Whole Grain Consumption and the Risk of Colorectal Cancer
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Online Supplemental Material
Supplementary appendix: PubMed Search
(cereal OR grain OR grains OR rice OR bread OR roots OR tubers OR vegetable OR fruits OR pulse OR pulses OR bean OR beans OR lentil OR lentils OR legume OR legumes OR soy OR soya OR pea OR chickpeas OR chickpea OR nut OR seed OR peanut OR peanuts OR meat OR beef OR pork OR lamb OR poultry OR chicken OR fish OR egg OR eggs OR seafood OR shellfish OR dairy OR dairy products OR milk OR cheese OR yoghurt OR ice cream OR butter OR drink OR drinks OR beverage OR soda OR sodas OR juice OR juices OR punch OR foods) AND diabetes
Supplementary Table 1: Whole grains and type 2 diabetes, nonlinear dose-response
Intake (servings/day) / RR (95% CI)0 / 1.00
0.5 / 0.86 (0.80-0.92)
1.0 / 0.78 (0.73-0.84)
1.5 / 0.75 (0.70-0.80)
2.0 / 0.72 (0.68-0.77)
2.5 / 0.71 (0.66-0.76)
3.0 / 0.70 (0.65-0.74)
Supplementary Table 2: Refined grains and type 2 diabetes, nonlinear dose-response
Intake (servings/day) / RR (95% CI)0.45 / 1.00
1.0 / 0.94 (0.87-1.01)
1.5 / 0.92 (0.84-1.01)
2.0 / 0.91 (0.83-1.00)
2.5 / 0.91 (0.82-1.00)
3.0 / 0.91 (0.82-1.01)
3.5 / 0.90 (0.81-1.01)
4.0 / 0.90 (0.80-1.01)
4.5 / 0.90 (0.80-1.02)
5.0 / 0.90 (0.79-1.03)
5.5 / 0.90 (0.78-1.04)
6.0 / 0.90 (0.77-1.05)
6.5 / 0.90 (0.76-1.06)
7.0 / 0.90 (0.75-1.08)
Supplementary Table 3: Total grains and type 2 diabetes, nonlinear dose-response
Intake (servings/day) / RR (95% CI)1.37 / 1.00
1.5 / 0.96 (0.94-0.98)
2.0 / 0.89 (0.83-0.95)
3.0 / 0.83 (0.76-0.91)
4.0 / 0.80 (0.72-0.89)
5.0 / 0.77 (0.69-0.85)
6.0 / 0.73 (0.65-0.82)
7.0 / 0.68 (0.60-0.78)
8.0 / 0.63 (0.54-0.74)
9.0 / 0.56 (0.46-0.69)
10.0 / 0.49 (0.37-0.65)
11.0 / 0.42 (0.29-0.60)
12.0 / 0.34 (0.21-0.55)
13.0 / 0.27 (0.15-0.50)
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Supplementary Table 4: Definitions of whole grains
Author, publication year, country / Study name / Exposure / Definition of whole grain / RR (95% CI)Parker ED et al, 2013, USA / Women’s Health Initiative Observational Study / Whole grains / Whole grain bread and cereals / 0.79 (0.66-0.94)
0.73 (0.58-0.93)
Von Ruesten A et al, 2013, Germany / European Prospective Investigation into Cancer and Nutrition - Potsdam study / Whole grain bread / Whole grain bread, dark or whole grain rolls / 0.92 (0.82-1.03)
Wirström T et al, 2013, Sweden / NA / Whole grains / Whole-grain food is defined in Sweden as food that contains ≥50% of whole grain on a dry-matter basis. All food items that contained ≥50% of whole grain per serving (ie, crisp bread, whole-meal bread, oatmeal, and muesli). / 0.71 (0.48-1.04)
0.88 (0.74-1.04)
Ericson U et al, 2013, Sweden / Malmo Diet and Cancer Cohort / Fibre-rich bread and cereals, w
Fibre-rich bread and cereals, m
Fibre-rich bread and cereals, w
Fibre-rich bread and cereals, m / Fibre-rich cereal products (portions of fibre-rich bread and breakfast cereals) / 0.83 (0.67-1.03)
0.83 (0.67-1.02)
0.85 (0.68-1.06)
0.84 (0.68-1.04)
Sun Q et al, 2010, USA / Health Professionals Follow-up Study / Brown rice
Whole grain
Bran
Germ / Consumption of whole grain (in g/d) was estimated from all grain foods (rice, bread, pasta, and
breakfast cereals) based on their dry weight of whole grain ingredients. This included both intact and
pulverized forms containing the expected proportion of bran, germ, and endosperm for the specific grain types. The following ingredients in the database were considered whole grains: whole wheat and whole wheat flour, whole oats and whole oat flour, whole cornmeal and whole corn flour, brown
rice and brown rice flour, whole rye and whole rye flour, whole barley, bulgur, buckwheat, popcorn, amaranth, and psyllium. / 0.96 (0.82-1.12)
0.72 (0.63-0.83)
0.69 (0.60-0.81)
1.04 (0.89-1.21)
Sun Q et al, 2010, USA / Nurses’ Health Study 1 / Brown rice
Whole grain
Bran
Germ / Consumption of whole grain (in g/d) was estimated from all grain foods (rice, bread, pasta, and
breakfast cereals) based on their dry weight of whole grain ingredients. This included both intact and
pulverized forms containing the expected proportion of bran, germ, and endosperm for the specific grain types. The following ingredients in the database were considered whole grains: whole wheat and whole wheat flour, whole oats and whole oat flour, whole cornmeal and whole corn flour, brown
rice and brown rice flour, whole rye and whole rye flour, whole barley, bulgur, buckwheat, popcorn, amaranth, and psyllium. / 0.83 (0.72-0.96)
0.70 (0.64-0.77)
0.77 (0.69-0.86)
0.88 (0.79-0.97)
Sun Q et al, 2010, USA / Nurses’ Health Study 2 / Brown rice
Whole grain
Bran
Germ / Consumption of whole grain (in g/d) was estimated from all grain foods (rice, bread, pasta, and
breakfast cereals) based on their dry weight of whole grain ingredients. This included both intact and
pulverized forms containing the expected proportion of bran, germ, and endosperm for the specific grain types. The following ingredients in the database were considered whole grains: whole wheat and whole wheat flour, whole oats and whole oat flour, whole cornmeal and whole corn flour, brown
rice and brown rice flour, whole rye and whole rye flour, whole barley, bulgur, buckwheat, popcorn, amaranth, and psyllium. / 0.89 (0.75-1.07)
0.81 (0.70-0.94)
0.83 (0.71-0.97)
1.04 (0.90-1.21)
Fisher E et al, 2009, Germany / European Prospective Investigation into Cancer and Nutrition - Potsdam study / Whole grains, rs7903146 CC genotype
Whole grains, rs7903146 CT + TT genotype / Sum of whole-grain bread, whole-grain bread rolls, and whole-grain cereals / 0.86 (0.75-0.99)
1.08 (0.96-1.23)
de Munter JSL et al, 2007, USA / Nurses’ Health Study 1 / Whole grains, no BMI adj.
Bran
Germ
Whole grains, with BMI adj.
Bran
Germ / Whole grains included both intact and pulverized forms containing the expected proportion of bran, germ, and endosperm for the specific grain types. The following ingredients in the database were considered whole grains: whole wheat and whole wheat flour, whole oats and whole oat flour, whole cornmeal and whole corn flour, brown rice and brown rice flour, whole rye and whole rye flour, whole barley, bulgur, buckwheat, popcorn, amaranth, and psyllium. Bran and germ in this study refer to total bran and total germ respectively including both the amount naturally contained in whole grains and the amount eaten separately or added during industrial processing or during cooking by the participant. / 0.63 (0.57-0.69)
0.57 (0.51-0.63)
0.76 (0.69-0.84)
0.75 (0.68-0.83)
0.72 (0.65-0.80)
0.83 (0.75-0.92)
de Munter JSL et al, 2007, USA / Nurses’ Health Study 2 / Whole grains, no BMI adj.
Bran
Germ
Whole grains, with BMI adj. Bran
Germ / Whole grains included both intact and pulverized forms containing the expected proportion of bran, germ, and endosperm for the specific grain types. The following ingredients in the database were considered whole grains: whole wheat and whole wheat flour, whole oats and whole oat flour, whole cornmeal and whole corn flour, brown rice and brown rice flour, whole rye and whole rye flour, whole barley, bulgur, buckwheat, popcorn, amaranth, and psyllium. Bran and germ in this study refer to total bran and total germ respectively including both the amount naturally contained in whole grains and the amount eaten separately or added during industrial processing or during cooking by the participant. / 0.68 (0.57-0.81)
0.64 (0.54-0.76)
0.94 (0.80-1.10)
0.86 (0.72-1.02)
0.84 (0.71-1.00)
1.00 (0.85-1.17)
Schulze MB et al, 2007, Germany / European Prospective Investigation into Cancer and Nutrition - Potsdam study / Whole grain bread / Not available / 0.78 (0.62-0.97)
Simmons RK et al, 2007, UK / European Prospective Investigation into Cancer and Nutrition - Norfolk study / Wholemeal/brown bread / Not available / 0.72 (0.53-0.97)
Kochar J et al, 2007, USA / Physicians’ Health Study 1 / Breakfast cereals
Whole grains cereals / Breakfast cereals that contain at least 25% of oat or bran were classified as whole grain. / 0.69 (0.60-0.79)
0.60 (0.50-0.71)
Van Dam RM et al, 2006, USA / Black Women’s Health Study / Whole grains / Whole grains: “dark breads, such as wheat, rye, pumpernickel” and “high fiber, bran or granola cereals, shredded wheat” / 0.69 (0.60-0.79)
Hodge AM et al, 2004, Australia / Melbourne Collaborative Cohort Study / Whole-meal bread / “Wholewheat or rye bread, rolls, or toast” / 0.94 (0.83-1.05)
Montonen J et al, 2003, Finland / Finnish Mobile Clinic Health Examination Survey / Total grain
Whole grain
Rye
Other whole grain / The whole-grain food group contained rye bread, rye crisp bread, and all whole-grain flours
and other products (rye, whole wheat, wheat germ, rolled oats, barley, millet, and buckwheat) derived from different grain foods [eg, porridge, gruel, and Karelian pie (a national food of rice pudding baked in rye pastry and greased by butter)]. In addition, breads prepared from mixtures of whole grains and
refined grains were classified into the whole-grain group. The proportion of whole-grain flours in these mixtures was 25–50%, as determined from the available cookbook information. The refined-grain group contained white bread, wheat rusk, cream crackers, refined breakfast cereals, polished rice, and pasta.
White wheat flour in sweet wheat buns and wheat flour and starches in cookies, cakes, and other foods (eg, porridge, gruel, sauce, pudding, and pancakes) were included in the refinedgrain category. / 0.38 (0.19-0.77)
0.65 (0.36-1.18)
0.65 (0.36-1.18)
1.14 (0.69-1.87)
Fung TT et al, 2002, USA / Health Professionals Follow-up Study / Whole grains / Whole-grain foods included dark bread, whole-grain breakfast cereal, popcorn, cooked oatmeal, wheat germ, brown rice, bran, and other grains (eg, bulgar, kasha, and couscous). Refined grain included sweet rolls, cake desserts, white bread, pasta, English muffins, muffins or biscuits, refined-grain breakfast cereal, white rice, pancakes or waffles, and pizza. The list of breakfast cereals reported in the SFFQ was evaluated for whole grain and bran content;
breakfast cereals with 25% whole grain or bran content by weight were classified as whole grain. / 0.70 (0.57-0.85)
Liu S et al, 2000, USA / Nurses’ Health Study 1 / Whole grain
Dark bread
Whole-grain breakfast cereal
Popcorn
Cooked oatmeal
Brown rice
Wheat germ
Bran
Other grains / Specifically, whole-grain foods included dark bread, whole-grain breakfast cereal, popcorn, cooked oatmeal, wheat germ, brown rice, bran, and other grains (e.g., bulgur, kasha, couscous). Refined-grain foods included
sweet rolls and cakes or desserts, white bread, pasta, English muffins, muffins or biscuits, refined-grain breakfast cereal, white rice, pancakes or waffles, and pizza. The list of breakfast cereals reported in the food frequency
questionnaire was evaluated for whole-grain and bran content on the basis of data provided on the package labels or by General Mills Co; breakfast cereals with 25% or greater wholegrain or bran content by weight were classified as whole grain. / 0.73 (0.63-0.85)
0.77 (0.66-0.90)
0.66 (0.55-0.80)
0.88 (0.59-1.31)
0.73 (0.35-1.54)
0.47 (0.15-1.45)
0.85 (0.52-1.37)
0.54 (0.41-0.72)
0.77 (0.63-0.94)
Meyer KA et al, 2000, USA / Iowa Women’s Health Study / Total grains
Whole grains / Breakfast cereals were considered to be whole grain if the product contained ≥25% whole grain or bran by
weight, as determined either from the package label or from records shared by General Mills, Inc (Minneapolis). Bran cereals were included in the whole-grain category because findings were
similar for bran cereals and nonbran, whole-grain cereals (data not shown). Of the 152 cereals mentioned by these women, 91 contained ≥25% whole grain or bran by weight. / 0.68 (0.54-0.87)
0.79 (0.65-0.96)
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Supplementary Figure 1: Whole grains and type 2 diabetes, high vs. low analysis
Supplementary Figure 2: Refined grains and type 2 diabetes, high vs. low analysis
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Supplementary Figure 3. Total grains and type 2 diabetes, high vs. low analysis
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Supplementary Figure 4. Total grains and type 2 diabetes, dose-response analyses
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Supplementary Figure 5: Whole grain subtypes and type 2 diabetes, nonlinear dose-response
