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Food products derived from cereal grains as wheat, rice, corn, rye, oat, and barley constitute a major part of the daily diet in many countries. In refined-grain products, the bran and germ of the grain, which contain the major amount of nutrients and dietary fibre, have been removed and only the starchy inner part of the grain (ca. 80% of the whole grain) is used. Whole grain foods contain either intact, flaked or broken grain kernels, coarsely ground kernels or flour that is made from whole grains (whole-meal flour). In this review the effect of whole grain foods and cereal fibre (as a marker of whole-grain food intake) on the prevention of type 2 diabetes mellitus (T2DM) was assessed using all available prospective cohort studies and randomised controlled trials. Only one randomised controlled trial was found which was of low methodological quality. This study investigated in 12 overweight persons during six weeks the effect of the consumption of refined grain foods versus that of whole grain foods on insulin sensitivity (risk factor for the development of T2DM). Intake of whole grain foods resulted in a slight improvement of insulin sensitivity, increased bowel movements and no adverse effects. No information was given about patient satisfaction, health related quality of life, total mortality and morbidity. In addition eleven prospective cohort studies were found. One study was conducted in Finland and the rest in the United States of America of which seven were done in health care workers. Some of the studies were of limited quality. They consistently showed that a high intake of whole grain foods or cereal fibre is associated with a lower risk of the development of T2DM. However, evidence for a protective effect coming from prospective cohort studies only has to be considered as weak as with this design no cause and effect relationship can be established. Well-designed randomised controlled trials are needed to be able to draw definite conclusions about the preventive effects of whole grain consumption on development of T2DM. —Cochrane 2009



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