Abstract / Summary
Abstract Background While whole‑grain cereals reduce cardiovascular and mortality risk in the general population, it remains unclear whether these benefits extend uniformly to all whole‑grain breakfast cereals, particularly in individuals with diabetes. We aimed to investigate the associations of breakfast cereal consumption with cardiovascular disease (CVD) events, CVD and all-cause mortality in diabetes. Methods This study included 10 146 individuals with diabetes from the UK Biobank. Breakfast cereal intake was assessed via at least one 24-hour dietary recall. Cox proportional hazards models were used to estimate hazard ratios (HR) for CVD events, CVD and all-cause mortality. Mediation analyses were performed to explore underlying mechanisms. Results Over a median follow-up of 12.8 years, 3 264 CVD events and 1 882 deaths (515 cardiovascular) occurred. Compared with non-consumers, breakfast cereal intake (≥ 1.5 bowl) was associated with reduced risks of CVD incidence (HR, 0.86; 95% CI, 0.77–0.95), CVD mortality (HR, 0.66; 95% CI, 0.51–0.85) and all-cause mortality (HR, 0.85; 95% CI, 0.77–0.97). However, these associations varied substantially by cereal type. Higher intake of porridge (≥ 1 bowl) was associated with lower CVD incidence (HR, 0.90; 95% CI, 0.82–0.98), CVD mortality (HR, 0.77; 95% CI, 0.60–0.99), and all-cause mortality (HR, 0.80; 95% CI, 0.71–0.91). Muesli consumption (≥ 1 bowl) was associated with reduced CVD incidence (HR,0.88; 95% CI, 0.77–0.99) and CVD mortality (HR, 0.70; 95% CI, 0.45–0.97). Conversely, sweetened cereal intake (≥ 0.5 bowl) was associated with higher CVD incidence (HR, 1.36; 95% CI, 1.11–1.64) and all-cause mortality (HR, 1.29; 95% CI, 1.01–1.71). C-reactive protein, BMI, and waist-to-hip ratio accounted for 4.99%, 4.14%, and 3.75% of the association between breakfast cereal intake and all-cause mortality. Conclusion Breakfast cereal intake was associated with lower CVD and mortality risk in diabetes; however, this concealed opposing associations by cereal type, with benefits confined to porridge and muesli, harms associated with sweetened cereals.