Current Atherosclerosis Reports

, Volume 12, Issue 6, pp 368–376 | Cite as

Effects of Whole Grains on Coronary Heart Disease Risk

  • Kristina A. Harris
  • Penny M. Kris-EthertonEmail author


Characterizing which types of carbohydrates, including whole grains, reduce the risk for coronary heart disease (CHD) is challenging. Whole grains are characterized as being high in resistant carbohydrates as compared with refined grains, meaning they typically are high in fiber, nutrients, and bound antioxidants. Whole grain intake consistently has been associated with improved cardiovascular disease outcomes, but also with healthy lifestyles, in large observational studies. Intervention studies that assess the effects of whole grains on biomarkers for CHD have mixed results. Due to the varying nutrient compositions of different whole grains, each could potentially affect CHD risk via different mechanisms. Whole grains high in viscous fiber (oats, barley) decrease serum low-density lipoprotein cholesterol and blood pressure and improve glucose and insulin responses. Grains high in insoluble fiber (wheat) moderately lower glucose and blood pressure but also have a prebiotic effect. Obesity is inversely related to whole grain intake, but intervention studies with whole grains have not produced weight loss. Visceral fat, however, may be affected favorably. Grain processing improves palatability and can have varying effects on nutrition (e.g., the process of milling and grinding flour increases glucose availability and decreases phytochemical content whereas thermal processing increases available antioxidants). Understanding how individual grains, in both natural and processed states, affect CHD risk can inform nutrition recommendations and policies and ultimately benefit public health.


Whole grains Coronary heart disease Cardiovascular disease Risk factors Processing Nutrition Carbohydrates Cereal fiber Phytochemicals Metabolic syndrome 



PM Kris-Etherton’s and KA Harris’ employer has received a grant from General Mills to conduct clinical trials assessing the effect of whole grains on metabolic syndrome.

KA Harris is supported by the Nestle PhD, RD Training Fellowship, which is a competitive award funded by Nestle Research Center for a nutritional science graduate student pursuing both degrees at the Pennsylvania State University.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    United States Department of Agriculture, United States Department of Health and Human Services: Dietary Guidelines for Americans, 6th edn. Washington, DC: Government Printing Office; 2005.Google Scholar
  2. 2.
    United States Department of Agriculture, United States Department of Health and Human Services: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. Washington, DC: Government Printing Office; 2010.Google Scholar
  3. 3.
    Siri-Tarino PW, Sun Q, Hu FB, Krauss RM: Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr 2010, 91:535–546.CrossRefPubMedGoogle Scholar
  4. 4.
    Jakobsen MU, Dethlefsen C, Joensen AM, et al.: Intake of carbohydrates compared with intake of saturated fatty acids and risk of myocardial infarction: importance of the glycemic index. Am J Clin Nutr 2010, 91:1764–1768.CrossRefPubMedGoogle Scholar
  5. 5.
    • Englyst KN, Liu S, Englyst HN: Nutritional characterization and measurement of dietary carbohydrates. Eur J Clin Nutr 2007, 61(Suppl 1):S19–39. This review thoroughly describes the issues surrounding classifying carbohydrates and provides a framework for a nutritional characterization.CrossRefPubMedGoogle Scholar
  6. 6.
    Wolever TM, Jenkins DJ, Jenkins AL, Josse RG: The glycemic index: methodology and clinical implications. Am J Clin Nutr 1991, 54:846–854.PubMedGoogle Scholar
  7. 7.
    Vega-Lopez S, Ausman LM, Griffith JL, Lichtenstein AH: Interindividual variability and intra-individual reproducibility of glycemic index values for commercial white bread. Diabetes Care 2007, 30:1412–1417.CrossRefPubMedGoogle Scholar
  8. 8.
    • De Moura FF: Whole Grain Intake and Cardiovascular Disease and Whole Grain Intake and Diabetes: A review. Bethesda, MD: Life Sciences Research Office; 2008:1–79. This is a thorough review of whole grain observational and intervention studies on cardiovascular disease and diabetes. It assessed evidence of studies testing whole grains that complied with FDA standards versus those that did not.Google Scholar
  9. 9.
    •• Okarter N, Liu RH: Health benefits of whole grain phytochemicals. Crit Rev Food Sci Nutr 2010, 50:193–208. This is an excellent review on the composition of grains and how they affect CVD risk.CrossRefPubMedGoogle Scholar
  10. 10.
    United States Food and Drug Administration: Draft Guidance: Whole Grains Label Statements, Guidance for Industry and FDA Staff. College Park, MD: US Food and Drug Administration; 2006.Google Scholar
  11. 11.
    United States Food and Drug Administration: Health Claims Notification for Whole Grain Foods. College Park, MD. US Food and Drug Administration; 1999.Google Scholar
  12. 12.
    Nettleton JA, Steffen LM, Loehr LR, et al.: Incident heart failure is associated with lower whole-grain intake and greater high-fat dairy and egg intake in the Atherosclerosis Risk in Communities (ARIC) study. J Am Diet Assoc 2008, 108:1881–1887.CrossRefPubMedGoogle Scholar
  13. 13.
    Jensen MK, Koh-Banerjee P, Hu FB, et al.: Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr 2004, 80:1492–1499.PubMedGoogle Scholar
  14. 14.
    Liu S, 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
  15. 15.
    Steffen LM, Jacobs DR Jr, Stevens J, et al.: Associations of whole-grain, 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
  16. 16.
    Jacobs DR Jr, Meyer KA, Kushi LH, Folsom AR: 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 1998, 68:248–257.PubMedGoogle Scholar
  17. 17.
    Jacobs DR Jr, Gallaher DD: Whole grain intake and cardiovascular disease: a review. Curr Atheroscler Rep 2004, 6:415–423.CrossRefPubMedGoogle Scholar
  18. 18.
    Anderson JW, Hanna TJ, Peng X, Kryscio RJ: Whole grain foods and heart disease risk. J Am Coll Nutr 2000, 19(Suppl 3):291S–299S.PubMedGoogle Scholar
  19. 19.
    Newby PK, Maras J, Bakun P, et al.: 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 2007, 86:1745–1753.PubMedGoogle Scholar
  20. 20.
    Koh-Banerjee P, Franz M, Sampson L, et al.: Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men. Am J Clin Nutr 2004, 80:1237–1245.PubMedGoogle Scholar
  21. 21.
    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
  22. 22.
    Kelly SA, Summerbell CD, Brynes A, et al.: Wholegrain cereals for coronary heart disease. Cochrane Database Syst Rev 2007, 2:CD005051.Google Scholar
  23. 23.
    Maki KC, Beiseigel JM, Jonnalagadda SS, et al.: Whole-grain ready-to-eat oat cereal, as part of a dietary program for weight loss, reduces low-density lipoprotein cholesterol in adults with overweight and obesity more than a dietary program including low-fiber control foods. J Am Diet Assoc 2010, 110:205–214.CrossRefPubMedGoogle Scholar
  24. 24.
    Shimizu C, Kihara M, Aoe S, et al.: Effect of high beta-glucan barley on serum cholesterol concentrations and visceral fat area in Japanese men—a randomized, double-blinded, placebo-controlled trial. Plant Foods Hum Nutr 2008, 63:21–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Behall KM, Scholfield DJ, Hallfrisch J: Lipids significantly reduced by diets containing barley in moderately hypercholesterolemic men. J Am Coll Nutr 2004, 23:55–62.PubMedGoogle Scholar
  26. 26.
    •• Katcher HI, Legro RS, Kunselman AR, et al.: 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 2008, 87:79–90. This randomized controlled trial compared whole and refined grain weight-loss diets and found a significant decrease in abdominal fat mass loss and CRP in the whole grain group despite equal weight loss between groups.PubMedGoogle Scholar
  27. 27.
    •• Brownlee IA, Moore C, Chatfield M, et al.: Markers of cardiovascular risk are not changed by increased whole-grain intake: the WHOLEheart study, a randomised, controlled dietary intervention. Br J Nutr 2010, 104:125–134. This study is the largest whole grain intervention study to date. It failed to find any improvement in risk factors for cardiovascular disease, but compliance is thought to have been an issue in this free-living study.CrossRefPubMedGoogle Scholar
  28. 28.
    Papathanasopoulos A, Camilleri M: Dietary fiber supplements: effects in obesity and metabolic syndrome and relationship to gastrointestinal functions. Gastroenterology 2010, 138:65–72.CrossRefPubMedGoogle Scholar
  29. 29.
    National Heart Lung and Blood Institute: Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Edited by National Cholesterol Education Program. Bethesda, MD: National Institutes of Health; 2002.Google Scholar
  30. 30.
    Flint AJ, Hu FB, Glynn RJ, et al.: Whole grains and incident hypertension in men. Am J Clin Nutr 2009, 90:493–498.CrossRefPubMedGoogle Scholar
  31. 31.
    Wang L, Gaziano JM, Liu S, et al.: Whole- and refined-grain intakes and the risk of hypertension in women. Am J Clin Nutr 2007, 86:472–479.PubMedGoogle Scholar
  32. 32.
    Keenan JM, Pins JJ, Frazel C, et al.: Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. J Fam Pract 2002, 51:369.PubMedGoogle Scholar
  33. 33.
    Pins JJ, Geleva D, Keenan JM, et al.: Do whole-grain oat cereals reduce the need for antihypertensive medications and improve blood pressure control? J Fam Pract 2002, 51:353–359.PubMedGoogle Scholar
  34. 34.
    Behall KM, Scholfield DJ, Hallfrisch J: Whole-grain diets reduce blood pressure in mildly hypercholesterolemic men and women. J Am Diet Assoc 2006, 106:1445–1449.CrossRefPubMedGoogle Scholar
  35. 35.
    National Heart Lung and Blood Institute: Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7). Bethesda, MD: National Institutes of Health; 2004.Google Scholar
  36. 36.
    Appel LJ, Moore TJ, Obarzanek E, et al.: A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997, 336:1117–1124.CrossRefPubMedGoogle Scholar
  37. 37.
    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 Public Health 2000, 90:1409–1415.CrossRefPubMedGoogle Scholar
  38. 38.
    de Munter JS, Hu FB, et al.: Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med 2007, 4:e261.CrossRefPubMedGoogle Scholar
  39. 39.
    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
  40. 40.
    Lutsey PL, Jacobs DR Jr, Kori S, et al.: Whole grain intake and its cross-sectional association with obesity, insulin resistance, inflammation, diabetes and subclinical CVD: The MESA Study. Br J Nutr 2007, 98:397–405.CrossRefPubMedGoogle Scholar
  41. 41.
    Pereira MA, Jacobs DR Jr, Pins JJ, et al.: Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am J Clin Nutr 2002, 75:848–855.PubMedGoogle Scholar
  42. 42.
    Andersson A, Tengblad S, Karlstrom B, et al.: Whole-Grain Foods Do Not Affect Insulin Sensitivity or Markers of Lipid Peroxidation and Inflammation in Healthy, Moderately Overweight Subjects. J Nutr 2007, 137:1401–1407.PubMedGoogle Scholar
  43. 43.
    Behall KM, Scholfield DJ, Canary J: Effect of starch structure on glucose and insulin responses in adults. Am J Clin Nutr 1988, 47:428–432.PubMedGoogle Scholar
  44. 44.
    Juntunen KS, Laaksonen DE, Autio K, et al.: Structural differences between rye and wheat breads but not total fiber content may explain the lower postprandial insulin response to rye bread. Am J Clin Nutr 2003, 78:957–964.PubMedGoogle Scholar
  45. 45.
    Hallfrisch J, Behall KM: Mechanisms of the effects of grains on insulin and glucose responses. J Am Coll Nutr 2000, 19(Suppl 3):320S–325S.PubMedGoogle Scholar
  46. 46.
    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.CrossRefPubMedGoogle Scholar
  47. 47.
    Behall KM, Scholfield DJ, Hallfrisch J: The effect of particle size of whole-grain flour on plasma glucose, insulin, glucagon and thyroid-stimulating hormone in humans. J Am Coll Nutr 1999, 18:591–597.PubMedGoogle Scholar
  48. 48.
    Najjar AM, Parsons PM, Duncan AM, et al.: The acute impact of ingestion of breads of varying composition on blood glucose, insulin and incretins following first and second meals. Br J Nutr 2009, 101:391–398.CrossRefPubMedGoogle Scholar
  49. 49.
    Good CK, Holschuh N, Albertson AM, et al.: Whole grain consumption and body mass index in adult women: an analysis of NHANES 1999–2000 and the USDA pyramid servings database. J Am Coll Nutr 2008, 27:80–87.PubMedGoogle Scholar
  50. 50.
    van de Vijver LP, van den Bosch LM, van den Brandt PA, Goldbohm RA: Whole-grain consumption, dietary fibre intake and body mass index in the Netherlands cohort study. Eur J Clin Nutr 2009, 63:31–38.CrossRefPubMedGoogle Scholar
  51. 51.
    Thane CW, Stephen AM, Jebb SA: Whole grains and adiposity: little association among British adults. Eur J Clin Nutr 2009, 63:229–237.CrossRefPubMedGoogle Scholar
  52. 52.
    Saltzman E, Moriguti JC, Das SK, et al.: Effects of a cereal rich in soluble fiber on body composition and dietary compliance during consumption of a hypocaloric diet. J Am Coll Nutr 2001, 20:50–57.PubMedGoogle Scholar
  53. 53.
    Sahyoun NR, Jacques PF, Zhang XL, et al.: Whole-grain intake is inversely associated with the metabolic syndrome and mortality in older adults. Am J Clin Nutr 2006, 83:124–131.PubMedGoogle Scholar
  54. 54.
    McKeown NM, Yoshida M, Shea MK, et al.: Whole-grain intake and cereal fiber are associated with lower abdominal adiposity in older adults. J Nutr 2009, 139:1950–1955.CrossRefPubMedGoogle Scholar
  55. 55.
    Du H, van der AD, Boshuizen HC, et al.: Dietary fiber and subsequent changes in body weight and waist circumference in European men and women. Am J Clin Nutr 2009, 91:329–336.CrossRefPubMedGoogle Scholar
  56. 56.
    • Davis JN, Alexander KE, Ventura EE, et al.: Inverse relation between dietary fiber intake and visceral adiposity in overweight Latino youth. Am J Clin Nutr 2009, 90:1160–1166. The reduction of visceral fat without weight loss in diets higher in fiber, which is prevalent in whole grains, is a novel finding. Associating longitudinal dietary and anthropometric data makes the relationship stronger.CrossRefPubMedGoogle Scholar
  57. 57.
    Qi L, van Dam RM, Liu S, et al.: Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care 2006, 29:207–211.CrossRefPubMedGoogle Scholar
  58. 58.
    Masters RC, Liese AD, Haffner SM, et al.: Whole and refined grain intakes are related to inflammatory protein concentrations in human plasma. J Nutr 2010, 140:587–594.CrossRefPubMedGoogle Scholar
  59. 59.
    Adom KK, Liu RH: Antioxidant activity of grains. J Agric Food Chem 2002, 50:6182–6187.CrossRefPubMedGoogle Scholar
  60. 60.
    Adom KK, Sorrells ME, Liu RH: Phytochemicals and antioxidant activity of milled fractions of different wheat varieties. J Agric Food Chem 2005, 53:2297–2306.CrossRefPubMedGoogle Scholar
  61. 61.
    Dewanto V, Wu X, Liu RH: Processed sweet corn has higher antioxidant activity. J Agric Food Chem 2002, 50:4959–4964.CrossRefPubMedGoogle Scholar
  62. 62.
    Gibson GR, Roberfroid MB: Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr 1995, 125:1401–1412.PubMedGoogle Scholar
  63. 63.
    Delzenne NM, Williams CM: Prebiotics and lipid metabolism. Curr Opin Lipidol 2002, 13:61–67.CrossRefPubMedGoogle Scholar
  64. 64.
    Tsai F, Coyle WJ: The microbiome and obesity: is obesity linked to our gut flora? Curr Gastroenterol Rep 2009, 11:307–313.CrossRefPubMedGoogle Scholar
  65. 65.
    Turnbaugh PJ, Ley RE, Mahowald MA, et al.: An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 2006, 444:1027–1031.CrossRefPubMedGoogle Scholar
  66. 66.
    Ley RE, Turnbaugh PJ, Klein S, Gordon JI: Microbial ecology: human gut microbes associated with obesity. Nature 2006, 444:1022–1023.CrossRefPubMedGoogle Scholar
  67. 67.
    Mai V, Draganov PV: Recent advances and remaining gaps in our knowledge of associations between gut microbiota and human health. World J Gastroenterol 2009, 15:81–85.CrossRefPubMedGoogle Scholar
  68. 68.
    Elia M, Cummings JH: Physiological aspects of energy metabolism and gastrointestinal effects of carbohydrates. Eur J Clin Nutr 2007, 61(Suppl 1):S40–74.CrossRefPubMedGoogle Scholar
  69. 69.
    Tarini J, Wolever TM: The fermentable fibre inulin increases postprandial serum short-chain fatty acids and reduces free-fatty acids and ghrelin in healthy subjects. Appl Physiol Nutr Metab 2010, 35:9–16.CrossRefPubMedGoogle Scholar
  70. 70.
    Hennes MM, Dua A, Kissebah AH: Effects of free fatty acids and glucose on splanchnic insulin dynamics. Diabetes 1997, 46:57–62.CrossRefPubMedGoogle Scholar
  71. 71.
    Freeland KR, Wilson C, Wolever TM: Adaptation of colonic fermentation and glucagon-like peptide-1 secretion with increased wheat fibre intake for 1 year in hyperinsulinaemic human subjects. Br J Nutr 2010, 103:82–90.CrossRefPubMedGoogle Scholar
  72. 72.
    Slavin JL, Jacobs D, Marquart L: Grain processing and nutrition. Crit Rev Biotechnol 2001, 21:49–66.CrossRefPubMedGoogle Scholar
  73. 73.
    Alminger M, Eklund-Jonsson C: Whole-grain cereal products based on a high-fibre barley or oat genotype lower post-prandial glucose and insulin responses in healthy humans. Eur J Nutr 2008, 47:294–300.CrossRefPubMedGoogle Scholar
  74. 74.
    Berger A, Rein D, Schafer A, et al.: Similar cholesterol-lowering properties of rice bran oil, with varied gamma-oryzanol, in mildly hypercholesterolemic men. Eur J Nutr 2005, 44:163–173.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Nutritional SciencesThe Pennsylvania State UniversityUniversity ParkUSA

Personalised recommendations