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Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults

European Journal of Clinical Nutrition volume 59, pages 353–362 (2005)Cite this article

Abstract

Background:

Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, epidemiologic data regarding whole-grain intake association with metabolic syndrome are sparse.

Objective:

To evaluate the relationship between whole-grain intakes, metabolic syndrome and metabolic risk factors in Tehranian adults.

Design:

Population-based cross-sectional study.

Setting:

Tehran, the capital of Iran.

Subjects:

A representative sample of 827 subjects (357 men and 470 women) aged 18–74 y.

Methods:

Usual dietary intake was assessed using a food frequency questionnaire. The procedure developed by Jacobs et al was used to classify grain products into whole and refined grains. Weight and height were measured according to standard protocols and body mass index was calculated. Fasting blood samples were taken for biochemical measurements and blood pressure was assessed according to standard methods. Hypertriglyceridemia, hypercholestrolemia, high LDL, low HDL and metabolic syndrome were defined according to ATP III guidelines and hypertension based on JNC VI. Diabetes was defined as fasting plasma glucose level of ≥126 mg/dl or 2-h postchallenge blood glucose level of ≥200 mg/dl. Subjects were categorized based on quartile cut-points of whole- and refined-grain intake.

Results:

Mean (±s.d.) consumptions of whole and refined grains were 93±29 and 201±57 g/day, respectively. Both men and women reported higher intakes of refined grain than of whole grains. Compared with subjects in the lower quartile category, those in the upper category of whole-grain intake had lower prevalence of metabolic risk factors. Conversely, those in the higher category of refined-grain intake had higher prevalence of metabolic risk factors, except for diabetes. After controlling for confounders, a significantly decreasing trend was observed for the risk of having hypertriglyceridemia (odds ratios among quartiles: 1.00, 0.89, 0.74, 0.61, respectively), hypertension (1.00, 0.99, 0.93, 0.84) and metabolic syndrome (1.00, 0.84, 0.76, 0.68). Higher consumption of refined grains was associated with higher odds of having hypercholestrolemia (1.00, 1.07, 1.19, 1.23), hypertriglyceridemia (1.00, 1.17, 1.49, 2.01), hypertension (1.00, 1.22, 1.48, 1.69) and metabolic syndrome (1.00, 1.68, 1.92, 2.25).

Conclusion:

Whole-grain intake is inversely and refined-grain intake is positively associated with the risk of having metabolic syndrome. Recommendations to increase whole-grain intake may reduce this risk.

Sponsorship:

Endocrine Research Center, Shaheed Beheshti University of Medical Sciences.

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References

  • Albertson A & Tobelmann R (1995): Consumption of grain and whole-grain foods by an American population during the years 1990–1992. J. Am. Diet. Assoc. 95, 703–704.

    Article  CAS  Google Scholar 

  • Anderson JE & Hanna TJ (1999): Impact of non-digestible carbohydrates on serum lipoproteins and risk for cardiovascular disease. J. Nutr. 129 (Suppl), 459S–463S.

    Google Scholar 

  • Azizi F, Emami H, Salehi P, Ghanbarian A, Mirmiran P, Mirbolooki M & Azizi T (2003c): Cardiovascular risk factors in the elderly: the Tehran Lipid and Glucose Study. J. Cardiovasc. Risk 10, 65–73.

    Article  Google Scholar 

  • Azizi F, Ghanbarian A, Madjid M & Rahmani M (2002b): Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study, 1999–2000. J. Hum. Hypertens. 16, 305–312.

    Article  CAS  Google Scholar 

  • Azizi F, Rahmani M, Emami H & Madjid M (2000): Tehran lipid and glucose study: rationale and design. C.V.D. Prev. 3, 242–247.

    Google Scholar 

  • Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M, Ghanbili J, Ghanbarian A, Mehrabi Y, Saadat N, Salehi P, Mortazavi N, Heydarian P, Sarbazi N, Allahverdian S, Saadati N, Ainy E & Moeini S (2002a): Cardiovascular risk factors in an Iranian urban population: Tehran Lipid and Glucose Study. Soc. Prev. Med. 47, 408–426.

    Article  Google Scholar 

  • Azizi F, Rahmani M, Ghanbarian A, Emami H, Salehi P, Mirmiran P & Sarbazi N (2003b): Serum lipid levels in an Iranian adults population: Tehran Lipid and Glucose Study. Eur. J. Epidemiol. 18, 311–319.

    Article  CAS  Google Scholar 

  • Azizi F, Salehi P, Etemadi A & Zahedi-Asl S (2003a): Prevalence of metabolic syndrome in an urban population: Tehran Lipid and Glucose Study. Diabetes Res. Clin. Pract. 61, 29–37.

    Article  Google Scholar 

  • Connor W (2000): Importance of n−3 fatty acids in health and disease. Am. J. Clin. Nutr. 47, 419–425.

    Google Scholar 

  • Davy BM, Davy KP, Ho RC, Reske SD, Davrath LR & Melby CL (2002): High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men. Am. J. Clin. Nutr. 76, 351–358.

    Article  CAS  Google Scholar 

  • de Kleijn MJ, van der Schouw YT, Wilson PW, Grobbee DE & Jacques PF (2002): Dietary intake of phytoestrogens is associated with a favorable metabolic cardiovascular risk profile in postmenopausal U.S. women: the Framingham study. J. Nutr. 132, 276–282.

    Article  CAS  Google Scholar 

  • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997): Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20, 1183.

  • Ford ES, Giles WH & Dietz WH (2002): Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287, 356–359.

    Article  Google Scholar 

  • Foster-Powell K, Holt SH & Brand-Miller JC (2002): International table of glycemic index and glycemic load values: 2002. Am. J. Clin. Nutr. 76, 5–56.

    Article  CAS  Google Scholar 

  • Friedewald WT, Levy RI & Fredrickson DS (1972): Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem. 18, 499–502.

    CAS  Google Scholar 

  • Fung TT, Hu FB, Pereira MA, Liu S, Stampfer MJ, Colditz GA & Willett WC (2002): Whole-grain intake and the risk of type 2 diabetes: a prospective study in men. Am. J. Clin. Nutr. 76, 535–540.

    Article  CAS  Google Scholar 

  • Ghaffarpour M, Houshiar-Rad A & Kianfar H (1999): The Manual for Household Measures, Cooking Yields Factors and Edible Portion of Foods. Tehran: Keshaverzi Press.

    Google Scholar 

  • Haffner SM & Miettinen H (1997): Insulin resistance implications for type II diabetes mellitus and coronary heart disease. Am. J. Med. 103, 152–162.

    Article  CAS  Google Scholar 

  • Hollenberg NK (2002): Genetic versus environmental etiology of the metabolic syndrome among male and female twins. Curr. Hypertens. Rep. 4, 178.

    Article  Google Scholar 

  • Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ, Ascherio A, Sampson L & Willett WC (1999): Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am. J. Clin. Nutr. 69, 243–249.

    Article  CAS  Google Scholar 

  • 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. Am. J. Clin. Nutr. 68, 248–257.

    Article  CAS  Google Scholar 

  • Jenkins DJ, Wolever TM, Kalmusky J, Guidici S, Giordano C, Patten R, Wong GS, Bird JN, Hall M & Buckley G (1987): Low-glycemic index diet in hyperlipidemia: use of traditional starchy foods. Am. J. Clin. Nutr. 46, 66–71.

    Article  CAS  Google Scholar 

  • Jenkins DJ, Wolever TM, Taylor RH, Barker H, Fielden H, Baldwin JM, Bowling AC, Newman HC, Jenkins HC & Goff DV (1981): Glycemic index of foods: a physiological basis for carbohydrate exchange. Am. J. Clin. Nutr. 34, 362–366.

    Article  CAS  Google Scholar 

  • Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (1997): The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch. Intern. Med. 157, 2413–2446.

  • Juntunen KS, Laaksonen DE, Poutanen KS, Niskanen LK & Mykkanen HM (2003): High-fiber rye bread and insulin secretion and sensitivity in healthy postmenopausal women. Am. J. Clin. Nutr. 77, 385–391.

    Article  CAS  Google Scholar 

  • Kimiagar SM, Ghaffarpour M, Houshiar-Rad A, Hormozdyari H & Zellipour L (1998): Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. East Mediterr. Health J. 4, 539–547.

    Google Scholar 

  • Liu S, Manson JE, Stampfer MJ, Hu FB, Giovannucci E, Colditz GA, Hennekens CH & Willett WC (2000): A prospective study of whole-grain intake and risk of type 2 diabetes mellitus in US women. Am. J. Public Health 90, 1409–1415.

    Article  CAS  Google Scholar 

  • 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. Am. J. Clin. Nutr. 70, 412–419.

    Article  CAS  Google Scholar 

  • Ma J, Folsom AR, Melnick SL, Eckfeldt JH, Sharrett AR, Nabulsi AA, Hutchinson RG & Metcalf PA (1995): Associations of serum and dietary magnesium with cardiovascular disease, hypertension, diabetes, insulin, and carotid arterial wall thickness: the ARIC study. J. Clin. Epidemiol. 48, 927–940.

    Article  CAS  Google Scholar 

  • McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PWF & Jacques PF (2004): Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care 27, 538–546.

    Article  Google 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. Am. J. Clin. Nutr. 76, 390–398.

    Article  CAS  Google Scholar 

  • Mennen L, Lafay L, Feskens EJ, Novak M, Lepinary P & Balkau B (2000): Possible protective effect of bread and dairy products on the risk of the metabolic syndrome. Nutr. Res. 20, 335–347.

    Article  CAS  Google Scholar 

  • Mirmiran P, Esmaillzadeh A & Azizi F (2004): Detection of cardiovascular risk factors by anthropometric measures in Tehranian adults: receiver operating characteristic (ROC) curve analysis. Eur. J. Clin. Nutr. 58, 1110–1118.

    Article  CAS  Google Scholar 

  • Mirmiran P, Mohammadi F, Allahverdian S & Azizi F (2003): Estimation of energy requirements for adults: Tehran Lipid and Glucose Study. Int. J. Vitam. Nutr. Res. 73, 193–200.

    Article  CAS  Google Scholar 

  • Montonen J, Knekt P, Jarvinen R, Aromaa A & Reunanen A (2003): Whole-grain and fiber intake and the incidence of type 2 diabetes. Am. J. Clin. Nutr. 77, 622–629.

    Article  CAS  Google Scholar 

  • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (2002): Third report of the national cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults. Circulation 106, 3143–3421.

  • National Food Consumption Survey (1995): Tehran: National Nutrition and Food Technology Research Institute.

  • NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults (1998): Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults—the evidence report. Obes. Res. 6, 51S–209S.

  • Pereira MA, Jacobs Jr DR, Pin JJ, Raatz SK, Gross MD, Slavin JL & Seaquist ER (2002b): Effect of whole grains on insulin sensitivity in overweight hyperinsulinemic adults. Am. J. Clin. Nutr. 75, 848–855.

    Article  CAS  Google Scholar 

  • Pereira MA, Jacobs Jr DR, Van Horn L, Slattery ML, Kartashov AI & Ludwig DS (2002a): Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. JAMA 287, 2081–2089.

    Article  Google Scholar 

  • Reaven GM (1988): Banting lecture 1988: role of insulin resistance in human disease. Diabetes 37, 1595–1607.

    Article  CAS  Google Scholar 

  • Rimm EB, Willett WC, Hu FB, Sampson L, Colditz GA, Manson JE, Hennekens C & Stampfer MJ (1998): Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. JAMA 279, 359–364.

    Article  CAS  Google Scholar 

  • Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M & Khalili A, et al (1999): Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol. 54, 327–333.

    CAS  PubMed  Google Scholar 

  • Slavin J, Jacobs D & Marquart L (1997): Whole grain consumption and chronic disease: protective mechanisms. Nutr. Cancer 27, 14–21.

    Article  CAS  Google Scholar 

  • Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B & Willett WC (1993): Vitamin E consumption and the risk of coronary disease in women. N. Engl. J. Med. 328, 1444–1449.

    Article  CAS  Google Scholar 

  • Stevens J, Ahn K, Juhaeri, Houston D, Steffan L & Couper D (2002): Dietary fiber intake and glycemic index and incidence of diabetes in African-American and white adults: the ARIC study. Diabetes Care 25, 1715–1721.

    Article  CAS  Google Scholar 

  • Vessby B (2000): Dietary fat and insulin action in humans. Br. J. Nutr. 83, 591–596.

    Article  Google Scholar 

  • WHO Expert Committee on Diabetes Mellitus (1980): Second report, World Health Organization Tech Rep Ser 646, Geneva.

  • Willett WC (1998): Nutritional epidemiology, 2nd Edition, New York: Oxford University press.

    Book  Google Scholar 

  • Wirfalt E, Hedblad B, Gullberg B, Mattisson I, Andren C, Rosander U, Janzon L & Berglund G (2001): Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer cohort. Am. J. Epidemiol. 154, 1150–1159.

    Article  CAS  Google Scholar 

  • Wolever TM & Bolognesi C (1996): Prediction of glucose and insulin responses of normal subjects after consuming mixed meals varying in energy, protein, fat, carbohydrate and glycemic index. J. Nutr. 126, 2807–2812.

    CAS  Google Scholar 

  • Wolk A, Manson JE, Stampfer MJ, Colditz GA, Hu FB, Speizer FE, Hennekens CH & Willett WC (1999): Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. JAMA 281, 1998–2004.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, IR, Iran

    A Esmaillzadeh, P Mirmiran & F Azizi

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  1. A Esmaillzadeh
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  2. P Mirmiran
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  3. F Azizi
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Correspondence to F Azizi.

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Guarantor: F Azizi.

Contributors: AE and PM designed the study, collected and analyzed the data and wrote the manuscript. FA supervised the research.

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Esmaillzadeh, A., Mirmiran, P. & Azizi, F. Whole-grain consumption and the metabolic syndrome: a favorable association in Tehranian adults. Eur J Clin Nutr 59, 353–362 (2005). https://doi.org/10.1038/sj.ejcn.1602080

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