Fiber from Whole Grains, but not Refined Grains, Is Inversely Associated with All-Cause Mortality in Older Women: The Iowa Women’s Health Study

Background: Inconsistencies in epidemiologic findings relating grain fiber to chronic disease may be explained by differentiating nutrient-rich fiber derived from whole grain vs. nutrient-poor fiber derived from refined grain. Objective: Given that phytochemicals are most varied and abundant in the outer layers of grains, we tested the hypothesis that whole grain fiber consumption is associated with a reduced mortality risk in comparison to a similar amount of refined grain fiber. Design: 11040 postmenopausal women enrolled in the Iowa Women’s Health Study, matched on total grain fiber intake, but differing in the proportion of fiber consumed from whole vs. refined grain, were followed from baseline in 1986 through 31 December, 1997, during which time 1341 deaths occurred in 124,823 observed woman-years. Results: After multivariate adjustment in proportional hazards regression, women who consumed on average 1.9 g refined grain fiber/2000 kcal and 4.7 g whole grain fiber/2000 kcal had a 17% lower mortality rate (RR=0.83, 95% CI=0.73–0.94) than women who consumed predominantly refined grain fiber: 4.5 g/2000 kcal, but only 1.3 g whole grain fiber/2000 kcal. Conclusion: Inferences from studies that have reported associations between grain fiber intake and morbidity or mortality may be limited by not differentiating fiber sources. Future studies should distinguish fiber from whole vs. refined grains. Public health policy should differentiate whole grains from refined, and recommend increased consumption of the former.