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Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women.
JAMA Intern Med 2015; 175(3):373-84JIM

Abstract

IMPORTANCE

Higher intake of whole grains has been associated with a lower risk of major chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease (CVD), although limited prospective evidence exists regarding whole grains' association with mortality.

OBJECTIVE

To examine the association between dietary whole grain consumption and risk of mortality.

DESIGN, SETTING, AND PARTICIPANTS

We investigated 74 341 women from the Nurses' Health Study (1984-2010) and 43 744 men from the Health Professionals Follow-Up Study (1986-2010), 2 large prospective cohort studies. All patients were free of CVD and cancer at baseline.

MAIN OUTCOMES AND MEASURES

Hazard ratios (HRs) for total mortality and mortality due to CVD and cancer according to quintiles of whole grain consumption, which was updated every 2 or 4 years by using validated food frequency questionnaires.

RESULTS

We documented 26 920 deaths during 2 727 006 person-years of follow-up. After multivariate adjustment for potential confounders, including age, smoking, body mass index, physical activity, and modified Alternate Healthy Eating Index score, higher whole grain intake was associated with lower total and CVD mortality but not cancer mortality: the pooled HRs for quintiles 1 through 5, respectively, of whole grain intake were 1 (reference), 0.99 (95% CI, 0.95-1.02), 0.98 (95% CI, 0.95-1.02), 0.97 (95% CI, 0.93-1.01), and 0.91 (95% CI, 0.88-0.95) for total mortality (P fortrend < .001); 1 (reference), 0.94 (95% CI, 0.88-1.01), 0.94 (95% CI, 0.87-1.01), 0.87 (95% CI, 0.80-0.94), and 0.85 (95% CI, 0.78-0.92) for CVD mortality (P fortrend < .001); and 1 (reference), 1.02 (95% CI, 0.96-1.08), 1.05 (95% CI, 0.99-1.12), 1.04 (95% CI, 0.98-1.11), and 0.97 (95% CI, 0.91-1.04) for cancer mortality (P fortrend = .43). We further estimated that every serving (28 g/d) of whole grain consumption was associated with a 5% (95% CI, 2%-7%) lower total morality or a 9% (95% CI, 4%-13%) lower CVD mortality, whereas the same intake level was nonsignificantly associated with lower cancer mortality (HR, 0.98; 95% CI, 0.94-1.02). Similar inverse associations were observed between bran intake and CVD mortality, with a pooled HR of 0.80 (95% CI, 0.73-0.87; P fortrend < .001), whereas germ intake was not associated with CVD mortality after adjustment for bran intake.

CONCLUSIONS AND RELEVANCE

These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.

Authors+Show Affiliations

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts.Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.Saw Swee Hock School of Public Health and Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore4National University Health System, Singapore, Republic of Singapore.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts5The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts5The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts6Department of Epidemiology, Harvard School of Public Hea.The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts6Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts5The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts6Department of Epidemiology, Harvard School of Public Hea.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts5The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts6Department of Epidemiology, Harvard School of Public Hea.Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts5The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25559238

Citation

Wu, Hongyu, et al. "Association Between Dietary Whole Grain Intake and Risk of Mortality: Two Large Prospective Studies in US Men and Women." JAMA Internal Medicine, vol. 175, no. 3, 2015, pp. 373-84.
Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA Intern Med. 2015;175(3):373-84.
Wu, H., Flint, A. J., Qi, Q., van Dam, R. M., Sampson, L. A., Rimm, E. B., ... Sun, Q. (2015). Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA Internal Medicine, 175(3), pp. 373-84. doi:10.1001/jamainternmed.2014.6283.
Wu H, et al. Association Between Dietary Whole Grain Intake and Risk of Mortality: Two Large Prospective Studies in US Men and Women. JAMA Intern Med. 2015;175(3):373-84. PubMed PMID: 25559238.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. AU - Wu,Hongyu, AU - Flint,Alan J, AU - Qi,Qibin, AU - van Dam,Rob M, AU - Sampson,Laura A, AU - Rimm,Eric B, AU - Holmes,Michelle D, AU - Willett,Walter C, AU - Hu,Frank B, AU - Sun,Qi, PY - 2015/1/7/entrez PY - 2015/1/7/pubmed PY - 2015/5/6/medline SP - 373 EP - 84 JF - JAMA internal medicine JO - JAMA Intern Med VL - 175 IS - 3 N2 - IMPORTANCE: Higher intake of whole grains has been associated with a lower risk of major chronic diseases, such as type 2 diabetes mellitus and cardiovascular disease (CVD), although limited prospective evidence exists regarding whole grains' association with mortality. OBJECTIVE: To examine the association between dietary whole grain consumption and risk of mortality. DESIGN, SETTING, AND PARTICIPANTS: We investigated 74 341 women from the Nurses' Health Study (1984-2010) and 43 744 men from the Health Professionals Follow-Up Study (1986-2010), 2 large prospective cohort studies. All patients were free of CVD and cancer at baseline. MAIN OUTCOMES AND MEASURES: Hazard ratios (HRs) for total mortality and mortality due to CVD and cancer according to quintiles of whole grain consumption, which was updated every 2 or 4 years by using validated food frequency questionnaires. RESULTS: We documented 26 920 deaths during 2 727 006 person-years of follow-up. After multivariate adjustment for potential confounders, including age, smoking, body mass index, physical activity, and modified Alternate Healthy Eating Index score, higher whole grain intake was associated with lower total and CVD mortality but not cancer mortality: the pooled HRs for quintiles 1 through 5, respectively, of whole grain intake were 1 (reference), 0.99 (95% CI, 0.95-1.02), 0.98 (95% CI, 0.95-1.02), 0.97 (95% CI, 0.93-1.01), and 0.91 (95% CI, 0.88-0.95) for total mortality (P fortrend < .001); 1 (reference), 0.94 (95% CI, 0.88-1.01), 0.94 (95% CI, 0.87-1.01), 0.87 (95% CI, 0.80-0.94), and 0.85 (95% CI, 0.78-0.92) for CVD mortality (P fortrend < .001); and 1 (reference), 1.02 (95% CI, 0.96-1.08), 1.05 (95% CI, 0.99-1.12), 1.04 (95% CI, 0.98-1.11), and 0.97 (95% CI, 0.91-1.04) for cancer mortality (P fortrend = .43). We further estimated that every serving (28 g/d) of whole grain consumption was associated with a 5% (95% CI, 2%-7%) lower total morality or a 9% (95% CI, 4%-13%) lower CVD mortality, whereas the same intake level was nonsignificantly associated with lower cancer mortality (HR, 0.98; 95% CI, 0.94-1.02). Similar inverse associations were observed between bran intake and CVD mortality, with a pooled HR of 0.80 (95% CI, 0.73-0.87; P fortrend < .001), whereas germ intake was not associated with CVD mortality after adjustment for bran intake. CONCLUSIONS AND RELEVANCE: These data indicate that higher whole grain consumption is associated with lower total and CVD mortality in US men and women, independent of other dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/25559238/full_citation L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2014.6283 DB - PRIME DP - Unbound Medicine ER -