The association between whole and refined grain consumption and stroke risk remains unclear. A search using MEDLINE and EMBASE databases was performed through February 29, 2016. Seven prospective studies with a total of 446 451 subjects and 5892 stroke events were included. The summary relative risk (SRR) of stroke for the high versus low consumption was 0.95 (95% confidence interval [CI] = 0.83-1.14) for total grains, 0.92 (95% CI = 0.72-1.17) for whole grains, and 0.99 (95% CI = 0.84-1.16) for refined grains. Diets rich in whole grains were inversely associated with ischemic stroke risk (SRR = 0.75, 95% CI = 0.60-0.95). Our meta-analysis revealed that whole and refined grain consumption is not associated with total stroke risk; however, whole grain consumption is associated with reduced ischemic stroke risk.
JohnstonSCMendisSMathersCD.Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009;8:345-354.
2.
HataJKiyoharaY.Epidemiology of stroke and coronary artery disease in Asia. Circ J. 2013;77:1923-1932.
3.
SherzaiAHeimLTBoothbyCSherzaiAD.Stroke, food groups, and dietary patterns: a systematic review. Nutr Rev. 2012;70:423-435.
4.
FlintAJHuFBGlynnRJ. Whole grains and incident hypertension in men. Am J Clin Nutr. 2009;90:493-498.
5.
WangLGazianoJMLiuSMansonJEBuringJESessoHD.Whole- and refined-grain intakes and the risk of hypertension in women. Am J Clin Nutr. 2007;86:472-479.
6.
BazzanoLASongYBubesVGoodCKMansonJELiuS.Dietary intake of whole and refined grain breakfast cereals and weight gain in men. Obes Res. 2005;13:1952-1960.
7.
Koh-BanerjeePFranzMSampsonL. Changes in whole-grain, bran, and cereal fiber consumption in relation to 8-y weight gain among men. Am J Clin Nutr. 2004;80:1237-1245.
8.
LiuSWillettWCMansonJEHuFBRosnerBColditzG.Relation between changes in intakes of dietary fiber and grain products and changes in weight and development of obesity among middle-aged women. Am J Clin Nutr. 2003;78:920-927.
9.
SteffenLMJacobsDRJrMurtaughMA. Whole grain intake is associated with lower body mass and greater insulin sensitivity among adolescents. Am J Epidemiol. 2003;158:243-250.
10.
AuneDNoratTRomundstadPVattenLJ.Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Eur J Epidemiol. 2013;28:845-858.
11.
ParkerEDLiuSVan HornL. The association of whole grain consumption with incident type 2 diabetes: the Women’s Health Initiative Observational Study. Ann Epidemiol. 2013;23:321-327.
12.
SunQSpiegelmanDvan DamRM. White rice, brown rice, and risk of type 2 diabetes in US men and women. Arch Intern Med. 2010;170:961-969.
13.
LiuSMansonJEStampferMJ. Whole grain consumption and risk of ischemic stroke in women: a prospective study. JAMA. 2000;284:1534-1540.
14.
LiuSSessoHDMansonJEWillettWCBuringJE.Is intake of breakfast cereals related to total and cause-specific mortality in men?Am J Clin Nutr. 2003;77:594-599.
15.
SteffenLMJacobsDRJrStevensJShaharECarithersTFolsomAR.Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Clin Nutr. 2003;78:383-390.
16.
JacobsDRJrAndersenLFBlomhoffR.Whole-grain consumption is associated with a reduced risk of noncardiovascular, noncancer death attributed to inflammatory diseases in the Iowa Women’s Health Study. Am J Clin Nutr. 2007;85:1606-1614.
17.
LarssonSCMannistoSVirtanenMJKonttoJAlbanesDVirtamoJ.Dietary fiber and fiber-rich food intake in relation to risk of stroke in male smokers. Eur J Clin Nutr. 2009;63:1016-1024.
18.
MizrahiAKnektPMontonenJLaaksonenMAHeliovaaraMJarvinenR.Plant foods and the risk of cerebrovascular diseases: a potential protection of fruit consumption. Br J Nutr. 2009;102:1075-1083.
19.
SharmaSCruickshankJKGreenDMVikSTomeAKolonelLN.Impact of diet on mortality from stroke: results from the U.S. multiethnic cohort study. J Am Coll Nutr. 2013;32:151-159.
20.
StroupDFBerlinJAMortonSC. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008-2012.
DerSimonianRLairdN.Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
23.
HigginsJPThompsonSGDeeksJJAltmanDG.Measuring inconsistency in meta-analyses. BMJ. 2003;327:557-560.
24.
GreenlandSLongneckerMP.Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135:1301-1309.
25.
OrsiniN BRGreenlandS.Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6:40-57.
26.
AuneDChanDSLauR. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ. 2011;343:d6617.
27.
EggerMDavey SmithGSchneiderMMinderC.Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629-634.
28.
FangJFooSHFungCWylie-RosettJAldermanMH.Stroke risk among Chinese immigrants in New York City. J Immigr Minor Health. 2006;8:387-393.
29.
LiangWLeeAHBinnsCW.White rice-based food consumption and ischemic stroke risk: a case-control study in southern China. J Stroke Cerebrovasc Dis. 2010;19:480-484.
30.
MisirliGBenetouVLagiouPBamiaCTrichopoulosDTrichopoulouA.Relation of the traditional Mediterranean diet to cerebrovascular disease in a Mediterranean population. Am J Epidemiol. 2012;176:1185-1192.
31.
JacobsDRJrMeyerKAKushiLHFolsomAR.Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women’s Health Study. Am J Public Health. 1999;89:322-329.
32.
SuzukiYNagaiNUmemuraK.Novel situations of endothelial injury in stroke—mechanisms of stroke and strategy of drug development: intracranial bleeding associated with the treatment of ischemic stroke: thrombolytic treatment of ischemia-affected endothelial cells with tissue-type plasminogen activator. J Pharmacol Sci. 2011;116:25-29.
33.
KapralMKFangJHillMD. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke. 2005;36:809-814.
34.
PalmFUrbanekCWolfJ. Etiology, risk factors and sex differences in ischemic stroke in the Ludwigshafen Stroke Study, a population-based stroke registry. Cerebrovasc Dis. 2012;33:69-75.
35.
AburtoNJHansonSGutierrezHHooperLElliottPCappuccioFP.Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ. 2013;346:f1378.
36.
NieZLWangZMZhouBTangZPWangSK.Magnesium intake and incidence of stroke: meta-analysis of cohort studies. Nutr Metab Cardiovasc Dis. 2013;23:169-176.
37.
KaptogeSDi AngelantonioELoweG. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet. 2010;375:132-140.
38.
ErtaMQuintanaAHidalgoJ.Interleukin-6, a major cytokine in the central nervous system. Int J Biol Sci. 2012;8:1254-1266.
39.
WisemanSMarlboroughFDoubalFWebbDJWardlawJ.Blood markers of coagulation, fibrinolysis, endothelial dysfunction and inflammation in lacunar stroke versus non-lacunar stroke and non-stroke: systematic review and meta-analysis. Cerebrovasc Dis. 2014;37:64-75.
40.
PengMWuSJiangXJinCZhangW.Long-term alcohol consumption is an independent risk factor of hypertension development in northern China: evidence from Kailuan study. J Hypertens. 2013;31:2342-2347.
41.
GoldsteinLB.Physical activity and the risk of stroke. Expert Rev Neurother. 2010;10:1263-1265.
42.
DateCFukuiMYamamotoA. Reproducibility and validity of a self-administered food frequency questionnaire used in the JACC study. J Epidemiol. 2005;15(suppl 1):S9-S23.
43.
BreslowRAGuentherPMJuanWGraubardBI.Alcoholic beverage consumption, nutrient intakes, and diet quality in the US adult population, 1999-2006. J Am Diet Assoc. 2010;110:551-562.
44.
HanselBThomasFPannierB. Relationship between alcohol intake, health and social status and cardiovascular risk factors in the Urban Paris-Ile-de-France Cohort: is the cardioprotective action of alcohol a myth?Eur J Clin Nutr. 2010;64:561-568.
45.
PaavolaMVartiainenEHaukkalaA.Smoking, alcohol use, and physical activity: a 13-year longitudinal study ranging from adolescence into adulthood. J Adolesc Health. 2004;35:238-244.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
