Abstract: Anthocyanins are a water-soluble flavonoids widely distributed in dark grains, berries and vegetables. Anthocyanins have strong antioxidant and anti-inflammatory activities, and adequate intake of cereal-based anthocyanins can reduce the risk of chronic diseases including diabetes, cardiovascular disease, age-related macular degeneration and so on. This paper will review the health effects and mechanism of different cereal-based anthocyanins in chronic diseases, focuses on clarifying the distribution and content of anthocyanins in different grains, the effects of cereal anthocyanins regulating Nrf2, NF-κB, MAPK, and PI3K/AKT signaling pathways. The paper also points out the current utilization and development trend of cereal anthocyanins. This paper provides scientific evidence for fundamental research and product development of cereal-based anthocyanins in the fields of food and medicine.