Association between dietary whole grain intake and risk of mortality

Two large prospective studies in US Men and Women

Hongyu Wu, Alan J. Flint, Qibin Qi, Rob M. Van Dam, Laura A. Sampson, Eric B. Rimm, Michelle D. Holmes, Walter C. Willett, Frank B. Hu, Qi Sun

Research output: Contribution to journalArticle

73 Citations (Scopus)

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 investigated74 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. MAINOUTCOMES ANDMEASURES: 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 for trend <.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 for trend <.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 for trend =.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 ora 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 for trend <.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 ofother dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.

Original languageEnglish (US)
Pages (from-to)373-384
Number of pages12
JournalJAMA Internal Medicine
Volume175
Issue number3
DOIs
StatePublished - Mar 1 2015

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Prospective Studies
Mortality
Cardiovascular Diseases
Neoplasms
Whole Grains
Men's Health
Women's Health
Type 2 Diabetes Mellitus
Life Style
Body Mass Index
Chronic Disease
Cohort Studies
Smoking
Nurses
Exercise
Food

ASJC Scopus subject areas

  • Internal Medicine

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Association between dietary whole grain intake and risk of mortality : Two large prospective studies in US Men and Women. / Wu, Hongyu; Flint, Alan J.; Qi, Qibin; Van Dam, Rob M.; Sampson, Laura A.; Rimm, Eric B.; Holmes, Michelle D.; Willett, Walter C.; Hu, Frank B.; Sun, Qi.

In: JAMA Internal Medicine, Vol. 175, No. 3, 01.03.2015, p. 373-384.

Research output: Contribution to journalArticle

Wu, H, Flint, AJ, Qi, Q, Van Dam, RM, Sampson, LA, Rimm, EB, Holmes, MD, Willett, WC, Hu, FB & 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, vol. 175, no. 3, pp. 373-384. https://doi.org/10.1001/jamainternmed.2014.6283
Wu, Hongyu ; Flint, Alan J. ; Qi, Qibin ; Van Dam, Rob M. ; Sampson, Laura A. ; Rimm, Eric B. ; Holmes, Michelle D. ; Willett, Walter C. ; Hu, Frank B. ; Sun, Qi. / Association between dietary whole grain intake and risk of mortality : Two large prospective studies in US Men and Women. In: JAMA Internal Medicine. 2015 ; Vol. 175, No. 3. pp. 373-384.
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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 investigated74 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. MAINOUTCOMES ANDMEASURES: 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 for trend <.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 for trend <.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 for trend =.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 ora 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 for trend <.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 ofother dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.",
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TY - JOUR

T1 - Association between dietary whole grain intake and risk of mortality

T2 - 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 - 2015/3/1

Y1 - 2015/3/1

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 investigated74 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. MAINOUTCOMES ANDMEASURES: 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 for trend <.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 for trend <.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 for trend =.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 ora 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 for trend <.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 ofother dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.

AB - 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 investigated74 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. MAINOUTCOMES ANDMEASURES: 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 for trend <.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 for trend <.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 for trend =.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 ora 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 for trend <.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 ofother dietary and lifestyle factors. These results are in line with recommendations that promote increased whole grain consumption to facilitate disease prevention.

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