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. 2023 Apr 19;14(4):652–670. doi: 10.1016/j.advnut.2023.04.003

TABLE 4.

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

Author, year Cohort Country N Mean age [range], y % Male Racial or ethnic background (%) Health status Follow-up duration Dietary whole-grain assessment method (foods) Outcome assessment method Outcome analyzed Key findings1
Cognition
Fortune, 2019 [31] The Bogalusa Heart Study United States 516 49.7 [NR] 37.4 Non-Hispanic White: 72.1; Non-Hispanic Black: 27.9 Generally healthy2 15 y FFQ (whole-grain cereal, cooked oats, dark bread, kasha, couscous, and bulgur) Wechsler Adult Intelligence Scale; Wechsler Memory Scale IV; Wide Range Achievement Test IV; Trail Making Test parts A and B Cognitive function Crude association,3 cognitive function: ++
Full adjustment4, cognitive function: 0
Qin, 2015 [32] China Health and Nutrition Survey (CHNS) China 1650 63.4 [NR] 49.7 NR Generally healthy5 5 y 24-h dietary recalls by trained interviewers (fiber-rich grains: corn grain, yellow corn flour, corn grits, and barley grain, buckwheat)6 Modified Telephone Interview for Cognitive Status (immediate and delayed recall of a 10-word list; counting backward from 20; serial 7 subtraction and orientation) Global Cognitive Score7 Global cognitive score
All participants: 0; age at entry <65: 0; age at entry 65: 0
Samieri, 2013 [20] NHS United States 16,058 74.3 [NR] 0 NR Generally healthy8 6 y FFQ (whole-grain foods) Cognitive Battery:
1) the Telephone Interview for Cognitive Status (TICS); immediate and/or delayed recalls of 2) the East Boston Memory Test (EBMT); 3) the TICS 10-word list; 4) category fluency; and 5) digit span-backward.
Global score
Verbal memory score9,10
Global score: 0
Verbal memory score: 0
Samieri, 2013 [33] Women’s Health Study (WHS) United States 6174 66.0 [NR] 0 Non-Hispanic White: 96.0; other: ∼4.0 Generally healthy11 5 y FFQ (dark bread, brown rice, oatmeal/bran, wheat germ, crackers/wheat thins, and other grains) Cognitive battery: immediate and delayed recalls of 1) the telephone interview of cognitive status and 2) the East Boston Memory Test Global cognition
Verbal memory12
Global cognition: ++
Verbal memory: 0
Shakersain, 2018 [34] Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) Sweden 2223 70.6 [NR] 39.2 NR Generally healthy13 6 y Swedish FFQ (whole-grain breads or cereals) MMSE MMSE scores14 MMSE scores: 0
Wengreen, 2013 [35] Cache County Memory Study (CCMS) United States 3580 74.1 [NR] 43.0 Non-Hispanic White: 90.0; other: ∼10.0 100% healthy 11 y FFQ (dark bread or pita, whole-grain cold breakfast and cooked cereal, oatmeal, popcorn, bulgur, kasha, and couscous) Modified MMSE (3MS) 3MS scores15 3MS scores: ++
Mood, anxiety, and depression
Gangwisch, 2015 [42] Women’s Health Initiative (WHI) United States 69,954 65.7 [NR] 0 Non-Hispanic White: 86.6; Non-Hispanic Black: 6.2; Asian or Pacific Islander: 3.0; Hispanic: 2.7; American Indian or Alaskan Native: 1.3 Generally healthy16 3 y FFQ (whole-grain foods) Burnam 8-item scale for depressive disorders17 Incident depression Incident depression
Model 1: −−18
Model 2: −−19
Gibson-Smith, 2020 [43] Netherlands Study of Depression and Anxiety (NESDA) Netherlands 1634 52.0 [[18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65]] 32.1 NR 100% healthy 9 y Dutch FFQ (nonrefined grains) Inventory of Depressive Symptomatology—Self Report (IDS-SR); Beck Anxiety Inventory (BAI) Severity of depression (IDS) and anxiety (BAI) scores20 IDS scores: −−
BAI scores: −−
Those with current depression and anxiety disorders compared to controls: −−21
Kleppang, 2021 [44] Trøndelag Health Study (HUNT) Norway 2230 NR [[23], [24], [25], [26], [27], [28], [29], [30], [31]] 42.3 NR NR 11 y FFQ (whole-grain bread) Conor Mental Health Index (CONOR-MHI) Psychological distress Psychological distress:22
Crude model: −−
Adjusted model: −−23

Abbreviations: N, number of individuals enrolled; NR, not reported; TICS, Telephone Interview for Cognitive Status.

1

Key findings’ symbols: ++ significant positive associations (P ≤ 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 ≤ 0.05).

2

Part of the study population had hypertension (75%) and diabetes (15%).

3

Adjusted for total caloric intake.

4

Adjusted for total caloric intake, sex, age at follow-up, race, physical activity, diabetes, hypertension, BMI at follow-up, word score, education, and depressive symptoms.

5

Part of the study population had hypertension (∼40%).

6

The whole-grain foods in this study were defined as “fiber-rich grain” with a fiber to carbohydrate ratio 7.4 g:100 g.

7

Adjusted for age, sex, region (south/north), urbanization index, education (graduated from primary/less), annual household income per capita (≥5,000 yuan/less), total EI, time, physical activity (tertile), current smoking (yes/no), BMI (linear and squared terms) and hypertension, and time interactions with each covariate.

8

Part of the study population had a history of MI (∼6%), hypertension (∼55%), hypercholesterolemia (∼65%), diabetes (∼10%), and depression (∼9%).

9

The authors in this study compared cognitive outcomes associated with whole-grain consumers (of any intake of whole grains) to nonconsumers.

10

Adjusted for age, education, long-term physical activity and EI, BMI, smoking, history of depression, multivitamin use, and histories of diabetes, hypertension, hypercholesterolemia, and MI.

11

Part of the study population had a history of hypertension (40%), hypercholesterolemia (53%), depression (6%), and diabetes (4%).

12

Adjusted for treatment arm, age at initial cognitive testing, Caucasian race, high education, high income, EI, physical activity, BMI, smoking, diabetes, hypertension, hypercholesterolemia, hormone use, depression, and alcohol intake.

13

Part of the study population had vascular disorders (∼85%), diabetes (∼31%), cancer (∼5%), and depression (∼5%).

14

Adjusted for total calorie intake, age, sex, education, civil status, physical activity, smoking, BMI, vitamin/mineral supplement intake, vascular disorders, diabetes, cancer, APOE ε4, and dietary components other than main exposure(s) in each model.

15

Adjusted for age, sex, education, BMI, frequency of moderate physical activity, multivitamin and mineral supplement use, history of drinking and smoking, and history of diabetes, heart attack, and stroke.

16

Part of the study population had hypertension (∼30%), diabetes (∼5%), MI (∼2%), stroke (∼1%), cancer (∼12%), and CVD (∼18%).

17

The Burnam scale includes 2 items from the Diagnostic Interview Schedule and 6 items from the Center for Epidemiologic Studies–Depression Scale.

18

Adjusted for nutrient density.

19

Adjusted for nutrient density, race-ethnicity, education, income, BMI, diabetes, hypertension, hormone replacement therapy, stroke, MI, Alzheimer’s disease, CVD, cancer, physical activity, stressful life events, social support, smoking, alcohol, and energy-adjusted intakes of saturated, monounsaturated, polyunsaturated, and trans FAs.

20

Adjusted for age, sex, education (y), partner status physical activity, and smoking status and corrected for all other food groups. Findings were significant after correction for multiple testing.

21

Higher nonrefined grain consumption was significantly related to a lower odds of having a current clinically diagnosed depression or anxiety disorder compared to controls.

22

Kleppang and authors set the reference as “daily consumption of whole-grain bread,” rather than “less than daily consumption.” Thus, the interpretation would be those who consumed whole-grain bread “less than daily” had a greater odds of psychological distress compared with those who consumed whole-grain bread daily.

23

Adjusted for age, sex, psychological distress in adolescence and highest education as young adults from the main effects model.