Vollkorngetreide zur primären oder sekundären Prävention von kardiovaskulären Erkrankungen
Appendices
Appendix 1. Checklist to aid consistency and reproducibility of GRADE assessments
| Total cholesterol change | ||
|---|---|---|
| Study limitations | 1. Was random sequence generation used (i.e. no potential for selection bias)? | Yes |
| 2. Was allocation concealment used (i.e. no potential for selection bias)? | Unclear (half of the studies low risk and the other half unclear) | |
| 3. Was there blinding of participants and personnel (i.e. no potential for performance bias)? | N/A (not applicable in lifestyle interventions) | |
| 4. Was there blinding of outcome assessment (i.e. no potential for detection bias)? | No (does not affect objective outcomes) | |
| 5. Was an objective outcome used? | Yes | |
| 6. Were more than 80% of participants enrolled in trials included in the analysis (i.e. no potential reporting bias)?a | Yes | |
| 7. Were data reported consistently for the outcome of interest (i.e. no potential selective reporting)? | Unclear | |
| 8. No other biases reported (i.e. no potential of other bias)? | Possible risk of attrition bias | |
| 9. Did the trials end up as scheduled (i.e. not stopped early)? | Yes | |
| Inconsistency | 1. Point estimates did not vary widely? | No (some variability) (↓) |
| 2. To what extent did confidence intervals overlap (substantial: all confidence intervals overlap at least 1 of the included studies point estimate; some: confidence intervals overlap but not all overlap at least 1 point estimate; no: at least 1 outlier, where the confidence intervals of some of the studies do not overlap with those of most included studies)? | Some | |
| 3. Was the direction of effect consistent? | No (↓) | |
| 4. What was the magnitude of statistical heterogeneity (as measured by I2) ‐ low (I2 < 40%), moderate (I2 40% to 60%), high (I2 > 60%)? | Low | |
| 5. Was the test for heterogeneity statistically significant (P < 0.1)? | No | |
| Indirectness | 1. Were the populations in included studies applicable to the decision context? | Yes |
| 2. Were the interventions in the included studies applicable to the decision context? | Yes | |
| 3. Was the included outcome not a surrogate outcome? | No (however relevant risk factors) | |
| 4. Was the outcome timeframe sufficient? | Yes | |
| 5. Were the conclusions based on direct comparisons? | Yes | |
| Imprecision | 1. Was the confidence interval for the pooled estimate not consistent with benefit and harm? | No (↓) |
| 2. What is the magnitude of the median sample size (high: 300 participants, intermediate: 100‐300 participants, low: <100 participants)?a | Intermediate (103 participants) | |
| 3. What was the magnitude of the number of included studies (large: > 10 studies, moderate: 5 to 10 studies, small: < 5 studies)?a | Moderate | |
| 4. Was the outcome a common event (e.g. occurs more than 1/100)? | N/A | |
| Publication bias | 1. Was a comprehensive search conducted? | Yes |
| 2. Was grey literature searched? | No | |
| 3. Were no restrictions applied to study selection on the basis of language? | No | |
| 4. There was no industry influence on studies included in the review? | Some industry support but all declared | |
| 5. There was no evidence of funnel plot asymmetry? | N/A | |
| 6. There was no discrepancy in findings between published and unpublished trials? | N/A | |
| aDepends on the context of the systematic review area. (↓): key item for potential downgrading the quality of the evidence (GRADE) as shown in the footnotes of the 'Summary of findings' table(s); N/A: not applicable | ||
Appendix 2. Search strategies for previous versions of this review
MEDLINE OVID (previous version of this review)
1. wholegrain$.ab,ti.
2. wholemeal$.ab,ti.
3. wholewheat$.ab,ti.
4. (whole adj3 grain$).ab,ti.
5. (whole adj3 meal).ab,ti.
6. (whole adj3 wheat).ab,ti.
7. (whole adj3 food$).ab,ti.
8. (wheat adj3 meal).ab,ti.
9. cereal$.ab,ti.
10. bread$.ab,ti.
11. wheat$.ab,ti.
12. oat$.ab,ti.
13. rye$.ab,ti.
14. barley$.ab,ti.
15. maize$.ab,ti.
16. corn.ab,ti.
17. cornmeal.ab,ti.
18. popcorn.ab,ti.
19. sorghum$.ab,ti.
20. (bulgar or bulghar).ab,ti.
21. couscous$.ab,ti.
22. grain$.ab,ti.
23. porridge.ab,ti.
24. rice$.ab,ti.
25. millet$.ab,ti.
26. exp CEREALS/
27. exp BREAD/
28. exp Dietary Fiber/
29. exp Coronary Disease/
30. exp Cardiovascular Diseases/
31. heart disease$.tw.
32. coronary disease$.tw.
33. chd.tw.
34. cardiovascular.tw.
35. angina.tw.
36. cvd.tw.
37. exp CHOLESTEROL/
38. exp Blood Pressure/
39. exp Obesity/
40. exp Insulin Resistance/
41. exp Diabetes Mellitus/
42. exp LIPIDS/
43. insulin resistance.ab,ti.
44. insulin sensitivity.ab,ti.
45. (glyc?emic adj3 control).ab,ti.
46. or/1‐28
47. or/29‐45
48. 46 and 47
Embase OVID (previous version of this review)
1. wholegrain$.ab,ti.
2. wholemeal$.ab,ti.
3. wholewheat$.ab,ti.
4. (whole adj3 grain$).ab,ti.
5. (whole adj3 meal$).ab,ti.
6. (whole adj3 wheat).ab,ti.
7. (whole adj3 food$).ab,ti.
8. (wheat adj3 meal).ab,ti.
9. cereal$.ab,ti.
10. bread.ab,ti.
11. breads.ab,ti.
12. wheat$.ab,ti.
13. oat$.ab,ti.
14. rye$.ab,ti.
15. barley$.ab,ti.
16. maize.ab,ti.
17. corn.ab,ti.
18. cornmeal.ab,ti.
19. popcorn.ab,ti.
20. sorghum$.ab,ti.
21. (bulgar or bulghar).ab,ti.
22. couscous.ab,ti.
23. grain.ab,ti.
24. grains.ab,ti.
25. porridge.ab,ti.
26. exp Cereal/
27. exp BREAD/
28. exp Dietary Fiber/
29. exp Coronary Artery Disease/
30. exp Cardiovascular Disease/
31. heart disease$.tw.
32. coronary disease$.tw.
33. chd.tw.
34. cardiovascular.tw.
35. angina.tw.
36. cvd.tw.
37. exp CHOLESTEROL/
38. exp Blood Pressure/
39. exp OBESITY/
40. exp Insulin Resistance/
41. (glyc?emic adj3 control).ab,ti.
42. exp Diabetes Mellitus/
43. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28
44. 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42
45. 43 and 44
46. Controlled Study/
47. Clinical Trial/
48. random$.tw.
49. compar$.ab,ti.
50. control$.ab,ti.
51. study.ab,ti.
52. follow$ up.ab,ti.
53. clinic$.ab,ti.
54. blind$.ab,ti.
55. Double Blind Procedure/
56. double$.ab,ti.
57. 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56
58. 45 and 57
59. limit 58 to human
CINAHL (previous version of this review)
1. wholegrain$.ab,ti.
2. wholemeal$.ab,ti.
3. wholewheat$.ab,ti.
4. (whole adj3 grain$).ab,ti.
5. (whole adj3 meal).ab,ti.
6. (whole adj3 wheat).ab,ti.
7. (whole adj3 food$).ab,ti.
8. (wheat adj3 meal).ab,ti.
9. cereal$.ab,ti.
10. bread$.ab,ti.
11. wheat$.ab,ti.
12. oat$.ab,ti.
13. rye$.ab,ti.
14. barley$.ab,ti.
15. maize$.ab,ti.
16. corn.ab,ti.
17. cornmeal.ab,ti.
18. popcorn.ab,ti.
19. sorghum$.ab,ti.
20. (bulgar or bulghar).ab,ti.
21. couscous$.ab,ti.
22. grain$.ab,ti.
23. porridge.ab,ti.
24. rice$.ab,ti.
25. millet$.ab,ti.
26. exp CEREALS/
27. exp BREAD/
28. exp Dietary Fiber/
29. exp Coronary Disease/
30. exp Cardiovascular Diseases/
31. heart disease$.tw.
32. coronary disease$.tw.
33. chd.tw.
34. cardiovascular.tw.
35. angina.tw.
36. cvd.tw.
37. exp CHOLESTEROL/
38. exp Blood Pressure/
39. exp Obesity/
40. exp Insulin Resistance/
41. exp Diabetes Mellitus/
42. exp LIPIDS/
43. insulin resistance.ab,ti.
44. insulin sensitivity.ab,ti.
45. (glyc?emic adj3 control).ab,ti.
46. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 26 or 27 or 28
47. 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 43 or 44 or 45
48. 46 and 47
49. clinical trial.pt.
50. exp Clinical Trials/
51. (clin$ adj25 trial$).tw.
52. ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$ or mask$)).tw.
53. exp PLACEBOS/
54. placebo$.tw.
55. random$.tw.
56. exp Evaluation Research/
57. exp Prospective Studies/
58. exp Random Assignment/
59. exp Random Sample/
60. exp Crossover Design/
61. exp Comparative Studies/
62. 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or 58 or 59 or 60 or 61
63. 48 and 62
CENTRAL (previous version of this review)
1. wholegrain$.af.
2. wholemeal$.af.
3. wholewheat$.af.
4. (whole adj3 grain$).af.
5. (whole adj3 meal$).af.
6. (whole adj3 wheat$).af.
7. (whole adj3 food$).af.
8. (wheat adj3 meal$).af.
9. cereals.af.
10. bread$.af.
11. wheat$.af.
12. oat$.af.
13. rye$.af.
14. barley$.af.
15. maize$.af.
16. corn.af.
17. cornmeal.af.
18. popcorn.af.
19. sorghum$.af.
20. (bulgar or bulghar).af.
21. couscous$.af.
22. grain$.af.
23. porridge$.af.
24. (rice$:ti or rice$:ab).af.
25. millet$.af.
26. cereals.sh.
27. bread.sh.
28. dietary fiber.sh.
29. (diet$ adj fiber$).af.
30. (diet$ adj fiber$).af.
31. or/1‐30
32. cardiovascular diseases.sh.
33. (heart adj disease$).af.
34. chd.af.
35. (coronary adj3 disease$).af.
36. cardiovascular.af.
37. angina.af.
38. cvd.af.
39. cholesterol.sh.
40. cholesterol.tw.
41. (blood adj pressure).af.
42. blood pressure.sh.
43. hypertension.sh.
44. hypertension.tw.
45. obesity.sh.
46. obesity.tw.
47. obese.af.
48. insulin resistance.af.
49. (insulin adj resistance).af.
50. (metabolic adj syndrome).af.
51. diabetes mellitus.sh.
52. diabetes.af.
53. (insulin adj sensitivity).af.
54. (glycemic adj3 control).af.
55. (glycaemic adj3 control).af.
56. hyperlipidemia.af.
57. hyperlipidaemia.af.
58. hyperlipidemia.sh.
59. or/32‐58
60. 31 and 59
1. wholegrain$.af.
2. wholemeal$.af.
3. wholewheat$.af.
4. (whole adj3 grain$).af.
5. (whole adj3 meal$).af.
6. (whole adj3 wheat$).af.
7. (whole adj3 food$).af.
8. (wheat adj3 meal$).af.
9. cereals.af.
10. bread$.af.
11. wheat$.af.
12. oat$.af.
13. rye$.af.
14. barley$.af.
15. maize$.af.
16. corn.af.
17. cornmeal.af.
18. popcorn.af.
19. sorghum$.af.
20. (bulgar or bulghar).af.
21. couscous$.af.
22. grain$.af.
23. porridge$.af.
24. (rice$:ti or rice$:ab).af.
25. millet$.af.
26. cereals.sh.
27. bread.sh.
28. dietary fiber.sh.
29. (diet$ adj fiber$).af.
30. (diet$ adj fiber$).af.
31. or/1‐30
32. cardiovascular diseases.sh.
33. (heart adj disease$).af.
34. chd.af.
35. (coronary adj3 disease$).af.
36. cardiovascular.af.
37. angina.af.
38. cvd.af.
39. cholesterol.sh.
40. cholesterol.tw.
41. (blood adj pressure).af.
42. blood pressure.sh.
43. hypertension.sh.
44. hypertension.tw.
45. obesity.sh.
46. obesity.tw.
47. obese.af.
48. insulin resistance.af.
49. (insulin adj resistance).af.
50. (metabolic adj syndrome).af.
51. diabetes mellitus.sh.
52. diabetes.af.
53. (insulin adj sensitivity).af.
54. (glycemic adj3 control).af.
55. (glycaemic adj3 control).af.
56. hyperlipidemia.af.
57. hyperlipidaemia.af.
58. hyperlipidemia.sh.
59. or/32‐58
60. 31 and 59
ProQuest Digital Dissertations (previous version of this review)
AB (wholegrain*) or AB (wholemeal) or AB (grain*) or AB (wheat*) or AB (cereal*) or AB ( bread* ) or AB (oat*) or AB (rye*) or AB (barley*) or AB (maize*) or AB (corn*) or AB ( sorghum*) or AB (bulgar*) or AB (bulghar*) or AB (couscous*) or AB (grain*) or AB (porridge*) or AB ( rice*) or AB (millet*)
Appendix 3. Search strategies for this updated review
CENTRAL
#1wholegrain*
#2wholemeal*
#3wholewheat*
#4(whole near/3 meal*)
#5(whole near/3 food*)
#6cereal*
#7bread*
#8wheat*
#9oat*
#10rye*
#11barley*
#12maize*
#13corn
#14cornmeal
#15popcorn
#16sorghum*
#17bulgar or bulghar
#18couscous*
#19grain*
#20porridge*
#21rice*
#22millet*
#23MeSH descriptor: [Cereals] explode all trees
#24MeSH descriptor: [Bread] this term only
#25MeSH descriptor: [Dietary Fiber] explode all trees
#26(diet* next fiber*)
#27bulgur
#28roughage*
#29triticale
#30farro
#31emmer
#32einkorn
#33spelt
#34quinoa
#35amaranth
#36teff
#37#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10
#38#11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20
#39#21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30
#40#31 or #32 or #33 or #34 or #35 or #36
#41#37 or #38 or #39 or #40
#42#37 or #38 or #39 or #40
#43MeSH descriptor: [Cardiovascular Diseases] explode all trees
#44heart near/2 disease*
#45coronary near/3 disease*
#46chd
#47cardiovascular
#48angina
#49cvd
#50MeSH descriptor: [Cholesterol] explode all trees
#51cholesterol
#52blood near/2 pressure
#53MeSH descriptor: [Blood Pressure] explode all trees
#54MeSH descriptor: [Hypertension] explode all trees
#55hypertensi*
#56MeSH descriptor: [Obesity] explode all trees
#57obes*
#58insulin next resistan*
#59metabolic next syndrome*
#60MeSH descriptor: [Diabetes Mellitus] explode all trees
#61diabetes
#62insulin next sensitiv*
#63glycemic near/3 control*
#64glycaemic near/3 control*
#65MeSH descriptor: [Hyperlipidemias] explode all trees
#66MeSH descriptor: [Overweight] explode all trees
#67MeSH descriptor: [Glucose Metabolism Disorders] explode all trees
#68MeSH descriptor: [Hyperinsulinism] explode all trees
#69cardio* near/6 risk*
#70overweight
#71over‐weight
#72hdl or ldl
#73hyperlip*
#74lipid*
#75hyperglycem*
#76hyperglycaem*
#77#43 or #44 or #45 or #46 or #47 or #48 or #49 or #50 or #51 or #52
#78#53 or #54 or #55 or #56 or #57 or #58 or #59 or #60 or #61 or #62
#79#63 or #64 or #65 or #66 or #67 or #68 or #69 or #70 or #71 or #72 or #73 or #74 or #75 or #76
#80#77 or #78 or #79
#81#42 and #80
MEDLINE Ovid
1. wholegrain*.tw.
2. wholemeal*.tw.
3. wholewheat*.tw.
4. (whole adj3 meal*).tw.
5. (whole adj3 food*).tw.
6. cereal*.tw.
7. bread*.tw.
8. wheat*.tw.
9. oat*.tw.
10. rye*.tw.
11. barley*.tw.
12. maize*.tw.
13. corn.tw.
14. cornmeal.tw.
15. popcorn.tw.
16. sorghum*.tw.
17. (bulgar or bulghar).tw.
18. couscous*.tw.
19. grain*.tw.
20. porridge.tw.
21. rice*.tw.
22. millet*.tw.
23. exp Dietary Fiber/
24. Bread/
25. exp Cereals/
26. bulgur.tw.
27. (dietary adj2 fiber*).tw.
28. roughage*.tw.
29. triticale.tw.
30. farro.tw.
31. emmer.tw.
32. einkorn.tw.
33. spelt.tw.
34. quinoa.tw.
35. amaranth.tw.
36. teff.tw.
37. or/1‐36
38. exp Cardiovascular Diseases/
39. (heart adj2 disease*).tw.
40. (coronary adj2 disease*).tw.
41. chd.tw.
42. cardiovascular.tw.
43. angina*.tw.
44. cvd.tw.
45. exp Cholesterol/
46. exp blood pressure/
47. exp Obesity/
48. exp Hyperinsulinism/
49. exp Hyperlipidemias/
50. exp Glucose Metabolism Disorders/
51. insulin resistan*.tw.
52. insulin sensitiv*.tw.
53. (glyc?emic adj3 control).tw.
54. exp Hypertension/
55. exp Overweight/
56. (cardio* adj6 risk*).tw.
57. (blood adj2 pressure).tw.
58. overweight.tw.
59. obes*.tw.
60. over‐weight.tw.
61. cholesterol.tw.
62. (hdl or ldl).tw.
63. hyperlip*.tw.
64. lipid*.tw.
65. hyperglyc?em*.tw.
66. hypertens*.tw.
67. diabet*.tw.
68. or/38‐67
69. 37 and 68
70. randomized controlled trial.pt.
71. controlled clinical trial.pt.
72. randomized.ab.
73. placebo.ab.
74. drug therapy.fs.
75. randomly.ab.
76. trial.ab.
77. groups.ab.
78. 70 or 71 or 72 or 73 or 74 or 75 or 76 or 77
79. exp animals/ not humans.sh.
80. 78 not 79
81. 69 and 80
Embase Ovid
1. wholegrain*.tw.
2. wholemeal*.tw.
3. wholewheat*.tw.
4. (whole adj3 meal*).tw.
5. (whole adj3 food*).tw.
6. cereal*.tw.
7. bread*.tw.
8. wheat*.tw.
9. oat*.tw.
10. rye*.tw.
11. barley*.tw.
12. maize*.tw.
13. corn.tw.
14. cornmeal.tw.
15. popcorn.tw.
16. sorghum*.tw.
17. (bulgar or bulghar).tw.
18. couscous*.tw.
19. grain*.tw.
20. porridge.tw.
21. exp cereal/
22. dietary fiber/
23. rice*.tw.
24. millet*.tw.
25. bulgur.tw.
26. (dietary adj2 fiber*).tw.
27. roughage*.tw.
28. triticale.tw.
29. farro.tw.
30. emmer.tw.
31. einkorn.tw.
32. spelt.tw.
33. quinoa.tw.
34. amaranth.tw.
35. teff.tw.
36. or/1‐35
37. exp coronary artery disease/
38. exp cardiovascular disease/
39. (heart adj2 disease*).tw.
40. (coronary adj2 disease*).tw.
41. chd.tw.
42. cardiovascular.tw.
43. angina*.tw.
44. cvd.tw.
45. exp cholesterol/
46. exp blood pressure/
47. exp Obesity/
48. exp "disorders of carbohydrate metabolism"/
49. (glyc?emic adj3 control).tw.
50. insulin resistan*.tw.
51. insulin sensitiv*.tw.
52. exp Hypertension/
53. exp Overweight/
54. (cardio* adj6 risk*).tw.
55. (blood adj2 pressure).tw.
56. overweight.tw.
57. obes*.tw.
58. over‐weight.tw.
59. cholesterol.tw.
60. (hdl or ldl).tw.
61. hyperlip*.tw.
62. lipid*.tw.
63. hyperglyc?em*.tw.
64. hypertens*.tw.
65. exp hyperinsulinism/
66. exp hyperlipidemia/
67. diabet*.tw.
68. or/37‐67
69. 36 and 68
70. random$.tw.
71. factorial$.tw.
72. crossover$.tw.
73. cross over$.tw.
74. cross‐over$.tw.
75. placebo$.tw.
76. (doubl$ adj blind$).tw.
77. (singl$ adj blind$).tw.
78. assign$.tw.
79. allocat$.tw.
80. volunteer$.tw.
81. crossover procedure/
82. double blind procedure/
83. randomized controlled trial/
84. single blind procedure/
85. 70 or 71 or 72 or 73 or 74 or 75 or 76 or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84
86. (animal/ or nonhuman/) not human/
87. 85 not 86
88. 69 and 87
89. limit 88 to embase
CINAHL Plus
S68 S37 AND S67
S67 S38 or S39 or S40 or S41 or S42 or S43 or S44 or S45 or S46 or S47 or S48 or S49 or S50 or S51 or S52 or S53 or S54 or S55 or S56 or S57 or S58 or S59 or S60 or S61 or S62 or S63 or S64 or S65 or S66
S66TI diabet* or AB diabet*
S65 TI hypertens* or AB hypertens*
S64 TI hyperglycaem* or AB hyperglycaem*
S63 TI hyperglycem* or AB hyperglycem*
S62 TI lipid* or AB lipid*
S61 TI hyperlip* or AB hyperlip*
S60 (TI hdl or ldl) or (AB hdl or ldl)
S59 TI cholesterol or AB cholesterol
S58 TI obes* or AB obes*
S57 TI over‐weight or AB over‐weight
S56 TI overweight or AB overweight
S55 TI blood N2 pressure or AB blood N2 pressure
S54 TI cardio* N6 risk* or AB cardio* N6 risk*
S53 (MH "Hypertension")
S52 TI glycaemic N3 control* or AB glycaemic N3 control*
S51 TI glycemic N3 control* or AB glycemic N3 control*
S50 TI insulin N2 sensitiv* or AB insulin N2 sensitiv*
S49 TI insulin N2 resist* or AB insulin N2 resist*
S48 (MH "Metabolic Diseases+")
S47 (MH "Obesity")
S46 (MH "Blood Pressure+")
S45 (MH "Cholesterol")
S44 TI cvd or AB cvd
S43 TI angina* or AB angina*
S42 TI cardiovascular or AB cardiovascular
S41 TI chd or AB chd
S40 (TI coronary N2 disease*) or (AB coronary N2 disease*)
S39 (TI heart N2 disease*) or (AB heart N2 disease*)
S38 (MH "Cardiovascular Diseases+")
S37 S1 or S2 or S3 or S4 or S5 or S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17 or S18 or S19 or S20 or S21 or S22 or S23 or S24 or S25 or S26 or S27 or S28 or S29 or S30 or S31 or S32 or S33 or S34 or S35 or S36
S36 TI teff or AB teff
S35 TI amaranth or AB amaranth
S34 TI quinoa or AB quinoa
S33 TI spelt or AB spelt
S32 TI einkorn or AB einkorn
S31 TI emmer or AB emmer
S30 TI farro or AB farro
S29 TI triticale or AB triticale
S28 TI roughage* or AB roughage*
S27 TI dietary N2 fiber* or AB dietary N2 fiber*
S26 TI bulgur or AB bulgur
S25 (MH "Dietary Fiber")
S24 (MH "Bread")
S23 (MH "Cereals+")
S22 TI millet* or AB millet*
S21 TI rice* or AB rice*
S20 TI porridge* or AB porridge*
S19 TI grain* or AB grain*
S18 TI couscous* or AB couscous*
S17 (TI bulgar or bulghar) or (AB bulgar or bulghar)
S16 TI sorghum* or AB sorghum*
S15 TI popcorn or AB popcorn
S14 TI cornmeal or AB cornmeal
S13 TI corn or AB corn
S12 TI maize* or AB maize*
S11 TI barley* or AB barley*
S10 TI rye* or AB rye*
S9 TI oat* or AB oat*
S8 TI wheat* or AB wheat*
S7 TI bread* or AB bread*
S6 TI cereal* or AB cereal*
S5 (TI whole N3 food*) or (AB whole N3 food*)
S4 (TI whole N3 meal*) or (AB whole N3 meal*)
S3 TI wholewheat* or AB wholewheat*
S2 TI wholemeal* or AB wholemeal*
S1 TI wholegrain* or AB wholegrain*
ClinicalTrials.gov
Search terms: cardiovascular diseases, diet (under interventions), limited to interventions, adults and seniors, all study results chosen.
World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/)
Search terms: cardiovascular disease (condition), diet (intervention)
Study flow diagram for updated searches 2016.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: Whole grain versus control, Outcome 1: Body weight change (kg)
Comparison 1: Whole grain versus control, Outcome 2: BMI change
Comparison 1: Whole grain versus control, Outcome 3: Total cholesterol change (mmol/L)
Comparison 1: Whole grain versus control, Outcome 4: LDL cholesterol change (mmol/L)
Comparison 1: Whole grain versus control, Outcome 5: HDL cholesterol change (mmol/L)
Comparison 1: Whole grain versus control, Outcome 6: Triglycerides change (mmol/L)
Comparison 1: Whole grain versus control, Outcome 7: Systolic blood pressure change (mmHg)
Comparison 1: Whole grain versus control, Outcome 8: Diastolic blood pressure (mmHg)
| Whole grain cereals for the primary prevention of cardiovascular disease (no studies were available to examine secondary prevention) | ||||||
| Patient or population: Free‐living adults who were healthy, had established cardiovascular disease or risk factors for cardiovascular disease Control: Refined grains or lower levels of wholegrain | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect | No. of participants | Quality of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Refined grains or lower levels of whole grain dietary intake | Refined grains or higher levels of whole grain dietary intake | |||||
| Total cardiovascular mortality | See comment | See comment | See comment | See comment | See comment | No trials reported total CVD mortality for the primary prevention of CVD. |
| Fatal and non‐fatal myocardial infarction | See comment | See comment | See comment | See comment | See comment | No trials reported total myocardial infarction for the primary prevention of CVD. |
| Unstable angina | See comment | See comment | See comment | See comment | See comment | No trials reported unstable angina for the primary prevention of CVD. |
| Coronary artery bypass graft surgery | See comment | See comment | See comment | See comment | See comment | No trials reported coronary artery bypass graft surgery for the primary prevention of CVD. |
| Percutaneous transluminal coronary angioplasty | See comment | See comment | See comment | See comment | See comment | No trials reported percutaneous transluminal coronary angioplasty for the primary prevention of CVD. |
| Stroke | See comment | See comment | See comment | See comment | See comment | No trials reported total stroke for the primary prevention of CVD. |
| Total cholesterol change (mmol/L) Follow‐up: 12 to 16 weeks | The mean total cholesterol change ranged across lower levels of whole grain dietary intake groups from ‐0.4 to 0.3. | The mean total cholesterol change (mmol/L) in the intervention groups was 0.07 higher | ‐ | 722 | ⊕⊕⊝⊝ | See Appendix 1 for total cholesterol change checklist. |
| Abbreviations: CI: confidence interval; CVD: cardiovascular disease | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1The term 'whole grain' includes foods based on milled whole grains, such as wholemeal or oatmeal. | ||||||
| Study ID | Dietary component | Whole grain | Control | P value |
|---|---|---|---|---|
| Energy (kJ/day) | Baseline: Not reported Data are change from baseline. Intervention 1 (lower WG) Wk 8: 379 (SD/SEM NR) Wk 16: 387 (SD/SEM NR) Intervention 2 (higher WG) Wk 8: ‐399 (SD/SEM NR) Wk 16: 587 (SD/SEM NR) | Baseline: Not reported Data are change from baseline. Wk 8: ‐430 (SD/SEM NR) Wk 16: ‐679 (SD/SEM NR) | Intervention 1 (lower WG) Wk 8: 0.015 Wk 16: NS Intervention 2 (higher WG) Wk 8: 0.32 Wk 16: 0.005 | |
| Carbohydrate (g/day) | Baseline: Not reported Data are change from baseline. Intervention 1 (lower WG) Wk 8: 22.6 (SD/SEM NR) Wk 16: 37.1 (SD/SEM NR) Intervention 2 (higher WG) Wk 8: 14.8 (SD/SEM NR) Wk 16: 53.8 (SD/SEM NR) | Baseline: Not reported Data are change from baseline. Wk 8: ‐1.97 (SD/SEM NR) Wk 16: ‐14.8 (SD/SEM NR) | Intervention 1 (lower WG) 0.004 0.007 Intervention 2 (higher WG) 0.026 < 0.001 | |
| Fat (g/day) | Baseline: Not reported Data are change from baseline. Intervention 1 (lower WG) Wk 8: 0.245 (SD/SEM NR) Wk 16: ‐2.96 (SD/SEM NR) Intervention 2 (higher WG) Wk 8: ‐8.12 (SD/SEM NR) Wk 16: ‐1.63 (SD/SEM NR) | Baseline: Not reported Data are change from baseline. Wk 8: ‐2.87 (SD/SEM NR) Wk 16: ‐4.05 (SD/SEM NR) | Intervention 1 (lower WG) NS NS Intervention 2 (higher WG) NS NS | |
| Protein (g/day) | Baseline: Not reported Data are change from baseline. Intervention 1 (lower WG) Wk 8: 6.15 (SD/SEM NR) Wk 16: 5.05 (SD/SEM NR) Intervention 2 (higher WG) Wk 8: 1.75 (SD/SEM NR) Wk 16: 6.99 (SD/SEM NR) | Baseline: Not reported Data are change from baseline. Wk 8: ‐3.17 (SD/SEM NR) Wk 16: ‐4.25 (SD/SEM NR) | Intervention 1 (lower WG) NS NS Intervention 2 (higher WG) NS NS | |
| NSP/fibre (g/day) | Baseline: Not reported Data are change from baseline. Intervention 1 (lower WG) Wk 8: 4.69 (SD/SEM NR) Wk 16: 5.70 (SD/SEM NR) Intervention 2 (higher WG) Wk 8: 6.23 (SD/SEM NR) Wk 16: 11.0 (SD/SEM NR) | Baseline: Not reported Data are change from baseline. Wk 8: ‐0.144 (SD/SEM NR) Wk 16: ‐0.438 (SD/SEM NR) | Intervention 1 (lower WG) < 0.001 < 0.001 Intervention 2 (higher WG) < 0.001 < 0.001 | |
| Whole grain (g/day) | Working definition of whole grain product: commercially available whole grain products readily available in the UK, ranging from 34 to 80.8 g/100 g dry weight or 11.2 g cooked weight of whole grain Data approximated from graph; SD/SEM not available. Intervention 1 (lower WG) (mean intake g/day) Wk 8: 75 Wk 16: 70 Intervention 2 (higher WG) (mean intake g/day) Wk 8: 80 Wk 16: 115 | Data taken from graph; SD/SEM not available. < 20 g/day (mean intake g/day) | NR NR | |
| Energy (kilocalories/day) | Baseline: 1702 (SEM 62) Wk 12: 1900 (SEM 57) | Baseline: 1719 (SEM 63) Wk 12: 1965 (SEM 57) | NR NS | |
| Carbohydrate (% E) | Baseline: 46 (SEM 0.6) Wk 12: 48 (SEM 0.6) | Baseline: 48 (SEM 0.7) Wk 12: 49 (SEM 0.6) | NR NS | |
| Fat (% E) | Baseline: 33.5 (SEM 0.6) Wk 12: 31 (SEM 0.7) | Baseline: 31.8 (SEM 0.6) Wk 12: 30.8 (SEM 0.7) | NR NS | |
| Protein (% E) | Baseline: 18 (SEM 0.4) Wk 12: 18.7 (SEM 0.3) | Baseline: 18 (SEM 0.4) Wk 12: 17.8 (SEM 0.3) | NR < 0.05 | |
| Fibre (g/day) | Total fibre Baseline: 22.7 (SEM 0.8) Wk 12: 32.6 (SEM 0.7) Cereal fibre Baseline: 11.9 (SEM 0.8) Wk 12: 24.3 (SEM 0.9) | Total fibre Baseline: 21.6 (SEM 0.8) Wk 12: 19.8 (SEM 0.7) Cereal fibre Baseline: 11.4 (SEM 0.6) Wk 12: 10.4 (SEM 0.3) | NR < 0.05 NR < 0.05 | |
| Whole grain (g/day) Whole grain level (plasma total alkylresorcinol concentration nmol/L) | Study states that Working definition of whole grain: 51% whole grain per day, dry weight was used according to HealthGrain forum definition and analysis of whole grain but no data reported for wholegrain levels. However plasma total alkylresorcinol as a proxy for wholegrain content was reported as below: | NR ‐19.7 (n = 26) | NR 88.3 (n = 28) | |
| Energy (kilocalories/day) | Calculated from menus. All food provided. 86% compliance reported. Mean/day 2079 | Mean/day 2023 | NR | |
| Carbohydrate (g/day) | 299 | 280 | NR | |
| Fat (g/day) | 62 | 64 | NR | |
| Protein (g/day) | 97 | 90 | NR | |
| Fibre (g/day) | 38 | 22 | NR | |
| Whole grain (g/day) | Working definition of whole grain: whole grain products made from milled flour were required to have > 51% of dry weight from whole grain flour. When possible, whole grain products with the 100% whole grain stamp were selected, which indicated that each grain serving contained at least 16 g whole grain and used 100% whole grain flour. Whole grain content of diets ranged from 163 to 301 g/day, as energy content of diets were adjusted for individual requirements. Energy of diets was 1600 to 3600 kilocalories/day. Based on energy intake of 2100 kilocalories/day, typical whole grains supplied were 187 g/day (7 servings/day). | 0 servings/day 0 g/day | NR NR | |
| Energy (kilocalories/day) | Baseline: 1967 (SD 545) Wk 4: 1812 (SD 505) Wk 8: 1744 (SD 533) Wk 12: 1611 (SD 377) | Baseline: 2265 (SD 744) Wk 4: 1616 (SD 468) Wk 8: 1562 (SD 398) Wk 12: 1575 (SD 500) | NS | |
| Carbohydrate (% E) | Baseline: 47.8 (SD 8.3) Wk 4: 54.0 (SD 7.1) Wk 8: 53.9 (SD 9.1) Wk 12: 54.6 (SD 6.8) | Baseline: 47.5 (SD 8.7) Wk 4: 49.6 (SD 10.7) Wk 8: 47.5 (SD 10.2) Wk 12: 49.9 (SD 9.7) | NS | |
| Fat (% E) | Baseline: 35.4 (SD 5.9) Wk 4: 28.7 (SD 6.6) Wk 8: 29.6 (SD 7.2) Wk 12: 27.8 (SD 6.9) | Baseline: 36.2 (SD 6.8) Wk 4: 32.3 (SD 8.4) Wk 8: 33.8 (SD 8.5) Wk 12: 30.5 (SD 8.0) | NS | |
| Protein (% E) | Baseline: 16.9 (SD 3.2) Wk 4: 18.2 (SD 2.7) Wk 8: 18.4 (SD 3.4) Wk 12: 19.1 (SD 4.3) | Baseline: 16.5 (SD 3.2) Wk 4: 18.7 (SD 4.5) Wk 8: 19.2 (SD 4.8) Wk 12: 20.0 (SD 4.8) | NS | |
| Fibre (g/1000 kilocalories) | Baseline: 8.6 (SD 3.7) Wk 4: 12.6 (SD 3.2) Wk 8: 13.3 (SD 3.4) Wk 12: 12.9 (SD 2.2) | Baseline: 9.1 (SD 3.7) Wk 4: 10.0 (SD 3.0) Wk 8: 9.5 (SD 2.0) Wk 12: 9.7 (SD 3.5) | Significant difference between WG and RG at wks 8 and 12 (P < 0.05) | |
| Whole grain (g/day) | Definition of whole grain product: "grain product was identified as a wholegrain if a wholegrain was listed as the first ingredient on the food label". Data taken from graph so approximate: 1 serving whole grain equivalent to 1 slice wholemeal bread, or 28 g (1 oz ready‐to‐eat cereal), or 1/2 cup cooked cereal, rice, or pasta (2005 dietary guidelines for Americans). Baseline: 1.5 servings/day Wk 12: 5 servings/day | Baseline: ~1.5 servings/day Week 12: 0.2 servings/day | NR | |
| Energy (kJ/day) | Wks 1 to 6: 5830 (SEM 190) Wks 7 to 12: 6060 (SEM 150) | Wks 1 to 6: 5900 (SEM 280) Wks 7 to 12: 6330 (SEM 180) | NR NR | |
| Carbohydrate (g/day) | 86.8 | 95.8 | NR | |
| Fat (g/day) | 6.8 | 6.6 | NR | |
| Protein (g/day) | 16.6 | 16.0 | NR | |
| Fibre (g/day) | 11.0 | 4.5 | NR | |
| Whole grain (g/day) Alkylresorcinol (mg/day) | Working definition of whole grain: mean whole grain intake: 105 g/day 25.5 | Mean whole grain intake: 0 g/day AR: 3.1 | NR | |
| Energy (kJ/day) | Baseline: 6995 ± 2373 Wk 12: 7654 ± 2395 | Baseline: 7282 ± 2011 Wk 12: 8533 ± 1693 | 0.119 | |
| Carbohydrate (% E/day) | Baseline: 45.6 ± 6.3 Wk 12: 47.2 ± 7.5 | Baseline: 47.8 ± 5.6 Wk 12: 47.3 ± 5.1 | 0.268 | |
| Fat (% E/day) | Baseline: 33.6 ± 5.2 Wk 12: 3 ± 6.3 | Baseline: 31.3 ± 5.3 Wk 12: 31.9 ± 5.9 | 0.012 | |
| Protein (% E/day) | Baseline: 19.1 ± 3.2 Wk 12: 18.8 ± 2.5 | Baseline: 18.8 ± 3.7 Wk 12: 18.3 ± 2.5 | 0.950 | |
| Fibre (g/day) | Baseline: 24.6 ± 7.0 Wk 12: 26.5 ± 5.4 | Baseline: 22.5 ± 7.0 Wk 12: 18.0 ± 4.2 | 2.7x107 | |
| Whole grain (g/day) | Working definition of whole grain: whole grain breads and a bread with low glycaemic index products covered 20% to 25% of total energy intake and were delivered to the participants. The fibre contents of the breads were 6.9% (endosperm rye bread), 6.4% (whole grain wheat bread), and 10% to 14% (commercial whole grain rye breads). Wholemeal pasta. | Refined wheat breads and other cereal products with low fibre. Participants were allowed to eat maximum of 1 to 2 portions of rye products per day. | ‐ | |
| Energy (kilocalories/day) | Baseline: 1939 (SEM 97) Wk 4: 1563 (SEM 50) Wk 12: 1529 (SEM 44) | Baseline: 1853 (SEM 70) Wk 4: 1395 (SEM 44) Wk 12: 1443 (SEM 45) | 0.690 0.009 0.256 | |
| Carbohydrate (% E) | Baseline: 44.8 (SEM 0.9) Wk 4: 50.6 (SEM 0.9) Wk 12: 52.2 (SEM 0.9) | Baseline: 45.6 (SEM 1.2) Wk 4: 49.8 (SEM 1.0) Wk 12: 49.8 (SEM 1.0) | 0.660 0.625 0.017 | |
| Total fat (% E) | Baseline: 36.9 (SEM 0.8) Wk 4: 30.4 (SEM 0.9) Wk 12: 29.6 (SEM 0.8) | Baseline: 35.6 (SEM 0.8) Wk 4: 30.0 (SEM 0.8) Wk 12: 29.8 (SEM 0.7) | 0.297 0.697 0.718 | |
| Protein (% E) | Baseline: 18.2 (SEM 0.5) Wk 4: 20.1 (SEM 0.5) Wk 12: 19.7 (SEM 0.5) | Baseline: 17.9 (SEM 0.6) Wk 4: 20.0 (SEM 0.6) Wk 12: 20.1 (SEM 0.6) | 0.330 0.971 0.623 | |
| Fibre (g/day) | Baseline: 15.8 (SEM 1.0) Wk 4: 21.0 (SEM 0.5) Wk 12: 21.7 (SEM 0.5) | Baseline: 14.8 (SEM 0.8) Wk 4: 11.8 (SEM 0.6) Wk 12: 12.7 (SEM 0.6) | 0.612 < 0.001 < 0.001 | |
| Whole grain (g/day) | Working definition of whole grain: the whole grain used was a whole grain oat ready‐to‐eat cereal (Cheerios, General Mills, Minneapolis, MN), 2 portions per day (approximately 80 g/day), containing equivalent of 3 g oat β‐glucan. | ‐ | ‐ | |
| Energy (kilocalories/day) | Whole grain wheat group Baseline: 2115 (SEM 64) Wk 12: 2121 (SEM 75) Whole grain wheat + oats group Baseline: 2115 (SEM 58) Wk 12: 2142 (SEM 69) | Baseline: 2036 (SEM 79) Wk 12: 2080 (SEM 83) | Baseline: 0.650 Wk 12: 0.843 | |
| Carbohydrate (g/day) | Whole grain wheat group Baseline: 256 (SEM 9) Wk 12: 253 (SEM 9) Whole grain wheat + oats group Baseline: 252 (SEM 7) Wk 12: 243 (SEM 8) | Baseline: 238 (SEM 10) Wk 12: 245 (SEM 10) | Baseline: 0.324 Wk 12: 0.633 | |
| Fat (g/day) | Whole grain wheat group Baseline: 80.8 (SEM 2.8) Wk 12: 79.7 (SEM 3.3) Whole grain wheat + oats group Baseline: 78.6 (SEM 2.9) Wk 12: 82.1 (SEM 3.5) | Baseline: 78.7 (SEM 3.6) Wk 12: 79.9 (SEM 4.3) | Baseline: 0.847 Wk 12: 0.871 | |
| Protein (g/day) | Whole grain wheat group Baseline: 85.2 (SEM 3.0) Wk 12: 89.1 (SEM 3.5) Whole grain wheat + oats group Baseline: 83.1 (SEM 2.4) Wk 12: 87.0 (SEM 2.8) | Baseline: 81.3 (SEM 2.9) Wk 12: 84.0 (SEM 2.4) | Baseline: 0.627 Wk 12: 0.496 | |
| Fibre (NSP) (g/day) | Whole grain wheat group Baseline: 12.3 (SEM 0.4) Wk 12: 18.5 (SEM 0.5) Whole grain wheat + oats group Baseline: 12.4 (SEM 0.4) Wk 12: 16.8 (SEM 0.5) | Baseline: 10.9 (SEM 0.5) Wk 12: 11.3 (SEM 0.4) | Baseline: 0.049 Wk 12: < 0.001 | |
| Whole grain (g/day) | Working definition of whole grain: not reported Whole grain wheat group 3 servings whole grain foods: 70 to 80 g wholemeal bread and 30 to 40 g whole grain cereals/day Whole grain wheat + oats group 3 servings whole grain foods: 1 serving whole grain wheat products and 2 servings whole grain oat foods/day | ‐ | ‐ | |
| Energy (MJ/day) | Brown rice Baseline: 8.72 (SD 2.30) Wk 4: 8.31 (SD 1.75) Wk 8: 8.05 (SD 1.89) Wk 12: 8.00 (SD 1.86) Wk 16: 8.22 (SD 1.80) | White rice Baseline: 8.65 (SD 2.38) Wk 4: 8.16 (SD 2.23) Wk 8: 8.25 (SD 2.01) Wk 12: 8.46 (SD 2.04) Wk 16: 8.60 (SD 2.01) | ‐ | |
| Carbohydrate (% E) | Brown rice Baseline: 53.9 (SD 7.3) Wk 4: 53.3 (SD 6.5) Wk 8: 52.9 (SD 5.5) Wk 12: 51.8 (SD 7.0) Wk 16: 51.6 (SD 7.3) | White rice Baseline: 54.9 (SD 7.2) Wk 4: 51.8 (SD 6.4) Wk 8: 53.8 (SD 6.3) Wk 12: 52.8 (SD 5.8) Wk 16: 53.3 (SD 6.8) | ‐ | |
| Fat (% E) | Brown rice Baseline: 32.5 (SD 6.7) Wk 4: 32.3 (SD 5.9) Wk 8: 33.0 (SD 4.5) Wk 12: 34.2 (SD 6.4) Wk 16: 35.0 (SD 6.4) | White rice Baseline: 31.7 (SD 6.4) Wk 4: 33.1 (SD 6.2) Wk 8: 31.5 (SD 5.8) Wk 12: 32.7 (SD 5.7) Wk 16: 32.7 (SD 6.6) | ‐ | |
| Protein (% E) | Brown rice Baseline: 15.8 (SD 2.8) Wk 4: 17.2 (SD 2.8) Wk 8: 17.0 (SD 3.1) Wk 12: 16.8 (SD 2.7) Wk 16: 16.1 (SD 2.8) | White rice Baseline: 15.7 (SD 2.7) Wk 4: 17.4 (SD 2.8) Wk 8: 17.0 (SD 2.7) Wk 12: 16.7 (SD 2.4) Wk 16: 16.0 (SD 2.2) | ‐ | |
| Fibre (g/1000 kJ) | Brown rice Baseline: 1.34 (SD 0.49) Wk 4: 1.65 (SD 0.40) Wk 8: 1.69 (SD 0.42) Wk 12: 1.64 (SD 0.42) Wk 16: 1.57 (SD 0.51) | White rice Baseline: 1.32 (SD 0.38) Wk 4: 1.34 (SD 0.42) Wk 8: 1.37 (SD 0.49) Wk 12: 1.28 (SD 0.39) Wk 16: 1.20 (SD 0.39) | ‐ | |
| Whole grain (g/day) | Authors stated that the brown rice was a whole grain in the paper, and Table 1 of the paper reports nutrient comparison of the brown rice versus the white rice used in the study. | ‐ | ‐ | |
| % E: percentage energy | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Body weight change (kg) Show forest plot | 5 | 439 | Mean Difference (IV, Fixed, 95% CI) | ‐0.41 [‐1.04, 0.23] |
| 1.2 BMI change Show forest plot | 5 | 516 | Mean Difference (IV, Fixed, 95% CI) | ‐0.12 [‐0.24, 0.01] |
| 1.3 Total cholesterol change (mmol/L) Show forest plot | 7 | 722 | Mean Difference (IV, Fixed, 95% CI) | 0.07 [‐0.07, 0.21] |
| 1.4 LDL cholesterol change (mmol/L) Show forest plot | 8 | 770 | Mean Difference (IV, Fixed, 95% CI) | 0.06 [‐0.05, 0.16] |
| 1.5 HDL cholesterol change (mmol/L) Show forest plot | 8 | 772 | Mean Difference (IV, Fixed, 95% CI) | ‐0.02 [‐0.05, 0.01] |
| 1.6 Triglycerides change (mmol/L) Show forest plot | 8 | 771 | Mean Difference (IV, Fixed, 95% CI) | 0.03 [‐0.08, 0.13] |
| 1.7 Systolic blood pressure change (mmHg) Show forest plot | 8 | 768 | Mean Difference (IV, Fixed, 95% CI) | 0.04 [‐1.67, 1.75] |
| 1.8 Diastolic blood pressure (mmHg) Show forest plot | 8 | 768 | Mean Difference (IV, Fixed, 95% CI) | 0.16 [‐0.89, 1.21] |
