Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals
Open accessAbstract
BACKGROUND: Intakes of whole grains and cereal fiber have been inversely associated with the risk of chronic diseases; however, their relation with total and disease-specific mortality remain unclear. We aimed to prospectively assess the association of whole grains and cereal fiber intake with all causes and cause-specific mortality. METHODS: The study included 367,442 participants from the prospective NIH-AARP Diet and Health Study (enrolled in 1995 and followed through 2009). Participants with cancer, heart disease, stroke, diabetes, and self-reported end-stage renal disease at baseline were excluded. RESULTS: Over an average of 14 years of follow-up, a total of 46,067 deaths were documented. Consumption of whole grains were inversely associated with risk of all-cause mortality and death from cancer, cardiovascular disease (CVD), diabetes, respiratory disease, infections, and other causes. In multivariable models, as compared with individuals with the lowest intakes, those in the highest intake of whole grains had a 17% (95% CI, 14-19%) lower risk of all-cause mortality and 11-48% lower risk of disease-specific mortality (all P for trend <0.023); those in the highest intake of cereal fiber had a 19% (95% CI, 16-21%) lower risk of all-cause mortality and 15-34% lower risk of disease-specific mortality (all P for trend <0.005). When cereal fiber was further adjusted, the associations of whole grains with death from CVD, respiratory disease and infections became not significant; the associations with all-cause mortality and death from cancer and diabetes were attenuated but remained significant (P for trend <0.029). CONCLUSIONS: Consumption of whole grains and cereal fiber was inversely associated with reduced total and cause-specific mortality. Our data suggest cereal fiber is one potentially protective component.
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Whole grain intake has also been inversely associated with other less common causes of death including deaths from infection, respiratory disease, diabetes, and kidney disease in some studies, but the available data are limited.
“Whole grain intake has also been inversely associated with other less common causes of death including deaths from infection,4 20 22 respiratory disease,4 9 20 22 diabetes,9 20 22 and kidney disease20 in some studies, but the available data are limited.”
From Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies (2016) · cites this paper as [22]
The Results section (page not specified) reports inverse associations between whole-grain intake and deaths from infections, respiratory disease, and diabetes. The Methods section groups remaining causes as “all other/unknown causes”; it does not report kidney-disease deaths separately, so the claim’s kidney-disease component is not supported by this source. The Results also note that the infection and respiratory associations became non-significant after adjustment for cereal fiber. (LLM, conf=0.89)
Experimental — accuracy not yet measuredEpidemiological studies on whole grains and total cancer have reported mixed results, with some studies suggesting a possible inverse association and others showing no clear association.
“Epidemiological studies on whole grains and total cancer, however, have reported mixed results, with some studies suggesting a possible inverse association,4 9 22 29 while others have shown no clear association.20 27”
From Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies (2016) · cites this paper as [22]
The Results section reports an inverse association between whole-grain intake and death from cancer, supporting the inverse-association part of the citing sentence. The Discussion also says protective effects for some cancers were not consistently observed. The paper’s own outcome, however, is cancer mortality, not total cancer incidence, so it does not directly establish the claimed mixed findings for total cancer risk. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAuthors of included studies were contacted for clarification of reported intake amounts.
“The authors of one study22 were contacted for clarification of the amount of whole grain intake, which was reported in ounces/day (1 ounce=28 g) in the publication but was clarified to be in ounces/1000 kcal/day by the authors.”
From Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies (2016) · cites this paper as [22]
Table 2 (Results; page unavailable) labels whole-grain intake in ounce equivalents per day, supporting the sentence’s description of the published units. The Methods describe energy-adjusted intake quintiles, but our copy does not document the later contact or an author clarification that the units were ounces per 1,000 kcal per day. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSome but not all cohort studies on whole grains and cardiovascular disease or all cause mortality reported a possible plateau effect, with most of the benefit observed at relatively low levels of intake.
“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.”
Several large cohort studies including more than 22 000 cases of cardiovascular disease and more than 662 000 participants have been published since or were missed by previous meta-analyses of whole grains and cardiovascular disease.
“Several large cohort studies including more than 22 000 cases of cardiovascular disease and more than 662 000 participants9 20 22 27 35 have been published since or were missed36 by the previous meta-analyses of whole grains and cardiovascular disease.6 30”
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References 35 · Cited by 180
Research works printed but not linked: 28
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- Authors
- Huang, T., Xu, M., Lee, A., Cho, S., & Qi, L.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Qi, Lu
- Venue
- BMC Medicine
- Published
- 2015-03-24
- Volume
- 13
- Issue
- 1
- Pages
- 59-59
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC4371798
- OpenAlex
- W2741074962
- Cited by
- 180
- References
- 35
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 14 · 2023: 15 · 2022: 18 · 2021: 16 · 2020: 17 · 2019: 17 · 2018: 15 · 2017: 21 · 2016: 24 · 2015: 6 · 2014: 1
- FWCI
- 21.20
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-04-16)
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- National University of Singapore (submittedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL071981, HL-071981)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK091718, DK091718, P30DK046200, DK46200.)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Food composition and properties
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Life Sciences › Agricultural and Biological Sciences › General Agricultural and Biological Sciences › Natural Products and Applications
- Keywords
- whole grains, cereal fiber, mortality, all-cause mortality, cause-specific mortality, cancer mortality, cardiovascular mortality, diabetes mortality, respiratory mortality, infection, dietary intake, NIH-AARP Diet and Health Study
- MeSH terms
- Aged, Cardiovascular Diseases, Edible Grain, Diet, Diet Surveys, Dietary Fiber, Female, Humans, Male, Middle Aged, Prospective Studies, Proportional Hazards Models
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