Biomedical subjects

D R Jacobs

Publications and source records attributed to D R Jacobs.

At least 73 records · Page 4Linked to original sources

PubMed1999

Seven-year changes in physical fitness, physical activity, and lipid profile in the CARDIA study. Coronary Artery Risk Development in Young Adults.

PURPOSE: To relate seven year changes in physical fitness and physical activity in the young adult population to changes in the plasma lipid profile and to examine the influence of weight change on those relationships. METHODS: The participants in this observational study were the 1777 black and white men and women, ages 18-30 at entry into the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, who completed a symptom-limited graded treadmill exercise test and had an overnight fasting blood draw at both the Baseline (1985-86) and Year 7 (1992-93) exams. CARDIA, a longitudinal study of the relationships of lifestyle and physiological variables to the development of coronary heart disease risk factors, consists of population-based cohorts in Birmingham, Alabama, Minneapolis, Minnesota and Chicago, Illinois and a cohort recruited from the membership of a large, pre-paid health care plan, broadly representative of the population, in Oakland, California. RESULTS: All race/gender groups experienced mean decreases in physical fitness and self-reported physical activity and increases in weight. Decreased fitness was associated with decreased high density lipoprotein-cholesterol (HDL-C), and conversely, increased fitness was associated with increased HDL-C. The correlation coefficients of change in fitness with change in HDL-C ranged from 0.17 in white men and black women to 0.24 in white women (P < 0.001 for all race/gender groups). Change in fitness was minimally correlated with change in low density lipoprotein-cholesterol (LDL-C) in all groups (r ranged from -0.09 in black women to -0.20 in white women), triglycerides (TG) in men and white women (r ranged from -0.10 to -0.15), and total cholesterol (TC) in white men and women (r = -0.11 and -0.15, respectively). The magnitude of these correlations was further reduced with adjustment for weight change. Correlations between change in activity and change in lipid and lipoprotein values were generally weak or nonexistent, except for the suggestion of a small, direct relationship with change in HDL-C in black and white women (r = 0.14 and r = 0.11, respectively). All of the weight change adjusted correlations were essentially unaffected by further adjustment for baseline fitness or activity and other covariates. CONCLUSIONS: Decreased fitness during young adulthood is associated with unfavorable changes in lipid profile, explained mostly by increased weight. Lack of association between change in activity and change in lipid profile observed in this study may be due, in part, to imprecision of activity measurement.

Adolescent↗

PubMed1999

Intra-individual variation and estimates of usual physical activity.

PURPOSE: The magnitude of intra-individual variation, as determined by three methods of physical activity (PA) assessment, was estimated to determine the optimal number of repeated measures needed to reliably measure an individual's usual PA habits. METHODS: Data were obtained from 77 healthy adults enrolled in the Survey of Activity, Fitness, and Exercise (SAFE). PA was measured by: 1) Caltrac accelerometers worn 48-hours every 26 days for one year; 2) concurrent 48-hour PA records (PARs); and 3) a corresponding series of four-week PA histories (FWH). Repeated measures regression analyses were used to analyze the data. RESULTS: PA tended to be slightly higher in the summer months as compared with the winter months, but this seasonality explained little of the intra-individual variation. The intra-individual standard deviation (SD) estimated for the FWH (180 MET-min(d(-1))) was 39% of the mean annual MET-min(d(-1)), as compared with the Caltrac (163 MET-mind(d(-1)) or 9%) and PAR (259 MET-min(d(-1)) or 11%). Given the intra-individual variation, three repeated observations of the FWH, six Caltrac, or nine PAR over the course of the year were needed to achieve 80% reliability in estimation of mean annual PA. CONCLUSIONS: Intra-individual variation in PA is substantial and must be accounted for in estimates of usual PA.

Adult↗

PubMed1999

Ten-year incidence of elevated blood pressure and its predictors: the CARDIA study. Coronary Artery Risk Development in (Young) Adults.

Few prospective studies have examined associations of lifestyle factors or variables in the insulin resistance syndrome (syndrome X) with incidence of elevated blood pressure (BP) in black subjects and women. This report estimates the 10-year incidence of high blood pressure (HBP) and high normal blood pressure (HNBP) in the biracial cohort of the Coronary Artery Risk Development in (Young) Adults Study (CARDIA), and examines lifestyle factors and four syndrome X variables, measured at baseline, as predictors. CARDIA examined 5115 black and white men and women aged 18-30 years in 1985-1986, and re-examined them at 2, 5, 7, and 10 years. The 10-year incidence of HBP was 16.4% in black men, 7.8% in white men, 13.1% in black women, and 3.2% in white women, while the 10-year incidence of HBP or HNBP was 29.5%, 16.2%, 19.2%, and 6.3%, respectively, in the four sex-race subgroups. Predictors included body mass index, waist circumference, physical activity, alcohol intake, pulse rate, cigarette smoking, education, fasting insulin, triglycerides, uric acid, and high-density lipoprotein cholesterol, as well as age and systolic BP. In univariate analyses, each of these variables was significantly related to incidence in at least one of the four sex-race groups. In multivariate analyses that included control for age and systolic pressure, independent predictors included fasting insulin in white men and women, triglycerides in white men, uric acid and pulse rate in black men, waist circumference in white men and black women, and education (inverse) in white men and black and white women. These results suggest that lower socioeconomic status, as assessed by education level, and one or more syndrome X variables, ie, fasting insulin, triglycerides, uric acid, may be associated with development of elevated BP in young adults.

Adult↗

PubMed1999

Cereals, legumes, and chronic disease risk reduction: evidence from epidemiologic studies.

There is growing evidence that cereals and legumes play important roles in the prevention of chronic diseases. Early epidemiologic studies of these associations focused on intake of dietary fiber rather than intake of grains or legumes. Generally, these studies indicated an inverse association between dietary fiber intake and risk of coronary artery disease; this observation has been replicated in recent cohort studies. Studies that focused on grain or cereal intake are fewer in number; these tend to support an inverse association between intake of whole grains and coronary artery disease. Studies on the association of dietary fiber with colon and other cancers have generally shown inverse relations, but whether these relations are attributable to cereals, other fiber sources, or other factors is less clear. Although legumes have been shown to lower blood cholesterol concentrations, epidemiologic studies are few and inconclusive regarding the association of legumes with risk of coronary artery disease. It has been hypothesized that legumes, in particular soybeans, reduce the risk of some cancers, but epidemiologic studies are equivocal in this regard. Overall, there is substantial epidemiologic evidence that dietary fiber and whole grains are associated with decreased risk of coronary artery disease and some cancers, whereas the role of legumes in these diseases appears promising but as yet inconclusive.

Chronic Disease↗

PubMed1999

Plausible mechanisms for the protectiveness of whole grains.

Dietary guidelines recommend the consumption of whole grains to prevent chronic diseases. Epidemiologic studies support the theory that whole grains are protective against cancer, especially gastrointestinal cancers such as gastric and colon can-cer, and cardiovascular disease. Components in whole grains that may be protective include compounds that affect the gut environment, such as dietary fiber, resistant starch, and oligosaccharides. Whole grains are also rich in compounds that function as antioxidants, such as trace minerals and phenolic compounds, and phytoestrogens, with potential hormonal effects. Other potential mechanisms whereby whole grains may protect against disease include binding of carcinogens and modulation of the glycemic response. Clearly, the range of protective substances in whole grains is impressive and advice to consume additional whole grains is justified. Further study is needed regarding the mechanisms behind this protection so that the most potent protective components of whole grains will be maintained when developing whole grains into acceptable food products for the public.

Cardiovascular Diseases↗

PubMed1999

Refined-cereal intake and risk of selected cancers in italy.

BACKGROUND: Although consumption of whole-grain foods seems to reduce the risk of several types of neoplasms, the potential influence of a diet rich in starches and refined grains is less clear. OBJECTIVE: We studied the relation between the frequency of consumption of refined cereals (bread, pasta, or rice) and the risk of selected neoplasms. DESIGN: This was an integrated series of case-control studies conducted in northern Italy between 1983 and 1993. The subjects were patients admitted to the major teaching and general hospitals in Milan and Pordenone with incident, histologically confirmed cancers: 343 with cancer of the oral cavity and pharynx, 94 with cancer of the esophagus, 146 with cancer of the larynx, 745 with cancer of the stomach, 955 with cancer of the colon, 625 with cancer of the rectum, and 428 with cancer of the thyroid. The control subjects were 3526 patients admitted to the same network of hospitals for acute nonneoplastic conditions unrelated to long-term modification of diet. Odds ratios (ORs) for consecutive tertiles of refined-cereal consumption were computed after allowance for sociodemographic variables, education, smoking status, alcohol consumption, body mass index, and consumption of fruit, vegetables, and whole-grain foods. RESULTS: The ORs for the highest tertile of refined-cereal intake were 1.6 for cancer of the oral cavity, pharynx, esophagus, or larynx; 1.5 for stomach cancer; 1.5 for colon cancer; 1.3 for cancer of the rectum; and 2.0 for thyroid cancer. The trends in risk were significant for all neoplasms considered. CONCLUSION: Consumption of refined cereals was associated with an increased risk of cancers of the large bowel, the stomach, and other selected digestive and nondigestive sites.

Adult↗

PubMed1999

Heart rate and subsequent blood pressure in young adults: the CARDIA study.

The objective of the present study was to examine the hypothesis that baseline heart rate (HR) predicts subsequent blood pressure (BP) independently of baseline BP. In the multicenter longitudinal Coronary Artery Risk Development in Young Adults study of black and white men and women initially aged 18 to 30 years, we studied 4762 participants who were not current users of antihypertensive drugs and had no history of heart problems at the baseline examination (1985-1986). In each race-sex subgroup, we estimated the effect of baseline HR on BP 2, 5, 7, and 10 years later by use of repeated measures regression analysis, adjusting for baseline BP, age, education, body fatness, physical fitness, fasting insulin, parental hypertension, cigarette smoking, alcohol consumption, oral contraceptive use, and change of body mass index from baseline. The association between baseline HR and subsequent systolic BP (SBP) was explained by multivariable adjustment. However, HR was an independent predictor of subsequent diastolic BP (DBP) regardless of initial BP and other confounders in white men, white women, and black men (0.7 mm Hg increase per 10 bpm). We incorporated the part of the association that was already present at baseline by not adjusting for baseline DBP: the mean increase in subsequent DBP was 1.3 mm Hg per 10 bpm in white men, white women, and black men. A high HR may be considered a risk factor for subsequent high DBP in young persons.

Adolescent↗

PubMed1999

Is whole grain intake associated with reduced total and cause-specific death rates in older women? The Iowa Women's Health Study.

OBJECTIVES: This study sought to determine whether nutrient-rich whole grains reduce mortality risk. METHODS: The study included 38,740 Iowa women, aged 55 to 69 years. A food frequency questionnaire was used to obtain data on grain intake. RESULTS: Median whole grain intake quintiles ranged from a median of 0.2 to more than 3 servings per day. Women with higher intakes had healthier lifestyles and less baseline disease. The total death rate decreased in increasing quintiles, and the pattern repeated for cancer, cardiovascular disease, and other causes combined. Adjusted for lifestyle and baseline disease, the relative hazard rate ratio for total death was about 0.85 in daily consumers of whole grain. Findings persisted in strata of baseline healthy and diseased and were not explained by dietary fiber. Rates of total mortality, but not cardiovascular disease mortality, were higher among frequent consumers of refined grain. CONCLUSIONS: Total mortality risk was inversely associated with whole grain intake and positively associated with refined grain intake. Refined grains contributed more than 20% of energy intake, and whole grains contributed 1%. Substitution of whole for refined grain may reduce chronic disease risk in the United States.

Aged↗

PubMed1999

Insulin resistance during puberty: results from clamp studies in 357 children.

Insulin resistance may be an important cause of a constellation of cardiovascular risk factors in adults, and onset of this syndrome may occur in childhood. However, children normally experience transient insulin resistance at puberty. There were 357 normal children (159 girls, 198 boys) age 10-14 years who underwent euglycemic clamp studies to assess the effects of Tanner stage (T), sex, ethnicity, and BMI on insulin resistance. Insulin resistance increased immediately at the onset of puberty (T2), but returned to near prepubertal levels by the end of puberty (T5). Its peak occurred at T3 in both sexes, and girls were more insulin resistant than boys at all T stages. White boys appeared to be more insulin resistant than black boys; no difference was seen between white and black girls. Insulin resistance was strongly related to BMI, triceps skinfold thickness, and waist circumference, and this relationship was independent of Tanner stage or sex. Differences in BMI and adiposity did not, however, entirely explain the insulin resistance of puberty. These results demonstrate that 1) significant differences in insulin resistance are present between boys and girls; 2) insulin resistance increases significantly at T2, T3, and T4, but decreases to near prepubertal levels at T5; and 3) while insulin resistance is related to BMI and anthropometric measures of fatness, these factors do not completely explain the insulin resistance that occurs during the Tanner stages of puberty.

Adolescent↗

PubMed1998

Whole grain food intake and cancer risk.

The relationship between frequency of consumption of whole grain food and risk of selected neoplasms has been analysed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1996. The overall dataset included the following incident, histologically confirmed neoplasms: oral cavity and pharynx 181, oesophagus 316, stomach 745, colon 828, rectum 498, liver 428, gallbladder 60, pancreas 362, larynx 242, breast 3,412, endometrium 750, ovary 971, prostate 127, bladder 431, kidney 190, thyroid 208, Hodgkin's disease 80, non-Hodgkin's lymphomas 200, multiple myelomas 120. Controls were 7,990 patients admitted to hospital for acute, non-neoplastic conditions, unrelated to long-term modifications in diet and not likely to have been caused by tobacco or alcohol use. Odds ratios (OR) for subsequent scores (never/occasional/frequent) of whole grain food consumption were derived after allowance for age, sex, education, smoking, alcohol intake and body mass index. High intake of whole grain foods consistently reduced risk of neoplasm at all sites, except thyroid. The ORs for the highest category of consumption were 0.2-0.3 for upper digestive and respiratory tract neoplasms, 0.5 for stomach, colon and gallbladder, 0.7 for rectum, 0.6 for liver, 0.8 for pancreas and prostate, 0.9 for breast and endometrium, 0.6 for ovary, 0.4 for bladder and kidney, 1.3 for thyroid and around 0.5 for lymphomas and myeloma. The tests for trend in risks were significant for all neoplasms, except pancreas, endometrium, Hodgkin's disease and multiple myeloma. No significant heterogeneity was found across strata of age at diagnosis, sex, education, smoking habit, alcohol intake and body mass index. Thus, even in the absence of a univocal and satisfactory biological interpretation, the consistency of the patterns observed indicate that, in this population, higher frequency of whole grain food intake is an indicator of reduced risk of several neoplasms.

Adult↗

PubMed1998

Validation of death certificate diagnosis of out-of-hospital sudden cardiac death.

The validity of death certificate diagnosis of out-of-hospital sudden cardiac death (OOH-SCD) was studied among 108,676 30- to 74-year-old residents in 5 Minnesota communities using 6-year mortality data (1985 to 1990). Among 4,244 total deaths, location of death was listed on the certificate as out of hospital in 2,035 cases. Of those, 911 were judged not to have OOH-SCD because they had actually been admitted to the hospital or were noncardiovascular deaths. Among the remaining 1,124, 254 were diagnosed as OOH-SCD using a thorough, physician-based procedure that used clinical records, autopsy reports, and an informant (next-of-kin) interview. We used only death certificate information to define OOH-SCD simply and inexpensively as ICD-9 code 427.5 (cardiac arrest) plus location of death listed as out-of-hospital. Compared with the physician diagnosis, sensitivity was only 24%, whereas specificity was 85%. When the definition of OOH-SCD was expanded to include ICD codes 410-414 (acute myocardial infarction and chronic coronary artery disease), sensitivity improved to 87%, whereas specificity became 66%. However, even with this higher sensitivity and specificity, only 27% of the cases labeled OOH-SCD by death certificate agreed with the physician diagnosis. Death certificate diagnosis of OOH-SCD included many erroneous cases, and may not have been suitable for study of etiologic factors, such as cardiac dysrhythmias. Death certificate diagnosis may be useful to assess population time trends in OOH-SCD, provided that misclassification (false-positive rate) remains constant over time.

Adult↗

PubMed1998

Association between serum total cholesterol and HIV infection in a high-risk cohort of young men.

Low serum total cholesterol (TC) is associated with a variety of nonatherosclerotic diseases, but the association of TC with infectious disease has been little studied. In this study, we examined the relationship between serum TC and HIV infection in members of a large health maintenance organization in Northern California. The cohort consisted of 2446 unmarried young men 15 to 49 years of age at high risk of HIV infection, defined as self-reported history of sexually transmitted disease or liver disease. Baseline measurements were taken between 1979 and 1985, and subjects were passively followed for HIV infection until the end of 1993 (average length of follow-up, 7.7 years). From a multivariate-adjusted Cox regression, the rate ratio (RR) of HIV infection was 1.66 (95% CI = 1.07, 2.56) for men with serum TC levels <160 mg/dl compared with those with TC levels between 160 and 199 mg/dl. Similar excess risk of AIDS and AIDS-related death was observed. These findings suggest that low serum TC levels should be considered a marker of increased risk of HIV infection in men already at heightened risk of HIV infection.

Adolescent↗

PubMed1998

Clustering of cardiovascular risk factors in hyperinsulinemia in Japanese without diabetes.

Clustering of cardiovascular risk factors in hyperinsulinemia was investigated in 247 Japanese subjects without diabetes. After adjustment for age and sex, the highest quartile of the summed values of insulin concentrations after oral glucose loading showed high odds ratios (OR; 95% confidence intervals) for the prevalence of cardiovascular risk factors: OR = 2.02 (1.07-3.83) for hypertension, 3.91 (1.82-8.40) for hypertriglyceridemia, 2.41 (1.30-4.46) for low high-density lipoprotein cholesterol, 2.41 (1.28-4.51) for impaired glucose tolerance, and 3.58 (1.44-8.88) for high uric acid. Two or more of these factors were clinically elevated in 50% of those in the highest quartile of the summed values of insulin, compared to 16-28% of those in the lower three quartiles. These findings were slightly attenuated after further adjustment for body mass index and sum of skinfolds. In conclusion, multiple risk factors for cardiovascular disease existed in the subjects with hyperinsulinemia in Japanese without diabetes.

Adult↗

PubMed1998

Relationship between changes in dietary sucrose and high density lipoprotein cholesterol: the CARDIA study. Coronary Artery Risk Development in Young Adults.

PURPOSE: Cross-sectional data from several observational studies have suggested that dietary sucrose may be inversely associated with high density lipoprotein cholesterol (HDL-C). This study examined associations between energy from dietary sucrose and HDL-C at baseline, year 7 and longitudinally (year 7 minus baseline) in a cohort of young black and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS: The sample included 4734 black men, black women, white men and white women, ages 18-30 years, in 1985-86 (baseline); 3513 at year 7; and 3335 for longitudinal analyses. Multivariate analyses was used with adjustment for age, BMI, cigarettes smoked per day, physical activity score, and alcohol intake. RESULTS: Multivariate analyses indicated that energy intake from sucrose was inversely associated with HDL-C for each race-gender group at baseline, year 7, and longitudinally from baseline to year 7. This association was significant at baseline for black men, and white men and women (p < 0.01); at year 7 for white men and black women (p < 0.01), and longitudinally for white men, white women, and black women (p < 0.05). CONCLUSIONS: The consistent inverse associations between energy from dietary sucrose and HDL-C observed in both cross-sectional and longitudinal analyses, and in different race and gender groups in CARDIA suggest that lowering dietary sucrose intake may be beneficial for those who may have low HDL-C.

Adolescent↗

PubMed1998

Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases.

A multiethnic cohort of adult members of the Kaiser Permanente Medical Care Program (55300 men and 65271 women) was followed for 15 years (1979-93) to assess the association between total cholesterol and risk of infections (other than respiratory and HIV) diagnosed in the in-patient setting. Using multivariate Cox regression, total cholesterol was inversely and significantly related to urinary tract, venereal, musculo-skeletal, and all infections among men; and to urinary tract, all genito-urinary, septicaemia or bacteraemia, miscellaneous viral site unspecified, and all infections among women. The reduction of risk of all infections associated with a 1 S.D. increase in total cholesterol was 8% in both men (95% CI, 4-12 %) and women (95% CI, 5-11%). For urinary tract infections among men, as for septicaemia or bacteraemia and nervous system infections among women, the risk relation was restricted to persons aged 55-89 years. Nervous system infections were positively related to total cholesterol among women aged 25-54. In both genders, the significant inverse association with all infections persisted after excluding the first 5 years of follow-up. Collectively, these data are suggestive of an inverse association, although not entirely consistent, between total cholesterol and incidence of infections either requiring hospitalization or acquired in the hospital. Further research is needed to elucidate whether these associations are biologically plausible or represent uncontrolled confounding by unmeasured risk factors.

Adult↗

PubMed1998

Whole-grain intake and cancer: an expanded review and meta-analysis.

Whole grains are nutrient rich and may protect against chronic disease. To study this, we previously reviewed 14 case-control studies of colorectal, gastric, and endometrial cancers and found consistently lower risk in those with high than in those with low whole-grain intake. Questions remained concerning other cancers, dietary assessment, quantity consumed, confounding, and differential study quality. Here we expand the review to 40 case-control studies of 20 cancers and colon polyps. Odds ratios are < 1 for 46 of 51 mentions of whole-grain intake and for 43 of 45 after exclusion of 6 mentions with design/reporting flaws or low intake. The pooled odds ratio for high vs. low whole-grain intake among the 45 mentions was 0.66 (95% confidence interval = 0.60-0.72); they range from 0.59 to 0.78 across four types of dietary questionnaires. Odds ratios were < 1 in 9 of 10 mentions of studies of colorectal cancers and polyps, 7 of 7 mentions of gastric and 6 of 6 mentions of other digestive tract cancers, 7 of 7 mentions of hormone-related cancers, 4 of 4 mentions of pancreatic cancer, and 10 of 11 mentions of 8 other cancers. Most pooled odds ratios for specific cancers were in the range of 0.5-0.8, notable exceptions being breast (0.86) and prostate (0.90). The pooled odds ratio was similar in studies that adjusted for few and many covariates. Dose-response associations were stronger in studies using food-frequency questionnaires than in more quantitative questionnaires. The case-control evidence is supportive of the hypothesis that whole-grain intake protects against various cancers.

Adult↗

PubMed1998

Cellular immune responses to four doses of percutaneous bacille Calmette-Guérin in healthy adults.

To explore the hypothesis that low-dose immunization might induce preferential Th1 cell immunity, 76 adults were vaccinated with one of four doses of bacille Calmette-Guérin (BCG): The doses contained very low (1.6 x 10(5) cfu), low (3.2 x 10(6) cfu), standard (1.6 x 10(8) cfu), or high (3.2 x 10(8) cfu) levels of BCG. Delayed-type hypersensitivity responses occurred 8 weeks after vaccination in 10% of persons given very low or low doses of BCG, compared with 95% and 100% of persons given standard or high doses, respectively. Lymphoproliferative responses, which were increased only for high-dose vaccinees, peaked 2 weeks after vaccination and were directed chiefly against Mycobacterium tuberculosis-secreted proteins, particularly the antigen 85 complex. Significant increases in mycobacteria-specific interferon-gamma expression were present 16 weeks after vaccination only for persons given standard or high doses of BCG. Percutaneous BCG appears capable of inducing a temporary Th1-like immune response, but standard or higher dosages are required.

Administration, Cutaneous↗

PubMed1998

Whole-grain intake may reduce the risk of ischemic heart disease death in postmenopausal women: the Iowa Women's Health Study.

BACKGROUND: A recent review of epidemiologic literature found consistently reduced cancer and heart disease rates in persons with high compared with low whole-grain intakes. OBJECTIVE: We hypothesized that whole-grain intake was associated with a reduced risk of ischemic heart disease (IHD) death. DESIGN: We studied 34,492 postmenopausal women aged 55-69 y and free of IHD at baseline in 1986. There were 438 IHD deaths between baseline and 1995. Usual dietary intake was determined with use of a 127-item food-frequency questionnaire. RESULTS: Whole-grain intake in median servings/d was 0.2, 0.9, 1.2, 1.9, and 3.2 for quintiles of intake. The unadjusted rate of IHD death was 2.0/1 x 10(3) person-years in quintile 1 and was 1.7, 1.2, 1.0, and 1.4 IHD deaths/1 x 10(3) person-years in succeeding quintiles (P for trend < 0.001). Adjusted for demographic, physiologic, behavioral, and dietary variables, relative hazards were 1.0, 0.96, 0.71, 0.64, and 0.70 in ascending quintiles (P for trend = 0.02). The lower risk with higher whole-grain intake was not explained by intake of fiber or several other constituents of whole grains. CONCLUSION: A clear inverse association between whole-grain intake and risk of IHD death existed. A causal association is plausible because whole-grain foods contain many phytochemicals, including fiber and antioxidants, that may reduce chronic disease risk. Whole-grain intake should be studied further for its potential to prevent IHD and cancer.

Aged↗