Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.

    Original languageEnglish (US)
    Pages (from-to)361-371
    Number of pages11
    JournalAdvances in nutrition (Bethesda, Md.)
    Volume10
    Issue number3
    DOIs
    StatePublished - May 1 2019

    Fingerprint

    refined grains
    Guilt
    Health
    Type 2 Diabetes Mellitus
    Coronary Disease
    Food
    Cardiovascular Diseases
    eating habits
    noninsulin-dependent diabetes mellitus
    cardiovascular diseases
    grain foods
    red meat
    Mortality
    whole grain foods
    Stroke
    stroke
    hypertension
    Hypertension
    Food and Beverages
    Nutrition Policy

    Keywords

    • all-cause mortality
    • cardiovascular disease
    • diabetes
    • hypertension
    • obesity
    • red and processed meat
    • stroke
    • Western dietary pattern
    • white rice
    • whole grains

    ASJC Scopus subject areas

    • Food Science
    • Medicine (miscellaneous)
    • Nutrition and Dietetics

    Cite this

    Perspective : Refined Grains and Health: Genuine Risk, or Guilt by Association? / Gaesser, Glenn.

    In: Advances in nutrition (Bethesda, Md.), Vol. 10, No. 3, 01.05.2019, p. 361-371.

    Research output: Contribution to journalArticle

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    title = "Perspective: Refined Grains and Health: Genuine Risk, or Guilt by Association?",
    abstract = "Refined grain intake is widely assumed to be associated with adverse health outcomes, including increased risk for cardiovascular disease (CVD), type 2 diabetes (T2D), and obesity. The 2015 Dietary Guidelines Advisory Committee recommended that to improve dietary quality, the US population should replace most refined grains with whole grains. This recommendation was based largely on results from studies that examined dietary patterns, not separate food groups. A Western dietary pattern typically includes red and processed meat, sugar-sweetened foods and beverages, French fries, and high-fat dairy products, as well as refined grains, and has been linked to increased risk of many chronic diseases. However, when evaluated as a distinct food category, 11 meta-analyses of prospective cohort studies, which included a total of 32 publications with data from 24 distinct cohorts, demonstrated that refined grain intake was not associated with all-cause mortality, T2D, CVD, coronary heart disease (CHD), stroke, hypertension, or cancer. By contrast, consumption of red and processed meat was consistently associated with increased risk of these same health outcomes. Refined grain consumption up to 6-7 servings/d (1 serving = 30 g) was not associated with higher risk of CHD, T2D, hypertension, or all-cause mortality. Moreover, total grain intake was not associated with risk of CVD, CHD, stroke, or cancer, but was associated with lower risk of all-cause mortality. Consequently, the recommendation to reduce refined grain intake based on results from studies linking a Western dietary pattern to numerous adverse health outcomes is contrary to a substantial body of published scientific evidence. Future research needs to better define refined grain intake to distinguish between staple grain foods and indulgent grain foods, and to better design randomized controlled trials to resolve discrepancies between results from observational studies and such trials with regard to determining the benefits of whole grains compared with refined grains.",
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