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
Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, Tonstad S, Vatten LJ, Riboli E, Norat T
BMJ (Clinical research ed.) · 661 citations
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- University or hospital
- Norges Teknisk-Naturvitenskapelige Universitet
- Government
- National Institute for Health and Care Research
- University or hospital
- Imperial College London
- Government
- Helse Midt-Norge
- Government
- National Institutes of Health
Based on 5 listed funder(s).
Publication
- Published
- 2016-06-14 · BMJ · vol. 353 · p. i2716
- Cited
- 1021 citations · more than 100% of similar papers · 20.5× the field average
- Impact
- Top 10% most cited in its field
- References
- 128 works
- Access
- Open access (hybrid journal) · CC-BY
- Research areas
- Food composition and properties · Celiac Disease Research and Management · Microbial Metabolites in Food Biotechnology
- Keywords
- Medicine, Relative risk, Meta-analysis, Confidence interval, Prospective cohort study, Cancer, Disease, Stroke (engine), Internal medicine, Whole grains, Lung cancer, Cause of death, Incidence (geometry), Food science, Biology
- MeSH
- humans, neoplasms, cardiovascular diseases, diet, cause of death, risk factors, prospective studies, whole grains
10 authors
From NO, GB, US
- Dagfinn Aune · correspondingNorwegian Institute of Public Health; Norwegian University of Science and Technology; Imperial College London
- NaNa KeumHarvard University
- Edward L. GiovannucciBrigham and Women's Hospital; Harvard University
- Lars Thore FadnesUniversity of Bergen
- Paolo BoffettaIcahn School of Medicine at Mount Sinai
- Darren Charles GreenwoodUniversity of Leeds
Abstract
Objective
To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality.
Data sources
PubMed and Embase searched up to 3 April 2016.
Study selection
Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality.
Data synthesis
Summary relative risks and 95% confidence intervals calculated with a random effects model.
Results
45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings-for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.
Conclusions
This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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