Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies
Hu Y, Ding M, Sampson L, Willett WC, Manson JE, Wang M, Rosner B, Hu FB, Sun Q
BMJ (Clinical research ed.) · 126 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Cohort study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Food frequency questionnaire
Who paid for it
- Funding
- Independent funding
- Government
- National Institutes of Health
- Grants
- National Institutes of Health (HL-035464); National Institutes of Health (HL034594); National Institutes of Health (CA176726); National Institutes of Health (DK112940); National Institutes of Health (CA-167552); National Institutes of Health (CA186107); National Institutes of Health (DK120870)
Based on 1 listed funder(s).
Publication
- Published
- 2020-07-08 · BMJ · vol. 370 · p. m2206
- Cited
- 207 citations · more than 99% of similar papers · 12.8× the field average
- Impact
- Top 10% most cited in its field
- References
- 63 works
- Access
- Open access (hybrid journal) · CC-BY-NC
- Research areas
- Food composition and properties · Wheat and Barley Genetics and Pathology · Celiac Disease Research and Management
- Keywords
- Medicine, Type 2 diabetes, Whole grains, Confidence interval, Hazard ratio, Prospective cohort study, Refined grains, Diabetes mellitus, Cohort study, Cohort, Environmental health, Demography, Internal medicine, Food science, Endocrinology
- MeSH
- humans, diabetes mellitus, type 2, follow-up studies, prospective studies, adult, middle aged, united states, female, male, surveys and questionnaires, whole grains, diet, healthy
9 authors
From US
- Yang HuHarvard University
- Ming DingHarvard University
- Laura SampsonHarvard University
- Walter Churchill WillettBrigham and Women's Hospital; Harvard University
- JoAnn E. MansonBrigham and Women's Hospital; Harvard University
- Molin WangHarvard University
Abstract
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY-NC).
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