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Journal ArticleDOI

Cereal fibre intake in Australia: a cross-sectional analysis of the 2011-12 National Nutrition and Physical Activity Survey.

TL;DR: This study provides first quantification of cereal fibre from all sources in an Australian national sample, and individuals with the highest cereal fibre intake were more likely to meet dietary fibre recommendations.
Abstract: Extensive evidence supports health benefits of cereal fibre, however globally no national intake data exists. This study aimed to determine estimates of intake and food sources of cereal fibre, and relationships to dietary fibre intake in an Australian sample population. A cereal fibre database was applied to dietary intake data from the 2011–12 National Nutrition and Physical Activity Survey (n = 12,153). Usual intake based on 2-day intake data was weighted to infer population results. Median daily cereal fibre intake was 6.4 g/d (9.7 g/10 MJ/d) for adults (19–85 years) and 6.2 g/d (10.2 g/10 MJ/d) for children/adolescents (2–18 years). Individuals with the highest cereal fibre intake were more likely to meet dietary fibre recommendations than those with the lowest intake (males Q4: 17.1% Q1: 3.9%; females Q4: 20.3% Q1: 6.6%). Breakfast cereals, bread and bread rolls provided the most cereal fibre. This study provides first quantification of cereal fibre from all sources in an Australian national...

Summary (4 min read)

Introduction

  • The analysis of nutrient intakes within population-based surveys can offer insight into relationships between consumption and markers of health, contributing to the evidence-base to inform dietary guidelines.
  • Previous studies have considered cereal fibre intake as a summation of fibre sourced from foods specifically within the cereal and grains food group.
  • This neglects the contributions from mixed foods and many foods with cereals, or even specific cereal fibres as additives.
  • The application of the expanded AUSNUT database to the NNPAS dietary intake data, weighted to account for usual population intake, allows estimation of reported cereal fibre intakes and reported food sources within the Australian population.

Data and participants

  • This study used data from the Australian Bureau of Statistics (ABS) Basic Confidentialised Unit Record Files (CURF) for the 2011-12 NNPAS.
  • The NNPAS is a subcomponent of the 2011-13 AHS, the most recent nationally representative survey within Australia at the time of this study.
  • Details for the specific phases and tools used are provided elsewhere (ABS 2013a).
  • The assessment included five phases to develop greater layers of detail and accuracy in the answers provided.
  • One day of data were collected for n=12,153 participants, with a second 24-hour recall repeated via telephone for n=7,735 participants, at least eight days after the initial recall.

Estimation of cereal fibre intakes

  • The cereal fibre content of each food item reported within the survey was calculated within the expansion of the current AUSNUT 2011-13 Food Nutrient database.
  • Food sources listed in the AUSNUT 2011-13 database containing >0.1g of cereal fibre per 100g-food product were considered sources of cereal fibre, based on the limitations of the analytical tests that measure fibre (Prosky et al.
  • The method employs a three-step formula using two logistic regression models.
  • The first model estimates the individual probability of consumption of the nutrient and the second model estimates intake on consumption days.
  • Weighting applied was previously calculated and assigned by the ABS for use in the AHS data (ABS 2013b).

Reporting of nutrient-level data

  • Mean and median cereal fibre intake were reported by age, categorised using NRV age groupings (NHMRC 2006) , and gender.
  • Values were reported both as absolute cereal fibre intakes and cereal fibre intakes adjusted for daily energy intake (10 MJ/day) reported within the survey.
  • Adjusting for energy intake allowed for exploration of the relative cereal fibre density of the diet, as absolute cereal fibre intake may be highly influenced by total energy intake.
  • For further analyses of associations, NRV age groupings were dichotomised with participants categorised into those aged less than 19 years (children and adolescents), and those aged 19 years or older .
  • Participants within each division were then categorised into quartiles based on energy-adjusted cereal fibre intakes.

Statistical analysis comparing total dietary fibre intakes to cereal fibre intake in adults

  • All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS version 21, 2009, Chicago, IL) software.
  • Eta squared, calculated as the sum of squares between groups divided by total sum of squares, was used to calculate the effect size.
  • A chi-squared analysis was used to compare the proportion of respondents within each quartile of cereal fibre that are meeting the AI values for dietary fibre, set at 25g/day for females and 30g/day for males.

Reporting of food-level data

  • Unlike nutrient-level data, major food contributors of cereal fibres were reported using only day-1 dietary intake data from the NNPAS.
  • For these purposes of this study, day-1 data were deemed suitable to provide a snapshot overview of food sources of cereal fibres.
  • Weighting was not applied to analyses at the food level, as the method was designed for scaling of nutrient intakes.
  • Foods were also coded as either core or discretionary based on specific nutrient cut-off criteria outlined by the ABS (2013c).
  • The proportion of cereal fibre and the proportion of total intake from core foods were compared between quartiles of energy-adjusted cereal fibre intake.

Cereal fibre intakes in NNPAS 2011-12

  • At the time of the survey, median cereal fibre intakes were relatively consistent between all NRV age groups ranging from 5.2 g-6.7 g/d (9.1 g-11.1 g/10 MJ/day) (Table 1 reports median and mean values).
  • The highest median cereal fibre (6.7g/d) was reported by persons in the over 70-age group and in the 14-18 years age group.
  • The lowest median cereal fibre was reported by children aged 2-3 years (5.2g/d).

Associations to dietary fibre intake

  • Table 2 displays the trends between quartiles of energy-adjusted cereal fibre intakes and total dietary fibre intakes.
  • For both males and females, mean dietary fibre intake increased significantly with each higher quartile of energy-adjusted reported cereal fibre intake.
  • On average, males within quartile 4 consumed 6.13g/day more total dietary fibre than males within quartile 1, while females within quartile 4 consumed, on average, 3.78g/day more total dietary fibre than females with quartile 1.
  • Correlations between energy-adjusted cereal fibre intake and total dietary fibre intake indicated a medium positive correlation for males (r=0.345, p=0.000) and a weak positive correlation for females (r=0.225, p=0.000).

Sources of cereal fibre

  • On day one of the survey, participants reported consuming 1918 foods containing >0.1g cereal fibre.
  • Within this group, regular bread and bread rolls, as well as ready to eat breakfast cereals were the main food group contributors of cereal fibre.
  • Relatively high proportions of fibre were obtained from refined cereals (e.g. white bread, instant noodles) even though these would be considered low fibre products, reflecting the reasonably high consumption of such products.
  • The percentage contribution to total cereal fibre intakes within these three groups was higher amongst children and adolescents than adults.
  • In contrast, participants within the lowest quartile of adjusted cereal fibre intakes (Q1, median intake 6.1g and 6.9g, respectively) were consuming the lowest proportion (55% and 50%, adults and children and adolescents, respectively) of cereal fibre from cereal and cereal-based products, and the highest proportion from cereal based products and dishes (32% and 36%, adults and children and adolescents, respectively).

Core food and discretionary food cereal fibre contribution

  • Among adults, core foods contributed 87% of total cereal fibre intakes, indicating that only a relatively small amount (13%) of cereal fibre for adults was obtained from discretionary foods.
  • Children and adolescents reported 80% of total cereal fibres from core foods on the day of the survey, indicating a slightly higher contribution (20%) from discretionary food sources.
  • The main discretionary sources of cereal fibre for both adults and children and adolescents were from the pastries minor food group (26% and 16% of total cereal fibre from discretionary foods, respectively), as well as cakes, muffins, scones and cake-type desserts minor food group (16% and 13%, respectively).
  • The proportion of total cereal fibres from core foods increased linearly for participants within each higher quartile of energy-adjusted cereal fibre intakes.
  • In contrast, core foods contributed 74% of intakes in both adult and children and adolescents within the lowest quartile of reported cereal fibre intakes (Q1).

Discussion

  • The present study reports an estimation of the usual cereal fibre intakes of Australians based on two days of dietary intake data from the 2011-12 NNPAS.
  • Furthermore, it details main food sources of cereal fibre consumed by participants on day-1 of the survey, and presents an analysis of how usual cereal fibre intakes may be associated with total dietary fibre intake.
  • The median intakes of cereal fibre were 6.2g/day for children and adolescents and 6.4g/day for adults, equating to roughly 2-3 slices of wholegrain bread, or 2 cups of cooked brown rice.
  • Even within the highest quartile of energy adjusted cereal fibre intakes, 82.9% of males and 79.7% of females are failing to meet the AI values.
  • There are some limitations to this study.

Conclusion

  • This study provides the first quantification of cereal fibre intake within Australia at the time of the study.
  • The study indicates that while Australians are consuming cereal foods, the choices they are making are likely more refined, lower-fibre varieties, evident by low cereal fibre intake.
  • As there is no distinct group consuming considerably less cereal fibre than others, males and females of all ages are suitable targets for communication and education strategies.
  • This may also contribute significantly to an increase in total dietary fibre, as persons with diets highest in cereal fibre tended to have significantly higher total dietary fibre intakes.

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1
Cereal fibre intake in Australia: a cross sectional analysis of the 2011-12
1
National Nutrition and Physical Activity Survey
2
3
Author names and affiliations: Eden M Barrett,
1,2
Yasmine C Probst,
1,2
Eleanor J Beck
1,2
4
1
School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia
5
2
Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
6
7
Eden M Barrett (corresponding author)
8
School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
9
Email emb952@uowmail.edu.au, Phone +61 4 1828 5480, Fax +61 2 4221 4844.
10
Eden Barrett is a PhD student in the School of Medicine at the University of Wollongong and an Accredited
11
Practising Dietitian. Her research interests focus on the role of nutrition in the prevention of chronic disease,
12
with specific emphasis on the association between whole grain and cereal fibre intake to cardiovascular risk and
13
outcomes.
14
15
Yasmine C Probst
16
School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
17
Email yasmine@uow.edu.au, Phone +61 2 4221 5302, Fax +61 2 4221 4844.
18
Dr Yasmine Probst is a Research Fellow with the Illawarra Health and Medical Research Institute and an
19
Advanced Accredited Practising Dietitian. She is the Honours Coordinator for Nutrition and Dietetics at the
20
University of Wollongong and coordinator of the Visiting Researcher program for the Smart Foods Centre.
21
Yasmine works within the clinical trials research team to manage food-based intervention trials with a specific
22
focus on dietary methodology, dietary modeling and food composition. In 2013, she developed a virtual
23
interdisciplinary Centre for Nutrition Informatics and is a leader for food composition data use in Australia.
24
25
26

2
Eleanor J Beck
27
School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia.
28
Email eleanor@uowmail.edu.au, Phone +61 2 4298 1271, Fax +61 2 4221 4844.
29
Associate Professor Eleanor Beck is Discipline Leader in Nutrition and Dietetics at the University of
30
Wollongong. Her clinical research includes close links with dietetics service delivery in hospitals, while
31
working with industry partners and international collaborators in grains research. Current projects include
32
review of both individual grains and fibres, as well as cereal fibre and whole grains generally, and their effects
33
on metabolic health. Eleanor is also Deputy Chair of the Council of Deans of Nutrition and Dietetics (ANZ) and
34
the Chair of the ANZ NNEdPro group, which is part of a global network to promote nutrition teaching and
35
research in health professions.
36

3
Key words: Australian Health Survey; dietary intake data; cereal fibre; grains; dietary fibre.
37
38
Abstract
39
Extensive evidence supports health benefits of cereal fibre, however globally no national
40
intake data exists. This study aimed to determine estimates of intake and food sources of
41
cereal fibre, and relationships to dietary fibre intake in an Australian sample population. A
42
cereal fibre database was applied to dietary intake data from the 2011-12 National Nutrition
43
and Physical Activity Survey (n=12,153). Usual intake based on 2-day intake data was
44
weighted to infer population results. Median daily cereal fibre intake was 6.4g/d (9.7g/10
45
MJ/d) for adults (19-85 years) and 6.2g/d (10.2g/10 MJ/d) for children/adolescents (2-18
46
years). Individuals with the highest cereal fibre intake were more likely to meet dietary fibre
47
recommendations than those with the lowest intake (males Q4: 17.1% Q1: 3.9%; females Q4:
48
20.3% Q1: 6.6%). Breakfast cereals, bread and bread rolls provided the most cereal fibre.
49
This study provides first quantification of cereal fibre from all sources in an Australian
50
national sample.
51

Citations
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Journal ArticleDOI
TL;DR: Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations, and adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.
Abstract: Dietary fibre is important for regular laxation and reduces chronic disease risk. The National Health and Medical Research Council outlines daily fibre intake targets, yet the proportion of the population that meets these targets is unknown. Using the 2011–2012 National Nutrition and Physical Activity Survey, we profiled fibre intake among Australian children and adults. Data from one-day dietary recalls were analysed (n = 12,153, ≥2 years) as well as demographic and anthropometric factors. The median fibre intake was 18.2 g (interquartile range [IQR] 13.2–25.0) in children and 20.7 g (IQR 14.3–28.7) in adults. We found that 42.3% (95% CI 40.5–44.1%) of children and 28.2% (95% CI 27.3–29.1%) of adults met the Adequate Intake (AI), and less than 20% of adults met the Suggested Dietary Target (SDT) to reduce the risk of chronic disease. Older children (aged 14–18 years), girls, young adults (19–30 years), males, and those of lower socio-economic status were less likely to meet the AI (p < 0.001). Those with a higher energy intake were more likely to meet the AI. Anthropometric measures were not associated with fibre intake or the likelihood of meeting the AI. Fibre is a nutrient of concern in Australian diets, with most children and adults falling short of recommendations. Adolescents, girls, young adults, men, and those of lower socio-economic status were less likely to meet the recommendations and may benefit most from public health interventions.

53 citations

Journal ArticleDOI
01 Jun 2020-Appetite
TL;DR: It is suggested that further public education and promotion of whole grain benefits, with a focus on food-based targets and messaging, may be important in efforts to increase whole grain and subsequently fibre intakes.

36 citations

Journal ArticleDOI
TL;DR: The study of dietary patterns in cardiovascular disease prevention presents with a number of methodological challenges relating to the way food groups are formed and the limitations of food composition databases.
Abstract: Purpose of Review The relationship between dietary patterns and cardiovascular disease has been the subject of much research, but an important methodological consideration is the interdependence between the nutrient composition of foods and the recognition of healthy dietary patterns. This review considers some of the challenges in researching dietary patterns with implications for translation to public health promotions.

22 citations

Journal ArticleDOI
TL;DR: Exploration of nut consumption in a representative sample of Australians identified that nut intake does not meet recommendations, and strategies to increase nut intake to recommended levels are required.
Abstract: Objective: Nut consumption is associated with a range of health benefits. The current study aimed to examine nut consumption in the 2011–2012 National Nutrition and Physical Activity Survey (NNPAS) and to investigate associations between nut intake, nutrient intake and anthropometric and blood pressure measurements. Design: Secondary analysis of the 2011–2012 NNPAS. Usual consumption of nuts in the 2011–2012 NNPAS was determined, and nut consumption was compared with population recommendations of 30 g nuts per day. The relationship between nut consumption and intakes of key nutrients, anthropometric outcomes (weight, BMI and waist circumference) and blood pressure was examined using linear regression for participants aged over 18 years. Setting: Australia. Participants: Australians (2 years and older, n 12 153) participating in the representative 2011–2012 NNPAS. Results: Mean nut intake was 4·61 (95 % CI: 4·36, 4·86) g/d, with only 5·6 % of nut consumers consuming 30 g of nuts per day. Nut consumption was associated with significantly greater intakes of fibre, vitamin E, Fe, Mg and P. There was no association between nut consumption and body weight, BMI, waist circumference, or blood pressure. Conclusions: Exploration of nut consumption in a representative sample of Australians identified that nut intake does not meet recommendations. Higher nut consumption was not adversely associated with higher body weight, aligning with the current evidence base. Given the current levels of nut consumption in Australia, strategies to increase nut intake to recommended levels are required.

17 citations


Cites methods from "Cereal fibre intake in Australia: a..."

  • ...To provide an overview of contribution to food group and nutrient intakes, the current analysis was restricted to data from Day 1 of the 2011–2012 NNPAS only, as outlined previously in analyses examining other dietary components in the 2011–2012 NNPAS(25)....

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Journal ArticleDOI
TL;DR: Higher intakes of wholegrain, fruits, and vegetables, and a lower discretionary intake were associated with higher fibre intake, and encouraging these foods as part of any public health intervention is likely to be effective for increasing dietary fibre intakes.
Abstract: Intakes of dietary fibre in Australia are lower than recommended An understanding of food choices associated with fibre intake can help to inform locally relevant dietary interventions that aim to increase its consumption This study aimed to profile the relationship between dietary choices and fibre intake of Australians Using Day 1 data from the 2011–2012 National Nutrition and Physical Activity Survey (n = 12,153, ≥2 years), dietary fibre intake was classified by quartiles for children (2–18 years) and adults (≥19 years) Intakes of the Australian Dietary Guidelines (ADG) food groups were calculated, as well as the major, sub-major, and minor food groups from the Australian Food Composition Database Each of these food groups provide a progressively greater level of detail Associations with ADG food groups and major food groups were determined, and the leading sub-major and minor food group sources of fibre for low (Quartile 1) and high (Quartile 4) fibre consumers were profiled Energy-adjusted intakes of wholegrain and/or high fibre but not refined grain (cereal) foods, vegetables, and fruit were positively associated, and discretionary foods negatively associated, with quartile of fibre intake (p < 0001) The top three sub-major food group sources of fibre were regular breads, cereal mixed dishes, and ready-to-eat breakfast cereals in high fibre consumers and regular breads, cereal mixed dishes, and potatoes in low fibre consumers White breads was the leading minor food group contributor in low fibre consumers, and apples and lower sugar wheat based breakfast cereal were the leading fibre contributors in high fibre consumers in children and adults, respectively Higher intakes of wholegrain, fruits, and vegetables, and a lower discretionary intake were associated with higher fibre intake Encouraging these foods as part of any public health intervention is likely to be effective for increasing dietary fibre intakes

17 citations

References
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Journal ArticleDOI
Jacob Cohen1
TL;DR: The application of positron emis sion tomography (PEM) to the study of panic disorder was discussed in this paper, where a focal brain abnormal ity in panic disorder, a severe form of anxiety, was discussed.
Abstract: pression, Journal of Clinical Psychiatry, 51, 61-69 (1990). 11. L.R. Baxter, Jr., J.M. Schwartz, B.H. Guze, J.C. Mazziotta, M.P. Szuba, K. Bergman, A. Alazraki, C.E. Selin, H.K. Freng, P. Munford, and M.E. Phelps, Obsessive-compulsive disorder vs. Tourette's disorder: Differential function in subdivi sions of the neostriatum, paper presented at the an nual meeting of the American College of Neuropsy chopharmacology, San Juan, Puerto Rico (December 1991). 12. E.M. Reiman, M.E. Raichle, F.K. Butler, P. Herscovitch, and E. Robins, A focal brain abnormal ity in panic disorder, a severe form of anxiety, Na ture, 310, 683-685 (1984); E.M. Reiman, M.E. Ra ichle, E. Robins, F.K. Butler, P. Herscovitch, P. Fox, and J. Perlmutter, The application of positron emis sion tomography to the study of panic disorder, American Journal of Psychiatry, 143, 469-477 (1986); T.E. Nordahl, W.E. Semple, M. Gross, T.A. Mellman, M.B. Stein, P. Goyer, A.C. King, T.W. Uhde, and R.M. Cohen, Cerebral glucose metabolic differences in patients with panic disorder, Neuro psychopharmacology, 3, 261-272 (1990).

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"Cereal fibre intake in Australia: a..." refers methods in this paper

  • ...Pearson’s r correlation was used to assess effect size based on Cohen’s criteria, where 0.1 indicates a small, 0.3 a medium and 0.5 indicates a large effect size (Cohen 1988)....

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  • ...The effect size was interpreted based on Cohen’s criteria (Cohen 1988), where 176...

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  • ...The effect size was interpreted based on Cohen’s criteria (Cohen 1988), where 0.01 is considered a small effect, 0.06 a medium effect and 0.14 a large effect....

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Journal ArticleDOI
TL;DR: The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used, and is best used in conjunction with the TRIPod explanation and elaboration document.
Abstract: Prediction models are developed to aid health care providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision making. However, the overwhelming evidence shows that the quality of reporting of prediction model studies is poor. Only with full and clear reporting of information on all aspects of a prediction model can risk of bias and potential usefulness of prediction models be adequately assessed. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative developed a set of recommendations for the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. This article describes how the TRIPOD Statement was developed. An extensive list of items based on a review of the literature was created, which was reduced after a Web-based survey and revised during a 3-day meeting in June 2011 with methodologists, health care professionals, and journal editors. The list was refined during several meetings of the steering group and in e-mail discussions with the wider group of TRIPOD contributors. The resulting TRIPOD Statement is a checklist of 22 items, deemed essential for transparent reporting of a prediction model study. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. The TRIPOD Statement is best used in conjunction with the TRIPOD explanation and elaboration document. To aid the editorial process and readers of prediction model studies, it is recommended that authors include a completed checklist in their submission (also available at www.tripod-statement.org).

954 citations

Journal ArticleDOI
14 Feb 1996-JAMA
TL;DR: The results suggest an inverse association between fiber intake and MI and suggest that fiber, independent of fat intake, is an important dietary component for the prevention of coronary disease.
Abstract: Objective. —To examine prospectively the relationship between dietary fiber and risk of coronary heart disease. Design. —Cohort study. Setting. —In 1986, a total of 43 757 US male health professionals 40 to 75 years of age and free from diagnosed cardiovascular disease and diabetes completed a detailed 131 -item dietary questionnaire used to measure usual intake of total dietary fiber and specific food sources of fiber. Main Outcome Measure. —Fatal and nonfatal myocardial infarction (Ml). Results. —During 6 years of follow-up, we documented 734 cases of Ml (229 were fatal coronary heart disease). The age-adjusted relative risk (RR) for total Ml was 0.59 (95% confidence interval [CI], 0.46 to 0.76) among men in the highest quintile of total dietary fiber intake (median, 28.9 g/d) compared with men in the lowest quartile (median, 12.4 g/d). The inverse association was strongest for fatal coronary disease (RR, 0.45; 95% CI, 0.28 to 0.72). After controlling for smoking, physical activity and other known nondietary cardiovascular risk factors, dietary saturated fat, vitamin E, total energy intake, and alcohol intake, the RRs were only modestly attenuated. A 10-g increase in total dietary fiber corresponded to an RR for total Ml of 0.81 (95% CI, 0.70 to 0.93). Within the three main food contributors to total fiber intake (vegetable, fruit, and cereal), cereal fiber was most strongly associated with a reduced risk of total Ml (RR, 071; 95% CI, 0.55 to 0.91 for each 10-g increase in cereal fiber per day). Conclusions. —Our results suggest an inverse association between fiber intake and Ml. These results support current national dietary guidelines to increase dietary fiber intake and suggest that fiber, independent of fat intake, is an important dietary component for the prevention of coronary disease. (JAMA. 1996;275:447-451)

868 citations


"Cereal fibre intake in Australia: a..." refers background in this paper

  • ...…the association between fibre intakes and favourable health outcomes is frequently found to be strongest with high cereal fibre intakes specifically, particularly when assessing risk of cardiovascular disease (Pietinen et al. 1996; Rimm et al. 1996; Wolk et al. 1999; Mozaffarian et al. 2003)....

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  • ...The health benefits of a diet high in dietary fibres are well supported (Pietinen et al. 1996; Rimm et al. 1996; Wolk et al. 1999; Bingham et al. 2003) and are currently reflected in dietary guidelines outlined by governments worldwide, including Australia....

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This study provides first quantification of cereal fibre from all sources in an Australian national sample.