Abstract
BackgroundControl of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies.Methods and FindingsWe followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37–65 y for NHSI and 26–46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12–18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57–0.69) for NHSI and 0.68 (95% CI 0.57–0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68–0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72–1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%–28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI.ConclusionsWhole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes.
Highlights
The prevalence of type 2 diabetes is increasing rapidly worldwide [1]
Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ
We conducted analyses modeling whole grain intake as a continuous variable: relative risk (RR) of type 2 diabetes was calculated for a 40 g increment in whole grain intake, which was approximately equivalent to the difference between the 5th and the 95th percentile of intake in our studies (NHSI: 35.9 g, NHSII: 44.3 g)
Summary
The prevalence of type 2 diabetes is increasing rapidly worldwide [1]. Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established [2]. Type 2 diabetes mellitus ( sometimes called adultonset or noninsulin-dependent diabetes) is increasing worldwide and is the most common form of diabetes It puts people at risk of poor health and death by increasing their risk of heart disease and stroke, and a range of other conditions including blindness, kidney disease, and ulcers. It has long been recognized that there is a link between diet and developing type 2 diabetes, because people who are overweight (because the amount of energy in their diet is greater than the energy they use up) run a greater risk of getting type 2 diabetes It has not been clear which particular nutrients or foods might increase the risk or might give protection. Some evidence suggests that eating a diet rich in whole grains might help protect against diabetes, but this has not been firmly established
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