Bread score (slices x %WG)

Breakfast cereal FFQ (WG classified as 25% w/w)

serving per day Refined grains " mortality with " consumption HRR graded and inverse with " consumption

HRR # with " consumption

Jacobs et al. (1999) Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women's Health Study. American Journal of Public Health 89: 322-329.

Jacobs et al. (2001) Reduced mortality among whole grain bread eaters in men and women in the Norwegian County Study. European Journal of Clinical Nutrition 55: 137-143.

Liu et al. (2003) Is intake of breakfast cereals related to total and cause-specific mortality in men? American Journal of Clinical Nutrition 77: 594-599.

scores categories: 7% versus 10% for men and 2.7% versus 4.6% for women).

In the Physicians' Health Study, breakfast cereal consumption was used as an indicator of whole-grain intake in over 86 000 US male physicians aged 40-84 years studied over 5.5 years. Breakfast cereal consumption was assessed using a semiquantitative FFQ where men had to report the amount, frequency, brand, and type of cereal consumed over the previous year. Whole-grain cereals were classified as those with >25% whole grain or bran by weight; all others were considered to be refined grains. Whole-grain breakfast cereal consumption was inversely associated with total mortality independent of a range of dietary and lifestyle considerations.

The use of bread and cereal intakes as a measure of total whole-grain consumption is of some concern, as the extent to which they correlate with overall whole-grain consumption is uncertain. Indeed, such studies also fail to distinguish whether it is in fact something within the whole-grain package that is of benefit, or something else entirely.

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