B. A., Gökşen, G., Chabı, I. B., Kumagaı, H., & Özoğul, F. (2023) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2023.2292790 · Cited by 10
“For instance, an increasing cereal fiber intake in the human diet was voiced to prevent or risk-reduce various disorders, such as diabetes (Aune et al. 2013; Hu et al. 2020; Krishnan et al. 2007; Kyrø et al. 2018).”
Zhang, Z., Liu, F., Yin, X., Wu, B., Li, H., Peng, F., Cheng, M., Li, J., Xiang, J., Yao, P., et al. (2024) · European Journal of Nutrition · doi:10.1007/s00394-023-03321-7 · Cited by 9
“…lower concentrations of insulin and inflammatory indicators due to the richness of dietary fiber, phytochemicals, and anti-oxidants, these beneficial components were lost in the processing of refining grains, and high consumption of refined grains was adversely associated with diabetes [6, 33].”
Derbyshire, E. J., & Ruxton, C. H. S. (2025) · Nutrients · doi:10.3390/nu17101680 · Cited by 9
“This, in turn, has been linked to beneficial health outcomes, such as improvements in body weight and reduced risk of T2D, CHDs and total cancer [76,100,109,110].”
Boshuizen, B., de Vega, C. V. M., Maré, L. D., meeûs, C. D., de Oliveira, J. E., Hosotani, G., Gansemans, Y., Deforce, D. L. D., Nieuwerburgh, F. V., & Delesalle, C. J. G. (2021) · Frontiers in Veterinary Science · doi:10.3389/fvets.2021.642809 · Cited by 9
Omoto, T., Kyozuka, H., Murata, T., Imaizumi, K., Yamaguchi, A., Fukuda, T., Isogami, H., Yasuda, S., Satô, A., Ogata, Y., et al. (2022) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.15501 · Cited by 9
“, whole-grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ) is significantly associated with a decreased risk of type 2 diabetes.(30) Martinez-Gonzalez et al.”
BackgroundDietary carbohydrate intake and risk of type 2 diabetes: a 16-year prospective cohort study
Gan, L., Yang, Y., Zhao, B., Yu, K., Guo, K., Fang, F., Zhou, Z., Albanes, D., & Huang, J. (2025) · Science China Life Sciences · doi:10.1007/s11427-024-2804-0 · Cited by 9
Modification of cellulosic structures from fruit by-products: Toward better nutritional properties
Zhu, H., Li, H., Fan, X., Wang, T., & Dhital, S. (2025) · Food Research International · doi:10.1016/j.foodres.2025.116604 · Cited by 9
Metadata
- Authors
- Hu, Y., Ding, M., Sampson, L., Willett, W. C., Manson, J. E., Wang, M., Rosner, B., Hu, F. B., & Sun, Q.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Sun, Qi
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2020-07-08
- Volume
- 370
- Pages
- m2206
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC7341349
- OpenAlex
- W3040770042
- Cited by
- 202
- References
- 61
- Citations by year
- 2026: 15 · 2025: 34 · 2024: 44 · 2023: 24 · 2022: 48 · 2021: 34 · 2020: 3
- FWCI
- 17.20
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (CA176726, CA-167552)
- National Heart, Lung, and Blood Institute (R01HL035464, R01HL034594)
- National Cancer Institute (UM1CA186107)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK120870, R01DK112940)
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- whole grains, type 2 diabetes, whole grain intake, popcorn, oatmeal, brown rice, wheat germ, dose-response relationship, diabetes risk factors, Nurses' Health Study, Health Professionals Follow-up Study, Nurses' Health Study II, dietary risk factors, lifestyle risk factors, nonlinear relationship, women and men comparison
- MeSH terms
- Whole Grains, Diet, Healthy, Adult, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Surveys and Questionnaires, United States
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