Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study

Abstract

Objective To evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study. Design Prospective cohort study. Setting PURE study in 21 countries. Participants 148 858 participants with median follow-up of 9.5 years. Exposures Country specific validated food frequency questionnaires were used to assess intakes of refined grains, whole grains, and white rice. Main outcome measure Composite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios were estimated for associations of grain intakes with mortality, major cardiovascular events, and their composite by using multivariable Cox frailty models with random intercepts to account for clustering by centre. Results Analyses were based on 137 130 participants after exclusion of those with baseline cardiovascular disease. During follow-up, 9.2% (n=12 668) of these participants had a composite outcome event. The highest category of intake of refined grains (≥350 g/day or about 7 servings/day) was associated with higher risk of total mortality (hazard ratio 1.27, 95% confidence interval 1.11 to 1.46; P for trend=0.004), major cardiovascular disease events (1.33, 1.16 to 1.52; P for trend<0.001), and their composite (1.28, 1.15 to 1.42; P for trend<0.001) compared with the lowest category of intake (<50 g/day). Higher intakes of refined grains were associated with higher systolic blood pressure. No significant associations were found between intakes of whole grains or white rice and health outcomes. Conclusion High intake of refined grains was associated with higher risk of mortality and major cardiovascular disease events. Globally, lower consumption of refined grains should be considered.

Multinomial Logistic Regression Model for Assessing Factors Associated with Junk Food Consumption of Secondary Level Students

“…The term junk food is inherently colloquial (Hadjikakou and Baker, 2019). Palatable but unwholesome foods rife in fat, salt, and sugar (HFSS) and scarce in nutrients like proteins, vitamins, minerals, and fibers are junk foods (Stedman, 2012). Junk food has been interpreted and defined from a different perspective depending on its incidence in the literature.…”

“…Such foods also contain different preservatives that may be toxic if taken in a large amount. Also, maximum consumption of white flour/ refined flour used in producing various food products and packaged foods leads to serious health issues (Swaminathan et al, 2021). In Nepal, the percentage of households consuming biscuits/cookies is 95.6 % according to the Nepal National Micronutrients Status Survey (NNMSS) 2016 (MOHP et al, 2018), which indicates the consumption of prepacked foods is rapidly increasing in Nepal.…”

Whole-Grain Intake in the Mediterranean Diet and a Low Protein to Carbohydrates Ratio Can Help to Reduce Mortality from Cardiovascular Disease, Slow Down the Progression of Aging, and to Improve Lifespan: A Review

“…We already know that adherence to a diet pattern such as the traditional MD [ 6 ] was associated with a reduction in overall mortality, coronary heart disease, and cardiovascular disease. An overall high-quality diet that emphasizes a high consumption of polyunsaturated and monounsaturated fatty acids, raw vegetables, dairy, legumes, low-fat lean meats fat, fresh fish, bread (especially whole-grain bread), and wine in moderation, has been inversely associated with overall mortality, especially in the elderly [ 167 , 168 ]. In addition, a healthy diet of high quality can increase the number of years without disease and without disabilities [ 169 ].…”

“…Concerning protein intake, an established dietary bias is that older people need to obtain more protein with their diet, even though they are not malnourished. The main objective of this advice is to first prevent sarcopenia, then to maintain a good state of health, which allows for the prevention of malnutrition, improving wound healing and faster recovery from acute illness [ 167 ]. Instead, these recommendations are in contrast with the results of basic research on animal models and with the results of observational studies on population cohorts, which on the contrary have shown that a low-protein, high-carbohydrate diet (LPHC) can delay aging and extend lifespan [ 123 , 133 , 142 , 159 , 172 ].…”

The Study of Dietary Patterns: Righting the Remedies

“…This misapplication of “bigger is better” to nutrition is not theoretical, but on prominent display in the peer-reviewed literature. 24,25 As with RCTs, large samples, particularly when spanning multiple countries, tend to garner special attention and reverence. 26 But when they violate the requirement that a given study population be subject to the same general effects of an exposure, they, too, are apt to propagate fallacies.…”