Download THE ROLE OF WHOLE GRAINS IN A HEALTHy dIET

The role of whole
grains in a healthy diet
Find out more about the role that whole grains play in a balanced diet, their reported
health benefits, and a summary of the international dietary recommendations that
include consumption of whole grains.
Whole grains are a traditional part of a
healthy balanced diet
Historically, cereals have been an important staple food in the diets of our
ancestors. From the earliest records, we know that cereals have been
considered to be gifts from the Gods, and eaten by hunter-gatherers in
ancient times (Toussaint-Samat, 1994). It is now clear from research that
The health advantages of whole grains are largely associated with
consuming the entire whole grain “package,” which includes vitamins
(B vitamins, vitamin E), minerals (iron, magnesium, zinc, potassium,
selenium), essential fatty acids, phytochemicals (physiologically active
components of plants that have functional health benefits) and other
bioactive food components such as the flavonoid antioxidants.
whole grain cereals are important sources of carbohydrate, protein, fibre,
Whole grains are typically a source of fibre, and although the benefits of
bioactive phytonutrients, B vitamins and minerals for the world’s
fibre for gut and heart health have been known for some time, evidence
population. Whole grains are therefore internationally recommended in
suggests that whole grain provides protection over and above that
preference to refined grains as a staple part of a healthy balanced diet.
provided by the fibre. It appears that all the nutrients and other compounds
A healthy balanced diet contains a variety of foods including plenty of fruit
and vegetables, plenty of starchy foods such as bread, cereals, potatoes,
pasta and rice, some protein-rich foods such as meat, fish, eggs and lentils,
and some dairy foods (like milk, yogurt and cheese). The balance of food
groups usually recommended by health professionals is one third starchy
foods, one third fruit & vegetables, and the last third consisting of smaller
amounts of foods providing protein and those high in fat and sugar (UK
Food Standards Agency, 2007).
Why eat whole grains?
Scientific studies consistently show that people who eat at least 48 grams
of whole grains each day can reduce the risk of coronary heart disease
and diabetes by between 20-40% (Montonen et al. 2003; Venn & Mann, 2004;
Flight & Clifton, 2006; Mellen et al. 2008; de Munter et al. 2007) and certain
cancers by up to 40% (McIntosh 2001; Haas et al.. 2009). Whole grain intake
has also been inversely associated with the metabolic syndrome (Sayhoun
et al. 2006). Research also shows that a diet rich in whole grains is associated
with lower body mass index (BMI), smaller waist circumference and lower
risk of being overweight by helping to maintain a healthy body weight
(Williams et al. 2008; Harland & Garton, 2007).
An educational resource for Health Care Professionals.
WHOLE GRAINS FOR HEALTH
in whole grains, when consumed together, have an additive and potentially
synergistic effect on health. Moreover in epidemiological studies, when
the data is adjusted for fibre intakes, the associations of whole grains with
their many health benefits remain significant (Slavin et al. 2001; Anderson
2003; Seal 2006).
Many Dietary recommendations include Whole Grains
Country
Issuing Organisation
Recommendation
Reference
Australia
Go Grains Health
and Nutrition Ltd
Recommends all Australian adults and (>9y) children aim for 48g of
whole grains per day.
Go Grains Health & Nutrition
Ltd www.gograins.com.au
New South Wales
Cancer Council
Recommends half the daily serves of breads & cereals are either
whole grain or wholemeal.
New South Wales Cancer
Council 2008
Dietary Guidelines for
Australians
Recommend 4 – 12 grain based food servings each day including
plenty of whole grain varieties (exact number depending on age
and calorie requirements).
They state “eat plenty of cereals, preferably whole grain”.
NHMRC 2003
Austrian Ministry of
Health, Nutrition
Societies of Germany
and Austria, Swiss
Nutrition Association
The dietary recommendations suggest five servings of cereals,
cereal products and potatoes a day.
Elmadfa and Freisling
2007
Health Canada
Canadian Food Guide recommends 3-8 servings of grain products
per day and advises making at least half of the grain product
choices whole grain each day.
Austria,
Switzerland
& Germany
Canada
Wholemeal flours are encouraged. In Austria it states that
whole grain products are preferred.
National recommendations are visualised into food pyramid
and nutrition circle models.
Canada Food Guide
2007
It is stated that whole grains are a source of fibre
and are typically low in fat.
In addition the guide tells consumers that “Fibre rich foods can
help you feel full and satisfied” and “ A diet rich in whole grains
may also help reduce the risk of heart disease”.
Canadian
Hypertension
Education Program
Recommendations for the prevention and treatment of
hypertension encourage people to follow a diet that
emphasizes whole grains.
Khan et al. 2009
China
Chinese Nutrition
Society
Chinese Dietary Guidelines and Pagoda recommends to “consume
a diversified range of foods, with grains— both coarse and fine
— as the base. Daily consumption of total grains, cereals, legume
around 250 - 400 gram, among them around 50-100g are coarse
and wholegrain”.
Chinese Nutrition
Society 2005
Denmark
Danish Veterinary &
Food Administration
The national recommendation is to:
Danish Veterinary & Food
Administration 2008
Eat at least 75 grams of whole grains a day e.g. 1 portion of
oatmeal and 1 or 2 slices of rye bread.
Eat potatoes, rice or pasta and whole-grain bread – every day.
Choose whole grain products first when you eat breakfast
products, bread, rice or pasta.
Eat potatoes every day, if possible. Vary between products such as
whole grain rice and whole grain pasta a few times a week.
France
Ministry of Health
Recommend whole grains as part of the national nutrition
programme (PNNS 2).
PNNS 2, 2006
www.mangerbouger.fr
Country
Issuing Organisation
Recommendation
Reference
Greece
Ministry of Health
Recommend 8 non-refined cereal products each day, especially
whole grain varieties.
Dietary Guidelines, 1999
The Mediterranean Diet Pyramid includes “prefer whole grain
bread or pasta”.
Mexico
Mexico Health Ministry
The Norm that specifies nutrition recommendations for the general
population, states that: “Consumption of cereals should be
recommended, preferably whole grains or their derivatives and
starchy roots. Their fiber and energy content should be highlighted”.
Mexican Health Ministry,
2004
Norway
National Council for
Nutrition
Increase in whole grain products intake is listed as a high priority
initiative in the 2005 strategy plan to promote healthy diet in Norway.
National Council for
Nutrition 2005
Singapore
Health Promotion
Board
The Healthy Diet Pyramid for Adults recommends “You should
consume 2-3 servings of whole grain foods daily (equivalent to
about 50g of whole grains)”.
National Dietary Guidelines
for Singapore 2009
Health Promotion
Board
One of the nine dietary guidelines for children and adolescents is
“encourage eating of wholegrain foods”.
Dietary Guidelines for Children and Adolescents 2007
UK
Food Standards
Agency
The Eatwell plate model recommends that people “eat plenty of
bread, rice, potatoes, pasta and other starchy foods and choose
whole grain varieties whenever you can”.
Dietary Guidelines, 1999
USA
USDA
The Dietary Guidelines for Americans, MyPyramid includes the
recommendation to “Consume 3 or more ounce-equivalents of
whole-grain products per day, with the rest of the recommended
grains coming from enriched or whole-grain products. In general,
at least half the grains should come from whole grains”.
USDA 2005
American Diabetes
Association (ADA)
The ADA Nutrition Recommendations and Interventions for
Diabetes recommend an increase in whole grain intakes as a
strategy to both prevent and manage diabetes.
ADA 2008
American Heart
Association (AHA)
The AHA Diet and Lifestyle Recommendations for cardiovascular
disease risk reduction encourage a diet where the major sources
of calories in the diet should come from foods that are whole
grains. They state that at least half the grain intake should come
from whole grains.
Lichtenstein et al. 2006
American Cancer
Society (ACS)
The ACS Nutrition and Physical Activity Guidelines for both primary
prevention and tertiary treatment of cancer include “choose whole
grains in preference to refined grains, and choose whole grain
rice, bread, pasta, and cereals”.
Kushi et al. 2006
Global
World Health
Organisation (WHO)
Recommend an increase in whole grain intakes as a strategy to
reduce obesity, cardiovascular disease and diabetes.
The WHO rates the evidence linking WG and cardiovascular
disease and diabetes as ‘probable’.
WHO 2003
OCTOBER 2009
THIS HAS BEEN WRITTEN By REGISTEREd NUTRITIONISTS ANd
dIETITIANS ANd FUNdEd By NESTLÉ WHOLE GRAIN CEREALS.
us MyPyraMid
To help consumers put the dietary
guidelines into practice the USDA developed
US MyPyramid (see Figure 1), supported by the
website www.mypyramid.gov . This pyramid has a
Many global dietary reCoMMendations
inClude WHole grains
In recognition of the role of whole grains in preventing global chronic
diseases, they are increasingly being recommended in population-wide
specific section on grains and helps consumers to understand
what a portion of grain, and whole grain is in food terms.
Figure 1
The US MyPyramid showing the Grains section in Orange,
where the recommendation is ‘make half your grains whole’.
dietary guidelines internationally, and by health professional groups.
There is a general consensus amongst nutrition experts and health care
professionals that people should be eating more whole grain foods.
To reduce the burden of chronic diseases that are related to diet and
physical activity, adequate nutrition policies have to be developed and
maintained. The translation of nutrient-based dietary guidelines into foodbased dietary guidelines is part of nutrition policy at the national level as
recommended by the World Health Organization (WHO). This section gives
examples of where whole grains have been included in food based dietary
guidelines and other nutrition recommendations.
GRAINS
VEGETABLES
FRUITS
MILK
MEAT &BEANS
referenCes
American Diabetes Association (2008). Nutrition Recommendations and Interventions for Diabetes: A position
statement of the American Diabetes Association. Diabetes Care 31: S61–S78.
Anderson JW (2003) Whole grains protect against atherosclerotic cardiovascular disease. Proc Nutr Soc 62, 135–142.
Cancer Council New South Wales (2008). POSITION STATEMENT Fibre, Wholegrain Cereals and Cancer
Prevention. www.cancercouncil.com.au
Chinese Dietary Guidelines and Pagoda (2005) Established by Chinese Nutrition Society and The Institute of
Nutrition and Food Hygiene affiliated with The Chinese Academy of Preventive Medicine.
http://www.cnsoc.org:80 Dietary Pagoda 2005-4-2.
de Munter JSL, Hu FB, Spiegelman D, Franz M, van Dam RM (2007). Whole grain, bran, and germ intake and
risk of type 2 diabetes: A prospective cohort study and systematic review. PLoS Med 4 (8): e261. doi:10.1371/journal.
pmed. 0040261.
Dietary guidelines for adults in Greece (1999). Ministry of Health and Welfare, Supreme Scientific Health Council.
Eating Well with Canada’s Food Guide (2007) Minister of Health Canada.
Mexican Health Ministry. (2004). Norma Oficial Mexicana. NOM-043-SSA2-2005, Servicios básicos de salud.
Promoción y educación par a la salud en materia alimentaria. Criterios para brindar orientación.
Montonen J, Knekt P, Järvinen R, Aromaa A, Reunanen A. (2003). Whole-grain and fiber intake and the
incidence of type 2 diabetes. Am J Clin Nutr. 77(3):622-9.
National Food Institute, Technical University of Denmark. Wholegrain – Definition and scientific background
for recommendations of wholegrain intake in Denmark. May 2008.
NHMRC, 2003. Food for health - Dietary Guidelines for Australians. Australian Government Publishing
Service, Canberra.
Elmadfa, I. and Freisling, H. (2007). Food-Based Dietary Guidelines in Austria. Ann Nutr Metab 51 (suppl 2): 8–14.
Norwegian Council for Nutrition (2005) A HEALTHY DIET FOR GOOD HEALTH. Strategy plan for 2005–2009
under the auspices of the Norwegian Directorate for Health and Social Affairs.
Flight, I and Clifton, P. (2006). Cereal grains and legumes in the prevention of coronary heart disease and stroke:
a review of the literature. Eur J Clin Nutr 60: 1145 –1159.
Sahyoun NR, Jacques PF, Zhang XL, Juan W, McKeown NM (2006). Whole-grain intake is inversely associated
with the metabolic syndrome and mortality in older adults. Am J Clin Nutr 83: 124–31.
Food Standards Agency (2007) The Eatwell Plate
www.food.gov.uk/healthiereating/eatwellplate
Seal CJ. (2006). Whole grains and CVD risk. Proc Nutr Soc.65(1):24-34.
French Ministry of Health (2006). Le deuxième Programme national nutrition santé (PNNS 2).
Slavin JL, Jacobs D, Marquart L, Wiemer K (2001) The role of whole grains in disease prevention. J Am Diet Assoc
101, 780–785.
Haas, P. et al. (2009). Effectiveness of whole grain consumption in the prevention of colorectal cancer:
meta-analysis of cohort studies. Int J Food Sci Nutr March 21: 1–13. Epub ahead of print.
Singapore Health Promotion Board (2009) The Healthy Diet Pyramid (For Healthy Adult Singaporeans (18-65 years).
www.hpb.gov.sg
Harland, J.I. and Garton, L.E. (2008). Whole grain intake as a marker of healthy body weight and adiposity.
Pub Health Nutr 11 (6): 554-63.
Singapore Health Promotion Board (2001). Dietary recommendations for Healthy Children & Adolescents
(birth -18 years). www.hpb.gov.sg
Khan, N.A. et al. (2009). The 2009 Canadian Hypertension Education Program recommendations for the
management of hypertension: Part 2 – therapy. Hypertension 25 (5): 287-298.
Toussaint-Samat, M. (1992) A History of Food. 2nd edition. Blackwell Publishers Ltd., Oxford.
Kushi, L.H. et al. (2006). American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer
Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. CA Cancer J Clin 56: 254–281.
Lichtenstein, A.H. et al. (2006). Diet and Lifestyle Recommendations Revision 2006 A Scientific Statement From
the American Heart Association Nutrition Committee. Circulation 114: 82-96.
U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for
Americans, 2005. 6th Edition, Washington, DC: U.S. Government Printing Office, January 2005.
www.healthierus.gov/dietaryguidelines
Venn, B.J. and Mann, J.I. (2004). Cereal grains, legumes and diabetes. Eur J Clin Nutr. 58: 1443 –1461.
McIntosh, G.H. (2001). Cereal foods, fibres and the prevention of cancers. Nutr Diet 58(suppl 2): S35 – S48.
Williams, P. et al. (2008). Cereal grains, legumes and weight management: a comprehensive review of the scientific
evidence. Nutr Rev 66 (4): 171–182.
Mellen PB, Walsh TF, Herrington DM (2008) Whole grain intake and cardiovascular disease: a meta-analysis
Nutr Metab Cardiovasc Dis. 18(4): 283-90.
World Health Organisation: Diet, Nutrition and the Prevention of Chronic Diseases (2003). Report of a Joint
WHO/FAO Expert Consultation. WHO Technical report series 916, Geneva.