The epidemic of type 2 diabetes among children, adolescents and adults is increasing along with the increasing prevalence of overweight and obesity. Overweight is the most powerful modifiable risk factor for type 2 diabetes. Intake of wholegrain foods may reduce diabetes risk. Three prospective studies in 160 000 men and women examined the relationship of whole-grain or cereal-fibre intake with the risk of type 2 diabetes. Each study used a mailed Willett foodfrequency questionnaire and similar methods of quantifying wholegrain foods and cereal fibre. The self-reported incident diabetes outcome was more reliably determined in the two studies of health-care professionals than in the study of Iowa women. Risk for incident type 2 diabetes was 21-27 % lower for those in the highest quintile of whole-grain intake, and 30-36 % lower in the highest quintile of cereal-fibre intake, each compared with the lowest quintile. Risk reduction persisted after adjustment for the healthier lifestyle found among habitual whole-grain consumers. Observations in non-diabetic individuals support an inverse relationship between whole-grain consumption and fasting insulin levels. In feeding studies in non-diabetic individuals insulin resistance was reduced using whole grains or diets rich in whole grains. Glucose control improved with diets rich in whole grains in feeding studies of subjects with type 2 diabetes. There is accumulating evidence to support the hypothesis that whole-grain consumption is associated with a reduced risk of incident type 2 diabetes; it may also improve glucose control in diabetic individuals. Although several risk factors for the development of type 2 diabetes among children, adolescents and adults (Rosenbloom, 2002) are well recognized, there is a growing epidemic of type 2 diabetes. Several of the risk factors for type 2 diabetes are non-modifiable, including family history, age and ethnicity, while other factors are modifiable, including obesity (Rosenbloom, 2002), central adiposity (Franz et al. 2002), and a sedentary lifestyle (Engelgau et al. 2000). The results of three randomized clinical trials showed that changes in these modifiable risk factors could alter the incidence rate of type 2 diabetes (Pan et al. 1997;Hu et al. 2001;Tuomilehto et al. 2001; Knowler et al. 2002). In the USA a lifestyle intervention of increasing physical activity and a low-energy low-fat diet, without specific mention of an increase in fibre or whole-grain intake, reduced the risk of diabetes by 58 %; use of the medication metformin was associated with a 31 % reduction in risk. In China a diet that focused on increasing the consumption of vegetables and reducing the intake of alcohol and simple sugars reduced the risk of type 2 diabetes in individuals with impaired glucose tolerance by 31 % after adjustment for baseline glucose and BMI (Pan et al. 1997). A lifestyle intervention aimed at increasing physical activity and fibre intake and decreasing body weight and total and saturated fat intake was associated with a 58 % reduc...

In response to the 1990 Nutrition Labeling and Education Act, the Food and Drug Administration approved seven health claims that addressed the relationship between broad food categories and risk of certain chronic diseases. These claims are based on scientific consensus that includes epidemiological, animal and clinical research. The Food and Drug Administration also established a process to petition for new health claims that address substance-disease relationships supported by adequate scientific and specific regulatory requirements. The whole grain-cancer and heart disease authoritative statement health claim approved in July 1999 followed a completely different process mandated by the Food and Drug Administration Modernization Act of 1997. It is based on an authoritative statement made by a government body that represents scientific consensus and is supported by other scientific agencies and organizations. The scientific basis for the claim published in Diet and Health reflects a comprehensive and deliberative review of epidemiological, animal and human studies by the National Academy of Sciences Committee on Diet and Health. Health claims used on whole-grain products can attract the attention of health-conscious consumers and are important tools in communicating health messages. However, the US public consumes substantially fewer whole-grain servings than recommended by US dietary guidance. Reasons given by consumers for not purchasing whole-grain foods include colour, price, softness, texture, moisture content and taste. Developing tastier value-added whole-grain foods along with simple coordinated messages from industry, the scientific community, public health experts and government will help consumers identify, purchase and consume more whole-grain products.

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