An analysis linking cereals and diabetes qualified as defective


ROCHESTER, MINN. — Contrary to the findings of dietary advisory committees in 2015 and 2020, scientific evidence does not suggest an association between higher consumption of refined grains and an increased risk of type 2 diabetes (T2D), said Glenn A Gaesser, professor at the College of Health Solutions, University of Arizona, Phoenix.

The findings, which challenge Dietary Guidelines recommendations to reduce refined grain intake, will be published in a commentary in the August issue of Mayo Clinic Proceedings.

Dr. Gaesser, a member of the Grain Foods Foundation’s Scientific Advisory Board, based his findings on data from 10 publications covering 11 adult cohorts comprising a total of 398,994 people – 268,419 women and 130,575 men. Of the 11 cohorts, 9 showed no statistically significant association between higher T2D consumption and refined grain consumption, 1 showed higher risk and 1 showed lower risk. The only study showing a higher risk was the smallest cohort in the collection, representing 0.3% of study participants.

“These findings refute the common belief that refined, not whole grains can directly lead to T2DM when consumed,” the GFF said. “Consumption of refined grain staples such as bread, cereals, and pasta was not associated with T2D risk, and total grain intake was consistently associated with a lower T2D risk. Even in studies that included indulgent grain foods such as cakes, cookies, buns, and muffins in the refined grain foods category, no association with T2D risk was observed.

In a YouTube video of Dr. Gaesser’s comment, he concluded, “The take-home message here is that individuals should consume more whole grains, for sure, and the studies support that quite strongly, but it also suggests that we should probably relax our recommendations on reducing refined grain intake because there is no convincing evidence to suggest that reducing refined grain intake will lead to a reduced risk of diabetes.

The results weren’t just for staple grain foods, such as bread, pasta, cereal or rice.

“Whether refined grains were defined to include only staple grain foods or a combination of staple and pleasure grain foods did not appear to influence the results,” he said.

By way of background, Dr Gaesser said the last two Dietary Recommendations Advisory Committees (DGACs) based their recommendations to reduce refined grain intake on “moderate” evidence suggesting such reductions were associated with risk. lower than DT2. The moderate evidence was generated using research on eating habits.

“‘Healthy’ eating habits are characterized by higher consumption of fruits, vegetables, whole grains, low-fat or fat-free dairy products, seafood, legumes and nuts,” said Dr. Gaess. “In contrast, ‘unhealthy’ (Western) diets are characterized by higher intakes of red and processed meat, sugary foods and beverages, French fries, high-fat dairy products, and refined grains. substantial body of research shows that a healthy diet is associated with a lower risk of T2D and an unhealthy diet is associated with an increased risk of T2D.

Since diet research lumps together many foods, Dr Gaesser said the risk identified by the DGAC may not be “attributable to refined grains per se, but rather to other foods in the unhealthy diet. “. In fact, he noted that the risk of T2D was independently associated with the consumption of red and processed meat and sugary drinks.

To conclude that consumption of refined grains is associated with T2DM, studies in which refined grains are considered as a separate food category, independent of diet, should be considered. To that end, Dr. Gaesser reviewed studies analyzing refined grains as a separate food category.

Ideally, when trying to assess the risk of cereal consumption and T2D, Dr Gaesser said further distinctions should be made between so-called staple cereal foods such as bread, cereals, pasta and rice and gourmet grain foods such as cookies and cakes. Such distinctions were not made in the 10 studies he analyzed, making the lack of an association between refined grains and T2DM surprising, Dr. Gaesser said.

The studies he assessed included in the refined grain categories cakes, cookies, sweets and desserts, buns, pancakes, waffles, muffins and pizza.

“These foods typically contain high amounts of sugar and fat and low amounts of fiber,” Dr. Gaesser said. “None of the cohort studies examined distinct associations between T2D risk and consumption of staple or indulgent refined grain foods or provided information on the percentage contributions of different refined grain foods to T2D risk. total intake of refined grains.”

He continued: “Even with the inclusion of grain-based foods, none of the studies showed an elevated risk of T2D associated with the highest consumption of refined grains, and none of the meta-analyses found indicated an association between refined grain consumption and T2D. ”

Relying on dietary habits to establish an association with T2D likely led the DGAC to draw its conclusions about refined grains, conclusions that now seem suspect.

“The higher risk of T2D associated with the unhealthy (Western) diet is likely attributable to the consumption of red and processed meat and sugary drinks rather than refined grain foods per se,” Dr. Gaesser said.

The DGAC has always recommended eating at least three servings of whole grains a day, but Dr. Gaesser said less than 7% of the US population consumes the recommended minimum of three servings a day of whole grains, and more than 70% of Americans eat less than one serving of whole grains a day. He cited data indicating that consumption of refined grains is five times greater than consumption of whole grains (in the case of wheat flour, USDA data actually suggests that consumption of refined grains is about 20 times that of whole grains).

“Although research strongly supports the recommendation to increase whole grain consumption to reduce the risk of T2D, the optimal amount of whole grain intake is not entirely clear,” Dr. Gaesser said. “The risk appears to be significantly reduced up to about three servings per day of whole grains. Americans currently consume less than one serving per day.

In the Women’s Health Initiative observational study, one of the largest studies discussed in Dr. Gaesser’s commentary, the lower risk of diabetes for the highest consumption of refined grains was similar to that for the highest consumption. high in whole grains.

Dr. Gaesser said there is evidence that as total grain consumption increases, the risk of T2D declines non-linearly by up to 10 servings per day.

“This may be particularly relevant to US dietary recommendations because this level of total grain consumption exceeds current grain consumption among Americans,” Dr. Gaesser said.


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