role of grain foods and associated nutrients in body ... · hauner h, et al. ann nutr metab....

Role of Grain Foods and Associated Nutrients in Body Weight Management

and Chronic Disease Risk Reduction

Penny M. Kris-Etherton, PhD, RD Distinguished Professor of Nutrition Department of Nutritional Sciences

Pennsylvania State University

Outline

● Nutrition and disease statistics

● Whole grains and body weight

● ASN and German Nutrition Society Scientific Statements

● Other evidence for health benefits of whole grains

● Summary

Leading Risk Factors for Health Attributable Mortality, 2004

WHO 2009

Nutrition related

Top nutrition-related risk factors for health are linked to obesity.

Relationships between Changes in Food and Beverage

Consumption and Weight Changes Every 4 Years, According to

Study Cohort

Mozaffarian. N Engl J Med 2011; 364:2392-2404

33 Studies:

(Observational, either

Prospective or Cross-

Sectional) were Included

in the Systematic Review

Am J Clin Nutr. 2013;98:594-619.

ASN Position:

Consumption of foods rich in cereal

fiber or mixtures of WG and bran is

modestly associated with reduced risk

of obesity, T2D, and CVD.

Summary of Evidence Level

T2D Obesity CVD HTN

Cereal fiber B B/C B D

Mixtures of whole grains and bran

B B/C B D

Whole grains C C/D C D

Cho et al. Am J Clin Nutr. 2013;98:594-619.

Prospective Cohort Study of Whole Grain Intake & Body Weight

Whole-grain intake

Reference Participants

(age) Length Highest Lowest Endpoints

Highest vs lowest

P-trend

Koh-Banerjee et al, 2004

27,082 M, (40–75 y)

8 y Change in

intake: +15.6 g/d

Change in intake:

−17.8 g/d

Body weight change (kg/8 y)

+0.69 vs +0.96 (difference:

0.27) 0.002


Health Professionals Follow-Up Study

Prospective Cohort Studies on Mixtures of Whole Grains and Bran: Risk of Obesity

Intake of mixtures of whole grains and bran

Reference Participants

(age) Length

(y) Highest Lowest Endpoints

RR (95% CI) or body weight measure

(highest vs lowest) P-trend

Liu et al, 2003

74,091 F, (38–63 y)

12 Servings/ 1000 kcal per day:

at baseline,

1.62; change in intake in 12 y, 0.90

Servings/ 1000 kcal

per day: at baseline,

0.07; change in

intake 12 y, −0.59

OR for weight gain, ≥25 kg in 12 y

0.77 (0.59, 1.01) 0.03

OR for BMI (in kg/m2) ≥30 in 12 y

0.81 (0.73, 0.91) 0.0002

Weight gain (kg) 4.12 vs 4.51 <0.0001

2–4 Avg changes in BMI

(kg/m2) 0.46 vs 0.56 <0.0001

Avg changes in weight (kg) 1.23 vs 1.52 <0.0001


26,082 M, (40–75 y)

8 +27.0 g/d −11.0 g/d BW change (kg/8 y) +0.73 vs +1.25

(difference: 0.52) <0.0001

Bazzano et al, 2005

17,881 M 8

≥1 serving/d

Rarely

Weight gain (kg) 1.13 vs 1.55 0.003

RR for BMI ≥25 0.83 (0.71, 0.98) 0.06

13 Weight gain (kg) 1.83 vs 2.18 0.08

RR for BMI ≥25 0.91 (0.79, 1.05) 0.13

RR for weight gain ≥10 kg 0.78 (0.64, 0.96) 0.01

Steffen et al, 2003

285 M + F, (mean =13 y)

2 >1.5

servings/d

<0.5 servings/d

BMI (kg/m2) 21.9 vs 23.6 0.05


Prospective Cohort Studies on Cereal Fiber & Body Weight

Cereal fiber intake

Reference Participants Length Highest Lowest Endpoints Body weight

measures (highest vs lowest)

P-trend

g/d


27,082 M, aged 40–75 y

8 y Change in

intake: 5.1

Change in intake:

−2.2

Body weight change (kg/8 y)

+0.91 vs +1.30 (0.39 kg

difference) 0.0004

Du et al, 2010

89,432 M + F, aged 20–78 y

6.5 y 12.6 ± 4.6 9.3 ± 3.5

Body weight change (g/y) per

10 g cereal fiber/d

−77 g/y (−127, –26)

0.01

WC change (cm/y) per 10 g cereal fiber/d

−0.10 cm/y (−0.18, −0.02)

<0.001

WC, waist circumference.


Health Professionals Follow-Up Study & Diogenes Project

Summary of the Evidence Regarding the Association Between Carbohydrate Intake and Obesity

Risk of Dietary fiber/whole-grain products

Evidence

Obesity

Adults Total DF: ↓↓ Whole-grain products: ↓

↓↓= probable evidence, risk reducing ↓ = possible evidence, risk reducing

Children Total DF: О Whole-grain products: ~

О = possible evidence, no association ~ = insufficient evidence

“The majority of the cohort studies indicate that increased dietary fibre intake is associated with a reduced risk of obesity . Therefore, the evidence regarding this association is judged as probable .”

Hauner H, et al. Ann Nutr Metab. 2012;60(Suppl 1):1-58.

“The few existing cohort studies regarding adults mainly suggest that increased whole-grain product intake is accompanied by a reduced risk of obesity. The overall evidence is judged as possible .”

Summary of the Evidence Regarding the Association Between Carbohydrate Intake and Type 2 Diabetes and Metabolic Syndrome


Evidence

Type 2 Diabetes

Total DF: О Whole-grain products: ↓↓ DF from cereal products: ↓↓

О = possible evidence, no association ↓↓= probable evidence, risk reducing ↓↓= probable evidence, risk reducing

Metabolic Syndrome

Total DF: О Whole-grain products: ~

О = possible evidence, no association ~ = insufficient evidence

“The prospective cohort studies indicate with high consistency that high intake of whole-grain products or dietary fibre from cereal products, respectively, causes a lower risk of diabetes. The evidence regarding this association is judged as probable .”


Summary of the Evidence Regarding the Association Between Carbohydrate Intake and Hypertension


Evidence

HTN Total DF: ↓↓ Whole-grain products: ↓↓

↓↓= probable evidence, risk reducing ↓↓= probable evidence, risk reducing

“Based on the results of the present studies, there is probable evidence that increased dietary fibre consumption in a population with different blood pressure levels lowers the risk of hypertension. This also applies to the food group of whole-grain products.”


Summary of the Evidence Regarding the Association Between Carbohydrate Intake and LDL-C


Evidence

Dyslipidemia (LDL-C)

Total DF: ↓ Whole-grain products: ↓↓↓

↓= possible evidence, risk reducing ↓↓↓= convincing evidence, risk reducing

“According to the results of a Cochrane Review, there is convincing evidence

that an increased consumption of whole-grain products reduces the plasma

levels of total and LDL cholesterol. Regarding the effect of dietary fibre on the

plasma concentrations of total and LDL cholesterol in total, there is possible

evidence for an inverse risk relation. There is convincing evidence that an

increase in the intake of total soluble dietary fibre lowers the plasma

concentrations of total and LDL cholesterol....”


Summary of the Evidence Regarding the Association Between Carbohydrate Intake and CHD

Source Evidence statements in relation to CHD

Dietary fibre On the basis of the available literature, the evidence regarding the primary prevention of CHD by an increased dietary fibre intake is judged as probable .

Dietary fibre from cereal products and fruit

The results regarding the intake of dietary fibre from cereal products and fruit show with possible evidence that there is an inverse association with the risk of CHD; whereas regarding the intake of dietary fibre intake from vegetables, there is possible evidence that there is no association with the risk of CHD.

Soluble and Insoluble fibre

There is possible evidence that an increased intake of both soluble and insoluble dietary fibre is associated with a reduced CHD risk , although soluble dietary fibre seems to have a greater effect than insoluble dietary fibre.

Whole grain products According to the results of the available studies, there is probable evidence regarding primary prevention of CHD by increasing the consumption of whole-grain products.


Multivariable-Adjusted Relative Risk (RR) of Type 2

Diabetes and CVD Comparing the Highest and Lowest

Categories of Whole-Grain Intake in Prospective

Cohort Studies

Type 2 Diabetes CVD

Ye et al. J. Nutr. 2012;142:1304-1313

Whole-Grain Intake is Inversely Associated with Metabolic Syndrome in Older Adults

Variables

Grain intake

P for trend1 Q1 Q2 Q3 Q4

Whole grain

n 135 132 135 133

Median whole grain

intake (servings/d)2

0.31 0.86 1.49 2.90 0.001

BMI (kg/m2) 26.4 25.5 25.3 25.2 0.03

Glucose (mg/dL) 114.9 113.1 111.5 108.5 0.01

Metabolic syndrome

(Odds ratios)

1.00 0.58 0.41 0.46 0.005

The study population was composed of 179 (33%) men and

356 (67%) women with an average age of 72.1 y for men and

73.4 y for women

Sahyoun et al. Am J Clin Nutr. 2006;83:124-131.

Whole Grain & Total Mortality: Epidemiologic Studies

Harvard Male Health Professionals (86,000)

Iowa Women’s Health Study (34,333)

Liu et al. AJCN. 2003;77:594-599; Jacobs et al. Am J Pub Health. 1999;89:322-329.

1 or more serving/day of whole grain cereal (compared to none)

Mortality RR 0.80

3 or more servings/day of whole grain foods

Hazard RR 0.86

Relative risks (RRs) and 95% CIs of Incident

Hypertension in 31,684 Men by Quintile of Whole-grain

Intake: Health Professionals Follow-Up Study, 1986–

2004

Quintile of whole-grain intake

1 2 3 4 5 P for trend

Median intake

(g/d)2 3.3

(0–6.5)

9.8 (6.6–13.2)

17.1 (13.3–21.4)

26.9 (21.5–34.2)

46.0 (34.3–326.4)

—

No. of cases 1826 1917 1922 1914 1648 —

Person-years 61,137 68,966 72,196 73,184 69,877 —

Age- and

energy-

adjusted RR3

1.00 0.90

(0.84, 0.96)

0.83 (0.78, 0.89)

0.81 (0.76, 0.87)

0.72 (0.67, 0.77)

<0.0001

Multivariate-

adjusted

RR3,4

1.00 0.94

(0.88, 1.01)

0.89 (0.83, 0.95)

0.89 (0.84, 0.96)

0.81 (0.75, 0.87)

<0.0001

Flint et al. Am J Clin Nutr. 2009;90:493-498.

1 RRs derived from proportional hazards models. 2 Ranges in parentheses. 3 95% CIs in parentheses. 4 Adjusted for age, energy, family history of coronary heart disease, family history of hypertension, smoking, alcohol, marital status, profession, height, fruit and vegetable intakes, sodium intake, physical activity, multivitamin use, and cholesterol screening.

Whole Grains & LDL-C

Kelly, SA. Cochrane Database Syst Rev. 2007.

Summary

● Current research supports dietary recommendations for fiber-rich whole grains

● Fiber-rich whole grains decrease risk of obesity, type 2 diabetes, CVD, and cardiometabolic disease

Consume Fiber-Rich Whole Grains!

role of grain foods and associated nutrients in body ... · hauner h, et al. ann nutr metab....

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