Role of Grain Foods and Associated Nutrients in Body ... · Hauner H, et al. Ann Nutr Metab....
Transcript of 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
Cho et al. Am J Clin Nutr. 2013;98:594-619.
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
Koh-Banerjee et al, 2004
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
Cho et al. Am J Clin Nutr. 2013;98:594-619.
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
Koh-Banerjee et al, 2004
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.
Cho et al. Am J Clin Nutr. 2013;98:594-619.
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
Risk of Dietary fiber/whole-grain products
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 .”
Hauner H, et al. Ann Nutr Metab. 2012;60(Suppl 1):1-58.
Summary of the Evidence Regarding the Association Between Carbohydrate Intake and Hypertension
Risk of Dietary fiber/whole-grain products
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.”
Hauner H, et al. Ann Nutr Metab. 2012;60(Suppl 1):1-58.
Summary of the Evidence Regarding the Association Between Carbohydrate Intake and LDL-C
Risk of Dietary fiber/whole-grain products
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....”
Hauner H, et al. Ann Nutr Metab. 2012;60(Suppl 1):1-58.
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.
Hauner H, et al. Ann Nutr Metab. 2012;60(Suppl 1):1-58.
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!