title: Identifying whole grain foods: a comparison of different approaches for selecting more healthful whole grain products.
abstract: OBJECTIVE
  Eating whole grains (WG) is recommended for health, but multiple conflicting definitions exist for identifying whole grain (WG) products, limiting the ability of consumers and organizations to select such products. We investigated how five recommended WG criteria relate to healthfulness and price of grain products.
  
  
  METHODS
  We categorized grain products by different WG criteria including: the industry-sponsored Whole Grain stamp (WG-Stamp); WG as the first ingredient (WG-first); WG as the first ingredient without added sugars (WG-first-no-added-sugars); the word ‘whole’ before any grain in the ingredients (‘whole’-anywhere); and a content of total carbohydrate to fibre of ≤10:1 (10:1-ratio). We investigated associations of each criterion with health-related characteristics including fibre, sugars, sodium, energy, trans-fats and price.
  
  
  METHODS
  Two major grocery store chains.
  
  
  METHODS
  Five hundred and forty-five grain products.
  
  
  RESULTS
  Each WG criterion identified products with higher fibre than products considered non-WG; the 10:1-ratio exhibited the largest differences (+3·15 g/serving, P < 0·0001). Products achieving the 10:1-ratio also contained lower sugar (−1·28 g/serving, P = 0·01), sodium (−15·4 mg/serving, P = 0·04) and likelihood of trans-fats (OR = 0·14, P < 0·0001), without energy differences. WG-first-no-added-sugars performed similarly, but identified many fewer products as WG and also not a lower likelihood of containing trans-fats. The WG-Stamp, WG-first and ‘whole’-anywhere criteria identified products with a lower likelihood of trans-fats, but also significantly more sugars and energy (P < 0·05 each). Products meeting the WG-Stamp or 10:1-ratio criterion were more expensive than products that did not (+$US 0·04/serving, P = 0·009 and +$US 0·05/serving, P = 0·003, respectively).
  
  
  CONCLUSIONS
  Among proposed WG criteria, the 10:1-ratio identified the most healthful WG products. Other criteria performed less well, including the industry-supported WG-Stamp which identified products with higher fibre and lower trans-fats, but also higher sugars and energy. These findings inform efforts by consumers, organizations and policy makers to identify healthful WG products.
authors.affiliation: 1 Department of Society, Human Development and Health, Harvard School of Public Health Prevention Research Center, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Mozaffarian
authors.forename: Rebekka M
authors.initials: RM
authors.lastname: Lee
authors.forename: Mary A
authors.initials: MA
authors.lastname: Kennedy
authors.forename: David S
authors.initials: DS
authors.lastname: Ludwig
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
mesh_terms: D002755:Choice Behavior; D003365:Costs and Cost Analysis; D004032:Diet / Q000191:economics / Q000592:standards; D004043:Dietary Fiber; D019422:Dietary Sucrose; D002523:Edible Grain / Q000191:economics; D002149:Energy Intake; D005511:Food Handling; D017408:Guidelines as Topic; D006801:Humans; D018673:Nutrition Policy; D009749:Nutrition Surveys; D009753:Nutritive Value; D044242:Trans Fatty Acids
chemical_list: D004043:Dietary Fiber; D019422:Dietary Sucrose; D044242:Trans Fatty Acids