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Whole grain, bran and cereal fibre consumption and CVD: a systematic review

  • Eden M. Barrett (a1) (a2), Marijka J. Batterham (a2) (a3), Sumantra Ray (a4) and Eleanor J. Beck (a1) (a2)

Abstract

Whole grain intake is associated with lower CVD risk in epidemiological studies. It is unclear to what extent cereal fibre, located primarily within the bran, is responsible. This review aimed to evaluate association between intake of whole grain, cereal fibre and bran and CVD risk. Academic databases were searched for human studies published before March 2018. Observational studies reporting whole grain and cereal fibre or bran intake in association with any CVD-related outcome were included. Studies were separated into those defining whole grain using a recognised definition (containing the bran, germ and endosperm in their natural proportions) (three studies, seven publications) and those using an alternative definition, such as including added bran as a whole grain source (eight additional studies, thirteen publications). Intake of whole grain, cereal fibre and bran were similarly associated with lower risk of CVD-related outcomes. Within the initial analysis, where studies used the recognised whole grain definition, results were less likely to show attenuation after adjustment for cereal fibre content. The fibre component of grain foods appears to play an important role in protective effects of whole grains. Adjusting for fibre content, associations remained, suggesting that additional components within the whole grain, and the bran component, may contribute to cardio-protective association. The limited studies and considerable discrepancy in defining and calculating whole grain intake limit conclusions. Future research should utilise a consistent definition and methodical approach of calculating whole grain intake to contribute to a greater body of consistent evidence surrounding whole grains.

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Corresponding author

*Corresponding author: E. M. Barrett, fax +61 2 4221 4844, email emb952@uow.edu.au

References

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1. World Health Organization (2017) Cardiovascular diseases fact sheet. http://www.who.int/mediacentre/factsheets/fs317/en/ (accessed February 2018).
2. Pearson, TA (2002) AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. Circulation 106, 388391.
3. Yusuf, S, Hawken, S, Ounpuu, S, et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case–control study. Lancet 364, 937952.
4. He, M, van Dam, RM, Rimm, E, et al. (2010) Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus. Circulation 121, 21622168.
5. Jensen, MK, Koh-Banerjee, MF, Hu, FB, et al. (2004) Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr 80, 14921499.
6. Theuwissen, E & Mensink, RP (2008) Water-soluble dietary fibers and cardiovascular disease. Physiol Behav 94, 285292.
7. Fardet, A (2010) New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr Res Rev 23, 65134.
8. Cassidy, A & Hooper, L (2006) Phytoestrogens and cardiovascular disease. J Br Menopause Soc 12, 4956.
9. Aune, D, Keum, N, Giovannucci, E, et al. (2016) 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. BMJ 353, i2716.
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. Jacobs, DR Jr, Meyer, KA, Kushi, LH, et al. (1998) Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women’s Health Study. Am J Clin Nutr 68, 248257.
12. Ross, AB, van der Kamp, JW, King, R, et al. (2017) Perspective: a definition for whole-grain food products-recommendations from the healthgrain forum. Adv Nutr 8, 525531.
13. Liberati, A, Altman, DG, Tetzlaff, J, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. PLoS Med 6, e1000100.
14. American Association of Cereal Chemists International (2017)) Standard definitions and resources: whole grain. http://www.aaccnet.org/initiatives/definitions/Pages/WholeGrain.aspx (accessed September 2017).
15. National Health and Medical Research Council (2000) How to use the evidence: assessment and application of scientific evidence. https://www.nhmrc.gov.au/guidelines-publications/cp69 (accessed September 2017).
16. National Institute of Health (2014) Quality assessment tool for observational cohort and cross-sectional studies. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/cohort (accessed September 2017).
17. Qi, L, van Dam, RM, Liu, S, et al. (2006) Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care 29, 207211.
18. Wu, H, Flint, AJ, Qi, Q, et al. (2015) Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA Intern Med 175, 373384.
19. de Munter, JSL, Hu, FB, Spiegelman, D, et al. (2007) Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PloS Med 4, e261.
20. Flint, AJ, Hu, FB, Glynn, RJ, et al. (2009) Whole grains and incident hypertension in men. Am J Clin Nutr 90, 493498.
21. Koh-Banerjee, MF, Franz, M, Sampson, L, et al. (2004) Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men. Am J Clin Nutr 80, 12371245.
22. Jensen, MK, Koh-Banerjee, MF, Sampson, L, et al. (2006) Whole grains, bran, and germ in relation to homocysteine and markers of glycemic control, lipids, and inflammation. Am J Clin Nutr 83, 275283.
23. Liu, S, Stampfer, MJ, Hu, FB, et al. (1999) Whole-grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr 70, 412–308.
24. Juan, J, Liu, G, Willett, WC, et al. (2017) Whole grain consumption and risk of ischemic stroke: results from 2 prospective cohort studies. Stroke 48, 32033209.
25. Fung, TT, Hu, FB, Pereira, MA, et al. (2002) Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 76, 535540.
26. Montonen, J, Knekt, P, Jarvinen, R, et al. (2003) Whole-grain and fiber intake and the incidence of type 2 diabetes. Am J Clin Nutr 77, 622629.
27. Meyer, KA, Kushi, LH, Jacobs, DR, et al. (2000) Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 71, 921930.
28. McKeown, NM, Meigs, JB, Liu, S, et al. (2004) Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27, 538546.
29. Huang, T, Xu, M, Lee, A, et al. (2015) Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Med 13, 59.
30. Jacobs, DR, Pereira, MA, Meyer, KA, et al. (2000) Fiber from whole grains, but not refined grains, is inversely associated with all-cause mortality in older women: the Iowa Women’s Health Study. J Am Coll Nutr 19, Suppl. 3, 326S330S.
31. Erkkila, AT, Herrington, DM, Mozaffarian, D, et al. (2005) Cereal fiber and whole-grain intake are associated with reduced progression of coronary-artery atherosclerosis in postmenopausal women with coronary artery disease. Am Heart J 150, 94101.
32. Newby, PK, Maras, J, Bakun, P, et al. (2007) Intake of whole grains, refined grains, and cereal fiber measured with 7-d diet records and associations with risk factors for chronic disease. Am J Clin Nutr 86, 17451753.
33. McKeown, NM, Yoshida, M, Shea, MK, et al. (2009) Whole-grain intake and cereal fiber are associated with lower abdominal adiposity in older adults. J Nutr 139, 19501955.
34. van de Vijver, LP, van den Bosch, LM, van den Brandt, PA, et al. (2009) Whole-grain consumption, dietary fibre intake and body mass index in the Netherlands cohort study. Eur J Clin Nutr 63, 3138.
35. Jenkins, DJ, Kendall, CW, Axelsen, M, et al. (2000) Viscous and non-viscous fibres, non-absorbable and low glycaemic index carbohydrates, blood lipids and coronary heart disease. Curr Opin Lipidol 11, 4956.
36. Juntunen, KS, Laaksonen, DE, Poutanen, KS, et al. (2003) High-fiber rye bread and insulin secretion and sensitivity in healthy postmenopausal women. Am J Clin Nutr 77, 385391.
37. Appel, LJ, Moore, TJ, Obarzanek, E, et al. (1997) A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med 336, 11171124.
38. King, DE, Egan, BM & Geesey, ME (2003) Relation of dietary fat and fiber to elevation of C-reactive protein. Am J Cardiol 92, 13351339.
39. Ballantyne, CM (1998) Clinical trial endpoints: angiograms, events, and plaque instability. Am J Cardiol 82, Suppl. 1, 5M11M.
40. Anderson, JW, Gilinsky, NH, Deakins, DA, et al. (1991) Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake. Am J Clin Nutr 54, 678683.
41. Davy, BM, Davy, KP, Ho, RC, et al. (2002) High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men. Am J Clin Nutr 76, 351358.
42. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106, 31433421.
43. Koh-Banerjee, P & Rimm, EB (2003) Whole grain consumption and weight gain: a review of the epidemiological evidence, potential mechanisms and opportunities for future research. Proc Nutr Soc 62, 2529.
44. Pereira, MA & Ludwig, DS (2001) Dietary fiber and body-weight regulation. Observations and mechanisms. Pediatr Clin North Am 48, 969980.
45. Brownlee, IA, Moore, C, Chatfield, M, et al. (2010) Markers of cardiovascular risk are not changed by increased whole-grain intake: the WHOLEheart study, a randomised, controlled dietary intervention. Br J Nutr 104, Suppl. 1, 125S134S.
46. Rave, K, Roggen, K, Dellweg, S, et al. (2007) Improvement of insulin resistance after diet with a whole-grain based dietary product: results of a randomized, controlled cross-over study in obese subjects with elevated fasting blood glucose. Br J Nutr 98, 929936.
47. Melanson, KJ, Angelopoulos, TJ, Nguyen, VT, et al. (2006) Consumption of whole-grain cereals during weight loss effects on dietary quality, dietary fiber, magnesium, vitamin B-6, and obesity. J Am Diet Assoc 106, 13801388.
48. Jenkins, D, Wolever, T, Leeds, AR, et al. (1978) Dietary fibres, fibre analogues, and glucose tolerance: importance of viscosity. Br Med J 1, 13921394.
49. Weickert, MO, Mohlig, M, Schöfl, C, et al. (2006) Cereal fiber improves whole-body insulin sensitivity in overweight and obese women. Diabetes Care 29, 775780.
50. Anderson, JW (1986) Fiber and health: an overview. Am J Gastroenterol 81, 892897.
51. Cummings, JH & Englyst, HN (1987) Fermentation in the human large intestine and the available substrates. Am J Clin Nutr 45, 12431255.
52. Paolisso, G, Sgambato, S, Gambardella, A, et al. (1992) Daily magnesium supplements improve glucose handling in elderly subjects. Am J Clin Nutr 55, 11611167.
53. Ridker, PM, Buring, JE, Cook, NR, et al. (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation 107, 391397.
54. Schulze, MB, Rimm, EB, Li, T, et al. (2004) C-reactive protein and incident cardiovascular events among men with diabetes. Diabetes Care 27, 889894.
55. Pearson, TA, Mensah, GA, Alexander, RW, et al. (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107, 499511.
56. Gonzalez, F, Minium, J, Rote, NS, et al. (2005) Hyperglycemia alters TNF-alpha release from mononuclear cells in women with polycystic ovary syndrome. J Clin Endocrinol Metab 90, 53365342.
57. Devaraj, S, Venugopal, SK, Singh, U, et al. (2005) Hyperglycemia induces monocytic release of interleukin-6 via induction of protein kinase c-alpha and -beta. Diabetes 54, 8591.
58. Lillioja, S, Neal, AL, Tapsell, L, et al. (2013) Whole grains, type 2 diabetes, coronary heart disease, and hypertension: links to the aleurone preferred over indigestible fiber. Biofactors 39, 242258.
59. Kyrø, C, Skeie, G, Dragsted, L, et al. (2011) Intake of whole grains in Scandinavia is associated with healthy lifestyle, socio-economic and dietary factors. Public Health Nutr 14, 17871795.
60. Kris-Etherton, PM, Harris, WS & Appel, LJ (2003) Omega-3 fatty acids and cardiovascular disease: new recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol 23, 151152.

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Whole grain, bran and cereal fibre consumption and CVD: a systematic review

  • Eden M. Barrett (a1) (a2), Marijka J. Batterham (a2) (a3), Sumantra Ray (a4) and Eleanor J. Beck (a1) (a2)

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