ArticleBMJ (Clinical research ed.)2021
Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study.
Article in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
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Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it, 133 citations in OpenAlex.
- Sustainable dietary recommendations for the Spanish population.European journal of clinical nutrition · 2026Pooled it
- Health behaviors to prevent cardiovascular risk: a systematic review.BMC cardiovascular disorders · 2025Pooled it
- White rice, brown rice and the risk of type 2 diabetes: a systematic review and meta-analysis.BMJ open · 2022Pooled it
- Pooled incidence and case-fatality of acute stroke in Mainland China, Hong Kong, and Macao: A systematic review and meta-analysis.PloS one · 2022Pooled it
- Effects of an Extract of the Brown SeaweedMarine drugs · 2023Trial
- Discrepancies between validated and selected dietary exposures for association analysis: a meta-research study of cohorts examining diet-cardiovascular disease associations.European journal of epidemiology · 2026Article
- Whole Grains Perspective: Porridge or Popcorn.The Journal of nutrition · 2026Review
- Association between plant-based diet indices and depressive symptoms among South Korean adults: a cross-sectional study using the 2014 and 2016 Korea National Health and Nutrition Examination Surveys.Clinical nutrition research · 2026Article
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- Sex differences in association of cMIND diet with all-cause mortality in Chinese older adults: a 10-year national cohort study.BMC public health · 2026Observational
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- Fortified Pasta With Cricket (Acheta domesticus) Powder: Impact of an Alternative Protein Source on Pasta Nutritional, Functional, and Technological Properties.Journal of food science · 2026Article
- Plant-based diet indices in relation to novel cardiovascular risk factors, major adverse cardiovascular events, and novel anthropometric indices in patients with type 2 diabetes.Scientific reports · 2025Article
- Comparison of nutritional status between adults with and without disabilities: a population-based cross-sectional study in South Korea.Nutrition research and practice · 2025Article
- Association of plant-based diet indices with all-cause and cause-specific mortality among Korean adults in the KNHANES.Scientific reports · 2025Article
- Article
- Social factors, health policy, and environment: implications for cardiovascular disease across the globe.European heart journal · 2025Review
- Association of dietary preferences with cardiovascular disease: a Mendelian randomization study.Atherosclerosis plus · 2025Article
- Plant-based diets and mortality in Black and low-income Americans: findings from a large prospective cohort study.The American journal of clinical nutrition · 2025Article
- Article
Corrections and comments
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Authors and funding
33 authors at 20 institutions in 21 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the association between intakes of refined grains, whole grains, and white rice with cardiovascular disease, total mortality, blood lipids, and blood pressure in the Prospective Urban and Rural Epidemiology (PURE) study.
designProspective cohort study.
settingPURE study in 21 countries.
participants148 858 participants with median follow-up of 9.5 years. EXPOSURES: Country specific validated food frequency questionnaires were used to assess intakes of refined grains, whole grains, and white rice.
main outcome measureComposite of mortality or major cardiovascular events (defined as death from cardiovascular causes, non-fatal myocardial infarction, stroke, or heart failure). Hazard ratios were estimated for associations of grain intakes with mortality, major cardiovascular events, and their composite by using multivariable Cox frailty models with random intercepts to account for clustering by centre.
resultsAnalyses were based on 137 130 participants after exclusion of those with baseline cardiovascular disease. During follow-up, 9.2% (n=12 668) of these participants had a composite outcome event. The highest category of intake of refined grains (≥350 g/day or about 7 servings/day) was associated with higher risk of total mortality (hazard ratio 1.27, 95% confidence interval 1.11 to 1.46; P for trend=0.004), major cardiovascular disease events (1.33, 1.16 to 1.52; P for trend<0.001), and their composite (1.28, 1.15 to 1.42; P for trend<0.001) compared with the lowest category of intake (<50 g/day). Higher intakes of refined grains were associated with higher systolic blood pressure. No significant associations were found between intakes of whole grains or white rice and health outcomes.
conclusionHigh intake of refined grains was associated with higher risk of mortality and major cardiovascular disease events. Globally, lower consumption of refined grains should be considered.
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