TABLE 3.

Study design details, population characteristics, and key findings from cross-sectional studies describing the associations between whole-grain intake and cognition, mood, anxiety, and depression outcomes

Author, year	Country	N	Mean age [range], y	% Male	Racial or ethnic background	Health status	Dietary whole-grain assessment method (foods)	Outcome assessment method	Outcome analyzed	Key findings1
Cognition
Abbaszadeh, 20212 [49]	Iran	181	20.8 [[18], [19], [20], [21], [22], [23], [24], [25]]	0	NR	100% healthy	FFQ (whole-grain foods)	Cognitive Abilities Questionnaire; The Depression Anxiety Stress Scale (DASS)	Cognitive abilities and depression, anxiety, and stress3	Cognitive abilities: 0; depression, anxiety, and stress: 0
Anastasiou, 2017 [29]	Greece	1864	73 [NR]	40.6	NR	Generally healthy4	Greek FFQ (nonrefined cereals)	Comprehensive neuropsychological assessment: MMSE; Greek Verbal Learning Test (GVLT); Medical College of Georgia Complex Figure Test (MCG); Greek version of the Boston Diagnostic Aphasia Examination short form; Benton’s Judgment of Line Orientation; Clock Drawing Test; Trail Making Test (TMT)—part A and B; Graphical Sequence Test; and gross estimate of intellectual level. Diagnosis of dementia and its subtypes was based on DSM-IV-TR criteria5	Dementia, cognitive status, and cognitive performance6	Nonrefined cereal intake between those diagnosed with dementia and those without dementia: 0; cognitive status: 0; cognitive performance: ++
Croll, 2018 [36]	Netherlands	4213	65.7 [NR]	43.2	NR	Generally healthy7	FFQ (whole-grain products)	MRI	Total brain volume, gray matter volume, white matter volume, and hippocampus volume8	Total brain volume: ++; gray matter volume: ++; white matter volume: 0; hippocampus volume: 0
Dong, 2016 [37]	China	894	62.8 [[55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75], [76]]	32.8	100% Chinese9	100% healthy	FFQ (whole-grain foods)	Montreal Cognitive Assessment (MoCA)	Cognitive function (MoCA Score)10	MoCA Score: 0 Those with mild cognitive impairment compared to controls: 011
Huang, 2021 [38]	Taiwan	1115	73.8 [NR]	47.1	NR	100% healthy	SFFQ and 24-h dietary recall (whole-grain foods)	MMSE	Cognitive function based on degree of frailty severity (robust, prefrailty, and frailty)	Cognitive function: robust: ++; prefrailty: 0; frailty: ++
Xu, 2020 [39]	China	1262	72.3 [NR]	44.5	NR	100% healthy	FFQ (coarse cereals)	MMSE	Mild cognitive impairment (MCI)	MCI Crude: 0; model 1: −−12; model 2: −13
Mood, anxiety, and depression
Lanuza, 2021 [45]	Chile	2031	65.9 [NR]	48.2	NR	Generally healthy14	FFQ (whole-grain bread, whole-grain cereal, or any food product that contains whole-grain flour)	Composite International Diagnostic Interview—Short Form (CIDI-SF)	Major depressive episode (MDE)15	MDE: 0
Sadeghi, 2019 [46]	Iran	3172	36.5 [NR]	44.1	NR	100% healthy	DS-FFQ [wheat seed, diet bread (cooked by whole flour), and dark breads including Iranian breads of Sangak and Barbari]16	Iranian validated version of the Hospital Anxiety and Depression Scale (HADS)	Women: 1) Depression 2) Anxiety Men: 1) Depression 2) Anxiety17	Women: 1) Depression: 0 2) Anxiety: −−18 Men: 1) Depression: 0 2) Anxiety: 0

Abbreviations: DS-FFQ, dish-based FFQ; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, Text Revision, Fourth Edition; IADL: Instrumental Activities of Daily Living Scale; MNA-SF: Mini Nutritional Assessment Scale-Short Form; N, number of individuals enrolled; NR, not reported; WC, waist circumference; WHR, waist-to-hip ratio.

¹Key findings’ symbols: ++ significant positive associations (P$\le$ 0.05); + marginally significant positive associations (0.05 < P < 0.1); 0 no associations; − marginally significant inverse associations (0.05 < P < 0.1); −− significant inverse associations (P$\le$ 0.05).

²This article reported both cognition and mood, anxiety, and depression outcomes.

³Adjusted for age, BMI, WHR, and EI.

⁴On average, the study population was overweight (BMI: 29 kg/m²) and had a large waist circumference (WC: 100 cm).

⁵Diagnosis of vascular dementia: clinical history of stroke, clear temporal relation between stroke and the onset of dementia and the Hachinski Ischemia Scale score. Lewy body and frontotemporal dementias were also diagnosed using specified criteria. Dementia staging was performed through a semistructured interview, using the Clinical Dementia Rating Scale, which globally assesses 6 domains of cognitive and functional performance.

⁶Adjusted for age, sex, education, number of clinical comorbidities, and EI.

⁷Part of the study population had hypertension (22%), hypercholesterolemia (52%), and diabetes (9%).

⁸Adjusted for age, sex, intracranial volume, education, EI, smoking, physical activity, and BMI.

⁹Han: 94%; Hui: 2.3%; Mengolia: 0.1%; Manchu: 1.5%; Other: 1.7%.

¹⁰Adjusted for age, sex, nationality, BMI, and education level.

¹¹No differences in whole-grain intake between those diagnosed with MCI and controls.

¹²Adjusted for age and sex.

¹³Adjusted for age, sex, education, marital status, smoking, alcohol drinking, EI, diabetes mellitus, hypertension, physical activity, and MNA-SF and IADL scores.

¹⁴Part of the study population had hypertension (72.3%), diabetes (29.6%), hypercholesterolemia (41.3%), and CVD (23.9%).

¹⁵Adjusted for age, sex, region, residency area, education, tobacco status, alcohol intake, physical activity, hours of sleep, BMI, cognitive impairment, hypertension, hypercholesterolemia, diabetes, CVDs (acute MI, stroke, or peripheral artery disease), and the healthy eating score and each individual food item (as appropriate, for calculations of % of change in total effect).

¹⁶Intake of whole grains was further classified into quartiles of intake for analysis.

¹⁷Adjusted for age and EI (model 1); marital status, education, family size, smoking status, physical activity, home ownership, diabetes, dietary supplement use, and antipsychotic medications (model 2); intake of food groups including fruits, vegetables, red meat, fish, legumes and nuts, whole grains or refined grains, tea, and coffee (model 3); BMI (model 4); B-vitamins including thiamine, riboflavin, niacin, pantothenic acid, pyridoxine, folate, and cobalamin. All adjustments were additive across models.

¹⁸A moderate consumption of whole grains (Q3) was inversely associated with anxiety in women, across all adjusted models.