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Association of whole grain intake with all-cause, cardiovascular, and cancer mortality: a systematic review and dose–response meta-analysis from prospective cohort studies



Whole grains are rich source of nutrients and have shown beneficial effects on human health. This study was designed to systematically review the existing results and quantitatively assess the dose–response relationship of whole grain intake with all-cause and cause-specific mortality.


We searched ‘whole grain’ or ‘whole grains’ in combination with ‘mortality’’ or ‘cardiovascular disease’ or ‘cancer’ through the Web of Science and PubMed databases till 20 January 2016. To be eligible for inclusion, publications should be prospective cohort studies and reported the influence of whole grain intake on human mortality. Relative risks (RRs) and 95% confidence intervals (CIs) from the included studies were pooled by a random effects model or fixed effect model.


We included 19 cohort studies from 17 articles, with 1 041 692 participants and 96 710 deaths in total, in the analyses. We observed an inverse relationship of whole grain intake with risk of total, cardiovascular disease and cancer mortality. The pooled RR was 0.84 (95% CI 0.81–0.88, n=9) for total mortality, 0.83 (95% CI 0.79–0.86, n=8) for CVD mortality and 0.94 (95% CI 0.87–1.01, n=14) for cancer mortality, comparing the highest intake of whole grain with the lowest category. For dose–response analysis, we found a nonlinear relationship of whole grain intake with risk of total, cardiovascular and cancer mortality. Each 28 g/d intake of whole grains was associated with a 9% (pooled RR: 0.91 (0.90–0.93)) lower risk for total mortality, 14% (pooled RR: 0.86 (0.83–0.89)) lower risk for CVD mortality and 3% (pooled RR: 0.97 (0.95–0.99)) lower risk for cancer mortality.


Our study shows that whole grain intake was inversely associated with risk of total, CVD and cancer mortality. Our results support current dietary guidelines to increase the intake of whole grains. Government officials, scientists and medical staff should take actions to promote whole grains intake.

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  1. 1

    Slavin J . Whole grains and human health. Nutr Res Rev 2004; 17: 99–110.

    Article  Google Scholar 

  2. 2

    Qi L, Hu FB . Dietary glycemic load, whole grains, and systemic inflammation in diabetes: the epidemiological evidence. Curr Opin Lipidol 2007; 18: 3–8.

    CAS  Article  Google Scholar 

  3. 3

    Qi L, van Dam RM, Liu S, Franz M, Mantzoros C, Hu FB . Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women. Diabetes Care 2006; 29: 207–211.

    CAS  Article  Google Scholar 

  4. 4

    Harland JI, Garton LE . Whole-grain intake as a marker of healthy body weight and adiposity. Public Health Nutr 2008; 11: 554–563.

    Article  Google Scholar 

  5. 5

    Huang T, Xu M, Lee A, Cho S, Qi L . Consumption of whole grains and cereal fiber and total and cause-specific mortality: prospective analysis of 367,442 individuals. BMC Medicine 2015; 13: 59.

    Article  Google Scholar 

  6. 6

    Cleveland LE, Moshfegh AJ, Albertson AM, Goldman JD . Dietary intake of whole grains. J Am Coll Nutr 2000; 19 (3 Suppl), 331S–338S.

    CAS  Article  Google Scholar 

  7. 7

    Albertson AM, Reicks M, Joshi N, Gugger CK . Whole grain consumption trends and associations with body weight measures in the United States: results from the cross sectional National Health and Nutrition Examination Survey 2001-2012. Nutr J 2016; 15: 8.

    Article  Google Scholar 

  8. 8

    Jacobs DR, Meyer KA, Kushi LH, Folsom AR . Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women's Health Study. Am J Public Health 1999; 89: 322–329.

    Article  Google Scholar 

  9. 9

    Mellen PB, Walsh TF, Herrington DM . Whole grain intake and cardiovascular disease: a meta-analysis. Nutr Metab Cardiovasc Dis 2008; 18: 283–290.

    Article  Google Scholar 

  10. 10

    de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM . Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review. PLoS Med 2007; 4: e261.

    Article  Google Scholar 

  11. 11

    Aune D, Chan DS, Lau R, Vieira R, Greenwood DC, Kampman E et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011; 343: d6617.

    Article  Google Scholar 

  12. 12

    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806–808.

    Article  Google Scholar 

  13. 13

    Juni P, Witschi A, Bloch R, Egger M . The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 1999; 282: 1054–1060.

    CAS  Article  Google Scholar 

  14. 14

    Stang A . Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 2010; 25: 603–605.

    Article  Google Scholar 

  15. 15

    Hootman JM, Driban JB, Sitler MR, Harris KP, Cattano NM . Reliability and validity of three quality rating instruments for systematic reviews of observational studies. Res Synth Methods 2011; 2: 110–118.

    Article  Google Scholar 

  16. 16

    Wu H, Flint AJ, Qi Q, van Dam RM, Sampson LA, Rimm EB et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in US men and women. JAMA Int Med 2015; 175: 373–384.

    Article  Google Scholar 

  17. 17

    Tabung F, Steck SE, Su LJ, Mohler JL, Fontham ET, Bensen JT et al. Intake of grains and dietary fiber and prostate cancer aggressiveness by race. Prostate Cancer 2012; 2012: 323296.

    Article  Google Scholar 

  18. 18

    Nimptsch K, Kenfield S, Jensen MK, Stampfer MJ, Franz M, Sampson L et al. Dietary glycemic index, glycemic load, insulin index, fiber and whole-grain intake in relation to risk of prostate cancer. Cancer Causes Control 2011; 22: 51–61.

    CAS  Article  Google Scholar 

  19. 19

    Steffen LM, Jacobs Jr DR, Stevens J, Shahar E, Carithers T, Folsom AR . Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr 2003; 78: 383–390.

    CAS  Article  Google Scholar 

  20. 20

    Jacobs DR, Meyer HE, Solvoll K . Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. Eur J Clin Nutr 2001; 55: 137–143.

    Article  Google Scholar 

  21. 21

    Buil-Cosiales P, Zazpe I, Toledo E, Corella D, Salas-Salvado J, Diez-Espino J et al. Fiber intake and all-cause mortality in the Prevencion con Dieta Mediterranea (PREDIMED) study. Am J Clin Nutr 2014; 100: 1498–1507.

    CAS  Article  Google Scholar 

  22. 22

    Boggs DA, Ban Y, Palmer JR, Rosenberg L . Higher diet quality is inversely associated with mortality in African-American women. J Nutr 2015; 145: 547–554.

    CAS  Article  Google Scholar 

  23. 23

    Bakken T, Braaten T, Olsen A, Kyro C, Lund E, Skeie G . Consumption of whole-grain bread and risk of colorectal cancer among Norwegian Women (the NOWAC Study). Nutrients 2016; 8: 40.

    Article  Google Scholar 

  24. 24

    Liu S, Sesso HD, Manson JE, Willett WC, Buring JE . Is intake of breakfast cereals related to total and cause-specific mortality in men? Am J Clin Nutr 2003; 77: 594–599.

    CAS  Article  Google Scholar 

  25. 25

    Jensen MK, Koh-Banerjee P, Hu FB, Franz M, Sampson L, Gronbaek M et al. Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. Am J Clin Nutr 2004; 80: 1492–1499.

    CAS  Article  Google Scholar 

  26. 26

    Higgins JP, Thompson SG . Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–1558.

    Article  Google Scholar 

  27. 27

    Dong JY, Qin LQ . Dietary glycemic index, glycemic load, and risk of breast cancer: meta-analysis of prospective cohort studies. Breast Cancer Res Treat 2011; 126: 287–294.

    CAS  Article  Google Scholar 

  28. 28

    Dong JY, Qin LQ . Soy isoflavones consumption and risk of breast cancer incidence or recurrence: a meta-analysis of prospective studies. Breast Cancer Res Treat 2011; 125: 315–323.

    CAS  Article  Google Scholar 

  29. 29

    Dong JY . Depression and risk of stroke. JAMA 2011; 306: 2562 author reply 2563.

    CAS  Article  Google Scholar 

  30. 30

    Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–634.

    CAS  Article  Google Scholar 

  31. 31

    Begg CB, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088–1101.

    CAS  Article  Google Scholar 

  32. 32

    Kyro C, Skeie G, Loft S, Landberg R, Christensen J, Lund E et al. Intake of whole grains from different cereal and food sources and incidence of colorectal cancer in the Scandinavian HELGA cohort. Cancer Causes Control 2013; 24: 1363–1374.

    Article  Google Scholar 

  33. 33

    Egeberg R, Olsen A, Christensen J, Johnsen NF, Loft S, Overvad K et al. Intake of whole-grain products and risk of prostate cancer among men in the Danish Diet, Cancer and Health cohort study. Cancer Causes Control 2011; 22: 1133–1139.

    Article  Google Scholar 

  34. 34

    Egeberg R, Olsen A, Loft S, Christensen J, Johnsen NF, Overvad K et al. Intake of whole grain products and risk of breast cancer by hormone receptor status and histology among postmenopausal women. Int J Cancer 2009; 124: 745–750.

    CAS  Article  Google Scholar 

  35. 35

    Larsson SC, Giovannucci E, Bergkvist L, Wolk A . Whole grain consumption and risk of colorectal cancer: a population-based cohort of 60000 women. Br J Cancer 2005; 92: 1803–1807.

    CAS  Article  Google Scholar 

  36. 36

    Aarestrup J, Kyro C, Christensen J, Kristensen M, Wurtz AM, Johnsen NF et al. Whole grain, dietary fiber, and incidence of endometrial cancer in a Danish cohort study. Nutr Cancer 2012; 64: 1160–1168.

    CAS  Article  Google Scholar 

  37. 37

    Ross AB, Kristensen M, Seal CJ, Jacques P, McKeown NM . Recommendations for reporting whole-grain intake in observational and intervention studies. Am J Clin Nutr 2015; 101: 903–907.

    CAS  Article  Google Scholar 

  38. 38

    Aune D, Norat T, Romundstad P, Vatten LJ . Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol 2013; 28: 845–858.

    CAS  Article  Google Scholar 

  39. 39

    Greenland S, Longnecker MP . Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol 1992; 135: 1301–1309.

    CAS  Article  Google Scholar 

  40. 40

    Aune D, Greenwood DC, Chan DS, Vieira R, Vieira AR, Navarro Rosenblatt DA et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol 2012; 23: 843–852.

    CAS  Article  Google Scholar 

  41. 41

    Benisi-Kohansal S, Saneei P, Salehi-Marzijarani M, Larijani B, Esmaillzadeh A . Whole-grain intake and mortality from all causes, cardiovascular disease, and cancer: a systematic review and dose-response meta-analysis of prospective cohort studies. Adv Nutr 2016; 7: 1052–1065.

    Article  Google Scholar 

  42. 42

    Chen GC, Tong X, Xu JY, Han SF, Wan ZX, Qin JB et al. Whole-grain intake and total, cardiovascular, and cancer mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr 2016; 104: 164–172.

    CAS  Article  Google Scholar 

  43. 43

    Zong G, Gao A, Hu FB, Sun Q . Whole grain intake and mortality from all causes, cardiovascular disease, and cancer: a meta-analysis of prospective cohort studies. Circulation 2016; 133: 2370–2380.

    CAS  Article  Google Scholar 

  44. 44

    Wei H, Gao Z, Liang R, Li Z, Hao H, Liu X . Whole-grain consumption and the risk of all-cause, CVD and cancer mortality: a meta-analysis of prospective cohort studies. Br J Nutr 2016; 116: 514–525.

    CAS  Article  Google Scholar 

  45. 45

    Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC et al. Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies. BMJ 2016; 353: i2716.

    Article  Google Scholar 

  46. 46

    Lei Q, Zheng H, Bi J, Wang X, Jiang T, Gao X et al. Whole grain intake reduces pancreatic cancer risk: a meta-analysis of observational studies. Medicine 2016; 95: e2747.

    CAS  Article  Google Scholar 

  47. 47

    Haas P, Machado MJ, Anton AA, Silva ASS, De Francisco A . Effectiveness of whole grain consumption in the prevention of colorectal cancer: Meta-analysis of cohort studies. Int J Food Sci Nutr 2009; 60: 1–13.

    Article  Google Scholar 

  48. 48

    Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M et al. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 2012; 142: 1009–1018.

    CAS  Article  Google Scholar 

  49. 49

    Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D et al. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol 1999; 149: 531–540.

    CAS  Article  Google Scholar 

  50. 50

    Giovannucci E, Colditz G, Stampfer MJ, Rimm EB, Litin L, Sampson L et al. The assessment of alcohol-consumption by a simple self-administered questionnaire. Am J Epidemiol 1991; 133: 810–817.

    CAS  Article  Google Scholar 

  51. 51

    Chasan-Taber S, Rimm EB, Stampfer MJ, Spiegelman D, Colditz GA, Giovannucci E et al. Reproducibility and validity of a self-administered physical activity questionnaire for male health professionals. Epidemiology 1996; 7: 81–86.

    CAS  Article  Google Scholar 

  52. 52

    Sun Q, Spiegelman D, van Dam RM, Holmes MD, Malik VS, Willett WC et al. White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med 2010; 170: 961–969.

    Article  Google Scholar 

  53. 53

    Halton TL, Willett WC, Liu S, Manson JE, Stampfer MJ, Hu FB . Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr 2006; 83: 284–290.

    CAS  Article  Google Scholar 

  54. 54

    Wang L, Gaziano JM, Liu S, Manson JE, Buring JE, Sesso HD . Whole- and refined-grain intakes and the risk of hypertension in women. Am J Clin Nutr 2007; 86: 472–479.

    CAS  Article  Google Scholar 

  55. 55

    He M, van Dam RM, Rimm E, Hu FB, Qi L . Whole-grain, cereal fiber, bran, and germ intake and the risks of all-cause and cardiovascular disease-specific mortality among women with type 2 diabetes mellitus. Circulation 2010; 121: 2162–2168.

    Article  Google Scholar 

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This work was sponsored by National Natural Science Foundation (NSFC 81370966) of China.

Author contributions

Baihui Zhang, Qingxia Zhao and Wenwen Guo organized the data and drew up the article. Xia Wang and Wei Bao designed the study and conduct technical review for the manuscript. All authors agreed to the last draft.

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Correspondence to X Wang.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

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Zhang, B., Zhao, Q., Guo, W. et al. Association of whole grain intake with all-cause, cardiovascular, and cancer mortality: a systematic review and dose–response meta-analysis from prospective cohort studies. Eur J Clin Nutr 72, 57–65 (2018).

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