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Whole grains and CVD risk

Published online by Cambridge University Press:  07 March 2007

Chris J. Seal
Chris J. Seal*
Affiliation:
School of Agriculture, Food & Rural Development, Agriculture Building, University of Newcastle upon Tyne, Newcastle upon Tyne NE1 7RU, UK
*
Corresponding author: Dr Chris Seal, fax +44 191 2226720, email [email protected]
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Abstract

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There is an increasing body of evidence, including that from prospective population studies and epidemiological observational studies, suggesting a strong inverse relationship between increased consumption of wholegrain foods and reduced risk of CVD. This evidence has translated into specific dietary recommendations in the USA to consume at least three servings of whole grain per d, and has informed the development of specific health claims for wholegrain foods both in the USA and in Europe. Wholegrain foods are rich sources of many nutrients and phytochemicals, including complex carbohydrates, dietary fibre, minerals, vitamins, antioxidants and phyto-oestrogens such as lignans. Many of these components are lost from the grain during processing and although some may be replaced (such as in the mandatory fortification of white flour), this practice ignores the possible synergistic effects of the ‘natural’ constituents. The notion that wholegrain foods are simply a source of dietary fibre has been dispelled, although the additional components that contribute to the health benefits have not been clearly identified. In addition, the mechanisms by which wholegrain foods may have their effect are poorly understood. At present there are few strictly-controlled intervention studies that have confirmed a beneficial effect of increased consumption of wholegrain foods, demonstrated the level of consumption required to elicit a beneficial effect or provided evidence of modes of action. Although wholegrain foods are considered amongst the healthiest food choices available, their consumption falls well below current recommendations, which have been based mainly on epidemiological evidence. Well-controlled intervention studies are needed to provide more detailed mechanistic evidence to support the health claims and findings which can be used to develop effective public health strategies to promote whole-grain consumption.

Keywords

Whole grainCVDAntioxidantsDisease risk
Type
Symposium on ‘Plant foods and public health’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 1 , February 2006 , pp. 24 - 34
Copyright
Copyright © The Nutrition Society 2006

References

Adlercreutz, H, Bannwart, C, Wahala, K, Makela, T, Brunow, G, Hase, T, Arosemena, PJ, Kellis, JJT & Vickery, LE (1993) Inhibition of human aromatase by mammalian lignans and isoflavonoid phytoestrogens. Journal of Steroid Biochemistry and Molecular Biology 44 147–153.CrossRefGoogle ScholarPubMed
Adom, KK & Liu, RH (2002) Antioxidant activity of grains. Journal of Agricultural and Food Chemistry 50 6182–6187.CrossRefGoogle ScholarPubMed
Ajani, U, Ford, E, Mokdad, A (2004) Dietary fiber and C-reactive protein: findings from National Health and Nutrition Examination Survey data. Journal of Nutrition 134 1181–1185.CrossRefGoogle ScholarPubMed
American Association of Cereal Chemists (2005) Definition/Reports. http://www.aaccnet.org/definitions/wholegrain.asp (accessed August 2005)Google Scholar
American Heart Association (2005) American Heart Association publications and resources. http://www.americanheart.org/presenter.jhtml?identifier = 1200020 (accessed August 2005)Google Scholar
Anderson, JW (2003) Whole grains protect against atherosclerotic cardiovascular disease. Proceedings of the Nutrition Society 62 135–142.CrossRefGoogle ScholarPubMed
Anderson, JW (2004) Whole grains and coronary heart disease: the whole kernel of truth. American Journal of Clinical Nutrition 80 1459–1460.CrossRefGoogle ScholarPubMed
Anderson, JW, Hanna, TJ, Peng, X & Kryscio, RJ (2000) Whole grain foods and heart disease risk. Journal of the American College of Nutrition 19 291S–299S.CrossRefGoogle ScholarPubMed
Bach Knudsen, K, Serena, A, Kjaer, A, Tetens, I, Heinonen, S-M, Nurmi, T, Adlercreutz, H (2003) Rye bread in the diet of pigs enhances the formation of enterolactone and increases its levels in plasma, urine and feces. Journal of Nutrition 133 1368–1375.CrossRefGoogle ScholarPubMed
Benzie, I & Strain, J (1996) The ferric reducing ability of plasma (FRAP) as a measure of ‘antioxidant power’: The FRAP assay. Analytical Biochemistry 239 70–76.CrossRefGoogle ScholarPubMed
Bowey, E, Adlercreutz, H, Rowland, I (2003) Metabolism of isoflavones and lignans by the gut microflora: a study in germ-free and human micro flora associated rats. Food and Chemical Toxicology 41 631–636.CrossRefGoogle Scholar
British Heart Foundation (2005) British Heart Foundation statistics website. http://www.heartstats.org/datapage.asp?id=5340 (accessed August 2005)Google Scholar
Brown, AA & Hu, FB (2001) Dietary modulation of endothelial function: implications for cardiovascular disease. American Journal of Clinical Nutrition 73 673–686.CrossRefGoogle ScholarPubMed
Byrnes, S, Miller, J, Denyer, G (1995) Amylopectin starch promotes the development of insulin-resistance in rats. Journal of Nutrition 125 1430–1437.Google ScholarPubMed
Cao, G & Prior, R (1998) Comparison of different analytical methods for assessing total antioxidant capacity of human serum. Clinical Chemistry 44 1309–1315.CrossRefGoogle ScholarPubMed
Daly, M, Vale, C, Walker, M, Alberti, K, Mathers, J (1997) Dietary carbohydrates and insulin sensitivity: a review of the evidence and clinical implications. American Journal of Clinical Nutrition 66 1072–1085.CrossRefGoogle ScholarPubMed
Ells, LJ, Seal, CJ, Kettlitz, B, Bal, W & Mathers, JC (2005) Postprandial glycaemic, lipaemic and haemostatic responses to ingestion of rapidly- and slowly-digested starches in healthy young women. British Journal of Nutrition 96 948–955.CrossRefGoogle Scholar
Erkkilä, AT, Herrington, DM, Mozaffarian, D & Lichtenstein, AH (2005) Cereal fiber and whole-grain intake are associated with reduced progression of coronary-artery atherosclerosis in postmenopausal women with coronary artery disease? American Heart Journal 150 94–101.CrossRefGoogle ScholarPubMed
Esposito, K, Pontillo, A, Di Palo, C, Giugliano, G, Masella, M, Marfella, R & Giugliano, D (2003) Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: A randomized trial. Journal of the American Medical Association 289 1799–1804.CrossRefGoogle ScholarPubMed
Festa, A, D'Agostino, R, Mykkanen, L, Tracy, R, Zaccaro, D, Hales, C, Haffner, S (1999) Relative contribution of insulin and its precursors to fibrinogen and PAI-1 in a large population with different states of glucose tolerance: the Insulin Resistance Atherosclerosis Study (IRAS). Arteriosclerosis, Thrombosis, and Vascular Biology 19 562–568.CrossRefGoogle Scholar
Food and Drug Administration (2003) Health claim notification for whole grain foods with moderate fat content. http:// www.cfsan.fda.gov/~dms/flgrain2.html (accessed August 2005)Google Scholar
Food and Drug Administration (1999) Health claim notification for whole grain foods. http://www.cfsan.fda.gov/~dms/flgrains.html (accessed August 2005)Google Scholar
Foster-Powell, K, Brand-Miller, J (1995) International tables of glycemic index. American Journal of Clinical Nutrition 65 871S–893S.CrossRefGoogle Scholar
Fraser, GE (1999) Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. American Journal of Clinical Nutrition 70 532S–538S.CrossRefGoogle ScholarPubMed
Frost, G, Leeds, A, Trew, G, Magara, R, Dornhorst, A (1998) Insulin sensitivity in women at risk of coronary heart disease and the effect of a low GI food. Metabolism 47 1245–1251.CrossRefGoogle Scholar
Fung, TT, Hu, FB, Pereira, MA, Liu, S, Stampfer, MJ, Colditz, GA & Willet, WC (2002) Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. American Journal of Clinical Nutrition 76 535–540.CrossRefGoogle ScholarPubMed
Fung, TT, McCullough, ML, Newby, P, Manson, JE, Meigs, JB, Rifai, N, Willett, WC, Hu, FB (2005) Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. American Journal of Clinical Nutrition 82 163–173.CrossRefGoogle Scholar
Golden, S, Folsom, A, Coresh, J, Sharrett, A, Szkio, M & Brancati, F (2002) Risk factor groupings related to insulin resistance and their synergistic effects on subclinical atherosclerosis: the Atherosclerosis Risk in Communities Study. Diabetes 51 3069–3076.CrossRefGoogle ScholarPubMed
Grace, PB, Taylor, JI, Botting, NP, Fryatt, T, Oldfield, MF, Al-Maharik, N & Bingham, SA (2003) Quantification of isoflavones and lignans in serum using isotope dilution liquid chromatography/tandem mass spectrometry. Rapid Communications in Mass Spectrometry 17 1350–1357.CrossRefGoogle ScholarPubMed
Haffner, S (2003) Insulin resistance, inflammation, and the prediabetic state. American Journal of Cardiology 92 18J–26J.CrossRefGoogle ScholarPubMed
Hallfrisch, J, Scholfield, DJ, Behall, KM (2003) Blood pressure reduced by whole grain diet containing barley or whole wheat and brown rice in moderately hypercholesterolemic men. Nutrition Research 23 1631–1642.CrossRefGoogle Scholar
Halliwell, B, Aeschbach, R, Loliger, J & Aruoma, OI (1995) The characterization of antioxidants. Food and Chemical Toxicology 33 601–617.CrossRefGoogle ScholarPubMed
Hallmans, G, Zhang, JX, Lundin, E, Stattin, P, Johansson, A, Johansson, I, Hulten, K, Winkvist, A, Lenner, P, Aman, P & Adlercreutz, H (2003) Rye, lignans and human health. Proceedings of the Nutrition Society 62 193–199.CrossRefGoogle ScholarPubMed
Halvorsen, BL, Holte, K, Myhrstad, MCW, Barikmo, I, Hvattum, E, Remberg, SF et al. (2002) A systematic screening of total antioxidants in dietary plants. Journal of Nutrition 132 461–471.CrossRefGoogle ScholarPubMed
Horner, NK, Kristal, AR, Prunty, JA, Skor, HE, Potter, JD & Lampe, JW (2002) Dietary determinants of plasma enterolactone. Cancer Epidemiology, Biomarkers & Prevention 11 121–126.Google ScholarPubMed
Jacobs, DR, Meyer, KA, Kushi, LH & Folsom, AR (1998) Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women's Health Study. American Journal of Clinical Nutrition 68 248–257.CrossRefGoogle ScholarPubMed
Jacobs, DR, Meyer, KA, Kushi, LH & Folsom, AR (1999) Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women's Health Study. American Journal of Public Health 89 322–329.CrossRefGoogle ScholarPubMed
Jacobs, DR, Meyer, HE & Solvoll, K (2001) Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. European Journal of Clinical Nutrition 55 137–143.CrossRefGoogle ScholarPubMed
Jacobs, DR, Pereira, MA, Meyer, KA & Kushi, LH (2000) Fiber from whole grains, but not refined grains is inversely associated with all-cause mortality in older women: the Iowa Women's Health Study. Journal of the American College of Nutrition 19 326S–330S.CrossRefGoogle Scholar
Jensen, MK, Koh-Banerjee, P, Hu, FB, Franz, M, Sampson, L, Gronbaek, M & Rimm, EB (2004) Intakes of whole grains, bran, and germ and the risk of coronary heart disease in men. American Journal of Clinical Nutrition 80 1492–1499.CrossRefGoogle ScholarPubMed
Johnsen, N, Hausner, H, Olsen, A, Tetens, I, Christensen, J, Knudsen, K, Overvad, K & Tjonneland, A (2004) Intake of whole grains and vegetables determines the plasma enterolactone concentration of Danish women. Journal of Nutrition 134 2691–2697.CrossRefGoogle ScholarPubMed
Jones, AR, Hepples, ML, Coulson, J, Kuznesof, S, Richardson, DP, Seal, CJ (2004 a) Increased wholegrain food consumption and indicators of adiposity: preliminary results from the CHEW-IT study. Proceedings of the Nutrition Society 63 70AGoogle Scholar
Jones, AR, Kuznesof, S, Richardson, DP, Seal, CJ (2004 b) Barriers to the consumption of wholegrain foods. Proceedings of the Nutrition Society 63 96AGoogle Scholar
Kähkonen, MP, Hopia, AI, Vuorela, HJ, Rauha, J-P, Pihlaja, K, Kujala, TS & Heinonen, M (1999) Antioxidant activity of plant extracts containing phenolic compounds. Journal of Agricultural and Food Chemistry 47 3954–3962.CrossRefGoogle ScholarPubMed
Katz, R, Ratner, R, Cohen, R, Eisenhower, E, Verme, D (1999) Are insulin and proinsulin independent risk markers for premature coronary artery disease. Diabetes 45 736–741.CrossRefGoogle Scholar
Kilkkinen, A, Stumpf, K, Pietinen, P, Valsta, L, Tapanainen, H & Adlercreutz, H (2001) Determinants of serum enterolactone concentration. American Journal of Clinical Nutrition 73 1094–1100.CrossRefGoogle ScholarPubMed
Kilkkinen, A, Valsta, L, Virtamo, J, Stumpf, K, Adlercreutz, H & Pietinen, P (2003) Intake of lignans is associated with serum enterolactone concentration in Finnish men and women. Journal of Nutrition 133 1830–1833.CrossRefGoogle ScholarPubMed
Koh-Banerjee, P, Franz, M, Sampson, L, Liu, S, Jacobs, DR Jr, Spiegelman, D, Willett, W & Rimm, E (2004) Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men. American Journal of Clinical Nutrition 80 1237–1245.CrossRefGoogle ScholarPubMed
Kreijkamp-Kaspers, S, Kok, L, Bots, ML, Grobbee, DE, van der Schouw, YT (2005) Dietary phytoestrogens and plasma lipids in Dutch postmenopausal women; a cross-sectional study. Atherosclerosis 178 95–100.CrossRefGoogle ScholarPubMed
Langley-Evans, SC (2000) Consumption of black tea elicits an increase in plasma antioxidant potential in humans. International Journal of Food Sciences and Nutrition 51 309–315.CrossRefGoogle ScholarPubMed
Leenen, R, Roodenburg, AJC, Tijburg, LBM & Wiseman, SA (2000) A single dose of tea with or without milk increases plasma antioxidant activity in humans. European Journal of Clinical Nutrition 54 87–92.CrossRefGoogle ScholarPubMed
Liese, AD, Roach, AK, Sparks, KC, Marquart, L, D'Agostino, RB Jr, Mayer-Davis, EJ (2003) Whole-grain intake and insulin sensitivity: the Insulin Resistance Atherosclerosis Study. American Journal of Clinical Nutrition 78 965–971.CrossRefGoogle ScholarPubMed
Liu, S, Manson, J, Buring, J, Stampfer, M, Willett, W & Ridker, P (2002) Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. American Journal of Clinical Nutrition 75 492–498.CrossRefGoogle ScholarPubMed
Liu, S, Manson, JE, Stampfer, MJ, Hu, FB, Giovannucci, E, Colditz, GA, Hennekens, CH & Willett, WC (2000 a) A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women. American Journal of Public Health 90 1409–1415.Google ScholarPubMed
Liu, S, Manson, J, Stampfer, MJ, Rexrode, KM, Hu, FB, Rimm, EB & Willett, WC (2000 b) Whole grain consumption and risk of ischemic stroke in women: A prospective study. Journal of the American Medical Association 284 1534–1540.CrossRefGoogle ScholarPubMed
Liu, S, Stampfer, MJ, Hu, FB, Giovannucci, E, Rimm, E, Manson, JE, Hennekens, CH & Willett, WC (1999) Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. American Journal of Clinical Nutrition 70 412–419.CrossRefGoogle ScholarPubMed
Liu, S, Willett, WC, Manson, JE, Hu, FB, Rosner, B, Colditz, G (2003) Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. American Journal of Clinical Nutrition 78 920–927.CrossRefGoogle ScholarPubMed
Lopez-Garcia, E, Schulze, MB, Fung, TT, Meigs, JB, Rifai, N, Manson, JE, Hu, FB (2004) Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. American Journal of Clinical Nutrition 80 1029–1035.CrossRefGoogle Scholar
McKeown, NM, Meigs, JB, Liu, S, Wilson, PWF & Jacques, PF (2002) Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular disease in the Framingham Offspring Study. American Journal of Clinical Nutrition 76 390–398.CrossRefGoogle ScholarPubMed
Macko, SA, Lubec, G, Teschler-Nicola, M, Andrusevich, V & Engel, MH (1999) The Ice Man's diet as reflected by the stable nitrogen and carbon isotopic composition of his hair. FASEB Journal 13 559–562.CrossRefGoogle ScholarPubMed
Milder, IEJ, Feskens, EJM, Arts, ICW, de Mesquita, HBB, Hollman, PCH & Kromhout, D (2005) Intake of the plant lignans secoisolariciresinol, matairesinol, lariciresinol, and pinoresinol in Dutch men and women. Journal of Nutrition 135 1202–1207.CrossRefGoogle ScholarPubMed
Morris, JN, Marr, JW, Clayton, DG (1977) Diet and heart: a postscript. British Medical Journal 2 1307–1314.CrossRefGoogle Scholar
Nagah, AMS (2005) Antioxidant properties of wholegrain foods and the effect of wholegrain consumption on antioxidant status and lignan metabolism. PhD Thesis, University of Newcastle upon Tyne.Google Scholar
Nagah, AMS, Nurmi, T & Seal, CJ (2004) Consumption of wholegrain wheat, rye and rice by laboratory animals is associated with elevated plasma concentrations, urinary excretion and faecal output of enterolactone. Proceedings of the Nutrition Society 63 93AGoogle Scholar
Nagah, AMS & Seal, CJ (2005) In vitro procedure to predict apparent antioxidant release from wholegrain foods measured using three different methods. Journal of the Science of Food and Agriculture 85 1177–1185.CrossRefGoogle Scholar
Niemeyer, HB, Honig, DM, Kulling, SE & Metzler, M (2003) Studies on the metabolism of the plant lignans secoisolariciresinol and matairesinol. Journal of Agricultural and Food Chemistry 51 6317–6325.CrossRefGoogle Scholar
Nurmi, T & Adlercreutz, H (1999) Sensitive high-performance liquid chromatographic method for profiling phytoestrogens using coulometric electrode array detection: application to plasma analysis. Analytical Biochemistry 274 110–117.CrossRefGoogle ScholarPubMed
Pereira, M, Jacobs, D, Slattery, M, Ruth, K, van Horn, L, Hilner, J & Kushi, L (1998) The association between whole grain intake and fasting insulin in a biracial cohort of young adults. The CARDIA study. CVD Prevention 1 231–242.Google Scholar
Pereira, MA (2002) Whole grain consumption and body weight regulation. In Whole Grain Foods in Health and Disease, pp. 233–242 [Marquart, L, Slavin, JL and Fulcher, RG, editors]. St Paul, MN: American Association of Cereal Chemists.Google Scholar
Pereira, MA, Jacobs, DR, Pins, JJ, Raatz, SK, Gross, MD, Slavin, JL, Seaquist, ER (2002) Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. American Journal of Clinical Nutrition 75 848–855.CrossRefGoogle ScholarPubMed
Pereira, MA, Pinns, JJ, Jacobs, DR, Marquart, L & Keenan, J (2001) Whole grains, cereal fiber and chronic diseases: Epidemio-logical evidence. In CRC Handbook of Dietary Fiber in Human Nutrition, pp. 461–479 [Spiller, GA, editor]. Boca Raton, FL: CRC Press.Google Scholar
Pietinen, P & Kilkkinen, A (2002) Enterolactone and risk of cancer. Journal of Nutrition 132 3535S–3536S.Google Scholar
Pietinen, P, Stumpf, K, Mannisto, S, Kataja, V, Uusitupa, M & Adlercreutz, H (2001) Serum enterolactone and risk of breast cancer: A case-control study in eastern Finland. Cancer Epidemiology, Biomarkers & Prevention 10 339–344.Google ScholarPubMed
Plutzky, J (2003) The vascular biology of atherosclerosis. American Journal of Medicine 115 55S–61S.CrossRefGoogle ScholarPubMed
Qu, H, Madl, RL, Takemoto, DJ, Baybutt, RC & Wang, W (2005) Lignans are involved in the antitumor activity of wheat bran in colon cancer SW480 cells. Journal of Nutrition 135 598–602.CrossRefGoogle ScholarPubMed
Re, R, Pellegrini, N, Proteggente, A, Pannala, A, Yang, M, Rice-Evans, C (1999) Antioxidant activity applying an improved ABTS radical cation decolorization assay. Free Radical Biology and Medicine 26 1231–1237.CrossRefGoogle ScholarPubMed
Richardson, DP (2003) Wholegrain health claims in Europe. Proceedings of the Nutrition Society 62 1–9.CrossRefGoogle ScholarPubMed
Ridker, P (2001) High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease in women. New England Journal of Medicine 103 1813–1818.Google Scholar
Ross, R (1999) Atherosclerosis: an inflammatory disease. New England Journal of Medicine 340 115–126.CrossRefGoogle ScholarPubMed
Saarinen, NM, Warri, A, Makela, SI, Eckerman, C, Reunanen, M, Ahotupa, M, Salmi, SM, Franke, AA, Kangas, L, Santti, R (2000) Hydroxymatairesinol, a novel enterolactone precursor with antitumor properties from coniferous tree (Picea abies ). Nutrition and Cancer 36 207–216.CrossRefGoogle ScholarPubMed
Seal, CJ, Daly, ME, Thomas, LC, Bal, W, Birkett, AM, Jeffcoat, R & Mathers, JC (2003) Postprandial carbohydrate metabolism in healthy subjects and those with type 2 diabetes fed starches with slow and rapid hydrolysis rates determined in vitro. British Journal of Nutrition 90 853–864.CrossRefGoogle ScholarPubMed
Shinozaki, K, Suzuki, M, Ikebuchi, M, Hara, Y, Harano, Y (1996) Demonstration of insulin resistance in coronary artery disease documented with angiography. Diabetes Care 19 1–7.CrossRefGoogle ScholarPubMed
Sies, H, Stahl, W, Sevanian, A (2005) Nutritional, dietary and postprandial oxidative stress. Journal of Nutrition 135 969–972.CrossRefGoogle ScholarPubMed
Slavin, JL (2003) Whole grains are protective: biological mechanisms. Proceedings of the Nutrition Society 62 129–134.CrossRefGoogle ScholarPubMed
Smith, AT, Kuznesof, S, Richardson, DP, Seal, CJ (2003) Behavioural, attitudinal and dietary responses to the consumption of wholegrain foods. Proceedings of the Nutrition Society 62 455–467.CrossRefGoogle Scholar
Southgate, DAT (2000) Cereals and cereal products. In Human Nutrition and Dietetics, pp. 333–347 [Garrow, JS, James, WPT and Ralph, A, editors]. London: Churchill Living-stone.Google Scholar
Steffen, LM, Jacobs, DR Jr, Stevens, J, Shahar, E, Carithers, T & Folsom, AR (2003) 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. American Journal of Clinical Nutrition 78 383–390.CrossRefGoogle ScholarPubMed
Swedish Nutrition Foundation (2003) New generic health claim. http://www.snf.ideon.se/snf/en/rh/Wholegrain.htm (accessed August 2005)Google Scholar
Trowell, H (1972) Ischemic heart disease and dietary fiber. American Journal of Clinical Nutrition 25 926–932.CrossRefGoogle ScholarPubMed
Trowell, H (1979) Recent developments in dietary-fibre hypothesis. In Dietary Fibre: Current Developments of Importance to Health, pp. 1–8 [Heaton, K, editor]. Westport, CT: Food and Nutrition Press.Google Scholar
US Department of Agriculture (2005) My pyramid. http:// www.mypyramid.gov/ (accessed August 2005)Google Scholar
Uwaifo, GI & Ratner, RE (2003) The roles of insulin resistance, hyperinsulinaemia, and thiazolidinediones in cardiovascular disease. American Journal of Medicine 115 12S–19S.CrossRefGoogle ScholarPubMed
van der Schouw, YT, Sampson, L, Willett, WC, Rimm, EB (2005) The usual intake of lignans but not that of isoflavones may be related to cardiovascular risk factors in U.S. men. Journal of Nutrition 135 260–266.CrossRefGoogle Scholar
Vanharanta, M, Voutilainen, S, Lakka, T, van der Lee, M, Adlercreutz, H & Salonen, J (1999) Risk of acute coronary events according to serum concentrations of enterolactone: a prospective population-based case-control study. Lancet 354 2112–2115.CrossRefGoogle ScholarPubMed
Wiemer, K (2002) Whole-grains health claims: supporting scientific evidence and the FDA Modernisation Act process. In Whole-Grain Foods in Health and Disease, pp. 327–340 [Marquart, L, Slavin, J and Fulcher, R, editors]. St Paul, MN: American Association of Cereal Chemists.Google Scholar
Yudkin, J, Stehouwer, C, Emeis, J & Coppack, S (1999) C-reactive protein in healthy subjects: Associations with obesity, insulin resistance, and endothelial dysfunction – A potential role for cytokines originating from adipose tissue? Arteriosclerosis, Thrombosis, and Vascular Biology 19 972–978.CrossRefGoogle ScholarPubMed
Zern, TL & Fernandez, ML (2005) Cardioprotective effects of dietary polyphenols. Journal of Nutrition 135 2291–2294.CrossRefGoogle ScholarPubMed
Zielinski, H & Kozlowska, H (2000) Antioxidant activity and total phenolics in selected cereal grains and their different morphological fractions. Journal of Agricultural and Food Chemistry 48 2008–2016.CrossRefGoogle ScholarPubMed