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Meta-Analysis
. 2016 Jun 14:353:i2716.
doi: 10.1136/bmj.i2716.

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

Dagfinn Aune  1 , NaNa Keum  2 , Edward Giovannucci  3 , Lars T Fadnes  4 , Paolo Boffetta  5 , Darren C Greenwood  6 , Serena Tonstad  7 , Lars J Vatten  8 , Elio Riboli  9 , Teresa Norat  9
Affiliations
Meta-Analysis

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

Dagfinn Aune et al. BMJ. .

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Flow chart of study selection
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Fig 2 Forest plot for consumption of whole grains (per 90 g/day) and risk of coronary heart disease, with graph illustrating non-linear response
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Fig 3 Forest plot for consumption of whole grains (per 90 g/day) and risk of stroke, with graph illustrating non-linear response
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Fig 4 Forest plot for consumption of whole grains (per 90 g/day) and risk of cardiovascular disease, with graph illustrating non-linear response
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Fig 5 Forest plot for consumption of whole grains (per 90 g/day) and risk of total cancer, with graph illustrating non-linear response
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Fig 6 Forest plot for consumption of whole grains (per 90 g/day) and risk of all cause mortality, with graph illustrating non-linear response
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Fig 7 Forest plot for consumption of whole grains (per 90 g/day) and risk of mortality from respiratory disease, with graph illustrating non-linear response
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Fig 8 Forest plot for consumption of whole grains (per 90 g/day) and risk of mortality from diabetes, with graph illustrating non-linear response
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Fig 9 Forest plot for consumption of whole grains (per 90 g/day) and risk of mortality from infectious diseases, with graph illustrating non-linear response
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Fig 11 Forest plot for consumption of whole grains (per 90 g/day) and risk of mortality from non-cardiovascular, non-cancer causes, with graph illustrating non-linear response
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Fig 10 Forest plot for consumption of whole grains (per 90 g/day) and risk of mortality from diseases of nervous system, with graph illustrating non-linear response
See this image and copyright information in PMC

Comment in

  • Vollkorn rettet nachweislich Leben.
    Wirth A. Wirth A. MMW Fortschr Med. 2017 May;159(8):40. doi: 10.1007/s15006-017-9571-z. MMW Fortschr Med. 2017. PMID: 28466323 German. No abstract available.

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