de Munter Jeroen S L, Hu Frank B, Spiegelman Donna, Franz Mary, van Dam Rob M
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America.
PLoS Med. 2007 Aug;4(8):e261. doi: 10.1371/journal.pmed.0040261.
Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies.
We followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37-65 y for NHSI and 26-46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12-18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57-0.69) for NHSI and 0.68 (95% CI 0.57-0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68-0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72-1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%-28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI.
Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes.
通过平衡能量摄入与能量消耗来控制体重对于预防2型糖尿病至关重要，但特定饮食因素在2型糖尿病病因学中的作用尚不明确。我们在前瞻性队列研究中评估了全谷物、麸皮和胚芽的摄入量与2型糖尿病风险的关系。
我们对护士健康研究（NHS）I和II中的161,737名美国女性进行了随访，这些女性在基线时无糖尿病、心血管疾病或癌症病史。NHSI的基线年龄为37 - 65岁，NHSII的基线年龄为26 - 46岁。通过定期发放的问卷评估饮食摄入量和潜在混杂因素。在12 - 18年的随访期间，我们记录了6486例2型糖尿病病例。通过检索截至2007年1月的MEDLINE和EMBASE数据库，确定了其他关于全谷物摄入量与2型糖尿病风险的前瞻性队列研究，并由两名审阅者独立提取数据。NHSI中摄入量最低和最高五分位数的全谷物摄入量中位数分别为3.7克/天和31.2克/天，NHSII中分别为6.2克/天和39.9克/天。在对潜在混杂因素进行调整后，NHSI中全谷物摄入量最高五分位数与最低五分位数相比的相对风险（RR）为0.63（95%置信区间[CI] 0.57 - 0.69），NHSII中为0.68（95% CI 0.57 - 0.81）（两者：趋势检验p值<0.001）。在进一步调整体重指数（BMI）后，这些RR分别为0.75（95% CI 0.68 - 0.83；趋势检验p值<0.001）和0.86（95% CI 0.72 - 1.02；趋势检验p值0.03）。麸皮摄入量的关联与总全谷物摄入量的关联相似，而在调整麸皮后，未观察到胚芽摄入量有显著关联。基于包括286,125名参与者和10,944例2型糖尿病病例的六项队列研究的汇总数据，在对潜在混杂因素和BMI进行调整后，每天增加两份全谷物摄入量与2型糖尿病风险降低21%（95% CI 13% - 28%）相关。
全谷物摄入量与2型糖尿病风险呈负相关，且这种关联对于麸皮比胚芽更强。前瞻性队列研究的结果一致支持增加全谷物摄入量以预防2型糖尿病。
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