1. Relationship between Whole-
Grain Intake, Chronic Disease
Risk Indicators, and Weight
Status among Adolescents
Laura Simonitch
B.S. University of Nebraska-Lincoln
Dietetic Intern, MS Student
University of Kansas Medical Center

2. Introduction
• Whole grains: dietary fiber, phytoestrogens,
minerals, antioxidants, vitamin E, folate1, 2
• Past studies contradictory3
• Little data for adolescents
• Inverse association between whole-grain intake
and BMI4
• Failed to account for other dietary factors1,5,6

3. Introduction
• Increased prevalence of obesity
– Type 2 diabetes, CVD risk factors7,8,9
• Future public health efforts about whole
grain intakes for adolescents
7. Ogden et al (2010) 8. Tybor et al (2011) 9. Freedman eta l (1999)

4. Research Question
What is the relationship among chronic
disease risk factors, weight status, and
whole-grain intake among adolescents ages
12-19 years by sex?
Reicks et al. Relationship between whole-grain intake, chronic disease risk
indicators, and weight status among adolescents in the National Health and Nutrition
Examination Survey, 1999-2004. Journal of the Academy of Nutrition and Dietetics.
2012;112:46-55.

5. Study Methods
• Cross-sectional data from the National
Health and Nutrition Examination Survey
from years 1999-2004 (NHANES)
• Stratified, multistage probability sample of
the non-institutionalized US population
• NHANES surveys from 1999-2000, 2001-
2002, and 2003-2004 combined

6. Participants
• Age 12 to 19 years old
• Boys and girls of various ethnicities and
anthropometrics
6,418 adolescents
screened
2,495 boys 2,433 girls
4,928
adolescents
included

7. Exclusion Criteria
• Extreme energy intakes
• Currently breastfeeding or pregnant
• Taking insulin, oral medication for
diabetes, or medication for hypertension
• Missing data for disease risk factors, C-
reactive protein, systolic blood pressure,
total cholesterol, HDL cholesterol, serum
folate, or homocysteine

8. Data Collection
• Dietary Intake:
– NHANES 1999-2000 and 2001-2002 data
sets based on a single 24-hour dietary recall
– NHANES 2003-2004 data based on 2 days of
dietary recall

9. Data Collection
• Anthropometrics
– Height
– Weight
– Waist, arm, and thigh circumferences
– Subscapular skinfold thickness
– BMI and BMI z scores

10. Data Collection
• Chronic disease risk factors/laboratory
measures
– Blood and urine samples
– complete blood count and pregnancy analyses
– standard clinical assays
– Friedewald formula
– Fluorescence polarization immunoassay
– Mercury sphygmomanometer
– CDC used standard assay procedures

11. Data Collection
• Whole grain intake
– MyPyramid Equivalents Database for USDA
Survey food codes show food group
information:
• total grain
• whole-grain
• non-whole grain
• total vegetables, fruits, milk, and meat and beans

12. Results
• Dietary Intake
– 52% boys and 50% girls did not consume
whole grains on days that intake was
measured
– Fiber intake below recommendations for boys
and girls
– Positive association between whole-grain
intake and daily energy intake for boys and
girls

13. Dietary Intake
Significance level: P < 0.05

14. Results
• Anthropometric Measures
– Whole-grain intake inversely related among
boys with BMI, BMI z score, weight, and
waist, thigh, and arm circumferences
– Only a significant inverse association between
whole-grain intake and arm circumference in
boys once adjusted for food group intake in
the second set of models

15. Anthropometric Parameter

16. Results
• Chronic disease risk factors/laboratory
measures
– Fasting insulin levels inversely related to
whole-grain intake for boys
– C-peptide inversely related to whole-grain
intake for girls
– Positive association between whole-grain
intake and HDL levels for girls
– Boys had an inverse association between
homocysteine levels and whole-grain
intake.

17. • Chronic disease risk factors/laboratory
measures
– Boys and girls had a positive association
between serum and red blood cell folate
levels and whole-grain intake
– Inverse association between whole-grain
intake and fasting insulin levels in girls
– C-reactive protein levels were higher for girls
who had low whole-grain intake compared to
those with no or high intake
Results

18. Chronic disease risk
factors/laboratory measures Boys Girls
None Low High P value None Low High P value
1st
set of models
Homocysteine
(µmol/L)
6.8 ± 0.1 6.7 ± 0.2 6.3 ± 0.1 0.002 5.8 ± 0.1 5.9 ± 0.1 5.8 ± 0.2 0.844
Folate, serum
(ng/mL)
12.5 ± 0.2 12.4 ± 0.3 14.3 ± 0.3 < 0.001 12.6 ± 0.3 13.6 ± 0.5 14.8 ± 0.5 < 0.001
Folate, red blood
cell (ng/mL)
236 ± 3 248 ± 4 259 ± 6 < 0.001 247 ± 5 244 ± 6 269 ± 6 < 0.001
2nd
set of models
Folate, serum
(ng/mL)
12.6 ± 0.2 12.5 ± 0.2 14.1 ± 0.3 < 0.001 12.7 ±0.2 13.7 ± 0.5 14.5 ± 0.4 < 0.001
Folate, red blood
cell (ng/mL)
237 ± 3 249 ± 4 256 ± 5 < 0.001 248 ± 5 244 ± 6 266 ± 5 < 0.001

19. Discussion/Implications
• Whole-grain intake was not found to be
associated with BMI in the second set of
models (adjusted for food group intake)
• Positive results between whole-grain
intake, nutrient intake, and chronic
disease risk indicators for protection
against chronic disease in the second set
of models

20. • Sex differences may be due to differences
in body composition, weight-gain patterns,
hormone involvement in growth
• Inconsistent results from very low overall
whole-grain intake
• Overall, this study supports current
recommendations that promote high
whole grain intake for adolescents
Discussion/Implications

21. Study Limitations
• Missing data in non-fasting blood samples
• Self-reported 24-hour and 2-day dietary
recalls
• High category scoring misconception

22. Thank you!
Questions?
Laura Simonitch
lsimonitch@kumc.edu
B.S. University of Nebraska-Lincoln
Dietetic Intern, MS Student
University of Kansas Medical Center