Evaluating Whole Grain Intervention Study Designs and Reporting Practices Using Evidence Mapping Methodology

High-throughput multitarget quantitative assay to profile the whole grain-specific phytochemicals alkylresorcinols, benzoxazinoids and avenanthramides in whole grain and grain-based foods

Currently, there is a growing interest in using whole grain (WG)-specific phytochemicals to perform WG research, including research on dietary assessment, health mechanisms, and quality control. However, the current approaches used for WG-specific phytochemical analysis cannot simultaneously achieve coverage, specificity, and sensitivity. In the present study, a series of WG-specific phytochemicals (alkylresorcinols (ARs), benzoxazinoids (BXs) and avenanthramides (AVAs)) were identified, and their mass spectrometry (MS) fragmentation mechanism was studied by TOF MS. Based on diagnostic fragmentation ions and retention time prediction models, a LC-MS/MS method was developed. Through this method, 56 ARs, 13 BXs, and 19 AVAs in WGs and grain-based foods were quantified for the first time. This method was validated and yielded excellent specificity, high sensitivity and negligible matrix effects. Finally, we established WG-specific phytochemical fingerprints in a variety of WG and grain-based foods. This method can be used for WG quality control and WG precision nutrition research.

Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort

BACKGROUND

Greater whole grain (WG) consumption is associated with reduced risk of cardiovascular disease (CVD); however, few prospective studies have examined WG or refined grain (RG) intake and intermediate cardiometabolic risk factors.

OBJECTIVES

We examined the longitudinal association between WG and RG intake on changes in waist circumference (WC); fasting HDL cholesterol, triglyceride, and glucose concentrations; and blood pressure.

METHODS

Subjects were participants in the Framingham Offspring cohort study [n = 3121; mean ± SD baseline age: 54.9 ± 0.2 y; BMI (kg/m2) 27.2 ± 0.1]. FFQ, health, and lifestyle data were collected approximately every 4 y over a median 18-y follow-up. Repeated measure mixed models were used to estimate adjusted mean changes per 4-y interval in risk factors across increasing categories of WG or RG intake.

RESULTS

Greater WG intake was associated with smaller increases in WC (1.4 ± 0.2 compared with 3.0 ± 0.1 cm in the highest compared with the lowest category, respectively; P-trend < 0.001), fasting glucose concentration (0.7 ± 0.4 compared with 2.6 ± 0.2 mg/dL; P-trend < 0.001), and systolic blood pressure (SBP; 0.2 ± 0.5 compared with 1.4 ± 0.3 mm Hg; P-trend < 0.001) per 4-y interval. When stratified by sex, a stronger association with WC was observed among females than males. Higher intake of WG was associated with greater increases in HDL cholesterol and declines in triglyceride concentrations; however, these differences did not remain significant after adjustment for change in WC. Conversely, greater RG intake was associated with greater increases in WC (2.7 ± 0.2 compared with 1.8 ± 0.1 cm, P-trend < 0.001) and less decline in triglyceride concentration (-0.3 ± 1.3 compared with -7.0 ± 0.7 mg/dL, P-trend < 0.001).

CONCLUSIONS

Among middle- to older-age adults, replacing RG with WG may be an effective dietary modification to attenuate abdominal adiposity, dyslipidemia, and hyperglycemia over time, thereby reducing the risk of cardiometabolic diseases.

Wearing masks to reduce the spread of respiratory viruses: a systematic evidence mapping

Since the outbreak of coronavirus disease in 2019, the controversy over the effectiveness, safety, and enforceability of masks used by the public has been prominent. This study aims to identify, describe, and organize the currently available high-quality design evidence concerning mask use during the spread of respiratory viruses and find evidence gaps. Databases including PubMed, Cochrane Library, Web of Science, EMBASE, WHO International Clinical Trials Registry Platform (ICTRP), clinical trial registry, gray literature database, and reference lists of articles were searched for relevant randomized controlled trials (RCTs) and systematic reviews (SRs) in April 2020. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. A bubble plot was designed to display information in four dimensions. Finally, twenty-one RCTs and nine SRs met our inclusion criteria. Most studies were of “Low quality” and focused on healthcare workers. Six RCTs reported adverse effects, with one implying that the cloth masks reuse may increase the infection risk. When comparing masks with usual practice, over 70% RCTs and also SRs showed that masks were “beneficial” or “probably beneficial”; however, when comparing N95 respirators with medical masks, 75% of SRs showed “no effect”, whereas 50% of RCTs showed “beneficial effect”. Overall, the current evidence provided by high-quality designs may be insufficient to deal with a second impact of the pandemic. Masks may be effective in interrupting or reducing the spread of respiratory viruses; however, the effect of an N95 respirator or cloth masks versus medical masks is unclear. Additional high-quality studies determining the impact of prolonged mask use on vulnerable populations (such as children and pregnant women), the possible adverse effects (such as skin allergies and shortness of breath) and optimal settings and exposure circumstances for populations to use masks are needed.

Evidence mapping to assess the available research on fiber, whole grains, and health

Evidence mapping is a useful methodology for characterizing existing research on a broad topic and identifying gaps in the scientific literature. Evidence mapping entails conducting a systematic literature search and extracting information on study details, often in the form of a database. Researchers at Tufts University and the North American branch of the International Life Sciences Institute created the Diet-Related Fibers & Human Health Outcomes Database, which is publicly available and updated annually. The database captures intervention studies examining dietary fiber and 10 predefined physiological health outcomes, including weight/adiposity, blood pressure, gut microbiota, and bone health. The database and subsequent potential for evidence mapping may be particularly useful in light of new food labeling requirements by the US Food and Drug Administration that require fibers to have accepted scientific evidence of a physiological health benefit in order to be labeled as "dietary fiber." Following the success of the fiber database, Tufts University and the General Mills Bell Institute of Health and Nutrition collaborated to develop a whole grain database and evidence map. This work successfully highlighted the need for better consistency in how whole grains are reported with respect to amount and type of whole grains and intervention compliance.

Evaluating an Intervention to Increase Cereal Fiber Intake in Children: A Randomized Controlled Feasibility Trial

BACKGROUND

Observational studies have shown that higher cereal fiber intake is associated with reduced type 2 diabetes risk. However, it remains uncertain whether this association is causal.

OBJECTIVE

This study evaluated the feasibility of an intervention to increase cereal fiber intake in children using breakfast cereals.

METHODS

The study was a 2-arm parallel group randomized controlled trial in 9-10-y-old children, who received free supplies of high-fiber breakfast cereals (>3.5 g/portion) or low-fiber breakfast cereals (<1.0 g/portion) to eat daily for 1 mo with behavioral support to promote adherence. Children provided baseline and 1-mo fasting blood samples, physical measurements, and 24-h dietary recalls. The primary outcome was the group difference in change in plasma total alkylresorcinol (AR) concentration; secondary outcomes were group differences in nutrient intakes and adiposity indices. Analyses (complete case and multiple imputation) were conducted by regressing the final AR concentration on baseline AR in models adjusted for sex, ethnicity, age, and school (random effect).

RESULTS

Two-hundred seventy-two children were randomly assigned (137 receiving a low-fiber and 135 a high-fiber diet) and 193 (71%) provided fasting blood samples at baseline and follow-up. Among randomized participants, median (IQR) of baseline AR was 43.1 (24.6-85.5) nmol/L and of cereal fiber intake was 4.5 (2.7-6.4) g; 87% of participants reported consuming the cereal on most or all days. Compared with changes in the low-fiber group, the high-fiber group had greater increases in AR (40.7 nmol/L; 95% CI: 21.7, 59.8 nmol/L, P < 0.0001) and in reported cereal fiber intake (2.9g/d; 95% CI: 2.0, 3.7 g; P < 0.0001). There were no appreciable differences in other secondary outcomes.

CONCLUSIONS

We have developed a simple and acceptable nutritional intervention that increases markers of daily cereal fiber intake in children. This intervention could be used to test whether increases in cereal fiber intake in children might reduce insulin resistance. This trial was registered at www.isrctn.com as ISRCTN33260236.

Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole"

Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.

Using Evidence Mapping to Examine Motivations for Following Plant-Based Diets

Motivations to adopt plant-based diets are of great public health interest. We used evidence mapping to identify methods that capture motivations to follow plant-based diets and summarize demographic trends in dietary motivations. We identified 56 publications that described 90 samples of plant-based diet followers and their dietary motivations. We categorized the samples by type of plant-based diet: vegan (19%), vegetarian (33%), semivegetarian (24%), and other, unspecified plant-based diet followers (23%). Of 90 studies examined, 31% administered multiple-choice questions to capture motivations, followed by rate items (23%), Food Choice Questionnaire (17%), free response (9%), and rank choices (10%). Commonly reported motivations were health, sensory/taste/disgust, animal welfare, environmental concern, and weight loss. The methodological variation highlights the importance of using a structured questionnaire to investigate dietary motivations in epidemiological studies. Motivations among plant-based diet followers appear distinct, but evidence on the association between age and motivations appears limited.

The Relationship between Whole Grain Intake and Body Weight: Results of Meta-Analyses of Observational Studies and Randomized Controlled Trials

Results from some observational studies suggest that higher whole grain (WG) intake is associated with lower risk of weight gain. Ovid Medline was used to conduct a literature search for observational studies and randomized controlled trials (RCTs) assessing WG food intake and weight status in adults. A meta-regression analysis of cross-sectional data from 12 observational studies (136,834 subjects) and a meta-analysis of nine RCTs (973 subjects) was conducted; six prospective cohort publications were qualitatively reviewed. Cross-sectional data meta-regression results indicate a significant, inverse correlation between WG intake and body mass index (BMI): weighted slope, −0.0141 kg/m² per g/day of WG intake (95% confidence interval (CI): −0.0207, −0.0077; r = −0.526, p = 0.0001). Prospective cohort results generally showed inverse associations between WG intake and weight change with typical follow-up periods of five to 20 years. RCT meta-analysis results show a nonsignificant pooled standardized effect size of −0.049 kg (95% CI −0.297, 0.199, p = 0.698) for mean difference in weight change (WG versus control interventions). Higher WG intake is significantly inversely associated with BMI in observational studies but not RCTs up to 16 weeks in length; RCTs with longer intervention periods are warranted.

The Effects of Intact Cereal Grain Fibers, Including Wheat Bran on the Gut Microbiota Composition of Healthy Adults: A Systematic Review

The human microbiota is increasingly recognized as a major factor influencing health and well-being, with potential benefits as diverse as improved immunity, reduced risk of obesity, Type 2 diabetes, and improved cognition and mood. Bacteria inhabiting the gut are dependent on the provision of fermentable dietary substrates making diet a major factor driving the composition of the human gut microbiota. Dietary fiber may modify microbiota abundance, diversity, and metabolism including short-chain fatty acid production. The majority of research to date has explored isolated fibers, and the influence of habitual fiber consumption is less well-established. The aim of the current article was to systematically review evidence from human intervention studies for the effects of intact cereal fibers, and their active sub-fractions, on gut microbiota composition in healthy adults. Studies published in the past 20 years were identified through the PubMed and Cochrane electronic databases. Inclusion criteria were: healthy adult participants (>18 years), inclusion of at least one intact cereal fiber, or its sub-fraction, and measurement of fecal microbiota related outcomes. As every individual has a unique microbiota many trials utilized a cross-over design where individuals acted as their own control. Outcome measures included change to the microbiota, species diversity, or species abundance, or metabolic indicators of microbiota fermentation such as short chain fatty acids or fecal nitrogen. Two hundred and twenty three publications were identified and 40 included in the final review. In discussing the findings, particular attention has been paid to the effects of wheat fiber, bran, and arabinoxylans (AXOS) as this is the dominant source of fiber in many Western countries. Thirty-nine of the forty-two studies demonstrated an increase in microbiota diversity and/or abundance following intact cereal fiber consumption, with effects apparent from 24 h to 52 weeks. Increases in wheat fiber as low as 6–8 g were sufficient to generate significant effects. Study duration ranged from 1 day to 12 weeks, with a single study over 1 year, and exploration of the stability of the microbiota following long-term dietary change is required. Increasing cereal fiber consumption should be encouraged for overall good health and for gut microbiota diversity.