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BURNABY, British Columbia — For those who grew up with the classic “food pyramid” of nutrition, they will remember that the largest group at the bottom contained grains. From bread to pasta to cereal, nutritionists have emphasized the importance of getting enough of these foods in your daily diet for years to come. Unfortunately, a new study reveals that consumers need to be more selective about the cereals they eat.

An international team warns that eating refined grains can significantly increase the risk of heart disease, stroke and death.

Although whole grain products continue to grow in popularity, it can still be difficult to avoid all foods regularly made with refined grains. These products include anything produced with refined (or white) flour. This includes white bread, pasta and noodles, cereals, crackers and pastries (like croissants), and desserts.

The researchers looked at data from the Prospective Urban Rural Epidemiology (PURE) study, looking at diets in low-, middle- and high-income countries. After 16 years of study, involving more than 130,000 participants in 21 countries, the study authors found that the consumption of refined grains and added sugars had increased significantly over the past two decades.

Their results reveal that consuming more than seven servings of refined grains each day increases the risk of premature death by 27%. The chances of developing heart disease increase by 33% and the risk of suffering a stroke skyrockets by 47%.

“This study reaffirms previous work indicating that a healthy diet includes limiting overly processed and refined foods,” health science professor Scott Lear of Simon Fraser University said in a statement.

Which grains are heart healthy?

The study also looked at daily consumption of whole grains and white rice. Unlike refined flour, the researchers found no link between these two categories of grains and cardiovascular problems.

Whole grains include cereal flours such as buckwheat. They also encompass intact and cracked whole grain products such as steel cut oats. The study authors suggest choosing foods like brown rice and barley to get the recommended daily amount of grains.

In the United States, heart disease is the leading cause of death for both men and women. According to the Centers for Disease Control and Prevention, one in four deaths (about 655,000 people) each year is caused by cardiovascular problems.

The study appears in The British medical journal.