Table 2.
Association between refined grain intake and clinical outcomes in participants (n=135 260) without baseline cardiovascular disease
| Hazard ratio (95% CI)* | P for trend | |||||
|---|---|---|---|---|---|---|
| <50 g/d (n=35 665)† | 50 to <150 g/d (n=44 015)‡ | 150 to <250 g/d (n=25 507)§ | 250 to <350 g/d (n=12 133)¶ | ≥350 g/d (n=17 940)** | ||
| Composite events | ||||||
| No (%) events | 3903 (10.9) | 3686 (8.4) | 1938 (7.6) | 1016 (8.4) | 1778 (9.9) | |
| Base model | 1.00 (reference) | 0.97 (0.91 to 1.02) | 0.93 (0.87 to 0.99) | 0.97 (0.89 to 1.05) | 1.12 (1.03 to 1.21) | 0.05 |
| Minimally adjusted | 1.00 (reference) | 1.07 (1.01 to 1.15) | 1.11 (1.03 to 1.20) | 1.16 (1.05 to 1.28) | 1.27 (1.14 to 1.41) | <0.001 |
| Fully adjusted | 1.00 (reference) | 1.07 (1.01 to 1.14) | 1.11 (1.03 to 1.21) | 1.17 (1.05 to 1.29) | 1.28 (1.15 to 1.42) | <0.001 |
| Fully adjusted with medications | 1.00 (reference) | 1.08 (1.01 to 1.15) | 1.12 (1.03 to 1.21) | 1.18 (1.06 to 1.30) | 1.29 (1.16 to 1.43) | <0.001 |
| Total mortality | ||||||
| No (%) events | 2703 (7.6) | 2289 (5.2) | 1122 (4.4) | 532 (4.4) | 878 (4.9) | |
| Base model | 1.00 (reference) | 0.91 (0.85 to 0.97) | 0.87 (0.80 to 0.95) | 0.85 (0.76 to 0.96) | 1.08 (0.97 to 1.20) | 0.84 |
| Minimally adjusted | 1.00 (reference) | 1.04 (0.96 to 1.13) | 1.08 (0.97 to 1.20) | 1.04 (0.91 to 1.19) | 1.26 (1.09 to 1.45) | 0.006 |
| Fully adjusted | 1.00 (reference) | 1.04 (0.96 to 1.13) | 1.09 (0.98 to 1.21) | 1.05 (0.91 to 1.20) | 1.27 (1.11 to 1.46) | 0.004 |
| Fully adjusted with medications | 1.00 (reference) | 1.05 (0.96 to 1.14) | 1.09 (0.98 to 1.21) | 1.05 (0.92 to 1.21) | 1.28 (1.11 to 1.47) | 0.003 |
| Non-cardiovascular mortality | ||||||
| No (%) events | 1907 (5.4) | 1564 (3.6) | 812 (3.2) | 375 (3.1) | 530 (3.0) | |
| Base Model | 1.00 (reference) | 0.89 (0.83 to 0.97) | 0.89 (0.81 to 0.99) | 0.85 (0.74 to 0.97) | 1.00 (0.88 to 1.14) | 0.49 |
| Minimally adjusted | 1.00 (reference) | 1.08 (0.98 to 1.19) | 1.19 (1.05 to 1.35) | 1.1 (0.94 to 1.30) | 1.29 (1.08 to 1.53) | 0.007 |
| Fully adjusted | 1.00 (reference) | 1.08 (0.98 to 1.19) | 1.19 (1.05 to 1.35) | 1.12 (0.95 to 1.31) | 1.31 (1.10 to 1.56) | 0.004 |
| Fully adjusted with medications | 1.00 (reference) | 1.08 (0.98 to 1.19) | 1.20 (1.05 to 1.35) | 1.12 (0.95 to 1.32) | 1.31 (1.11 to 1.56) | 0.003 |
| Cardiovascular mortality | ||||||
| No (%) events | 904 (2.5) | 851 (1.9) | 358 (1.4) | 179 (1.5) | 384 (2.1) | |
| Base model | 1.00 (reference) | 0.94 (0.83 to 1.05) | 0.8 (0.69 to 0.93) | 0.83 (0.69 to 1.01) | 1.20 (1.00 to 1.43) | 0.32 |
| Minimally adjusted | 1.00 (reference) | 0.99 (0.86 to 1.14) | 0.85 (0.71 to 1.02) | 0.91 (0.72 to 1.14) | 1.18 (0.94 to 1.47) | 0.40 |
| Fully adjusted | 1.00 (reference) | 0.99 (0.86 to 1.14) | 0.85 (0.71 to 1.02) | 0.9 (0.72 to 1.13) | 1.17 (0.94 to 1.47) | 0.44 |
| Fully adjusted with medications | 1.00 (reference) | 0.99 (0.86 to 1.14) | 0.86 (0.71 to 1.02) | 0.92 (0.73 to 1.15) | 1.18 (0.95 to 1.48) | 0.36 |
| Major cardiovascular disease | ||||||
| No (%) events | 1774 (5.0) | 2000 (4.5) | 1127 (4.4) | 654 (5.4) | 1233 (6.9) | |
| Base model | 1.00 (reference) | 1.08 (1.00 to 1.17) | 1.03 (0.94 to 1.13) | 1.12 (1.00 to 1.25) | 1.25 (1.12 to 1.39) | <0.001 |
| Minimally adjusted | 1.00 (reference) | 1.11 (1.01 to 1.21) | 1.13 (1.02 to 1.26) | 1.25 (1.10 to 1.42) | 1.32 (1.15 to 1.51) | <0.001 |
| Fully adjusted | 1.00 (reference) | 1.11 (1.01 to 1.21) | 1.13 (1.02 to 1.26) | 1.26 (1.10 to 1.43) | 1.33 (1.16 to 1.52) | <0.001 |
| Fully adjusted with medications | 1.00 (reference) | 1.11 (1.02 to 1.21) | 1.14 (1.03 to 1.27) | 1.27 (1.12 to 1.45) | 1.34 (1.17 to 1.53) | <0.001 |
| Myocardial infarction | ||||||
| No (%) events | 874 (2.5) | 983 (2.2) | 485 (1.9) | 229 (1.9) | 360 (2.0) | |
| Base model | 1.00 (reference) | 1.08 (0.97 to 1.21) | 1.01 (0.88 to 1.16) | 1.02 (0.85 to 1.22) | 1.08 (0.91 to 1.29) | 0.66 |
| Minimally adjusted | 1.00 (reference) | 1.10 (0.96 to 1.25) | 1.07 (0.91 to 1.26) | 1.13 (0.92 to 1.39) | 1.14 (0.92 to 1.42) | 0.25 |
| Fully adjusted | 1.00 (reference) | 1.10 (0.96 to 1.25) | 1.07 (0.91 to 1.25) | 1.12 (0.91 to 1.38) | 1.12 (0.90 to 1.39) | 0.35 |
| Fully adjusted with medications | 1.00 (reference) | 1.10 (0.96 to 1.25) | 1.07 (0.91 to 1.26) | 1.13 (0.92 to 1.39) | 1.13 (0.91 to 1.40) | 0.30 |
| Stroke | ||||||
| No (%) events | 751 (2.1) | 774 (1.8) | 519 (2.0) | 369 (3.0) | 797 (4.4) | |
| Base model | 1.00 (reference) | 1.04 (0.93 to 1.17) | 1.02 (0.89 to 1.17) | 1.16 (0.99 to 1.36) | 1.34 (1.15 to 1.57) | <0.001 |
| Minimally adjusted | 1.00 (reference) | 1.08 (0.94 to 1.23) | 1.13 (0.96 to 1.32) | 1.28 (1.07 to 1.54) | 1.44 (1.20 to 1.74) | <0.001 |
| Fully adjusted | 1.00 (reference) | 1.07 (0.94 to 1.22) | 1.13 (0.96 to 1.32) | 1.29 (1.08 to 1.55) | 1.47 (1.22 to 1.77) | <0.001 |
| Fully adjusted with medications | 1.00 (reference) | 1.07 (0.94 to 1.22) | 1.13 (0.97 to 1.32) | 1.30 (1.09 to 1.56) | 1.47 (1.22 to 1.78) | <0.001 |
| Heart failure | ||||||
| No (%) events | 129 (0.4) | 244 (0.6) | 150 (0.6) | 57 (0.5) | 72 (0.4) | |
| Base model | 1.00 (reference) | 1.20 (0.94 to 1.52) | 1.36 (1.04 to 1.77) | 1.19 (0.83 to 1.69) | 1.15 (0.81 to 1.65) | 0.34 |
| Minimally adjusted | 1.00 (reference) | 1.21 (0.92 to 1.59) | 1.55 (1.13 to 2.12) | 1.38 (0.92 to 2.07) | 1.1 (0.71 to 1.72) | 0.31 |
| Fully adjusted | 1.00 (reference) | 1.22 (0.93 to 1.61) | 1.59 (1.16 to 2.18) | 1.43 (0.95 to 2.15) | 1.16 (0.74 to 1.82) | 0.22 |
| Fully adjusted with medications | 1.00 (reference) | 1.22 (0.93 to 1.61) | 1.60 (1.17 to 2.19) | 1.46 (0.97 to 2.19) | 1.17 (0.75 to 1.82) | 0.19 |
*
Cox frailty model. Base model: adjusted for age and sex, with centre as random effect; minimally adjusted: adjusted for age, sex, location (urban/rural), wealth index, education, smoking, waist-hip ratio, physical activity, history of diabetes, and daily intakes of energy (kcal), vegetable and fruits, dairy, and red meats, with centre as random effect; fully adjusted: adjusted as for minimally adjusted plus whole grains, with centre as random effect; fully adjusted with medications: adjusted as for fully adjusted plus medications (statins and antihypertensives), with centre as random effect.
†
Median (interquartile range (IQR) intake) 18.5 (7.0-32.9).
‡
Median (IQR) intake 92.9 (72.0-118.9).
§
Median (IQR) intake 185.9 (165.4-213.9).
¶
Median (IQR) intake 300.0 (272.3-319.5).
**
Median (IQR) intake 498.4 (450.0-675.0).