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We calculated the quantity of gluten on the basis of the protein content of wheat, rye, and barley based on recipe ingredient lists from product labels provided by manufacturers or cookbooks in the case of home prepared items.

Previous studies have used conversion factors of 75% or 80% when calculating the proportion of protein content that comprises gluten; we used the more conservative estimate of 75%.222324 Although gluten’s proportion of total protein may be more variable for rye and barley than for wheat,25 we used the same conversion factor for all three grains, consistent with previous studies.2223 Although trace amounts of gluten can be present in oats and in condiments (for example, soy sauce), we did not calculate gluten on the basis of these items as the quantity of gluten is much lower than that in cereals and grains and the contribution to total gluten intake would be negligible.26In 1986 the five largest contributors to gluten in both cohorts were dark bread, pasta, cold cereal, white bread, and pizza (supplementary table A).

Deaths were identified from state vital records and the National Death Index or reported by participants’ next of kin.

We classified coronary heart disease deaths by examining autopsy reports, hospital records, or death certificates.

Conclusion Long term dietary intake of gluten was not associated with risk of coronary heart disease.

However, the avoidance of gluten may result in reduced consumption of beneficial whole grains, which may affect cardiovascular risk.

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We designated as probable those cases in which coronary heart disease was the underlying cause on the death certificate but no previous knowledge of coronary heart disease was indicated and medical records concerning the death were unavailable.

After additional adjustment for intake of whole grains (leaving the remaining variance of gluten corresponding to refined grains), the multivariate hazard ratio was 1.00 (0.92 to 1.09; P for trend=0.77).

In contrast, after additional adjustment for intake of refined grains (leaving the variance of gluten intake correlating with whole grain intake), estimated gluten consumption was associated with a lower risk of coronary heart disease (multivariate hazard ratio 0.85, 0.77 to 0.93; P for trend=0.002).

The Nurses’ Health Study (NHS) is a prospective cohort of 121 700 female nurses from 11 US states who were enrolled in 1976.

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The Health Professionals Follow-up Study (HPFS) is a prospective cohort of 51 529 male health professionals from all 50 states who were enrolled in 1986.Participants in NHS and HPFS have been followed via biennial self administered questionnaires on health and lifestyle habits, anthropometrics, environmental exposures, and medical conditions.



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