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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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Zhou, B., Rayner, A. W., Gregg, E. W., Sheffer, K. E., Carrillo-Larco, R. M., Bennett, J. E., Shaw, J. E., Paciorek, C. J., Singleton, R. K., Barradas Pires, A., et al. (2024) · The Lancet · doi:10.1016/s0140-6736(24)02317-1 · Cited by 1,013
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., et al. (2023) · Diabetes Care · doi:10.2337/dc23-s005 · Cited by 362
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s005 · Cited by 445
ElSayed, N. A., Aleppo, G., Bannuru, R. R., Beverly, E. A., Bruemmer, D., Collins, B. S., Darville, A. K., Ekhlaspour, L., Hassanein, M. M., Hilliard, M. E., et al. (2023) · Diabetes Care · doi:10.2337/dc24-s005 · Cited by 366
Chen, Z., Khandpur, N., Desjardins, C., Wang, L., Monteiro, C. A., Rossato, S. L., Fung, T. T., Manson, J. E., Willett, W. C., Rimm, E. B., et al. (2023) · Diabetes Care · doi:10.2337/dc22-1993 · Cited by 259
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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