Guidelines Dietary - Eat For Health

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2.3.2 The evidence for consuming ‘grain (cereal) foods, mostly wholegrain and/orhigh cereal fibre varieties’The evidence for the association of grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties,with reduced risk of cardiovascular disease, type 2 diabetes and excess weight gain has strengthened since the2003 edition of the dietary guidelines.The literature is difficult to interpret because studies use varied definitions of ‘wholegrain’. FSANZ applies theterm to products that use every part of the grain (cereal) including the outer layers, bran and germ even if theseparts are separated during processing and regardless of whether the grain (cereal) is in one piece or milled intosmaller pieces. 441 In the literature review for these Guidelines, the most commonly used definition was found tobe that of Jacobs et al 1998, 442 who defined wholegrain foods as those containing 25% or more of wholegrains.Other studies have included bran cereals as part of the definition of wholegrain and others only examined certaintypes of grain (cereal) food such as oats.Table 2.7: Evidence statements for consuming ‘grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties’Evidence statementGradeGuideline 2Consumption of cereal foods (especially wholegrains and those with fibre from oats or barley) is associated with a reduced riskof cardiovascular disease in adults.Consumption of one to three serves per day of wholegrain cereals is associated with a reduced risk of cardiovascular disease.Consumption of cereal foods (especially three serves a day of wholegrains) is associated with reduced risk of type 2 diabetesConsumption of three to five serves per day of cereal foods (mainly wholegrain) is associated with a reduced risk of weight gain.Consumption of one to three serves per day of cereals high in fibre is associated with reduced risk of colorectal cancer in adults.BBBBCNotes: Grades – A: convincing association, B: probable association, C: suggestive associationIncludes evidence statements and gradings from the Evidence Report (literature from years 2002–2009). Does not include evidence fromother sources, such as the 2003 edition of the dietary guidelines (in which individual studies were classified according to their design aslevel I, II or III but overall grades for relationships were not derived), although these sources have been used to inform these Guidelines.Grade C evidence statements showing no association and all Grade D statements can be found in Appendix E.Cardiovascular disease, type 2 diabetes and excess weight• Cardiovascular disease: There is evidence of a probable association between the consumption of grain (cereal)foods (especially wholegrains and those with fibre from oats or barley) and a reduced risk of cardiovasculardisease in adults (Grade B; Evidence Report, Section 6.3). 226,443-458 Almost all the high level trials were conductedwith oats, with the evidence of beneficial lowering of levels of LDL and total cholesterol levels. The protectiveeffect was noted with between one to three serves per day of wholegrain foods (predominantly oats).• Type 2 diabetes: There is evidence of a probable association between the consumption of grain (cereal) foods(especially wholegrains) and reduced risk of type 2 diabetes (Grade B; Evidence Report, Section 6.7). 445,457,459-466The evidence supports three serves per day of wholegrain foods conferring between 21% and 42% reductionin risk of type 2 diabetes.• Excess weight: There is evidence of a probable association between consumption of three to five serves perday of grain (cereal) foods (mainly wholegrain) and reduced risk of weight gain (Grade B; Evidence Report,Section 6.6). 215,220-229Enjoy a wide variety of nutritious foodsNational Health and Medical Research Council45
Cancer• Colorectal cancer: There is recent evidence suggesting that consumption of one to three serves of cerealshigh in dietary fibre per day is associated with reduced risk of colorectal cancer in adults (Grade C; EvidenceReport, Section 6.2). 397,467-471 Although previously the WCRF report noted a probable relationship, it recentlyreviewed the evidence and found it convincing that fibre-rich foods offer protection against colorectal cancer(see Appendix F). 43,472 This is also supported by a recent systematic review and dose response meta-analysisof prospective studies showing that three serves of wholegrain and high fibre cereals per day reduced the riskof colorectal cancer. 473• Other cancers: Recent evidence is inconclusive for an association regarding the consumption of grain (cereal)foods and risk of other cancers in adults (Evidence Report, Section 6.1).Guideline 22.3.3 How consuming grain (cereal) foods, mostly wholegrain and/or high cerealfibre varieties may improve health outcomesMuch depends on which wholegrain is being considered. 474 For example, oat ß-glucan binds with bile acids, sothe liver breaks down more cholesterol to maintain a supply of bile acids. Wheat does not contain these solublefibres. Also, the slow rate of glucose delivery from oats reduces the requirement for insulin. 475 The slower rate ofabsorption created by the presence of dietary fibre from some grain (cereal) foods can also influence appetite.For example, oat ß-glucan has been shown to have effects on postprandial cholecystokinin levels, decreasedinsulin response and extended subjective satiety in overweight adults. 476 Other sources of dietary fibre, suchas psyllium may act in a similar fashion. Grain (cereal) foods also contain starch (complex carbohydrate) thatmay be resistant to digestion in the small intestine (resistant starch) and may help to provide a more protectiveenvironment in the colon, particularly in the context of meals. 477 Note that as some degree of processing isapplied to most grains (cereals) to aid digestion, the effects can be significantly influenced by the technologyapplied in processing and cooking. 478Because wholegrains contain more nutrients and phytochemicals, concentrated in the bran and germ, 479 they arelikely to have greater effects than refined grains (cereals). Wholegrains contain phenolic compounds with stronganti-oxidant capacity that may be protective against processes involved in the pathology of type 2 diabetes,cardiovascular disease and cancer. 480 Choosing wholegrain options may also assist with satiety and help in notover consuming food beyond energy (kilojoule) requirements.The 2003 edition of the dietary guidelines discussed the glycaemic index (GI) of individual foods as a physiologicallybased classification of carbohydrate-containing foods according to their potential to raise blood glucose. 36Various factors such as the particle size of milled grains (cereals), the ratio of amylose to amylopectin, the degreeof starch gelatinisation and the presence of other food components such as viscous soluble fibres, fat, proteinand organic acids may affect the GI value of a food and may limit practical application. 199 Additionally, the accuracywith which published values can be used to predict GI when foods are eaten together as a meal is limited. 481Lower GI diets may assist in the management of type 1 and type 2 diabetes but are not associated with weightloss (see Chapter 1). 36,198 Further research on GI and health outcomes may be required to investigate otherpotential associations.The 2003 edition of the dietary guidelines also noted that consumption of dietary fibre assists in maintaining thehealth and function of the digestive system, for example in preventing constipation. 35,362.3.4 Practical considerations: enjoy grain (cereal) foods, mostly wholegrain and/or highcereal fibre varietiesConsuming at least four to six serves of grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties,per day is recommended for Australian adults, while the amount recommended for children and adolescentsdepends on their age and sex (see Tables 2.8 and 2.9), ranging from four serves a day for 2–8 year olds to sevena day for older adolescents.The companion resources provide more detailed information on the recommended number of serves and servesizes of grain (cereal) foods required for different population groups. Discussion of dietary patterns and theenvironment is included in Appendix G.46EAT FOR HEALTH – australian dietary guidelinesNational Health and Medical Research Council
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EAT FOR HEALTHAustralianDietaryGuid
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© Commonwealth of Australia 2013Pa
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Australian Dietary GuidelinesGuidel
Page 9 and 10: GUIDELINE 2• Enjoy a wide variety
Page 11 and 12: guideline 5• Food safety 975.1 Se
Page 13 and 14: Table A2: Mean daily intakes of ene
Page 15 and 16: More recent evidence from Western s
Page 17 and 18: Relationship between the documents
Page 19 and 20: In this way, the Evidence Report wa
Page 21 and 22: Challenges for adoption of the Guid
Page 23 and 24: Australian Guide to Healthy EatingA
Page 25 and 26: Guideline 11.1 Setting the sceneA h
Page 27 and 28: Guideline 1UnderweightWhile the gre
Page 29 and 30: Guideline 1Figure 1.2: Mean energy
Page 32 and 33: Evidence statementBabies born to mo
Page 34 and 35: • Childhood weight gain: There is
Page 36 and 37: Given the scope of the Guidelines,
Page 38 and 39: Appropriate steady weight gain duri
Page 40 and 41: Dietary restriction beyond prudent
Page 42: 1.5 Practice guide for Guideline 1T
Page 45 and 46: 2.1 Enjoy a wide variety of nutriti
Page 47 and 48: Pregnant and breastfeeding womenCon
Page 49 and 50: 2.2 Enjoy plenty of vegetables, inc
Page 51 and 52: • Prostate cancer: The evidence s
Page 53 and 54: The following studies relate primar
Page 55 and 56: Dietary fibre from vegetables and f
Page 57: Children and adolescentsThe recomme
Page 61 and 62: Based on current consumption data,
Page 63 and 64: disaggregate possibly different eff
Page 65 and 66: CancerNo recent studies investigati
Page 67 and 68: Based on most recent consumption da
Page 69 and 70: 2.5 Enjoy milk, yoghurt, cheese and
Page 71 and 72: Other conditionsThe traditional nut
Page 73 and 74: The 1995 National Nutrition Survey
Page 75 and 76: Reviews have also shown an associat
Page 77 and 78: 2.7 Practice guide for Guideline 2T
Page 80 and 81: GUIDELINE 3Limit intake of foods co
Page 82 and 83: 3.1.2 The evidence for ‘limit int
Page 84 and 85: 3.1.3 How limiting intake of foods
Page 86 and 87: InfantsFor infants under the age of
Page 88 and 89: Bone healthEvidence suggesting an a
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Page 96 and 97: 3.4.3 How limiting intake of alcoho
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Page 101 and 102: 4.1 Setting the sceneThe World Heal
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Page 107 and 108: Lower socioeconomic status mothersW
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4.4 Practice guide for Guideline 4T
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5.1 Setting the sceneFoodborne illn
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5.4.2 InfantsThe immune system of i
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A1Social distribution of diet-relat
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• Consumption of milk and milk pr
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Food intake, diet and nutritional s
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The prevalence of health risk facto
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Table B2: Members of the Working Co
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The evidence was assessed according
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As part of the consultation process
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Expert reviewThe Guidelines underwe
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1995 - The Core Food GroupsThe Core
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Appendix DQuestions for the literat
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Umbrella review questions1. What di
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Appendix ESummary of evidence state
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Evidence statementGradeFruitThe eff
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Limited - no conclusionEvidence is
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Appendix GFood, nutrition and envir
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Figure G1: Examples of environmenta
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G4Australia’s progress toward a s
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It is suggested that by 2011, 125 c
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Appendix IPhysical activity guideli
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Appendix JStudies examining the hea
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Appendix KAlcohol and energy intake
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Cholesterol: Cholesterol, chemicall
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Limit: Limit is used to emphasise t
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Salt: Dietary salt is an inorganic
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Acronyms and abbreviationsADHDAIDSA
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References1. Rayner M, Scarborough
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37. National Health and Medical Res
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75. Taveras EM, Berkey CS, Rifas-Sh
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112. Olds TS, Tomkinson GR, Ferrar
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153. Rangan AM, Schindeler S, Hecto
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192. Stookey JD, Constant F, Gardne
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231. Hyson DA, Schneeman BO, Davis
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271. Marks GC, Coyne C, Pang G. Typ
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312. Cunningham J, O’Dea K, Dunba
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355. Burns C, Inglis A. Measuring f
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392. Harland JI, Haffner TA. System
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433. Northern Territory Government.
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473. Aune D, Chan DSM, Lau R, Vieir
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512. Ness A, Maynard M, Frankel S,
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550. Vislocky LM, Pikosky MA, Rubin
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588. Sellers TA, Vierkant RA, Djeu
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628. Rosner SA, Åkesson A, Stampfe
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669. Siri-Tarino PW, Sun Q, Hu FB,
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705. Mamalakis G, Kiriakakis M, Tsi
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743. Cook NR, Cutler JA, Obarzanek
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782. Balakrishnan M, Simmonds RS, T
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820. Newcomb PA, Nichols HB, Beasle
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862. Australian Institute of Health
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903. Romero-Gutiérrez G, Vaca-Orti
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942. Käferstein F, Abdussalam M. F
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985. Centre for Epidemiology and Re
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1025. Lee A, Bonson A, Yarmirr D, O
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1066. Natural Resource Management M
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1106. Liu Y, Sobue T, Otani T, Tsug
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Notes
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www.nhmrc.gov.auwww.eatforhealth.go
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