TY - JOUR
T1 - Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in prospective urban and rural epidemiology study
T2 - Prospective cohort study
AU - Swaminathan, Sumathi
AU - Dehghan, Mahshid
AU - Raj, John Michael
AU - Thomas, Tinku
AU - Rangarajan, Sumathy
AU - Jenkins, David
AU - Mony, Prem
AU - Mohan, Viswanathan
AU - Lear, Scott A.
AU - Avezum, Alvaro
AU - Lopez-Jaramillo, Patricio
AU - Rosengren, Annika
AU - Lanas, Fernando
AU - AlHabib, Khalid F.
AU - Dans, Antonio
AU - Keskinler, Mirac Vural
AU - Puoane, Thandi
AU - Soman, Biju
AU - Wei, Li
AU - Zatonska, Katarzyna
AU - Diaz, Rafael
AU - Ismail, Noorhassim
AU - Chifamba, Jephat
AU - Kelishadi, Roya
AU - Yusufali, Afzalhussein
AU - Khatib, Rasha
AU - Xiaoyun, Liu
AU - Bo, Hu
AU - Iqbal, Romaina
AU - Yusuf, Rita
AU - Yeates, Karen
AU - Teo, Koon
AU - Yusuf, Salim
N1 - Publisher Copyright:
© Publications
PY - 2021/2/3
Y1 - 2021/2/3
N2 - 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, nonfatal 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.
AB - 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, nonfatal 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.
UR - http://www.scopus.com/inward/record.url?scp=85100381453&partnerID=8YFLogxK
U2 - 10.1136/bmj.m4948
DO - 10.1136/bmj.m4948
M3 - Article
C2 - 33536317
AN - SCOPUS:85100381453
SN - 0959-8146
VL - 372
JO - The BMJ
JF - The BMJ
M1 - m4948
ER -
