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Gaesser GA. Refined grain intake and cardiovascular disease: Meta-analyses of prospective cohort studies. Trends Cardiovasc Med 2024; 34:59-68. [PMID: 36075506 DOI: 10.1016/j.tcm.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022]
Abstract
Refined grains are included as part of an unhealthy, or Western, dietary pattern, which has been shown to be associated with increased risk of cardiovascular disease (CVD). To clarify the association between refined grain intake and CVD risk, Pubmed and Scopus databases were searched for relevant cohort studies from database inception to June 30, 2022. Only studies that examined refined grains as a distinct consumption category and not as part of a dietary pattern, were included. Meta-analyses were performed using Cochrane's RevMan 5.4.1 software, applying inverse variance risk ratios in random effects models for each outcome of interest. Heterogeneity was assessed with Cochrane's Q (chi2) and I2 statistics. Meta-analyses of hazard ratios (HR) and 95% confidence intervals (CI) obtained from 17 prospective cohort studies (>875,000 participants) indicated that refined grain intake was not associated with risk of CVD (HR = 1.08, 95% CI, 0.99-1.18, I2 = 70%; 9 cohorts), stroke (HR = 1.06, 95% CI 0.92-1.23, I2 = 70%; 9 cohorts), or heart failure (HR = 0.95, 95% CI 0.77-1.16, I2 = 10%; 5 cohorts). White rice intake was also not associated with risk of CVD (HR = 0.93, 95% CI 0.86-1.00, I2 = 25%; 7 cohorts) or stroke (HR = 1.03, 95% CI 0.93-1.14, I2 = 22%; 7 cohorts). No significant publication bias was evident (Egger's test P values all > 0.05). The lack of association between refined grain intake and CVD risk was observed in meta-analyses of studies that restricted analyses to only staple grain foods (e.g., bread, cereal, pasta, white rice), as well as for meta-analyses of studies that included both staple and indulgent grain foods (e.g., cakes, cookies, doughnuts, brownies, muffins, pastries). Probable confounding from unmeasured variables in studies included in the meta-analyses diminishes the overall quality of evidence. Although refined grains are included as a component of the Western dietary pattern, the results of the meta-analyses suggest that refined grains do not contribute to the higher CVD risk associated with this unhealthy dietary pattern. This information should be considered in formulation of future dietary recommendations.
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Affiliation(s)
- Glenn A Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, United States.
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2
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Kabisch S, Weickert MO, Pfeiffer AFH. The role of cereal soluble fiber in the beneficial modulation of glycometabolic gastrointestinal hormones. Crit Rev Food Sci Nutr 2022; 64:4331-4347. [PMID: 36382636 DOI: 10.1080/10408398.2022.2141190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
According to cohort studies, cereal fiber, and whole-grain products might decrease risk for type 2 diabetes (T2DM), inflammatory processes, cancer, and cardiovascular diseases. These associations, mainly affect insoluble, but not soluble cereal fiber. In intervention studies, soluble fiber elicit anti-hyperglycemic and anti-inflammatory short-term effects, partially explained by fermentation to short-chain fatty acids, which acutely counteract insulin resistance and inflammation. ß-glucans lower cholesterol levels and possibly reduce liver fat. Long-term benefits are not yet shown, maybe caused by T2DM heterogeneity, as insulin resistance and fatty liver disease - the glycometabolic points of action of soluble cereal fiber - are not present in every patient. Thus, only some patients might be susceptive to fiber. Also, incretin action in response to fiber could be a relevant factor for variable effects. Thus, this review aims to summarize the current knowledge from human studies on the impact of soluble cereal fiber on glycometabolic gastrointestinal hormones. Effects on GLP-1 appear to be highly contradictory, while these fibers might lower GIP and ghrelin, and increase PYY and CCK. Even though previous results of specific trials support a glycometabolic benefit of soluble fiber, larger acute, and long-term mechanistic studies are needed in order to corroborate the results.
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Affiliation(s)
- Stefan Kabisch
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V, Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism; The ARDEN NET Centre, ENETS CoE, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Centre of Applied Biological & Exercise Sciences (ABES), Faculty of Health & Life Sciences, Coventry University, Coventry, UK
- Translational & Experimental Medicine, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andreas F H Pfeiffer
- Department of Endocrinology and Metabolism, Campus Benjamin Franklin, Charité University Medicine, Berlin, Germany
- Deutsches Zentrum für Diabetesforschung e.V, Geschäftsstelle am Helmholtz-Zentrum München, Neuherberg, Germany
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Ghanbari‐Gohari F, Mousavi SM, Esmaillzadeh A. Consumption of whole grains and risk of type 2 diabetes: A comprehensive systematic review and dose-response meta-analysis of prospective cohort studies. Food Sci Nutr 2022; 10:1950-1960. [PMID: 35702290 PMCID: PMC9179146 DOI: 10.1002/fsn3.2811] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/11/2022] Open
Abstract
This study aimed to quantitatively summarize earlier findings on the association between whole grain (WG) intake and type 2 diabetes (T2D) risk. We searched related keywords on PubMed/Medline, Scopus, and Google Scholar up to October 2021. Prospective observational studies investigating the association between WG intake and risk of T2D were included. The random-effects model calculates the summary relative risks by contrasting categories and linear and nonlinear dose-response associations. Eleven prospective cohort studies, including 463,282 participants and 37,249 type 2 diabetes incidents, were analyzed. The pooled relative risk (RR) for the highest versus the lowest WG intake category indicated a 21% decrease in T2D risk (95% confidence interval (CI): 0.73-0.85, I 2 = 77%). Each additional 50 grams WG consumption per day was associated with a 23% reduced risk of T2D. The nonlinear association of WG and T2D revealed that 60 grams WG intake per day would give the highest benefit to prevent T2D (Pnonlinearity < 0.001). The findings were not affected by any individual study. No evidence of publication bias was documented. In conclusion, a high intake of WG was associated with a lower risk of T2D. Randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Faezeh Ghanbari‐Gohari
- Department of Community NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
| | - Seyed Mohammad Mousavi
- Department of Community NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Ahmad Esmaillzadeh
- Department of Community NutritionSchool of Nutritional Sciences and DieteticsTehran University of Medical SciencesTehranIran
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
- Food Security Research CenterDepartment of Community NutritionIsfahan University of Medical SciencesIsfahanIran
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Guo N, Zhu Y, Tian D, Zhao Y, Zhang C, Mu C, Han C, Zhu R, Liu X. Role of diet in stroke incidence: an umbrella review of meta-analyses of prospective observational studies. BMC Med 2022; 20:194. [PMID: 35606791 PMCID: PMC9128224 DOI: 10.1186/s12916-022-02381-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 04/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Stroke is one of the major challenges for the global healthcare system, which makes it necessary to explore the relationship between various modifiable factors and stroke risk. Recently, numerous meta-analyses of prospective observational studies have reported that dietary factors played a key role in the occurrence of stroke. However, the conclusions of previous studies have remained controversial and unclear. Accordingly, we conducted an umbrella review synthesizing and recalculating available evidence to assess the certainty of the associations between dietary factors and stroke. METHODS Relevant meta-analyses examining the associations between dietary factors and stroke were searched in PubMed and Embase databases up to September 1, 2021. For each eligible meta-analysis, two independent reviewers appraised the methodologic quality using the AMSTAR 2 criteria and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals, heterogeneity between studies, and small-study effects. Moreover, we further assessed the associations between dietary factors and ischemic stroke as well as hemorrhagic stroke. Lastly, a set of pre-specified criteria was applied to qualitatively evaluate the epidemiological credibility of each dietary factor. RESULTS Overall, our umbrella review included 122 qualified meta-analyses for qualitative synthesis, involving 71 dietary factors related to food groups, foods, macronutrients, and micronutrients. Using the AMSTAR 2 criteria, 5 studies were assessed as high quality, 4 studies as moderate quality, and 113 studies as low or critically low quality. We identified 34 dietary factors associated with stroke occurrence, 25 dietary factors related to ischemic stroke, and 11 factors related to hemorrhagic stroke. Among them, high/moderate certainty epidemiological evidence demonstrated an inverse association between intake of fruits (RR: 0.90) and vegetables (RR: 0.92) and stroke incidence, but a detrimental association between red meat (RR: 1.12), especially processed red meat consumption (RR:1.17), and stroke incidence. Besides, the evidence of high/moderate certainty suggested that the intake of processed meat, fruits, coffee, tea, magnesium, and dietary fiber was associated with ischemic stroke risk, while consumption of tea, fruits, and vegetables was relevant to hemorrhagic stroke susceptibility. CONCLUSIONS Our study has reported that several dietary factors have a significant impact on stroke risk and offered a new insight into the relationship between dietary modification and stroke occurrence. Our results may provide an effective strategy for stroke prevention.
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Affiliation(s)
- Na Guo
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ying Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Dandan Tian
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Yating Zhao
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chenguang Zhang
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Changqing Mu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Chen Han
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Ruixia Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China
| | - Xu Liu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 North Nanjing Street, Shenyang, 110001, Liaoning, China.
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Miller V, Micha R, Choi E, Karageorgou D, Webb P, Mozaffarian D. Evaluation of the Quality of Evidence of the Association of Foods and Nutrients With Cardiovascular Disease and Diabetes: A Systematic Review. JAMA Netw Open 2022; 5:e2146705. [PMID: 35113165 PMCID: PMC8814912 DOI: 10.1001/jamanetworkopen.2021.46705] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health goals. OBJECTIVE To assess the quality of evidence of the associations between specific dietary factors and CMD as well as the quantitative evidence for RRs and the uncertainty of these risk estimates. EVIDENCE REVIEW PubMed and the reference lists of eligible articles were searched between May 1, 2015, and February 26, 2021, for systematic reviews with meta-analyses of randomized clinical trials and prospective cohort studies that analyzed the consumption of 1 or more of the dietary factors of interest; reported dose-response meta-analyses; included healthy adults; and assessed 1 or more of the outcomes of interest. Study characteristics and RR estimates were extracted in duplicate. For identified associations, quality of evidence was assessed using the Bradford-Hill criteria for causation. FINDINGS A total of 2058 potentially relevant reports were identified, from which 285 full-text articles were assessed for eligibility. The final selection of articles included 28 meta-analyses representing 62 associations between diet and CMD. Among these associations, 10 foods, 3 beverages, and 12 nutrients had at least probable evidence of associations with coronary heart disease, stroke, and/or diabetes. Most RRs ranged from 0.87 to 0.96 per daily serving change for protective associations and from 1.06 to 1.15 per daily serving change for harmful associations. Most identified associations were protective (n = 38) and a smaller number were harmful (n = 24), with a higher risk associated with higher intake. CONCLUSIONS AND RELEVANCE This systematic review summarized the current quality of evidence of the associations of specific dietary factors with coronary heart disease, stroke, and diabetes. These findings may inform dietary guidance, the assessment of disease burden in specific populations, policy setting, and future research.
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Affiliation(s)
- Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
- Department of Food Science and Nutrition, University of Thessaly, Volos, Greece
| | - Erin Choi
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Dimitra Karageorgou
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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Papanikolaou Y, Slavin JL, Clemens R, Brenna JT, Hayes D, Gaesser GA, Fulgoni VL. Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting. Curr Dev Nutr 2020; 4:nzaa125. [PMID: 33062912 PMCID: PMC7538308 DOI: 10.1093/cdn/nzaa125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/17/2020] [Accepted: 07/14/2020] [Indexed: 11/14/2022] Open
Abstract
Although dietary guidance recommends increasing consumption of whole grains and concurrently limiting consumption of refined and/or enriched grain foods, emerging research suggests that certain refined grains may be part of a healthy dietary pattern. A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes. Based on a 1-d roundtable discussion, the expert panel reached consensus that 1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns, 2) whole and refined grain foods contribute nutrient density, 3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet, 4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and 5) gaps exist in the scientific literature with regard to grain foods and health.
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Affiliation(s)
| | - Joanne L Slavin
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, USA
| | - Roger Clemens
- USC School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - J Thomas Brenna
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | | | - Glenn A Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Tong TYN, Appleby PN, Key TJ, Dahm CC, Overvad K, Olsen A, Tjønneland A, Katzke V, Kühn T, Boeing H, Karakatsani A, Peppa E, Trichopoulou A, Weiderpass E, Masala G, Grioni S, Panico S, Tumino R, Boer JMA, Verschuren WMM, Quirós JR, Agudo A, Rodríguez-Barranco M, Imaz L, Chirlaque MD, Moreno-Iribas C, Engström G, Sonestedt E, Lind M, Otten J, Khaw KT, Aune D, Riboli E, Wareham NJ, Imamura F, Forouhi NG, di Angelantonio E, Wood AM, Butterworth AS, Perez-Cornago A. The associations of major foods and fibre with risks of ischaemic and haemorrhagic stroke: a prospective study of 418 329 participants in the EPIC cohort across nine European countries. Eur Heart J 2020; 41:2632-2640. [PMID: 32090257 PMCID: PMC7377582 DOI: 10.1093/eurheartj/ehaa007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/20/2019] [Accepted: 01/10/2020] [Indexed: 01/12/2023] Open
Abstract
AIM To investigate the associations between major foods and dietary fibre with subtypes of stroke in a large prospective cohort. METHODS AND RESULTS We analysed data on 418 329 men and women from nine European countries, with an average of 12.7 years of follow-up. Diet was assessed using validated country-specific questionnaires which asked about habitual intake over the past year, calibrated using 24-h recalls. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HRs) for ischaemic and haemorrhagic stroke associated with consumption of red and processed meat, poultry, fish, dairy foods, eggs, cereals, fruit and vegetables, legumes, nuts and seeds, and dietary fibre. For ischaemic stroke (4281 cases), lower risks were observed with higher consumption of fruit and vegetables combined (HR; 95% CI per 200 g/day higher intake, 0.87; 0.82-0.93, P-trend < 0.001), dietary fibre (per 10 g/day, 0.77; 0.69-0.86, P-trend < 0.001), milk (per 200 g/day, 0.95; 0.91-0.99, P-trend = 0.02), yogurt (per 100 g/day, 0.91; 0.85-0.97, P-trend = 0.004), and cheese (per 30 g/day, 0.88; 0.81-0.97, P-trend = 0.008), while higher risk was observed with higher red meat consumption which attenuated when adjusted for the other statistically significant foods (per 50 g/day, 1.07; 0.96-1.20, P-trend = 0.20). For haemorrhagic stroke (1430 cases), higher risk was associated with higher egg consumption (per 20 g/day, 1.25; 1.09-1.43, P-trend = 0.002). CONCLUSION Risk of ischaemic stroke was inversely associated with consumption of fruit and vegetables, dietary fibre, and dairy foods, while risk of haemorrhagic stroke was positively associated with egg consumption. The apparent differences in the associations highlight the importance of examining ischaemic and haemorrhagic stroke subtypes separately.
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Affiliation(s)
- Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Paul N Appleby
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Christina C Dahm
- Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Demark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Demark
- Department of Cardiology, Aalborg University Hospital, Reberbansgade 15, 9000 Aalborg, Denmark
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Arthur-Scheunert-Allee 114, 14558 Nuthetal, Germany
| | - Anna Karakatsani
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, 1, Rimini Str, Haidari, 12462 Athens, Greece
| | - Eleni Peppa
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos, 11527 Athens, Greece
| | - Elisabete Weiderpass
- International Agency for Research on Cancer (IARC), World Health Organization (WHO), 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Via Cosimo Il Vecchio
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Giacomo Venezian, 1, 20133 Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia Federico II University, Corso Umberto I, 40, 80138 Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “M.P.Arezzo” Hospital, ASP Contrada Rito, 97100 Ragusa, Italy
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
| | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 Utrecht, the Netherlands
| | - J Ramón Quirós
- Public Health Directorate, General Elorza 32, 33001 Oviedo, Asturias, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL. Avinguda de la Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada, Cuesta del Observatorio, 4, 18011 Granada, Spain
- CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain
| | - Liher Imaz
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Andia 13, 20004 Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Paseo Doctor Begiristain, s/n, 20014 Donostia-San Sebastian, Spain
| | - María-Dolores Chirlaque
- CIBER of Epidemiology and Public Health. Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0 28029 Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Ronda de Levante, 11, 30008 Murcia, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA, Navarre Institute for Health Research, Calle de Irunlarrea 3, 31008 Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Recinto Hospitalario de Navarra, Calle de Irunlarrea s/n, 31621 Pamplona, Spain
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Bergsgatan 31 B, 21445 Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, CRC, hus 60 plan 13 205 02 Malmö, Sweden
| | - Marcus Lind
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Department of Nutrition, Bjørknes University College, Lovisenberggata 13, N- 0456 Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Ullevål, OUS HF Aker sykehus, Postboks 4959 Nydalen, 0424 Oslo, Norway
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
| | - Emanuele di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Angela M Wood
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford OX3 7LF, UK
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Jones JM, García CG, Braun HJ. Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole". Adv Nutr 2020; 11:492-506. [PMID: 31682258 PMCID: PMC7231599 DOI: 10.1093/advances/nmz114] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/11/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.
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Affiliation(s)
| | - Carlos Guzmán García
- Department of Genetics, Advanced Technical College of Agricultural Engineering and Forestry, University of Córdoba, Córdoba, Spain
| | - Hans J Braun
- Global Wheat Program, Centro Internacional de Mejoramiento de Maiz y Trigo, El Batan, near Texcoco, Mexico
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9
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Tieri M, Ghelfi F, Vitale M, Vetrani C, Marventano S, Lafranconi A, Godos J, Titta L, Gambera A, Alonzo E, Sciacca S, Riccardi G, Buscemi S, Del Rio D, Ray S, Galvano F, Beck E, Grosso G. Whole grain consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr 2020; 71:668-677. [PMID: 31964201 DOI: 10.1080/09637486.2020.1715354] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Whole grains have been associated with a number of health benefits. We systematically reviewed existing meta-analyses of observational studies and evaluated the level of evidence for their putative effects based on pre-selected criteria. Of the 23 included studies, we found convincing evidence of an inverse association between whole grain consumption and risk of type-2 diabetes and colorectal cancer; possible evidence of decreased risk of colon cancer and cardiovascular mortality with increased whole grain intake, as well as increased risk of prostate cancer. Limited or insufficient evidence was available for all other outcomes investigated. Overall findings are encouraging for a positive effect of whole grain consumption on certain diseases, especially highly prevalent metabolic diseases, however, uncertainty of some negative associations deserves further attention.
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Affiliation(s)
- Maria Tieri
- SmartFood Program, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Ghelfi
- Fondazione De Marchi-Department of Pediatrics, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Stefano Marventano
- Rimini Women's Health, Childhood and Adolescent Department, AUSL Romagna, Rimini, Italy
| | - Alessandra Lafranconi
- University of Milano - Bicocca, Milan, Italy.,Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Lucilla Titta
- SmartFood Program, Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Angelo Gambera
- Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elena Alonzo
- Food and Nutrition Security and Public Health Service, ASP Catania, Catania, Italy
| | - Salvatore Sciacca
- Integrated Cancer Registry of Catania-Messina-Siracusa-Enna, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Silvio Buscemi
- Biomedical Department of Internal and Specialist Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - Daniele Del Rio
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,School of Advanced Studies on Food and Nutrition, University of Parma, Parma, Italy.,Human Nutrition Unit, Department of Veterinary Science, University of Parma, Parma, Italy
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Wolfson College at the University of Cambridge, Cambridge, UK.,Nutrition Innovation Centre for Food and Health, Ulster University, Newtownabbey, UK.,Human Nutrition Research Unit, Medical Research Council (MRC), Cambridge, UK
| | - Fabio Galvano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Eleanor Beck
- School of Medicine, University of Wollongong, Wollongong, Australia
| | - Giuseppe Grosso
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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10
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Lyskjær L, Overvad K, Tjønneland A, Dahm CC. Substitutions of Oatmeal and Breakfast Food Alternatives and the Rate of Stroke. Stroke 2019; 51:75-81. [PMID: 31826737 DOI: 10.1161/strokeaha.119.024977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Studies indicate that consuming breakfast every day, and particularly oatmeal, is associated with lower risk of stroke. However, few studies have considered replacement foods when considering foods usually consumed at breakfast. We, therefore, aimed to model substitutions between the breakfast food products oatmeal, eggs, yogurt, or white bread and subsequent risk of stroke. Methods- Participants from the Danish cohort study (Diet, Cancer and Health; n=55 095) were followed for 13.4 years, during which 2260 subjects experienced a first-ever stroke. Breakfast foods were assessed using a validated 192-item food-frequency questionnaire at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% CIs for associations between hypothetical substitutions of standard portion sizes of breakfast foods and stroke. Results- Modeling replacement of white bread or eggs with oatmeal was associated with a lower rate of total stroke (hazard ratio [HR]=0.96 [95% CI, 0.95-0.98]; HR=0.96 [95% CI, 0.93-0.98], respectively), total ischemic stroke (HR=0.96 [95% CI, 0.94-0.98]; HR=0.96 [95% CI, 0.94-0.99], respectively), and ischemic stroke due to small-artery occlusion (HR=0.95 [95% CI, 0.93-0.98]; HR=0.95 [95% CI, 0.91-0.99], respectively). Furthermore, modeling replacement of eggs with oatmeal was associated with a lower rate of total hemorrhagic stroke (HR=0.94 [95% CI, 0.89-0.99]). Modeling replacement of yogurt with oatmeal was not associated with stroke. Conclusions- Our findings suggest that a diet containing oatmeal instead of white bread or eggs may be associated with a lower rate of stroke.
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Affiliation(s)
- Line Lyskjær
- From the Department of Public Health, Aarhus University, Denmark (L.L., K.O., C.C.D.)
| | - Kim Overvad
- From the Department of Public Health, Aarhus University, Denmark (L.L., K.O., C.C.D.).,Department of Cardiology, Aalborg University Hospital, Denmark (K.O.)
| | - Anne Tjønneland
- Diet, Genes and Environment Group, Danish Cancer Society Research Center, Copenhagen, Denmark (A.T.).,Department of Public Health, University of Copenhagen, Denmark (A.T)
| | - Christina C Dahm
- From the Department of Public Health, Aarhus University, Denmark (L.L., K.O., C.C.D.)
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11
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Landberg R, Hanhineva K, Tuohy K, Garcia-Aloy M, Biskup I, Llorach R, Yin X, Brennan L, Kolehmainen M. Biomarkers of cereal food intake. GENES AND NUTRITION 2019; 14:28. [PMID: 31632507 PMCID: PMC6790055 DOI: 10.1186/s12263-019-0651-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
Background/objectives Cereal foods are major contributors to the daily energy, protein, and dietary fiber intake all over the world. The role of cereals in human health is dependent on whether they are consumed as refined or whole grain and on cereal species. To unravel the underlying mechanisms of health effects attributed to specific cereal foods and to provide more precise dietary advice, there is a need for improved dietary assessment of whole-grain intake. Dietary biomarkers of specific cereals, different fractions or cereal-containing foods could offer such a possibility. The aim of this review was to summarize the current status on biomarkers of different cereals, fractions, and specific cereal foods. Subjects and methods A literature review was conducted and putative biomarkers of different cereals and pseudo-cereals (wheat, oats, rye, barley, rice, and quinoa) as well as for different grain fractions (whole grain, refined grain, bran) and foods were summarized and discussed. Results Several putative biomarkers have been suggested for different cereals, due to their unique presence in these grains. Among the biomarkers, odd-numbered alkylresorcinols are the most well-studied and -evaluated biomarkers and reflect whole-grain wheat and rye intake. Even-numbered alkylresorcinols have been suggested to reflect quinoa intake. Recent studies have also highlighted the potential of avenanthramides and avenacosides as specific biomarkers of oat intake, and a set of biomarkers have been suggested to reflect rice bran intake. However, there are yet no specific biomarkers of refined grains. Most biomarker candidates remain to be evaluated in controlled interventions and free-living populations before applied as biomarkers of intake in food and health studies. Conclusion Several putative biomarkers of different cereals have been suggested and should be validated in human studies using recently developed food intake biomarker validation criteria.
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Affiliation(s)
- Rikard Landberg
- 1Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Kati Hanhineva
- 2Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Kieran Tuohy
- 3Nutrition and Nutrigenomics Unit, Department of Food Quality and Nutrition, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, 38010 Trento, Italy
| | - Mar Garcia-Aloy
- 4Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Food Technology Reference Net (XaRTA), Nutrition and Food Safety Research Institute (INSA-UB), Faculty of Pharmacy and Food Sciences, Campus Torribera, University of Barcelona, Barcelona, Spain.,5CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Izabela Biskup
- 1Department of Biology and Biological Engineering, Division of Food and Nutrition Science, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Rafael Llorach
- 4Biomarkers and Nutrimetabolomic Laboratory, Department of Nutrition, Food Sciences and Gastronomy, Food Technology Reference Net (XaRTA), Nutrition and Food Safety Research Institute (INSA-UB), Faculty of Pharmacy and Food Sciences, Campus Torribera, University of Barcelona, Barcelona, Spain.,5CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Barcelona, Spain
| | - Xiaofei Yin
- UCD School of Agriculture and Food Science, Institute of Food and Health, Belfield, Dublin 4, Ireland
| | - Lorraine Brennan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Belfield, Dublin 4, Ireland
| | - Marjukka Kolehmainen
- 2Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
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12
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Gaesser GA. Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association? Adv Nutr 2019; 10:361-371. [PMID: 30947337 PMCID: PMC6520038 DOI: 10.1093/advances/nmy104] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/24/2018] [Accepted: 11/01/2018] [Indexed: 01/07/2023] Open
Abstract
Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.
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Affiliation(s)
- Glenn A Gaesser
- College of Health Solutions, Arizona State University, Phoenix, AZ,Address correspondence to GAG (e-mail: )
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13
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Laskowski W, Górska-Warsewicz H, Rejman K, Czeczotko M, Zwolińska J. How Important are Cereals and Cereal Products in the Average Polish Diet? Nutrients 2019; 11:E679. [PMID: 30901972 PMCID: PMC6470554 DOI: 10.3390/nu11030679] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 12/21/2022] Open
Abstract
The main aim of this study was to identify the food sources of energy and 28 nutrients from cereals and cereal products in the average Polish diet based on data from a nationally representative sample of the Polish population attending in 2016 Household Budget Survey (i.e., 36,886 households). The contribution of energy and nutrients from cereals and cereal products were compared with reference values. The detailded analysis included five main groups and nine sub-groups of cereal food category. Our findings indicated that cereals and cereal products contributed 30.4% of total dietary energy supply, providing a significant percentage of six nutrients to the average Polish diet (i.e., 64.1% of manganese, 51% of carbohydrates, 48.5% of dietary fibre, 34.1% of iron, 33.6% of folate, and 31.3% of copper). Supply at the level of 20⁻30% was observed for protein, thiamin, phosphorus and zinc, and at 10⁻20% for polyunsaturated fatty acids (PUFA), sodium, potassium, calcium, riboflavin, niacin, and vitamin B6. For other nutrients i.e., total fat, saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), cholesterol, iodine, vitamins: A, D, B12, and C, the share of cereals and cereal products contribution was below 10%. Cereals and cereal products were the major food category in meeting the reference values for the Polish population in case of manganese, carbohydrates (approximately100%), and sodium (50%). The reference values was reached at the level of 30⁻40% for dietary fibre, protein, iron, copper, zinc, phosphorus and thiamin, and 20⁻30% for energy, magnesium, folate, niacin, riboflavin, vitamins B6 and E. For such nutrients as total fat, SFA, and potassium, the fulfillment of the reference values amounted to 10⁻20%. Our results document the importance of cereals and cereal products in the Polish diet, which should be emphasized from a nutritional and health point of view.
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Affiliation(s)
- Wacław Laskowski
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences,02-787 Warsaw, Poland.
| | - Hanna Górska-Warsewicz
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences,02-787 Warsaw, Poland.
| | - Krystyna Rejman
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences,02-787 Warsaw, Poland.
| | - Maksymilian Czeczotko
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences,02-787 Warsaw, Poland.
| | - Justyna Zwolińska
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences,02-787 Warsaw, Poland.
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14
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Sun T, Zhang Y, Huang H, Wang X, Zhou L, Li S, Huang S, Xie C, Wen Y, Zhu Y, Hu X, Chen L, Li P, Chen S, Yang W, Bao W, Hu FB, Cheng J, Liu L. Plasma alkylresorcinol metabolite, a biomarker of whole-grain wheat and rye intake, and risk of ischemic stroke: a case-control study. Am J Clin Nutr 2019; 109:1-7. [PMID: 30753322 DOI: 10.1093/ajcn/nqy323] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background Epidemiologic studies on whole grains and risk of stroke have reported inconsistent results, with some suggesting a protective effect but others showing a null association. Objectives The aim of this study was to examine whether plasma 3-(3,5-dihydroxyphenyl)-1-propanoic acid (DHPPA), a biomarker of whole-grain wheat and rye intake, is associated with risk of ischemic stroke. Methods A hospital-based case-control study was conducted between March 2011 and May 2016. Cases (n = 990) with first ischemic stroke were matched to controls (n = 990) by sex and age. Concentrations of plasma DHPPA were determined by high-performance liquid chromatography-tandem mass spectrometry. We calculated ORs for the association of plasma DHPPA concentrations with ischemic stroke risk through the use of logistic regression. Results Plasma DHPPA was inversely associated with ischemic stroke risk. After adjustment for potential confounding factors, the ORs for ischemic stroke across increasing quartiles of plasma DHPPA concentrations were 1 (referent), 0.76 (95% CI: 0.58, 0.99), 0.71 (95% CI: 0.54, 0.92), and 0.59 (95% CI: 0.45, 0.77), respectively (P-trend = 0.001). The inverse association was also observed in all subgroups of participants according to sex, age, body mass index, smoking status, alcohol consumption, history of hypertension, and history of diabetes. Conclusions Our study showed that higher plasma DHPPA concentrations were associated with lower risk of ischemic stroke. This finding provides further evidence to support the health benefits of whole-grain consumption.
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Affiliation(s)
- Taoping Sun
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanwei Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hao Huang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoqian Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhou
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shuzhen Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suli Huang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Changhui Xie
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ying Wen
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yalun Zhu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Hu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangkai Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiyun Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sijing Chen
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Yang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Bao
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Frank B Hu
- Department of Nutrition.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Liegang Liu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety.,Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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15
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Ponce-Martínez X, Colin-Ramirez E, Sánchez-Puerto P, Rivera-Mancía S, Cartas-Rosado R, Infante-Vázquez O, Vallejo-Allende M, Vargas-Barrón J. Bread Consumption Is Associated with Elevated Blood Pressure among Adults Living in Mexico City⁻A Sub-Analysis of the Tlalpan 2020 Study. Nutrients 2018; 10:nu10121969. [PMID: 30551575 PMCID: PMC6316157 DOI: 10.3390/nu10121969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 01/19/2023] Open
Abstract
Excessive dietary sodium is associated with elevated blood pressure (EBP). Bread products are identified as one of the main sources of daily sodium intake. The objective of this cross-sectional study was to evaluate the association between bread and others cereal products consumption with EBP. Frequency intake of a standard serving of bread and other cereal products was recorded and categorized as: ≤3 times/month or never (reference category group) and ≥ once/week. EBP was defined as systolic blood pressure (SBP) ≥120 mmHg and/or diastolic blood pressure (DBP) ≥80 mmHg. Raw and adjusted odds ratios (OR) for the association between consumption of the studied food products and blood pressure status were estimated. Overall, 2011 participants aged 37.3 ± 9.1 years old were included. In the models adjusted for relevant covariates, consumption of one piece of bolillo or telera (OR = 1.39; 95% CI = 1.01–1.89) ≥ once/week was associated with an increased risk of EBP, compared to the reference category. Also, participants consuming one bowl of high-fiber breakfast cereal once/week were less likely to have EBP (OR = 0.73; 95% CI = 0.53–0.98). Initiatives to reduce sodium levels in bread products such as bolillo and telera are needed in Mexico to help manage the cardiovascular risk at the population level.
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Affiliation(s)
- Xochitl Ponce-Martínez
- Sociomedical Research Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
| | - Eloisa Colin-Ramirez
- Sociomedical Research Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
- Cátedras CONACYT, National Council of Science and Technology, Mexico City 03940, Mexico.
| | - Paulina Sánchez-Puerto
- Sociomedical Research Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
| | - Susana Rivera-Mancía
- Sociomedical Research Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
- Cátedras CONACYT, National Council of Science and Technology, Mexico City 03940, Mexico.
| | - Raúl Cartas-Rosado
- Electromechanical Instrumentation Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
| | - Oscar Infante-Vázquez
- Electromechanical Instrumentation Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
| | - Maite Vallejo-Allende
- Sociomedical Research Department, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
| | - Jesús Vargas-Barrón
- Division of Research, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico.
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16
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Ludwig DS, Hu FB, Tappy L, Brand-Miller J. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ 2018; 361:k2340. [PMID: 29898880 PMCID: PMC5996878 DOI: 10.1136/bmj.k2340] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T H Chan School of Public Health, Boston, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Luc Tappy
- Department of Physiology, University of Lausanne, Lausanne, Switzerland
| | - Jennie Brand-Miller
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
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Juan J, Liu G, Willett WC, Hu FB, Rexrode KM, Sun Q. Whole Grain Consumption and Risk of Ischemic Stroke: Results From 2 Prospective Cohort Studies. Stroke 2017; 48:3203-3209. [PMID: 29127271 PMCID: PMC5726805 DOI: 10.1161/strokeaha.117.018979] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Higher intake of whole grains may exert cardiometabolic benefits, although findings on stroke risk are inconclusive. The potentially differential effects of individual whole grain foods on ischemic stroke have not been examined. METHODS We analyzed whole grain consumption in relation to ischemic stroke among 71 750 women from the Nurses' Health Study and 42 823 men from the Health Professionals Follow-up Study who were free of cardiovascular disease, diabetes mellitus, and cancer at baseline (1984 and 1986, respectively) through 2010 using a Cox proportional hazards model. Validated semiquantitative food frequency questionnaires were used to assess consumption of whole grain intake, including whole grain cold breakfast cereal, dark bread, oatmeal, brown rice, popcorn, bran, and germ. Self-reported incident cases of ischemic stroke were confirmed through medical record review. RESULTS During 2 820 128 person-years of follow-up in the 2 cohorts, 2458 cases of ischemic stroke were identified and confirmed. Intake of total whole grains was not associated with risk of ischemic stroke after adjustment for covariates: the pooled hazard ratio (95% confidence interval) comparing extreme intake levels was 1.04 (0.91-1.19). However, intake of whole grain cold breakfast cereal and total bran was inversely associated with ischemic stroke after multivariate adjustment: the pooled hazard ratios (95% confidence intervals) were 0.88 (0.80-0.96; Ptrend=0.008) and 0.89 (0.79-1.00; Ptrend=0.004), respectively. Other whole grain foods were not associated with a lower risk of ischemic stroke. CONCLUSIONS Although overall consumption of whole grains was not associated with lower risk of ischemic stroke, greater consumption of whole grain cold breakfast cereal and bran was significantly associated with a lower risk of ischemic stroke. More studies are needed to replicate these associations between individual whole grain foods and risk of ischemic stroke among other populations.
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Affiliation(s)
- Juan Juan
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Gang Liu
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Walter C Willett
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Frank B Hu
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kathryn M Rexrode
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Qi Sun
- From the Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, China (J.J.); Departments of Nutrition (J.J., G.L., W.C.W., F.B.H., Q.S.) and Epidemiology (W.C.W., F.B.H.), Harvard T.H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (W.C.W., F.B.H., Q.S.); and Divisions of Women's Health (K.M.R.) and Preventive Medicine (K.M.R.), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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Health Benefits of Dietary Whole Grains: An Umbrella Review of Meta-analyses. J Chiropr Med 2016; 16:10-18. [PMID: 28228693 DOI: 10.1016/j.jcm.2016.08.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The purpose of this study is to review the effectiveness of the role of whole grain as a therapeutic agent in type 2 diabetes, cardiovascular disease, cancer, and obesity. METHODS An umbrella review of all published meta-analyses was performed. A PubMed search from January 1, 1980, to May 31, 2016, was conducted using the following search strategy: (whole grain OR whole grains) AND (meta-analysis OR systematic review). Only English language publications that provided quantitative statistical analysis on type 2 diabetes, cardiovascular disease, cancer, and weight loss were retrieved. RESULTS Twenty-one meta-analyses were retrieved for inclusion in this umbrella review, and all the meta-analyses reported statistically significant positive benefits for reducing the incidence of type 2 diabetes (relative risk [RR] = 0.68-0.80), cardiovascular disease (RR = 0.63-0.79), and colorectal, pancreatic, and gastric cancers (RR = 0.57-0.94) and a modest effect on body weight, waist circumference, and body fat mass. Significant reductions in cardiovascular and cancer mortality were also observed (RR = 0.82 and 0.89, respectively). Some problems of heterogeneity, publication bias, and quality assessment were found among the studies. CONCLUSION This review suggests that there is some evidence for dietary whole grain intake to be beneficial in the prevention of type 2 diabetes, cardiovascular disease, and colorectal, pancreatic, and gastric cancers. The potential benefits of these findings suggest that the consumption of 2 to 3 servings per day (~45 g) of whole grains may be a justifiable public health goal.
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