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Whole grains linked to smaller increases in waist size, BP and blood sugar

Middle- to older-aged adults who ate at least three servings of whole grains daily had smaller increases in waist size, blood pressure (BP), and blood sugar levels over time compared with those who ate less than one-half serving per day, according to researchers at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University, US.

MedicalBrief reports that the team examined how whole- and refined-grain intake over time affected five risk factors of heart disease: waist size, blood pressure, blood sugar, triglyceride, and HDL (“good”) cholesterol.

Using data from the Framingham Heart Study Offspring Cohort, which began in the 1970s to assess long-term risk factors of heart disease, the research examined health outcomes associated with whole- and refined-grain consumption over a median of 18 years. The 3,100 participants from the cohort were mostly white and, on average, in their mid-50s at the start of data collection.

The research team compared changes in the five risk factors, over four-year intervals, across four categories of reported whole grain intake, ranging from less than a half serving per day to three or more servings per day.

According to the Dietary Guidelines for Americans 2020-2025, the recommended amount of whole grains is three or more servings daily. An example of a serving is one slice of whole-grain bread, a half cup of rolled oats cereal, or a half cup of brown rice.

The results showed that for each four-year interval, waist size increased by an average of more than one inch in the low intake participants, versus about ½ inch in the high intake participants. Even after accounting for changes in waist size, average increases in blood sugar levels and systolic blood pressure were greater in low intake participants compared with high intake participants.

The researchers also studied the five risk factors across four categories of refined-grain intake, ranging from less than two servings per day to more than four servings per day. Lower refined-grain intake led to a lower average increase in waist size and a greater mean decline in triglyceride levels for each four-year period.

“Our findings suggest that eating whole-grain foods as part of a healthy diet delivers health benefits beyond just helping us lose or maintain weight as we age. In fact, these data suggest that people who eat more whole grains are better able to maintain their blood sugar and blood pressure over time. Managing these risk factors as we age may help to protect against heart disease,” said Nicola McKeown, senior and corresponding author and a scientist on the Nutritional Epidemiology Team at the USDA HNRCA.

“There are several reasons that whole grains may work to help people maintain waist size and reduce increases in the other risk factors. The presence of dietary fibre in whole grains can have a satiating effect, and the magnesium, potassium, and antioxidants may contribute to lowering blood pressure. Soluble fibre in particular may have a beneficial effect on post-meal blood sugar spikes,” said Caleigh Sawicki.

Sawicki did this work as part of her doctoral dissertation while a student at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University and while working with the Nutritional Epidemiology Team at the USDA HNRCA.

The greatest contributor to whole-grain intake among participants was whole-wheat breads and ready-to-eat whole-grain breakfast cereals. The refined grains came mostly from pasta and white bread. The difference in health benefits between whole and refined grains may stem from the fact that whole grains are less processed than refined grains. Whole grains have a fibre-rich outer layer and an inner germ layer packed with B vitamins, antioxidants, and small amounts of healthy fats. Milling whole grains removes these nutrient-dense components, leaving only the starch-packed refined grain behind.

“The average American consumes about five servings of refined grains daily, much more than is recommended, so it’s important to think about ways to replace refined grains with whole grains throughout your day. For example, you might consider a bowl of whole-grain cereal instead of a white flour bagel for breakfast and replacing refined-grain snacks, entrees, and side dishes with whole-grain options. Small incremental changes in your diet to increase whole-grain intake will make a difference over time,” McKeown said.


To measure daily grain intake, the researchers used diet questionnaires that participants completed every four years from 1991 to 2014, resulting in a median of 18 years of data.

Dietary assessment data came from five study examinations, and observations were only included if participants attended at least two consecutive examinations with accurate dietary data. Participants with diabetes at baseline were excluded.

The statistical analysis was adjusted for factors that might influence the results, including other aspects of a healthy diet. Limitations of the study include the fact that food consumption is self-reported, and participants may over- or under-estimate intake of certain foods based on perceived social desirability. Due to its observational design, the study does not reflect a causal relationship.

Study details

Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort

Caleigh M Sawicki, Paul F Jacques, Alice H Lichtenstein, Gail T Rogers, Jiantao Ma, Edward Saltzman, Nicola M McKeown

Published in The Journal of Nutrition, 13 July 2021


Greater whole grain (WG) consumption is associated with reduced risk of cardiovascular disease (CVD); however, few prospective studies have examined WG or refined grain (RG) intake and intermediate cardiometabolic risk factors.

We examined the longitudinal association between WG and RG intake on changes in waist circumference (WC); fasting HDL cholesterol, triglyceride, and glucose concentrations; and blood pressure.

Subjects were participants in the Framingham Offspring cohort study [n = 3121; mean ± SD baseline age: 54.9 ± 0.2 y; BMI (kg/m2) 27.2 ± 0.1]. FFQ, health, and lifestyle data were collected approximately every 4 y over a median 18-y follow-up. Repeated measure mixed models were used to estimate adjusted mean changes per 4-y interval in risk factors across increasing categories of WG or RG intake.

Greater WG intake was associated with smaller increases in WC (1.4 ± 0.2 compared with 3.0 ± 0.1 cm in the highest compared with the lowest category, respectively; P-trend < 0.001), fasting glucose concentration (0.7 ± 0.4 compared with 2.6 ± 0.2 mg/dL; P-trend < 0.001), and systolic blood pressure (SBP; 0.2 ± 0.5 compared with 1.4 ± 0.3 mm Hg; P-trend < 0.001) per 4-y interval. When stratified by sex, a stronger association with WC was observed among females than males. Higher intake of WG was associated with greater increases in HDL cholesterol and declines in triglyceride concentrations; however, these differences did not remain significant after adjustment for change in WC. Conversely, greater RG intake was associated with greater increases in WC (2.7 ± 0.2 compared with 1.8 ± 0.1 cm, P-trend < 0.001) and less decline in triglyceride concentration (−0.3 ± 1.3 compared with −7.0 ± 0.7 mg/dL, P-trend < 0.001).

Among middle- to older-age adults, replacing RG with WG may be an effective dietary modification to attenuate abdominal adiposity, dyslipidemia, and hyperglycemia over time, thereby reducing the risk of cardiometabolic diseases.


The Journal of Nutrition article – Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort


See more from MedicalBrief archives:


Eating ultra-processed food increases risk of weight gain


UK dietary guidelines cut heart risk by up to 33%


'Compelling' evidence for a 'good-fibre' diet over a low-carb diet


Low-fat vs low carb? It doesn't matter for weight loss


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