Current Atherosclerosis Reports

, Volume 6, Issue 6, pp 415–423 | Cite as

Whole grain intake and cardiovascular disease: A review

  • David R. JacobsJr
  • Daniel D. Gallaher


Prospective epidemiologic and feeding studies find possible health benefits of whole cereal grain foods (which include the bran, germ, and endosperm in their naturally occurring proportions), especially for prevention of atherosclerotic cardiovascular diseases and type 2 diabetes. We review 17 articles that consistently found a 20% to 40% reduction in long-term risk of these diseases comparing habitual consumers of whole grains to those who rarely eat these foods. Another 12 studies found a similar risk reduction according to amount of cereal fiber consumed. Feeding studies show improvements in risk factors for these diseases when whole grain foods are consumed. Some authors have tried to explain the reduced risk by invoking cereal fiber, with no attention to nonfiber constituents. We interpret the data as supportive of a synergy of the whole grain constituents, including fiber as only one such constituent.


Bran Dietary Fiber Glycemic Index Glycemic Load Atherosclerotic Cardiovascular Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Kushi LH, Meyer KA, Jacobs DR: Cereals, legumes, and chronic disease risk reduction: evidence from epidemiologic studies. Am J Clin Nutr 1999, 70(Suppl):451S-458S.PubMedGoogle Scholar
  2. 2.
    Jacobs DR Jr, Pereira M, Slavin J, Marquart L: Defining the impact of whole grain intake on chronic disease. Cereal Foods World 2000, 45:51–53.Google Scholar
  3. 3.
    Pereira MA, Pins JJ: Dietary fiber and cardiovascular disease: experimental and epidemiologic advances. Curr Atheroscler Rep 2000, 2:494–502.PubMedGoogle Scholar
  4. 4.
    Pereira MA, Jacobs DR Jr, Pins JJ, et al.: Whole grains, cereal fiber, and chronic disease: the epidemiologic evidence. In CRC Handbook of Dietary Fiber in Human Disease, edn 3. Edited by Spiller GA. New York: CRC Press; 2001:461–480.Google Scholar
  5. 5.
    Liu S: Intake of refined carbohydrates and whole grain foods in relation to risk of type 2 diabetes mellitus and coronary heart disease. J Am Coll Nutr 2002, 21:298–306.PubMedCrossRefGoogle Scholar
  6. 6.
    Murtaugh MA, Jacobs DR Jr, Jacob B, et al.: Epidemiological support for the protection of whole grains against diabetes. Proc Nutr Soc 2003, 62:143–149.PubMedCrossRefGoogle Scholar
  7. 7.
    Koh-Banerjee P, Rimm EB: Whole grain consumption and weight gain: a review of the epidemiological evidence, potential mechanisms and opportunities for future research. Proc Nutr Soc 2003, 62:25–29.PubMedCrossRefGoogle Scholar
  8. 8.
    Hoseney RC: Principles of Cereal Science and Technology, edn 2. St Paul, MN: AACC Press; 1994.Google Scholar
  9. 9.
    Kent NL, Evers AD: Technology of Cereals, edn 4. United Kingdom: Pergamon Press; 1994.Google Scholar
  10. 10.
    Fulcher RG, Rooney Duke TK: Whole grain structure and organization: implications for nutritionists and processors. In Whole Grain Foods in Health and Disease. Edited by Marquart L, Fulcher RG, Slavin JL. St. Paul, MN: AACC Press; 2002:9–45.Google Scholar
  11. 11.
    McKeehen JD, Busch RH, Fulcher RG: Evaluation of wheat (Triticum aestivum L.) phenolic acids during grain development and their contribution to Fusarium resistance. J Agric Food Chem 1999, 47:1476–1482.PubMedCrossRefGoogle Scholar
  12. 12.
    Collins FW: Oat phenolics: structure, occurrence and function. In Oats: Chemistry and Technology. Edited by Webster FH. St. Paul, MN: AACC Press; 1986:227–296.Google Scholar
  13. 13.
    Jenkins DJ, Wesson V, Wolever TM, et al.: Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response. BMJ 1988, 297:958–960.PubMedGoogle Scholar
  14. 14.
    Foster-Powell K, Holt SH, Brand-Miller JC: International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr 2002, 76:5–56.PubMedGoogle Scholar
  15. 15.
    Fraser GE, Sabaté J, Beeson WL, Strahan TM: A possible protective effect of nut consumption on risk of coronary heart disease: the Adventist Health Study. Arch Intern Med 1992, 152:1416–1424.PubMedCrossRefGoogle Scholar
  16. 16.
    Pietinen P, Rimm EB, Korhonen P, et al.: Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Circulation 1996, 94:2720–2727.PubMedGoogle Scholar
  17. 17.
    Rimm EB, Ascherio A, Giovannucci E, et al.: Vegetable, fruit and cereal fiber intake and risk of coronary heart disease among men. JAMA 1996, 275:447–451.PubMedCrossRefGoogle Scholar
  18. 18.
    Key TJ, Thorogood M, Appleby PN, Burr ML: Dietary habits and mortality in 11,000 vegetarians and health conscious people: results of a 17 year follow up. BMJ 1996, 28:775–779.Google Scholar
  19. 19.
    Jacobs DR Jr, Meyer KA, Kushi LH, Folsom AR: Whole grain intake may reduce risk of coronary heart disease death in postmenopausal women: The Iowa Women’s Health Study. Am J Clin Nutr 1998, 68:248–257.PubMedGoogle Scholar
  20. 20.
    Jacobs DR, Meyer KA, Kushi LH, Folsom AR: Is whole grain intake associated with reduced total and cause-specific death rates in older women: the Iowa Women’s Health Study. Am J Public Health 1999, 89:322–329.PubMedGoogle Scholar
  21. 21.
    Liu SM, Stampfer MJ, Hu FB, et al.: Whole grain consumption and risk of coronary heart disease: results from the Nurses’ Health Study. Am J Clin Nutr 1999, 70:412–419.PubMedGoogle Scholar
  22. 22.
    Liu S, Manson JE, Stampfer MJ, et al.: Whole grain consumption and risk of ischemic stroke in women. JAMA 2000, 284:1534–1540.PubMedCrossRefGoogle Scholar
  23. 23.
    Jacobs DR, Meyer HE, Solvoll K: Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. Eur J Clin Nutr 2001, 55:137–143.PubMedCrossRefGoogle Scholar
  24. 24.
    Liu S, Sesso HD, Manson JE, et al.: Is intake of breakfast cereals related to total and cause-specific mortality in men? Am J Clin Nutr 2003, 77:594–599.PubMedGoogle Scholar
  25. 25.
    Mozaffarian D, Kumanyika SK, Lemaitre RN, et al.: Cereal, fruit, and vegetable fiber intake and the risk of cardiovascular disease in elderly individuals. JAMA 2003, 289:1659–1666.PubMedCrossRefGoogle Scholar
  26. 26.
    Steffen LM, Jacobs DR, Stevens J, et al.: Associations of wholegrain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003, 78:383–390.PubMedGoogle Scholar
  27. 27.
    Bazzano LA, He J, Ogden LG, et al.: Dietary fiber intake and reduced risk of coronary heart disease in US men and women. The National Health and Nutrition Examination Survey I Epidemiologic Followup Study. Arch Int Med 2003, 163:1897–1904.CrossRefGoogle Scholar
  28. 28.
    Meyer KA, Kushi LH, Jacobs DR, et al.: Carbohydrates, dietary fiber, and incident type 2 diabetes in older women. Am J Clin Nutr 2000, 71:921–330.PubMedGoogle Scholar
  29. 29.
    Liu S, Manson JE, Stampfer MJ, et al.: A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women. Am J Pub Health 2000, 90:1409–1415.PubMedGoogle Scholar
  30. 30.
    Fung TT, Hu FB, Pereira MA, et al.: Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am J Clin Nutr 2002, 76:535–540.PubMedGoogle Scholar
  31. 31.
    Montonen J, Knekt P, Jarvinen R, et al.: Whole-grain and fiber intake and the incidence of type 2 diabetes. Am J Clin Nutr 2003, 77:622–629.PubMedGoogle Scholar
  32. 32.
    Roe DA: History of promotion of vegetable cereal diets. J Nutr 1986, 116:1355–1363.PubMedGoogle Scholar
  33. 33.
    Kuhlmann CB: The Development of the Flour-Milling Industry in the United States with Special Reference to the Industry in Minneapolis. Cambridge, MA: The Riverside Press; 1992:238.Google Scholar
  34. 34.
    Bollet AJ: Politics and pellagra: the epidemic of pellagra in the U.S. in the early twentieth century. Yale J Biol Med 1992, 65:211–221.PubMedGoogle Scholar
  35. 35.
    Hegsted DM: A look back at lessons learned and not learned. J Nutr 1994, 124(Suppl):1867S-1870S.PubMedGoogle Scholar
  36. 36.
    Messina M, Lampe JW, Birt DF: Reductionism and the narrowing nutrition perspective: time for reevaluation and emphasis on food synergy. J Am Diet Assoc 2001, 101:1416–1419.PubMedCrossRefGoogle Scholar
  37. 37.
    Walker AR: The effects of recent changes of food habits and bowel motility. South Afr Med J 1947, 21:590–592.Google Scholar
  38. 38.
    Burkitt DP: Acute abdomens. British and Bag and compared. East Afr Med J 1952, 19:189–192.Google Scholar
  39. 39.
    Burkitt DP, Walker AR, Painter NS: Dietary fiber and disease. JAMA 1974, 229:1068–1074.PubMedCrossRefGoogle Scholar
  40. 40.
    Cleave TL: The neglect of the natural principles in current medical practice. J R Naval Med Service 1956, 42:55–60.Google Scholar
  41. 41.
    Trowell H: Ischemic heart disease and dietary fiber. Am J Clin Nutr 1972, 25:926–932.PubMedGoogle Scholar
  42. 42.
    Morris JN, Marr JW, Clayton DG: Diet and heart: a postscript.. BMJ 1977, 2:1307–1314.PubMedGoogle Scholar
  43. 43.
    Sinclair H: Diet and heart disease [letter to the editor]. BMJ 1977, 2:1602.CrossRefGoogle Scholar
  44. 44.
    Knekt P, Reunaen A, Järvinen R, et al.: Antioxidant vitamin intake and coronary mortality in a longitudinal population study. Am J Epidemiol 1994, 139:1180–1189.PubMedGoogle Scholar
  45. 45.
    Kromhout D, Bosschieter EB, de Lezenne Coulander C: Dietary fibre and 10-year mortality from coronary heart disease, cancer and all causes. The Zutphen Study. Lancet 1982, 2:518–522.PubMedCrossRefGoogle Scholar
  46. 46.
    Kushi LH, Lew RA, Stare FJ, et al.: Diet and 20-year mortality from coronary heart disease. The Ireland-Boston Diet-Heart Study. N Engl J Med 1985, 312:811–818.PubMedCrossRefGoogle Scholar
  47. 47.
    Khaw K, Barrett-Connnor E: Dietary fiber and reduced ischemic heart disease mortality rates in men an women: a 12-year prospective study. Am J Epidemiol 1987, 126:1093–1102.PubMedGoogle Scholar
  48. 48.
    Humble CG, Malarcher AM, Tyroler HA: Dietary fiber and coronary heart disease in middle-aged hypercholesterolemic men. Am J Prev Med 1993, 9:197–202.PubMedGoogle Scholar
  49. 49.
    Fehily AM, Yarnell JW, Sweetnam PM, et al.: Diet and incident ischaemic heart disease: the Caerphilly Study. Br J Nutr 1993, 69:303–314.PubMedCrossRefGoogle Scholar
  50. 50.
    Todd S, Woodward M, Tunstall-Pedoe H, Bolton-Smith C: Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and all-causes mortality: results from the Scottish Heart Health Study. Am J Epidemiol 1999, 150:1073–1080.PubMedGoogle Scholar
  51. 51.
    Wolk A, Manson JE, Stampfer MJ: Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 1999, 281:1998–2004.PubMedCrossRefGoogle Scholar
  52. 52.
    Pereira MA, O’Reilly E, Augustsson K, et al.: Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med 2004, 164:370–376.PubMedCrossRefGoogle Scholar
  53. 53.
    Salmeron J, Manson JE, Stampfer MJ, et al.: Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997, 12:277:472–477.CrossRefGoogle Scholar
  54. 54.
    Salmeron J, Ascherio A, Rimm EB: Dietary fiber, glycemic load, and risk of NIDDM in men. Diabetes Care 1997, 20:545–550.PubMedCrossRefGoogle Scholar
  55. 55.
    Stevens J, Ahn K, Juhaeri R, et al.: Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Diabetes Care 2002, 25:1715–1721.PubMedCrossRefGoogle Scholar
  56. 56.
    Pereira MA, Jacobs DR Jr, Slattery ML, et al.: The association of whole grain intake and fasting insulin in a biracial cohort of young adults: The CARDIA Study. CVD Prev 1998, 1:231–242.Google Scholar
  57. 57.
    Ludwig DS, Pereira MA, Kroenke CH, et al.: Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA 1999, 282:1539–1546.PubMedCrossRefGoogle Scholar
  58. 58.
    McKeown NM, Meigs JB, Liu S, et al.: Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. Am J Clin Nutr 2002, 76:390–398.PubMedGoogle Scholar
  59. 59.
    Steffen LM, Jacobs DR Jr, Murtaugh MA, et al.: Whole grain intake is associated with lower body mass and greater insulin sensitivity among adolescents. Am J Epidemiol 2003, 158:243–250.PubMedCrossRefGoogle Scholar
  60. 60.
    Pereira M, Pins J, Raatz S, et al.: The effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr 2002, 75:848–855.PubMedGoogle Scholar
  61. 61.
    Jang Y, Lee JH, Kim OY, et al.: Consumption of whole grain and legume powder reduces insulin demand, lipid peroxidation, and plasma homocysteine concentrations in patients with coronary artery disease: randomized controlled clinical trial. Arterioscler Thromb Vasc Biol 2001, 21:2065–2071.PubMedGoogle Scholar
  62. 62.
    Karlstrom B, Vessby B, Asp NG, et al.: Effects of an increased content of cereal fibre in the diet of Type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1984, 26:272–277.PubMedCrossRefGoogle Scholar
  63. 63.
    Bosello O, Ostuzzi R, Armellini F, et al.: Glucose tolerance and blood lipids in bran-fed patients with impaired glucose tolerance. Diabetes Care 1980, 3:46–49.PubMedCrossRefGoogle Scholar
  64. 64.
    Jenkins DJ, Kendall CW, Augustin LS, et al.: Effect of wheat bran on glycemic control and risk factors for cardiovascular disease in type 2 diabetes. Diabetes Care 2002, 25:1522–1528.PubMedCrossRefGoogle Scholar
  65. 65.
    Noakes M, Clifton PM, Nestel PJ, et al.: Effect of high-amylose starch and oat bran on metabolic variables and bowel function in subjects with hypertriglyceridemia. Am J Clin Nutr 1996, 64:944–951.PubMedGoogle Scholar
  66. 66.
    McIntosh GH, Noakes M, Royle PJ, et al.: Whole-grain rye and wheat foods and markers of bowel health in overweight middle-aged men. Am J Clin Nutr 2003, 77:967–974.PubMedGoogle Scholar
  67. 67.
    Anderson JW, Gilinsky NH, Deakins DA, et al.: Lipid responses of hypercholesterolemic men to oat-bran and wheat-bran intake. J Clin Nutr 1991, 54:678–683.Google Scholar
  68. 68.
    Davy BM, Davy KP, Ho RC, et al.: 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 2002, 76:351–358.PubMedGoogle Scholar
  69. 69.
    Jacobs DR Jr, Pereira MA, Meyer KA, Kushi LH: Fiber from whole grains, but not refined grains, is inversely associated with allcause mortality in older women: the Iowa Women’s Health Study. J Am Coll Nutr 2000, 19:326S-330S.PubMedGoogle Scholar
  70. 70.
    Jacobs DR Jr, Steffen LM: Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 2003, 78(Suppl 3):508S-513S.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • David R. JacobsJr
    • 1
  • Daniel D. Gallaher
  1. 1.Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisUSA

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