Healthcare Cost Savings Associated with Increased Whole Grain Consumption among Australian Adults

Many dietary guidelines emphasise “mostly” whole grain food choices as part of an overall healthy eating pattern based on evidence for enhancing nutritional status and reducing chronic disease. Still, countries including Australia fall short of their consumption targets. Furthermore, healthcare cost savings associated with increasing the consumption of whole grains in alignment with the Daily Target Intake (DTI) recommendation of 48 g are unknown. The aim of this study was to assess the potential savings in costs of healthcare and lost productivity associated with a reduction in the incidence of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease (CVD) through meeting the 48 g DTI recommendation for whole grains among the Australian adult population (>20 years). A three-step cost-of-illness analysis was conducted using input parameters from: 1) estimates of proportions of consumers (5%, 15%, 50%, and 100%) who would increase their current intake of whole grains to meet the recommended DTI in Australia; 2) relative reductions in risk of T2DM and CVD associated with specific whole grain consumption, as reported in meta-analysis studies; and 3) data on costs of healthcare and productivity loss based on monetary figures by national healthcare authorities. A very pessimistic (5% of the population) through to universal (100% of the population) adoption of the recommended DTI was shown to potentially yield AUD 37.5 (95% CI 22.3–49.3) to AUD 750.7 (95% CI 445.7–985.2) million, and AUD 35.9 (95% CI 8.3–60.7) to AUD 717.4 (95% CI 165.5–1214.1) million in savings on annual healthcare and lost productivity costs for T2DM and CVD, respectively. Given such economic benefits of the recommended consumption of whole grains, in exchange for refined grains, there is a real opportunity to facilitate relevant socioeconomic cost-savings for Australia and reductions in disease. These results are suggestive of a much greater opportunity to communicate the need for dietary change at all levels, but particularly through food-based dietary guidelines and front-of-pack labelling initiatives.

Download Full-text

Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States

Nutrients ◽

10.3390/nu12082323 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2323

Author(s):

Mary M. Murphy ◽

Jordana K. Schmier

Keyword(s):

Health Economic ◽

Direct Medical Cost ◽

Healthcare Cost ◽

Medical Cost ◽

Cost Savings ◽

The United States ◽

Whole Grains ◽

Dietary Guidelines ◽

Potential Health ◽

One Year

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

Download Full-text

Dietary intakes of whole grains, health benefits but do contaminants pose a major risk?

Proceedings of The Nutrition Society ◽

10.1017/s0029665120003845 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Anne Nugent ◽

Frank Thielecke

Keyword(s):

Heavy Metals ◽

Whole Grains ◽

Dietary Guidelines ◽

Food Storage ◽

Dietary Intakes ◽

Whole Grain ◽

Food Category ◽

Carbohydrate Source ◽

Potential Health ◽

The Impact

AbstractIntroductionThere is a long history of use for whole grain cereals as part of human dietary intakes with records of dietary grain consumption from the Middle Stone Ages. Whole grains are nutrient dense and research demonstrates that the healthiest diets (those associated with reduced risk of non-communicable diseases e.g. cardiovascular disease or cancer) are characterised by higher intake of fruit, vegetables, nuts and legumes and whole grains and lower intakes of red and processed meats. Currently, grains are a main energy and carbohydrate source and as such form a cornerstone of food based dietary guidelines and dietary guidance globally. However, grains also naturally contain contaminants and as a food category can represent a significant dietary source of foodborne contaminants.Materials and MethodsThe outcomes of a narrative review on the major contaminants present in whole grains, their potential health risks and suggested strategies to mitigate any risk are described. Contaminants are limited to mycotoxins (aflatoxinB1, ochratoxin A, Fumonisin B1, deoxynivalenol, zearalenone), heavy metals (e.g. arsenic, cadmium, lead) and the process contaminant acrylamide.ResultsWhole grains can contain more contaminants than refined versions e.g. whole grain rice with bran intact can have up to 80% more arsenic than white rice. However, whole grains also provide more nutrients which may mitigate against the impact of these contaminants. For example, for heavy metals, there is some evidence that dietary fibres (e.g. wheat bran) may bind to them and reduce their absorption, as can nutrients naturally found in whole grains e.g. zinc, magnesium or copper. Minerals such as iron, calcium, magnesium and zinc may also impede heavy metal absorption by down-regulating or competing for attachment to transporters that facilitate intestinal absorption. Although, strict regulatory thresholds and monitoring processes by competent authorities minimise any risk to public health, the consumer may further lessen any risk through their own dietary choices and food storage and preparation practicesDiscussionThere are a number of potential health-protective properties inherent to whole grains. Given that complete elimination of contaminants from grains is unlikely to be achieved, their presence merits continued monitoring with evidence to date suggesting any such risk does not outweigh the known benefits of wholegrain consumption.

Download Full-text

Important Steps in Cancer Prevention: Improving Population Whole-Grain Intake—The Danish Show Case or How Was the Danish Whole-Grain Intake Doubled in Less Than 10 Years?

Journal of Global Oncology ◽

10.1200/jgo.18.73000 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 127s-127s

Author(s):

S. Toettenborg

Keyword(s):

Dietary Habits ◽

Adult Population ◽

Health Benefits ◽

Lessons Learned ◽

Dietary Guidelines ◽

Noncommunicable Diseases ◽

Whole Grain ◽

High Knowledge ◽

Program Policy ◽

The Impact

Background and context: Dietary whole grain (WG) intake helps prevent noncommunicable diseases (NCDs) such as cancers. However, 92.4% of the global adult population does not meet WG recommendations, and WG intake even decreased between 1990 and 2010. In Denmark, WG intake was similarly decreasing during the 1990s and 2000s, and the Whole Grain Partnership (WGP) was established in 2009 to counteract this development. Aim: To describe the development of this public-private partnership (PPP), the results achieved so far, lessons learned and implications for future initiatives. Strategy/Tactics: The strategy is twofold: increasing availability of WG and campaigning about the health benefits of WG. Program/Policy process: · Research and documentation of WG health benefits · Initiate partnership and functioning of organization and secretariat · Ensure clear WG definitions and dietary guidelines · Set targets and success criteria and monitor progress · Create incentives for industry to reformulate and develop new WG products and make it easy for consumers to identify WG product by developing and endorsing a WG logo · Gradually enriching all bread and flour with WG · Develop education materials for chefs, waiters, bakers, in-store personnel and health professionals · Yearly consumer campaigns. Outcomes: Mean WG intake has near doubled in less than 10 years (from 32 in 2009 to 61 g/day 2017). The increment in intake were also significant among the population groups eating the least WG. The number of WG products increased in this period from 150 to currently 800. Continuous monitoring of consumer behavior show a high knowledge, trust and use of the WG logo has increased during the period. What was learned: · To make the PPP work effectively it is crucial to work evidence based, set realistic targets, reinforce the reasons and advantages for partnering, measure and celebrate progress · The impact on population dietary habits is primarily due to the increased availability of WG product combined with a long-term campaigning activity promoting WG health benefits.

Download Full-text

Healthy Eating Index-2015 Is Associated with Grip Strength among the US Adult Population

Nutrients ◽

10.3390/nu13103358 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3358

Author(s):

Galya Bigman ◽

Alice S. Ryan

Keyword(s):

Grip Strength ◽

Healthy Eating ◽

Adult Population ◽

Cross Sectional Study ◽

Whole Grains ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Cross Sectional ◽

Lower Odds ◽

Nationally Representative

The Healthy Eating Index-2015 (HEI-2015) was designed to reflect adherence to the 2015–2020 Dietary Guidelines for Americans (DGA). The study aims to examine the association between HEI-2015 and grip strength in a nationally representative sample of the U.S. adult population. This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011–2014. Low grip strength was defined as <35.5 kg for men and <20 kg for women. HEI-2015 was computed from two days of 24-h dietary recalls and comprised 13 components. Each component was scored on the density out of 1000 calories and summed to a total score divided into quartiles. Weighted logistic regressions examined the study aim while controlling for associated covariates. The sample included 9006 eligible participants, of those, 14.4% (aged 20+ years), and 24.8% (aged ≥50 years) had low grip strength. Mean (±SD) HEI-2015 total score was 54.2 ± 13.6 and in the lowest and highest quartiles 37.3 ± 5.1 and 72.0 ± 6.5, respectively. In the multivariable model, participants in the highest vs. lowest HEI-2015 quartile had 24% lower odds of having low grip strength (Odds Ratio (OR) = 0.76; 95% CI: 0.60–0.96). Specifically, participants who met the DGA for protein intakes, whole grains, greens and beans, vegetables, or whole fruits had 20–35% lower odds of having low grip strength than those who did not. Higher compliance to the DGA might reduce the risk for low grip strength as a proxy measure for sarcopenia among U.S. adults, particularly adequate intakes of proteins, whole grains, greens and beans, vegetables, and whole fruits.

Download Full-text

Deriving Sustainable Food-Based Dietary Guidelines for Germany via Multidimensional Optimization: Insights to Operationalise the Diet-Health Dimension

Current Developments in Nutrition ◽

10.1093/cdn/nzab048_016 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 881-881

Author(s):

Anne Schäfer ◽

Rozenn Gazan ◽

Heiner Boeing ◽

Christina Breidenassel ◽

Typhaine Haurogne ◽

...

Keyword(s):

Environmental Impact ◽

Adult Population ◽

Whole Grains ◽

Red Meat ◽

Dietary Guidelines ◽

Sustainable Food ◽

Dietary Changes ◽

Food And Agriculture ◽

Life Years ◽

Optimization Methodology

Abstract Objectives Development of a diet optimization methodology, forming the next generation of food-based dietary guidelines (FBDG) in Germany, to identify dietary changes accounting for various dimensions: diet-health relations, environmental impact, and nutrient needs while staying culturally acceptable. Methods Three parameters define the German Nutrition Optimization Model (GNOM): The decision variables, which are observed food intakes (FoodEx2 food grouping); acceptability constraints (acceptability upper limits (AL) are set for foods based on P95), and the linear objective function. The latter consists of three components that are weighted between each other and minimizes environmental impact (greenhouse-gas emissions and land use), diet-related health burden (disability adjusted life years), and relative deviation from the observed dietary intake (cultural acceptability). Also, deviations from nutritional needs for 39 nutrients are minimized. Five models were run on the adult population by increasing weight on diet-health and decreasing weight on cultural acceptability progressively (by steps of 20%, from 0% in model 1 (M1) to 80% in model 5 (M5)), with a fixed environmental weight at 20%. Dietary changes are exemplary described for fruits, vegetables, whole grains and red meat. Results All models satisfied nutrient needs and, compared to the observed diet, increased in fruits, vegetables, and whole grains and decreased in red meat; dietary changes were higher with increasing weight on diet-health. Compared to the observed intake (174,4g/d), fruits increased moderately in M1–3 (205,7g/d - 338,8g/d) and reached the AL of 552g/d in M4 and M5. Vegetables reached the AL of 267g/d in every model (observed intake: 96,3g/d) except M1 (261,5g/d). Whole grains increased progressively from 13g/d in observed intake to 16,3g/d and 16,7g/d in M1 and M2, 61,9g and 67,9g in M3 and M4 and increased strongly to 250,7g/d in M5. The observed amount of red meat was 34,4g/d, which dropped from 2,5g/d in M1 to 0g/d in M5. Conclusions This methodology accounts for multidimensional requirements in FBDGs and is flexible regarding the importance given to each dimension. Preliminary results suggest that using this innovative approach to operationalize diet-health relations, GNOM is able to help derive German FBDG. Funding Sources German Federal Ministry of Food and Agriculture.

Download Full-text

Challenges and Opportunities Associated with Whole Grains Use in Twin Cities Restaurants: A Food Systems Perspective

Journal of Food Research ◽

10.5539/jfr.v8n4p44 ◽

2019 ◽

Vol 8 (4) ◽

pp. 44

Author(s):

Keagan Ringling ◽

Alexander Yangas ◽

Melissa Riley ◽

Renee Korczak ◽

Len Marquart

Keyword(s):

Focus Groups ◽

Food Systems ◽

Food System ◽

Whole Grains ◽

Dietary Guidelines ◽

Twin Cities ◽

Whole Grain ◽

Systems Perspective ◽

Challenges And Opportunities ◽

Minimal Effort

Increasing whole grain (WG) availability in restaurants allows consumers to make healthier choices with minimal effort while improving adherence to the Dietary Guidelines. To understand challenges associated with increasing WG availability in Twin Cities (Minneapolis & St. Paul, Minnesota, USA) restaurants, interviews and focus groups were conducted with 24 local, national, and international food system members. This report identifies food system barriers, including policy, business, and societal pressures, that limit availability of WG based foods in restaurants. Insight provided by this study allows consortium members from various sectors and disciplines to work on a precompetitive basis to include more WG in Twin Cities restaurants.

Download Full-text

Enhancing whole grain, fiber, and iron content of pancakes: Impacts on quality attributes and adult receptivity

Journal of Student Research ◽

10.47611/jsr.v4i2.185 ◽

2015 ◽

Vol 4 (2) ◽

pp. 36-43

Author(s):

Anna Marie Rose Hayes ◽

Sarah Catherine Howe ◽

Teri Burgess-Champoux

Keyword(s):

Daily Intake ◽

Nutrient Deficiency ◽

Whole Grains ◽

Dietary Guidelines ◽

Whole Grain ◽

Dietary Practices ◽

Preparation Methods ◽

Sorghum Flour ◽

Child Bearing ◽

Hedonic Scale

The 2010 Dietary Guidelines recommend that individuals increase their daily intake of whole grains and fiber, as research has shown these dietary practices help reduce the risk of high blood pressure, coronary heart disease, and diabetes. Iron deficiency is the most common nutrient deficiency in the world, and maintaining appropriate levels of iron is of particular concern for women who are capable of becoming pregnant. The purpose of this project was to develop a pancake product which contained enhanced levels of whole grains, fiber, and iron to address recent health concerns. A baseline pancake recipe was modified with soy milk, sorghum flour, and teff grain in varying ratios and preparation methods to formulate the best combination of all three into one pancake product. Sensory panelists from the Department of Nutrition and Exercise Sciences at St. Catherine University evaluated the baseline and enhanced pancakes for appearance, tenderness, taste, texture, and overall likeability on a hedonic scale of 1 (“very poor”) to 7 (“excellent”). Findings indicated a pancake product can achieve acceptable taste while providing 16 percent of the recommended values for both iron (18 g) and dietary fiber (25 mg) for women of child-bearing years. Further research is needed to develop a nutritionally superior pancake with improved appearance through further manipulation of modified ingredients.

Download Full-text

Whole Grain Intakes Are Associated with Healthcare Cost Savings Following Reductions in Risk of Colorectal Cancer and Total Cancer Mortality in Australia: A Cost-of-Illness Model

Nutrients ◽

10.3390/nu13092982 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2982

Author(s):

Mohammad M. H. Abdullah ◽

Jaimee Hughes ◽

Sara Grafenauer

Keyword(s):

Colorectal Cancer ◽

Relative Risk ◽

Cost Of Illness ◽

Cancer Mortality ◽

Healthcare Costs ◽

Cost Savings ◽

Whole Grains ◽

Whole Grain ◽

Refined Grains ◽

Total Cancer

Whole grain consumption has been associated with the reduced risk of several chronic diseases with significant healthcare monetary burden, including cancer. Colorectal cancer (CRC) is one of the most common cancers globally, with the highest rates reported in Australia. Three servings of whole grains provide a 15% reduction in total cancer and 17% reduction in CRC risk; however, 70% of Australians fall short of this level of intake. The aim of this study was to assess the potential savings in healthcare costs associated with reductions in the relative risk of CRC and total cancer mortality following the whole grain Daily Target Intake (DTI) of 48 g in Australia. A three-step cost-of-illness analysis was conducted using input parameters from: (1) estimates of current and targeted whole grain intakes among proportions (5%, 15%, 50%, and 100%) of the Australian adult (≥20 years) population; (2) estimates of reductions in relative risk (with 95% confidence intervals) of CRC and total cancer mortality associated with specific whole grain intake from meta-analysis studies; and (3) estimates of annual healthcare costs of CRC and all cancers from disease expenditure national databases. A very pessimistic (5% of population) through to universal (100% of population) adoption of the recommended DTI in Australia were shown to potentially yield savings in annual healthcare costs equal to AUD 1.9 (95% CI 1.2–2.4) to AUD 37.2 (95% CI 24.1–48.1) million for CRC and AUD 20.3 (95% CI 12.2–27.0) to AUD 405.1 (95% CI 243.1–540.1) million for total cancers. As treatment costs for CRC and other cancers are increasing, and dietary measures exchanging whole grains for refined grains are not cost preclusive nor does the approach increase energy intake, there is an opportunity to facilitate cost-savings along with reductions in disease for Australia. These results suggest specific benefits of encouraging Australians to swap refined grains for whole grains, with greater overall adherence to suggestions in dietary guidelines.

Download Full-text

The associations between whole grain and refined grain intakes and serum C-reactive protein

European Journal of Clinical Nutrition ◽

10.1038/s41430-021-00996-1 ◽

2021 ◽

Author(s):

Riikka E. Taskinen ◽

Sari Hantunen ◽

Tomi-Pekka Tuomainen ◽

Jyrki K. Virtanen

Keyword(s):

Disease Risk ◽

High Sensitivity ◽

Epidemiological Studies ◽

Whole Grains ◽

Dietary Factors ◽

Low Grade ◽

Dietary Intakes ◽

Whole Grain ◽

Refined Grains ◽

Hs Crp

Abstract Background/objectives Epidemiological studies suggest that whole grain intake has inverse associations with low-grade inflammation, but findings regarding refined grains are inconclusive. Our objective was to investigate whether consumption of whole or refined grains is associated with serum high sensitivity CRP (hs-CRP). Subjects/methods The study included 756 generally healthy men and women aged 53–73 years from the Kuopio Ischaemic Heart Disease Risk Factory Study, examined in 1999–2001. Dietary intakes were assessed using 4-day food records. ANCOVA and linear regression were used for analyses. Results The mean intake of whole and refined grains was 136 g/day (SD 80) and 84 g/day (SD 46), respectively. Higher whole grain intake was associated with lower hs-CRP concentration and higher refined grain intake with higher concentration after adjustment for lifestyle and dietary factors. Each 50 g/d higher whole grain intake was associated with 0.12 mg/L (95% Cl 0.02–0.21 mg/L) lower hs-CRP concentration and each 50 g/d higher refined grain intake with 0.23 mg/L (95% Cl 0.08–0.38) higher concentration. Adjustment for fibre from grains attenuated the associations especially with whole grains. There were no statistically significant interactions according to gender or BMI (P for interactions >0.065). Conclusions The results of this study suggest that higher intake of whole grains is associated with lower concentrations of hs-CRP and higher intake of refined grains is associated with higher concentrations. However, especially the association with whole grain intake was attenuated after adjusting for fibre intake from grains, suggesting that cereal fibre may partly explain the association.

Download Full-text

Fermentation of Whole Grain Sorghum (Sorghum bicolor (L.) Moench) with Different Dry Matter Concentrations: Effect on the Apparent Total Tract Digestibility of Energy, Crude Nutrients and Minerals in Growing Pigs

Animals ◽

10.3390/ani11051199 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1199

Author(s):

Reinhard Puntigam ◽

Julia Slama ◽

Daniel Brugger ◽

Karin Leitner ◽

Karl Schedle ◽

...

Keyword(s):

Dry Matter ◽

Latin Square ◽

Grain Sorghum ◽

Whole Grains ◽

Growing Pigs ◽

Whole Grain ◽

Inorganic P ◽

Gross Energy ◽

Sorghum Grain ◽

Sorghum Bicolor L

This study investigated the effects of sorghum ensiled as whole grains with different dry matter concentrations on the apparent total tract digestibility (ATTD) of energy, crude nutrients and minerals in growing pigs. Whole grain sorghum batches with varying dry matter (DM) concentrations of 701 (S1), 738 (S2) and 809 g kg−1 (S3) due to different dates of harvest from the same arable plot, were stored in air-tight kegs (6 L) for 6 months to ensure complete fermentation. Subsequently, 9 crossbred barrows (34.6 ± 1.8 kg; (Duroc x Landrace) × Piétrain)) were used in a 3 × 3 Latin square feeding experiment. Diets were based on the respective sorghum grain silage and were supplemented with additional amino acids, minerals and vitamins to meet or exceed published feeding recommendations for growing pigs. The ATTD of gross energy, dry matter, organic matter, nitrogen-free extracts, and crude ash were higher in S1 compared to S3 treatments (p ≤ 0.05), while S2 was intermediate. Pigs fed S1 showed significantly higher ATTD of phosphorus (P) compared to all other groups while ATTD of calcium was unaffected irrespective of the feeding regime. In conclusion, growing pigs used whole grain sorghum fermented with a DM concentration of 701 g kg−1 (S1) most efficiently. In particular, the addition of inorganic P could have been reduced by 0.39 g kg−1 DM when using this silage compared to the variant with the highest DM value (809 g kg−1).

Download Full-text