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The term grain applies to plants of the Poaceae grass family and includes cereal grains and pseudocereals. All grains that belong to the Poaceae family are composed of the starchy endosperm, the germ and the outer bran layer (HEALTHGRAIN Consortium 2013).
Pseudocereals such as buckwheat and quinoa have a similar macronutrient composition to cereals, and they are often included in the bread cereal group. They are of great significance for persons suffering from intolerance to gluten (e.g. coeliac disease), contained in most cereals, and at the same time they allow for a wider consumer choice (HEALTHGRAIN Consortium 2013).
There is no legally endorsed definition of whole grain and whole grain products and foods at the European level. In European Union agricultural legislation, whole grains are referred as 'grains from which only the part of the end has been removed, irrespective of characteristics produced at each stage of milling (EU Regulation 1308/2013) EU Regulation No 1308/2013 of the European Parliament and of the Council of 17 December 2013 establishing a common organisation of the markets in agricultural products and repealing Council Regulations (EEC) No 922/72, (EEC) No 234/79, (EC) No 1037/2001 and (EC) No 1234/2007 . The European Food Safety Authority (EFSA 2010), in a whole-grain related health claim opinion, provides the definition of the American Association of Cereal Chemists (AACC), which states that whole grain 'consist of the intact, ground, cracked or flaked caryopsis, whose principal anatomical components - the starchy endosperm, germ and bran - are present in the same relative proportions as they exist in the intact caryopsis' (AACC 2000). Table 1 provides an overview of the available definitions and the grains that are included in each of them.
Taking into consideration that whole grain products from all cereal grains have higher levels of dietary fibre and bioactive compounds than their refined equivalents, and in line with the suggestion that a whole grain definition should be suitable for both dietary recommendation and labelling purposes, the definitions of AACC and HEALTHGRAIN (HEALTHGRAIN Consortium 2013) allow for both cereals and pseudocereals to be characterised as whole grain. Some examples of whole grains included in the aforementioned definitions are whole wheat, oatmeal, whole-grain cornmeal, brown rice, whole-grain barley, whole rye, and buckwheat (AACC 2012b).
Whole grains can be eaten in cooked form (after boiling) as a food on their own, for instance brown rice (wild, red, black), oatmeal, and corn (maize). However, in most cases, whole grains are further processed and thus deliver a variety of edible and safe products for human consumption (e.g. whole grain flour). This processing results in an alteration of the grain's physical form and may also affect the nutritional value of the grain.
Grains are staple foods and constitute a major source of carbohydrate, protein and fibre for the world's population (BNF 2004). In addition, they contain vitamins (B vitamins), minerals (zinc, phosphorus, magnesium, and iron), and bioactive compounds such as antioxidants and other phytochemicals. Some of the beneficial health effects of whole grains are attributed to their content in those bioactive phytonutrients. However, refinement of whole grains results in a significant removal of their bioactive compounds (AACC 2012b). Examples of the nutritional value of some whole grains along with two examples of refined grains are included in Table 2.
Whole grain foods (including whole grain flour) are defined differently across the EU (EFSA 2010). There is no legislation regarding labelling of whole grains at the EU level. For instance, in Denmark (DTU 2008) and Sweden (SNF 2007) for a food to be characterized as whole grain, it is required to consist of at least 50% of dry matter from whole grain ingredients. In the Netherlands, 100% of the flour must be whole grain for bread to be labelled as 100% whole grain (EFSA 2010). In Germany, whole grain bread must be at least 90% whole grain (BMEL 1993). In the United Kingdom (Richardson 2003) and the USA (FDA 2001), whole grain foods must contain ≥51% whole grain ingredients by weight. As whole grain foods are high in fibre, the legislation regarding declaration of fibre content is relevant (refer to Dietary Fibre in this series).
Whole grains are considered as significant components of a healthy diet (WHO 2015). Consumption of whole grains is associated with a reduction in the risk of developing several non-communicable diseases, as detailed in Table 3.
Data on whole grain intake in Europe is limited. This could be because whole grains do not have a consistent definition across Europe, but also because many studies limit their scope to the intake of fibre and not whole grains as a food group.
Due to this lack of intake data, Table 5 presents the data included in the Global Dietary Database (GDD) for whole grain intake (Micha et al 2015). GDD data comes from governments or ministries of health, researchers and the 2010 NutriCoDE project, and includes intake of whole grain foods, such as breakfast cereals, bread, rice, pasta, biscuits, muffins, tortillas, pancakes etc. A whole grain food is defined as a food with ≥1.0 g of fibre per 10 g of carbohydrate (GDD 2016).
As data on whole grain intake may not be available for all countries or all age groups, the GDD study group developed methods to impute data, based on non-missing exposure data from other regions and available data on country-level covariates. These caveats affect the reading and comparability of the data presented in Table 5.
The Global Burden of Disease study (GBD 2017 study) defines diets low in whole grains as average daily consumption of less than 125 grams per day of whole grains (bran, germ, and endosperm in their natural proportions) from breakfast cereals, bread, rice, pasta, biscuits, muffins, tortillas, pancakes, and other sources. According to the GBD 2017 study (GBD 2017 tool) a diet low in whole grains, resulted in more than 260000 avoidable deaths from all causes in 2017 in the EU, as well as in more than 5 million Disability Adjusted Life years (DALYs – sum of years lost due to premature death and years lived with disability) (GBD 2017 tool), of which almost 248.000 are deaths from cardiovascular disease, which accounts for the vast majority of all-cause deaths associated with diets low in whole grain. Values for individual EU Member States in 2017 can be seen in the map below.
As whole grains are considered part of a healthy diet, scientific associations, institutions and authorities have issued policy recommendations that aim to increase the availability and accessibility of whole grains and ultimately to increase its intake across the population.
A summary of such policy recommendations can be found in Table 6. They can be generally categorised in actions that aim to
increase the awareness of consumers regarding the benefits of whole grain and also provide information on how to recognize the appropriate products,
make the healthy option available by improving the food environment, e.g. increasing the availability of whole grains at school meals, and
implement financial incentives to promote the purchase of healthful foodstuffs by consumers.
Despite the aforementioned positive impact of whole grains on health, the little dietary intake data available indicate that in many countries whole grain intake is lower than the levels recommended by the institutions detailed in Table 4. Some countries are however addressing this point and have implemented policies to promote whole grain consumption. Some of these are also described in Table 7. They either fall under a legal framework or rely on voluntary agreements – and use tools such as economic incentives or directly working on the food environment to increase the purchase and consumption of whole grains.