The Effect of Replacing Refined Grains with Whole Grains on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Clinical Recommendation

Marshall, Skye; Petocz, Peter; Duve, Emily; Abbott, Kylie; Cassettari, Tim; Blumfield, Michelle; Fayet‐Moore, Flavia

doi:10.1016/j.jand.2020.06.021

Cited by 63 publications

(44 citation statements)

References 51 publications

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“…The greater use may also relate to perceptions regarding consumer understanding or may simply be aligned with research outcomes for whole grains and CVD. The benefits of regular consumption of whole grain foods are well documented [ 4 , 36 , 37 , 38 , 39 ], with every 16 g increase (one serving) associated with a 9% reduction in cardiovascular disease risk [ 40 , 41 ]. In addition to exploring the Australian consumer understanding of beta glucan claims, a comparison to more general whole grain claims would also be of value especially as whole grain claims are growing rapidly, with a 39% increase in the number of products making whole grain claims in Australia in the past 5 years [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Hughes¹,

Grafenauer

2021

Nutrients

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Beta glucan is a type of soluble dietary fibre found in oats and barley with known cholesterol-lowering benefits. Many countries globally have an approved beta glucan health claim related to lowering blood cholesterol, an important biomarker for cardiovascular disease. However, the use of these claims has not been examined. The aim of this study was to explore the range and variety of oat and barley products in the Australian and global market within a defined range of grain food and beverage categories and examine the frequency of beta glucan health claims. Australian data were collected via a recognised nutrition audit process from the four major Australian supermarkets in metropolitan Sydney (January 2018 and September 2020) and Mintel Global New Product Database was used for global markets where a claim is permitted. Categories included breakfast cereals, bread, savoury biscuits, grain-based muesli bars, flour, noodles/pasta and plant-based milk alternatives and information collected included ingredients lists and nutrition and health claims. Products from Australia (n = 2462) and globally (n = 44,894) were examined. In Australia, 37 products (1.5%) made use of the beta glucan claim (84% related to oat beta glucan and 16% related to barley beta glucan, specifically BARLEYmax®). Of products launched globally, 0.9% (n = 403) displayed beta glucan cholesterol-lowering claims. Despite the number of products potentially eligible to make beta glucan claims, their use in Australia and globally is limited. The value of dietary modification in cardiovascular disease treatment and disease progression deserves greater focus, and health claims are an opportunity to assist in communicating the role of food in the management of health and disease. Further assessment of consumer understanding of the available claims would be of value.

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Section: Discussionmentioning

confidence: 99%

Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Hughes¹,

Grafenauer

2021

Nutrients

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“…Antidiabetic properties, decreased inflammation, and the modulation of lipid metabolism and oxidative stress have been documented in in vitro studies and clinical trials investigating health benefits of consuming brown rice (38) . A recent systematic review and meta-analysis of randomized controlled trials found that, compared with white rice, brown rice led to an improvement in triacylglycerol levels (-1.6 mg/dL) in interventions ranging Accepted manuscript from 150 to 400g of cooked rice (39) . One serving of brown rice per day was also associated with reductions in type 2 diabetes risk (Hazard ratio [HR] 0.72) in three large prospective studies from the United States of America (USA); however the association was no longer significant after adjusting for BMI (40) .…”

Section: Discussionmentioning

confidence: 99%

Opportunities for diet quality improvement: the potential role of staple grain foods

Fontanelli

Martínez-Arroyo

Sales

et al. 2021

Public Health Nutr.

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Objective: Given the high disease burden associated with the low intake of whole grains, modelling studies that estimate the impact of dietary strategies to increase more healthful grain foods consumption are essential to inform evidence-based and culturally-specific policies. This study investigated the potential nutritional impact of replacing staple grain foods with more healthful options. Design: Based on the 2015 Health Survey of São Paulo, a cross-sectional, population-based study, we modelled the substitution of white rice and white bread with brown rice and whole-wheat bread. Outcomes included changes in more healthful grain foods, energy, and nutrient intakes. Setting: Urban area of São Paulo, Brazil. Participants: Participants aged over 12 years who completed a semi-structured questionnaire and one 24-h recall (n=1741). Results: The substitution of all white rice and white bread with brown rice and whole-wheat bread, respectively, would result in more than 5% increases in zinc (+9.1%), calcium (+9.3%), vitamin E (+18.8%), dietary fibre (+27.0%), and magnesium (+52.9%) intake, while more than a 5% decrease would be seen for total carbohydrate (-6.1%), folate (-6.6%), available carbohydrate (-8.5%), iron (-8.6%), vitamin B6 (-12.5%), vitamin B2 (-17.4%), and vitamin B1 (-20.7%). A substantial increase in the amount of more healthful grain foods consumed would be seen (10g/d to 220g/d), or from 4% to 69% of total grain intake. Conclusions: Replacing white rice and white bread with their whole-grain versions has the potential to improve diet quality, suggesting they are prime targets for policy actions aiming at increasing intake of more healthful grain foods.

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“…Higher nutrient density of whole grains may help explain some of the observed health benefits. Meta-analysis of up to 22 randomized clinical trials ( 49 ) showed that replacing refined grain or placebo with whole grain led to improvements in plasma lipid profiles that were attributed to whole-grain oats. Replacing refined grains with whole grains also improved glycated hemoglobin (a marker of diabetes risk) and C-reactive protein (a marker of inflammation).…”

Section: Current Status Of Knowledgementioning

confidence: 99%

Perspective: Why Whole Grains Should Be Incorporated into Nutrient-Profile Models to Better Capture Nutrient Density

Drewnowski

McKeown

Kissock

et al. 2021

Advances in Nutrition

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Healthy eating patterns, as described by dietary guidelines, typically favor whole grains, low-fat dairy, vegetables, fruit, legumes, and nuts and seeds. Nutrient-profiling (NP) models capture nutrient density of individual foods and can inform healthier food choices. Although whole grains are prominently featured in most dietary guidelines, they are not included in most NP models. Healthy foods, as identified by most NP models, are those that contain limited amounts of energy, saturated fat, total or added sugar, and sodium. As global dietary guidance turns to foods and food groups as opposed to individual nutrients, future nutrient-density metrics may need to do the same. Potential methods to incorporate whole grains into the overall concept of nutrient density and into selected NP models are outlined in this review. Incorporating whole grains into the Nutri-Score, Health Star Rating, or the Nutrient Rich Food index will require further analyses of dietary nutrient density in relation to health outcomes across diverse population subgroups. We present the rationale for how the inclusion of whole grains in NP models can assist in the implementation of dietary guidance.

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The Effect of Replacing Refined Grains with Whole Grains on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with GRADE Clinical Recommendation

Cited by 63 publications

References 51 publications

Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Oat and Barley in the Food Supply and Use of Beta Glucan Health Claims

Opportunities for diet quality improvement: the potential role of staple grain foods

Perspective: Why Whole Grains Should Be Incorporated into Nutrient-Profile Models to Better Capture Nutrient Density

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