Historical and Global Perspectives on Grains and Whole Grains within Dietary Guidelines

Food-based dietary guidelines provide advice on healthy eating for populations and help guide health and nutrition policies. Grains, particularly whole grains, have long played a key role in the human diet, and their role in nutrition and chronic disease prevention is well established. Despite this, whole grain consumption is low globally. The aim of this study is to summarize and explore Australian dietary recommendations on grains and whole grains over time and to offer a global perspective on how these recommendations compare with other dietary guidelines around the world. In Australia, grains have remained a constant in food group guides since 1955, with a focus on whole grains beginning in the 1979 dietary guidelines. Globally, all 90 countries with identified food guides promote grains, and 44% specifically encourage consumption of whole grains. Guidelines generally emphasize whole grains within a grain food statement, using “mostly” and “preferably” as an additional requirement. Many public health initiatives, such as the Australian front-of-pack labeling system (the Health Star Rating), do not include whole grain as part of the algorithm, highlighting a disconnect between dietary guidance and policy. To shift consumption patterns, a multi-stakeholder approach is required, including government, research organizations, the food industry, public health groups, and consumers. More specific wording and direct guidelines may also be needed to achieve the required outcomes of swapping whole grains for refined grains. Dietary recommendations in the form of food selection guides, or dietary guidelines, support food choices for a healthy population and form the basis of public health policies (1). Recommendations are based on existing knowledge and links between nutrition and the health of the general population and aim to support nutrition education initiatives and consider social and economic issues. Grains and grain-based foods are common dietary staples, with rice, maize, and wheat estimated to provide 60% of global energy intake (2), and they have formed a key component of dietary recommendations for many years. In Australia, National Nutrition Survey data (2011–2012) indicate that grain-based foods such as breads, cereals, pasta, rice, and noodles are the leading contributors of seven key nutrients in the diet, including carbohydrates, dietary fiber, folate, thiamine, iron, magnesium, and iodine (3). However, even though most Australians consume grain foods, few meet recommendations for whole grain foods, which are described by Food Standards Australia New Zealand (FSANZ) (4) as The intact grain or the dehulled, ground, milled, cracked or flaked grain where the constituents—endosperm, germ and bran—are present in such proportions that represent the typical ratio of those fractions occurring in the whole cereal, and includes wholemeal. The aim of this study is to outline historical and global perspectives on grain and whole grain food recommendations and to provide guidance for future whole grain promotion. Grain Food Promotion Using the Five Food Groups and Australian Dietary Guidelines The first food guide was published in Australia by the Commonwealth Department of Health in 1955 and included five food groups, listed in priority order, as the basis of the recommendations (5). At that time, bread and cereals (3–4 servings) were listed fourth in the priority order after milk; meat, poultry, fish, eggs, and cheese; and fruit and vegetable groups. As a necessity, protein foods were a priority with the focus on preventing nutrient deficiencies (e.g., vitamin A and iron) rather than on excess energy and related chronic diseases such as diabetes mellitus, heart disease, colon cancer, and obesity (6). Bread and cereals were listed ahead of butter and table margarine (Table I). In 1979, 24 years later, the dietary goals for Australians were documented by the Commonwealth Department of Health (5). These included a statement, “Eat more breads and cereals (preferably whole grain) and vegetables and fruits,” which were listed as the sixth of eight guidelines (Table II). This was the first mention of whole grains in government guidelines. Whole grains have consistently been recommended since that time (7) based on their dietary fiber, protein, B group vitamins, minerals, and antioxidant contents compared with refined grain foods, the nutrients of which are altered through processing (8). In 1982 the five food groups were revised, with 4 or more servings of bread and cereals listed ahead of all other groups, signaling a further change in emphasis. At the same time, meat was reduced, and yogurt was added to the milk and milk products group. Just short of 10 years later, in 1991, the Commonwealth Scientific and Industrial Research Organisation (CSIRO), with the guidance of a team headed by Katrine Baghurst, launched a 1,2,3,4,5+ plan (5). Bread and cereal foods were increased to 5 or more servings/day; meat was reduced; fruits, vegetables, and dairy were increased; and use of fats was assumed via an allowance on bread (6). This was a quantified system aimed at helping consumers achieve the Recommended Dietary Intakes and, therefore, addressed the total diet. A year later, the revised Australian Dietary Guidelines recommended eating “plenty of breads and cereals (preferably whole grain), vegetables (including legumes) and fruits,” following the general statement, “Enjoy a wide variety of nutritious foods. ” These guidelines were listed in priority order, and there was a distinct change in the language used. Earlier guidelines emphasized avoiding particular nutrients and were more permissive, with the aim of guiding better food choices. In 1994, the first National Food & Table II. Australian Dietary Guidelines 1979–2013