title: Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies.
abstract: BACKGROUND
  The potential role of whole grain in preventing various mortality outcomes has been inconsistently reported in a wealth of prospective observational studies.
  
  
  OBJECTIVE
  We evaluated the relations between whole-grain intake and risks of dying from any cause, cardiovascular disease (CVD), and cancer through a meta-analytic approach.
  
  
  METHODS
  Relevant studies were identified by searching PubMed and EMBASE databases and bibliographies of retrieved full publications. Summary RRs with 95% CIs were calculated with a random-effects model.
  
  
  RESULTS
  Thirteen studies on total mortality (104,061 deaths), 12 on CVD mortality (26,352 deaths), and 8 on cancer mortality (34,797 deaths) were included. Three studies reported whole-grain intake, and the remaining studies reported whole-grain product intake. In the dose-response analysis in which the intake of whole-grain products was converted to the amount of whole grain, the summary RRs for an increment in whole-grain intake of 50 g/d were 0.78 (95% CI: 0.67, 0.91) for total mortality, 0.70 (95% CI: 0.61, 0.79) for CVD mortality, and 0.82 (95% CI: 0.69, 0.96) for cancer mortality. A similar reduction was observed for the mortality from ischemic heart disease (RR: 0.68; 95% CI: 0.55, 0.84) but not from stroke (RR: 0.93; 95% CI: 0.54, 1.62). There was evidence of nonlinear associations of whole-grain intake with total (P-nonlinearity < 0.001) and CVD mortality (P-nonlinearity <0.001), but not with cancer mortality (P-nonlinearity = 0.12), with the curves for the associations appearing slightly steeper at lower ranges (<35 g/d) of the intake than at higher ranges.
  
  
  CONCLUSIONS
  Our findings suggest significant inverse relations between whole-grain intake and mortality due to any cause, CVD, or cancer. The findings support the recommendation of increasing whole-grain intake to improve public health.
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health.
authors.forename: Guo-Chong
authors.initials: GC
authors.lastname: Chen
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health.
authors.forename: Xing
authors.initials: X
authors.lastname: Tong
authors.affiliation: Key Laboratory of Radiation Biology, School of Radiation Medicine and Protection, and.
authors.forename: Jia-Ying
authors.initials: JY
authors.lastname: Xu
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health.
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Han
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health.
authors.forename: Zhong-Xiao
authors.initials: ZX
authors.lastname: Wan
authors.affiliation: Division of Medical Genetics, Maternal and Child Health Hospital of Hunan Province, Changsha, China.
authors.forename: Jia-Bi
authors.initials: JB
authors.lastname: Qin
authors.affiliation: Department of Nutrition and Food Hygiene, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Soochow University, Suzhou, China; and qinliqiang@suda.edu.cn.
authors.forename: Li-Qiang
authors.initials: LQ
authors.lastname: Qin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D009369:Neoplasms / Q000401:mortality*; D000067348:Whole Grains; D055815:Young Adult
keywords: cancer; cardiovascular disease; meta-analysis; mortality; whole grain