Table 3.
Association between whole grain intake and clinical outcomes in participants (n=137 130) without baseline cardiovascular disease
| Hazard ratio (95% CI)* | P for trend | ||||
|---|---|---|---|---|---|
| 0 (n=31 686)† | <50 g/d (n=45 112)‡ | 50 to <100 g/d (n=17 016)§ | ≥100 g/d (n=43 316)¶ | ||
| Composite events | |||||
| No (%) events | 2717 (8.6) | 4484 (9.9) | 1455 (8.6) | 4012 (9.3) | |
| Base model | 1.15 (1.08 to 1.23) | 1.08 (1.02 to 1.14) | 1.04 (0.97 to 1.11) | 1.00 (reference) | <0.001 |
| Minimally adjusted | 1.04 (0.97 to 1.12) | 1.02 (0.96 to 1.09) | 1.05 (0.98 to 1.13) | 1.00 (reference) | 0.37 |
| Fully adjusted | 1.03 (0.96 to 1.1) | 1.01 (0.95 to 1.08) | 1.05 (0.98 to 1.13) | 1.00 (reference) | 0.59 |
| Fully adjusted with medications | 1.03 (0.96 to 1.11) | 1.01 (0.95 to 1.08) | 1.05 (0.98 to 1.13) | 1.00 (reference) | 0.57 |
| Total mortality | |||||
| No (%) events | 1518 (4.8) | 2892 (6.4) | 840 (4.9) | 2571 (5.9) | |
| Base model | 1.17 (1.07 to 1.28) | 1.06 (0.99 to 1.14) | 0.99 (0.91 to 1.08) | 1.00 (reference) | <0.001 |
| Minimally adjusted | 0.99 (0.90 to 1.09) | 0.96 (0.88 to 1.04) | 1.01 (0.92 to 1.11) | 1.00 (reference) | 0.54 |
| Fully adjusted | 0.97 (0.88 to 1.07) | 0.95 (0.87 to 1.03) | 1.00 (0.91 to 1.11) | 1.00 (reference) | 0.37 |
| Fully adjusted with medications | 0.97 (0.88 to 1.07) | 0.95 (0.87 to 1.03) | 1.00 (0.91 to 1.10) | 1.00 (reference) | 0.37 |
| Non-cardiovascular mortality | |||||
| No (%) events | 1030 (3.3) | 2023 (4.5) | 570 (3.4) | 1783 (4.1) | |
| Base model | 1.18 (1.07 to 1.31) | 1.05 (0.96 to 1.14) | 0.96 (0.86 to 1.06) | 1.00 (reference) | 0.003 |
| Minimally adjusted | 0.96 (0.86 to 1.08) | 0.91 (0.83 to 1.00) | 0.98 (0.87 to 1.09) | 1.00 (reference) | 0.25 |
| Fully adjusted | 0.94 (0.83 to 1.05) | 0.89 (0.81 to 0.98) | 0.96 (0.86 to 1.08) | 1.00 (reference) | 0.11 |
| Fully adjusted with medications | 0.94 (0.83 to 1.05) | 0.89 (0.81 to 0.98) | 0.96 (0.86 to 1.08) | 1.00 (reference) | 0.10 |
| Cardiovascular mortality | |||||
| No (%) events | 557 (1.8) | 1008 (2.2) | 300 (1.8) | 912 (2.1) | |
| Base model | 1.17 (1.02 to 1.35) | 1.09 (0.96 to 1.23) | 1.03 (0.89 to 1.19) | 1.00 (reference) | 0.03 |
| Minimally adjusted | 1.06 (0.91 to 1.24) | 1.06 (0.92 to 1.21) | 1.02 (0.86 to 1.2) | 1.00 (reference) | 0.40 |
| Fully adjusted | 1.07 (0.91 to 1.26) | 1.07 (0.93 to 1.23) | 1.02 (0.87 to 1.21) | 1.00 (reference) | 0.34 |
| Fully adjusted with medications | 1.07 (0.91 to 1.26) | 1.07 (0.93 to 1.23) | 1.02 (0.86 to 1.21) | 1.00 (reference) | 0.33 |
| Major cardiovascular disease | |||||
| No (%) events | 1618 (5.1) | 2243 (5.0) | 853 (5.0) | 2184 (5.0) | |
| Base model | 1.11 (1.02 to 1.20) | 1.05 (0.98 to 1.13) | 1.06 (0.98 to 1.16) | 1.00 (reference) | 0.03 |
| Minimally adjusted | 1.04 (0.95 to 1.14) | 1.04 (0.96 to 1.13) | 1.07 (0.97 to 1.17) | 1.00 (reference) | 0.37 |
| Fully adjusted | 1.04 (0.95 to 1.14) | 1.04 (0.96 to 1.13) | 1.07 (0.97 to 1.17) | 1.00 (reference) | 0.41 |
| Fully adjusted with medications | 1.05 (0.95 to 1.15) | 1.04 (0.96 to 1.12) | 1.06 (0.97 to 1.17) | 1.00 (reference) | 0.38 |
| Myocardial infarction | |||||
| No (%) events | 651 (2.1) | 1038 (2.3) | 392 (2.3) | 918 (2.1) | |
| Base model | 1.12 (0.98 to 1.28) | 1.03 (0.92 to 1.16) | 1.12 (0.98 to 1.28) | 1.00 (reference) | 0.21 |
| Minimally adjusted | 1.12 (0.97 to 1.30) | 1.09 (0.96 to 1.23) | 1.14 (0.99 to 1.32) | 1.00 (reference) | 0.16 |
| Fully adjusted | 1.12 (0.97 to 1.31) | 1.08 (0.95 to 1.23) | 1.14 (0.99 to 1.32) | 1.00 (reference) | 0.18 |
| Fully adjusted with medications | 1.13 (0.97 to 1.31) | 1.08 (0.95 to 1.23) | 1.14 (0.99 to 1.32) | 1.00 (reference) | 0.18 |
| Stroke | |||||
| No (%) events | 852 (2.7) | 950 (2.1) | 383 (2.3) | 1042 (2.4) | |
| Base model | 1.14 (1.01 to 1.27) | 1.05 (0.94 to 1.16) | 1.03 (0.91 to 1.16) | 1.00 (reference) | 0.04 |
| Minimally adjusted | 1.06 (0.93 to 1.20) | 1.01 (0.90 to 1.13) | 1.02 (0.90 to 1.16) | 1.00 (reference) | 0.44 |
| Fully adjusted | 1.05 (0.93 to 1.19) | 1.00 (0.89 to 1.12) | 1.01 (0.88 to 1.15) | 1.00 (reference) | 0.51 |
| Fully adjusted with medications | 1.06 (0.93 to 1.19) | 1.00 (0.89 to 1.12) | 1.01 (0.88 to 1.15) | 1.00 (reference) | 0.47 |
| Heart failure | |||||
| No (%) events | 109 (0.3) | 243 (0.5) | 99 (0.6) | 205 (0.5) | |
| Base model | 0.86 (0.65 to 1.14) | 1.14 (0.91 to 1.44) | 1.21 (0.93 to 1.56) | 1.00 (reference) | 0.53 |
| Minimally adjusted | 0.77 (0.56 to 1.06) | 1.18 (0.92 to 1.53) | 1.25 (0.94 to 1.66) | 1.00 (reference) | 0.30 |
| Fully adjusted | 0.75 (0.55 to 1.04) | 1.19 (0.92 to 1.54) | 1.27 (0.95 to 1.69) | 1.00 (reference) | 0.25 |
| Fully adjusted with medications | 0.76 (0.55 to 1.04) | 1.19 (0.92 to 1.54) | 1.27 (0.95 to 1.69) | 1.00 (reference) | 0.26 |
*
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 0.0 (0.0-0.0).
‡
Median (IQR) intake 17.3 (9.2-31.3).
§
Median (IQR) intake 73.6 (62.0-84.2).
¶
Median (IQR) intake 226.8(154.3-362.2).