{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:14:48Z","timestamp":1758586488070,"version":"3.44.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To examine whether habitual whole-grain intake is associated with lower patient-reported systemic inflammatory distress among ambulatory survivors of esophageal squamous-cell carcinoma (ESCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross-sectional questionnaire study (May 2023\u2013July 2025) at four tertiary hospitals in Shanxi Province among adults with stage I\u2013IIIA ESCC (n = 392). A validated semi-quantitative food frequency questionnaire quantified five whole-grain categories. Exposures were modeled as grams\/day<jats:sup>-<\/jats:sup>\u00b9 (sex-specific quartiles; continuous per 10 g), an energy-adjusted density metric (g\/1,000 kcal), and a diversity score (0\u20135 categories consumed \u2265 once\/week). Systemic inflammatory symptoms were measured with the seven-item Inflammation Distress Index (IDI). Multivariable logistic models estimated adjusted odds ratios (aORs) for elevated IDI (\u2265 10); \u03b3-log generalized linear models analyzed continuous IDI; restricted cubic splines assessed dose\u2013response. Models adjusted for sociodemographic, clinical, and behavioral covariates, with total energy included when grams were exposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median whole-grain intake was 35.4 g\/day<jats:sup>-<\/jats:sup>\u00b9 (IQR 22.1\u201358.7); 28.1% had elevated IDI. Prevalence declined across quartiles (39.8%, 34.7%, 25.5%, 12.2%). Fully adjusted aORs (vs. Q1) were 0.95 (0.62\u20131.47), 0.49 (0.31\u20130.76), and 0.19 (0.11\u20130.33) for Q2\u2013Q4 (p-trend &amp;lt; 0.001). Each 10 g\/day<jats:sup>-<\/jats:sup>\u00b9 increment corresponded to a 6% lower mean IDI (mean ratio 0.94; 0.92\u20130.96). Splines showed a steep inverse slope up to ~60 g\/day<jats:sup>-<\/jats:sup>\u00b9 with a plateau (p-nonlinearity = 0.031). Findings were consistent by stage (interaction p = 0.59) and smoking status (p = 0.67), robust in sensitivity analyses, and supported by density (Q4 vs. Q1 aOR 0.21; per +5 g\/1,000 kcal<jats:sup>-<\/jats:sup>\u00b9 aOR 0.93) and diversity (per +1 category aOR 0.86; \u2265 3 vs. 0\u20131 aOR 0.48) metrics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In Shanxi ESCC survivorship care, higher whole-grain intake\u2014particularly ~50 g\/day<jats:sup>-<\/jats:sup>\u00b9 and with greater variety\u2014aligns with substantially lower systemic inflammatory distress, supporting grain-centered dietary counseling.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1643374","type":"journal-article","created":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T04:12:50Z","timestamp":1758514370000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Whole grains temper immune-mediated inflammation in 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