The epidemiological data suggest that health benefits can be obtained at relatively low levels of whole-grain consumption, typically 1-3 servings per day. In most studies, there was no clear dose-response relationship and a suggestion of a threshold effect as benefits were seen at the third quintile of whole-grain intakes with no further reduction in risk as intakes increased. However, assessment of intakes in different countries show that this threshold level of intake is not being achieved.
International dietary Guidelines recommend increased grain consumption. At present, the USA is the only nation to specify exact quantities of whole grain foods, and it is only within the last few years that whole grains have been considered seperately from total grain foods.
The recommendations for grains have evolved over time to reflect changes in research and to simplify and clarify consumer messages. The latest American Dietary Guidelines (2005) now state a recommendation of 3 or more ounce-equivalent portions of whole-grain foods daily, with a further recommendation that at least half of grain consumption should be whole-grain.
This recommendation of three servings per day was also specifically incorporated in the Department of Health and Health Services nutrition objectives for 2010 (US Department of Health and Human Services, 2000).
In the UK, the Food Standards Agency explicitly encourages consumers to select whole-grain varieties in their healthy eating advice, although no exact quantities are given. Many other European countries also tend to place emphasis on only cereals and fiber, without necessarily specifically highlighting whole grains.
Using data compiled from focus groups and consumer interviews in the US, a number of reasons as to why consumption of whole-grain foods may be low have been indentified. Consumers report difficulties in identifying whole-grain foods and express limited knowledge about the preparation and cooking of whole-grain foods. Adolescents in particular reported that whole-grain foods were bland and have a dry taste. While breakfast cereals appear to be well received in this age group, whole-grain breads were described as dry and bitter. Furthermore, whole-grain varieties of bread, pasta, and rice tend to be more expensive and this may deter those in low income and vulnerable groups.
In a UK intervention study to increase whole-grain consumption, 25-40-year-olds were encouraged to increase whole-grain food consumption over a period of 2 weeks by gradually increasing servings from 1 to 5 servings per day. Volunteers were given positive health messages about eating more whole-grain foods, were helped in identifying such food products, and were also given advice on how to incorporate them easily into their existing diet. In post study focus groups, participants were positive about the changes made and were happy to continue consuming whole-grain foods but at lower levels than that prescribed during the study period. Similar to findings in the US, breakfast was found to be a good meal to change habit and breakfast cereals and bread type was deemed the easiest way of incorporating whole-grain foods.
Consumer research suggests that few people are aware of the health benefits of whole-grain foods. Although other food groups, such as fruits and vegetables, have been identified as possessing health benefits, the association between whole-grain foods and a reduced risk of a number of chronic diseases is not recognized among the general population or indeed health professionals. Recent health claims in the US and UK may help to address this knowledge gap. In addition, consumer initiatives such as the 'Whole Grain for Health' campaign in the UK, and 'Go Grains' in Australia provide ongoing education relating to the benefits of including whole-grain products within the diet.
See also: Cancer: Epidemiology and Associations Between Diet and Cancer; Epidemiology of Gastrointestinal Cancers Other Than Colorectal Cancers. Cereal Grains. Diabetes Mellitus: Etiology and Epidemiology; Classification and Chemical Pathology; Dietary Management. Dietary Fiber: Physiological Effects and Effects on Absorption; Potential Role in Etiology of Disease; Role in Nutritional Management of Disease.
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