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Whole-grain foods and chronic disease: evidence from epidemiological and intervention studies

  • Chris J. Seal (a1) and Iain A. Brownlee (a2)


Cereal-based foods are key components of the diet and they dominate most food-based dietary recommendations in order to achieve targets for intake of carbohydrate, protein and dietary fibre. Processing (milling) of grains to produce refined grain products removes key nutrients and phytochemicals from the flour and although in some countries nutrients may be replaced with mandatory fortification, overall this refinement reduces their potential nutritional quality. There is increasing evidence from both observational and intervention studies that increased intake of less-refined, whole-grain (WG) foods has positive health benefits. The highest WG consumers are consistently shown to have lower risk of developing CVD, type 2 diabetes and some cancers. WG consumers may also have better digestive health and are likely to have lower BMI and gain less weight over time. The bulk of the evidence for the benefits of WG comes from observational studies, but evidence of benefit in intervention studies and potential mechanisms of action is increasing. Overall this evidence supports the promotion of WG foods over refined grain foods in the diet, but this would require adoption of standard definitions of ‘whole grain’ and ‘whole-grain foods’ which will enable innovation by food manufacturers, provide clarity for the consumer and encourage the implementation of food-based dietary recommendations and public health strategies.

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Corresponding author

* Corresponding author: Chris J. Seal, email


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1. Räsänen, L (2007) Of all foods bread is the most noble: Carl von Linné (Carl Linneaus) on bread. Scand J Food Nutr 51, 9199.
2. Thomas, RA (1894) Medical Essays. London, UK: F. Pitman.
3. Anonymous Editorial (1961) Longevity in hunza land. J AM Med Assoc 175, 706706.
4. Public Health England (2014) Consultation on draft SACN Carbohydrates and Health report. (accessed January 2015).
5. American Association of Cereal Chemists (1999) Whole grain definition. Cereal Foods World 45, 79.
6. Slavin, J, Tucker, M, Harriman, C et al. (2013) Whole grains: definition, dietary recommendations and health benefits. Cereal Foods World 58, 191198.
7. van der Kamp, JW, Poutanen, K, Seal, CJ et al. (2014) The HEALTHGRAIN definition of ‘whole grain’. Food Nutr Res 58, 22100.
8. Ferruzzi, MG, Jonnalagadda, SS, Liu, S et al. (2014) Developing a standard definition of whole-grain foods for dietary recommendations: summary report of a multidisciplinary expert roundtable discussion. Adv Nutr 5, 164176.
9. Mellen, PB, Walsh, TF & Herrington, DM (2008) Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis 18, 283290.
10. Ye, EQ, Chacko, SA, Chou, EL et al. (2012) Greater whole-grain intake is associated with lower risk of Type 2 diabetes, cardiovascular disease, and weight gain. J Nutr 142, 13041313.
11. Aune, D, Norat, T, Romundstad, P et al. (2013) Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 28, 845858.
12. Aune, D, Chan, DSM, Lau, R et al. (2011) Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. Br Med J 343.
13. Jacobs, D, Marquart, L, Slavin, J et al. (1998) Whole grain intake and cancer: an expanded review and meta-analysis. Nutr Cancer 30, 8596.
14. Scientific Advisory Committee on Nutrition (2014) Draft SACN Carbohydrates and Health Report. (accessed April 2015).
15. Bellisle, F, Hébel, P, Colin, J et al. (2014) Consumption of whole grains in French children, adolescents and adults. Br J Nutr 112, 16741684.
16. Devlin, NFC, McNulty, BA, Gibney, MJ et al. (2013) Whole grain intakes in the diets of Irish children and teenagers. Br J Nutr 110, 354362.
17. Mann, KD, Pearce, MS, McKevith, B et al. (2015) Low whole grain intake in the UK: results from the National Diet and Nutrition Survey rolling programme 2008–2011. Br J Nutr 113, 16431651.
18. Ross, AB, Kristensen, M, Seal, CJ et al. (2015) Recommendations for reporting whole-grain intake in observational and intervention studies. Am J Clin Nutr 101, 903907.
19. Pol, K, Christensen, R, Bartels, EM et al. (2013) Whole grain and body weight changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies. Am J Clin Nutr 98, 872884.
20. Seal, CJ, Jones, AR & Whitney, AD (2006) Whole grains uncovered. Nutr Bull 31, 129137.
21. Kazemzadeh, M, Safavi, SM, Nematollahi, S et al. (2014) Effect of brown rice consumption on inflammatory marker and cardiovascular risk factors among overweight and obese non-menopausal female adults. Int J Prev Med 5, 478488.
22. Sun, Q, Spiegelman, D, van Dam, RM et al. (2010) White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Int Med 170, 961969.
23. Rebello, SA, Koh, H, Chen, C et al. (2014) Amount, type, and sources of carbohydrates in relation to ischemic heart disease mortality in a Chinese population: a prospective cohort study. Am J Clin Nutr 100, 5364.
24. Parker, ED, Liu, S, Van Horn, L et al. (2013) The association of whole grain consumption with incident type 2 diabetes: the Women's Health Initiative Observational Study. Ann Epidemiol 23, 321327.
25. Atkinson, FS, Foster-Powell, K & Brand-Miller, JC (2008) International tables of glycemic index and glycemic load values: 2008. Diab. Care 31, 22812283.
26. Brand-Miller, J, McMillan-Price, J, Steinbeck, K et al. (2008) Carbohydrates-the good, the bad and the whole grain. Asia Pac J Clin Nutr 17, 1619.
27. Giacco, R, Costabile, G, Della Pepa, G et al. (2014) A whole-grain cereal-based diet lowers postprandial plasma insulin and triglyceride levels in individuals with metabolic syndrome. Nutr Metab Cardiovasc Dis 24, 837844.
28. Magnusdottir, OK, Landberg, R, Gunnarsdottir, I et al. (2014) Whole grain rye intake, reflected by a biomarker, is associated with favorable blood lipid outcomes in subjects with the metabolic syndrome – A randomized study. PLoS ONE 9, e110827.
29. Poulsen, SK, Due, A, Jordy, AB et al. (2014) Health effect of the New Nordic Diet in adults with increased waist circumference: a 6-mo randomized controlled trial. Am J Clin Nutr 99, 3545.
30. Kang, R, Kim, M, Chae, JS et al. (2014) Consumption of whole grains and legumes modulates the genetic effect of the APOA5 -1131C variant on changes in triglyceride and apolipoprotein A-V concentrations in patients with impaired fasting glucose or newly diagnosed type 2 diabetes. Trials 15, 100.
31. Katcher, HI, Legro, RS, Kunselman, AR et al. (2008) The effects of a whole grain enriched hypocaloric diet on cardiovascular disease risk factors in men and women with metabolic syndrome. Am J Clin Nutr 87, 7990.
32. Kristensen, M, Toubro, S, Jensen, MG et al. (2012) Whole grain compared with refined wheat decreases the percentage of body fat following a 12-week, energy-restricted dietary intervention in postmenopausal women. J Nutr 142, 710716.
33. Food and Drug Administration (1999) Health claim notification for whole grain foods. 39.htm (accessed April 2015).
34. Food and Drug Administration (2003) Health claim notification for whole grain foods with moderate fat content. (accessed April 2015).
35. Mourouti, N, Papavagelis, C, Plytzanopoulou, P et al. (2015) Dietary patterns and breast cancer: a case-control study in women. Eur J Nutr 54, 609617.
36. Arthur, AE, Peterson, KE, Shen, J et al. (2014) Diet and proinflammatory cytokine levels in head and neck squamous cell carcinoma. Cancer 120, 27042712.
37. Arthur, AE, Peterson, KE, Rozek, LS et al. (2013) Pretreatment dietary patterns, weight status, and head and neck squamous cell carcinoma prognosis. Am J Clin Nutr 97, 360368.
38. Schatzkin, A, Mouw, T, Park, Y et al. (2007) Dietary fiber and whole-grain consumption in relation to colorectal cancer in the NIH-AARP Diet and Health Study. Am J Clin Nutr 85, 13531360.
39. Knudsen, MD, Kyrø, C, Olsen, A et al. (2014) Self-reported whole-grain intake and plasma alkylresorcinol concentrations in combination in relation to the incidence of colorectal cancer. Am J Epidemiol 179, 11881196.
40. Ross, AB (2012) Present status and perspectives on the use of alkylresorcinols as biomarkers of wholegrain wheat and rye intake. J Nutr Metab, Article ID 462967.
41. Ross, AB, Bourgeois, A, Macharia, HNu et al. (2012) Plasma alkylresorcinols as a biomarker of whole-grain food consumption in a large population: results from the WHOLEheart Intervention Study. Am J Clin Nutr 95, 204211.
42. Cleveland, LE, Moshfegh, AJ, Albertson, AM et al. (2000) Dietary intake of whole grains. J Am Coll Nutr 19, 331S338S.
43. Zanovec, M, O'Neil, CE, Cho, SS et al. (2010) Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds. J Pediatr 157, 578583.
44. Egeberg, R, Olsen, A, Loft, S et al. (2010) Intake of wholegrain products and risk of colorectal cancers in the Diet, Cancer and Health cohort study. Br J Cancer 103, 730734.
45. Fardet, A, Rock, E & Rémésy, C (2008) Is the in vitro antioxidant potential of whole-grain cereals and cereal products well reflected in vivo? J Cereal Sci 48, 258276.
46. Fardet, A, Canlet, C, Gottardi, G et al. (2007) Whole-grain and refined wheat flours show distinct metabolic profiles in rats as assessed by a 1H NMR-based metabonomic approach. J Nutr 137, 923929.
47. Kararli, TT (1995) Comparison of the gastrointestinal anatomy, physiology, and biochemistry of humans and commonly used laboratory animals. Biopharm Drug Dispos 16, 351380.
48. La Fleur, SE, Luijendijk, MCM, Van Der Zwaal, EM et al. (2014) The snacking rat as model of human obesity: effects of a free-choice high-fat high-sugar diet on meal patterns. Int J Obes 38, 643649.
49. Muñoz Cano, JM, Aguilar, AC & Hernández, JC (2013) Lipid-lowering effect of maize-based traditional Mexican food on a metabolic syndrome model in rats. Lipids Health Dis 12, 9.
50. Lee, SH, Chung, I-M, Cha, Y-S et al. (2010) Millet consumption decreased serum concentration of triglyceride and C-reactive protein but not oxidative status in hyperlipidemic rats. Nutr Res 30, 290296.
51. Park, MY, Jang, HH, Kim, JB et al. (2011) Hog millet (Panicum miliaceum L.)-supplemented diet ameliorates hyperlipidemia and hepatic lipid accumulation in C57BL/6J-ob/ob mice. Nutr Res Pract 5, 511519.
52. Park, MY, Jang, HH, Lee, JY et al. (2012) Effect of hog millet supplementation on hepatic steatosis and insulin resistance in mice fed a high-fat diet. J Korean Soc Food Sci Nutr 41, 501509.
53. Kim, JY, Shin, JH & Lee, SS (2012) Cardioprotective effects of diet with different grains on lipid profiles and antioxidative system in obesity-induced rats. Int J Vitam Nutr Res 82, 8593.
54. Son, BK, Kim, JY & Lee, SS (2008) Effect of adlay, buckwheat and barley on lipid metabolism and aorta histopathology in rats fed an obesogenic diet. Ann Nutr Metab 52, 181187.
55. Andersson, U, Rosén, L, Östman, E et al. (2010) Metabolic effects of whole grain wheat and whole grain rye in the C57BL/6J mouse. Nutrition 26, 230239.
56. Buescher, MI & Gallaher, DD (2014) Wheat color (Class), not refining, influences colon cancer risk in rats. Nutr Cancer 66, 849856.
57. Maziya-Dixon, B, Klopfenstein, C & Leipold, H (1994) Protective effects of hard red versus hard white winter wheats in chemically induced colon cancer in CF1 mice. Cereal Chem 71, 359363.
58. Nielsen, KL, Hartvigsen, ML, Hedemann, MS et al. (2014) Similar metabolic responses in pigs and humans to breads with different contents and compositions of dietary fibers: a metabolomics study. Am J Clin Nutr 99, 941949.
59. Lærke, HN, Pedersen, C, Mortensen, MA et al. (2008) Rye bread reduces plasma cholesterol levels in hypercholesterolemia pigs when compared to wheat at similar dietary fibre level. J Sci Food Agr 88, 13851393.
60. Denmark Ministry of Food (2015) Fuldkorn (Whole Grain). (accessed April 2015).
61. Malaysia Ministry of Health (2015) Dietary guidelines key message 4. uan/diet/KM4.pdf (accessed April 2015).
62. National Health Service (2015) NHS choices, starchy foods and carbohydrates. (accessed April 2015).
63. US Department of Health and Human Sciences (2010) Dietary guidelines for Americans 2010. (accessed March 2015).
64. Selem, SSDC, Castro, MAD, César, CLG et al. (2014) Associations between dietary patterns and self-reported hypertension among Brazilian adults: a cross-sectional population-based study. J Acad Nutr Diet 114, 12161222.
65. Amankwaa, A & Annan, R (2014) Dietary patterns and metabolic risk factors for cardiovascular disease among University Students in Ghana. Asian J Clin Nutr 6, 1828.
66. Dugee, O, Khor, GL, Lye, MS et al. (2009) Association of major dietary patterns with obesity risk among Mongolian men and women. Asia Pac J Clin Nutr 18, 433440.
67. Song, S, Paik, H-Y & Song, Y (2012) High intake of whole grains and beans pattern is inversely associated with insulin resistance in healthy Korean adult population. Diab Res Clin Pract 98, e28e31.


Whole-grain foods and chronic disease: evidence from epidemiological and intervention studies

  • Chris J. Seal (a1) and Iain A. Brownlee (a2)


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