Serum lipid response to a fat-modified, oatmeal-enhanced diet

Global review of heart health claims for oat beta-glucan products

Coronary heart disease (CHD) is the leading cause of death globally. Consumption of whole grains and cereal fiber, as part of a healthy diet, can lower the risk of CHD. Health claims on food products are effective in helping consumers select healthful diets. The US Food and Drug Administration was the first to approve a health claim, in 1997, between beta-glucan soluble fiber from whole oats, oat bran, and whole oat flour and reduced risk of CHD. Only a few countries have approved similar claims. Since 1997, a significant amount of additional evidence has been published on the relationship between oat beta-glucan and CHD. To assist other jurisdictions in potentially utilizing this claim, the full extent of data that supports this claim (ie, the evidence utilized by the US Food and Drug Administration to substantiate the claim, as well as the results of 49 clinical trials published since 1997) are reviewed here. The complexities involved in authoring evidence-based health claims, including the impact of processing on beta-glucan cholesterol-lowering efficacy in approving eligible beta-glucan products, are also discussed.

Processing of oat: the impact on oat's cholesterol lowering effect

Epidemiological and interventional studies have clearly demonstrated the beneficial impact of consuming oat and oat-based products on serum cholesterol and other markers of cardiovascular disease. The cholesterol-lowering effect of oat is thought to be associated with the β-glucan it contains. However, not all food products containing β-glucan seem to lead to the same health outcome. Overall, highly processed β-glucan sources (where the oat tissue is highly disrupted) appear to be less effective at reducing serum cholesterol, but the reasons are not well understood. Therefore, the mechanisms involved still need further clarification. The purpose of this paper is to review current evidence of the cholesterol-lowering effect of oat in the context of the structure and complexity of the oat matrix. The possibility of a synergistic action and interaction between the oat constituents promoting hypocholesterolaemia is also discussed. A review of the literature suggested that for a similar dose of β-glucan, (1) liquid oat-based foods seem to give more consistent, but moderate reductions in cholesterol than semi-solid or solid foods where the results are more variable; (2) the quantity of β-glucan and the molecular weight at expected consumption levels (∼3 g day-1) play a role in cholesterol reduction; and (3) unrefined β-glucan-rich oat-based foods (where some of the plant tissue remains intact) often appear more efficient at lowering cholesterol than purified β-glucan added as an ingredient.

Whole grain cereals for the primary or secondary prevention of cardiovascular disease

BACKGROUND

There is evidence from observational studies that whole grains can have a beneficial effect on risk for cardiovascular disease (CVD). Earlier versions of this review found mainly short-term intervention studies. There are now longer-term randomised controlled trials (RCTs) available. This is an update and expansion of the original review conducted in 2007.

OBJECTIVES

The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.

SEARCH METHODS

We searched CENTRAL (Issue 8, 2016) in the Cochrane Library, MEDLINE (1946 to 31 August 2016), Embase (1980 to week 35 2016), and CINAHL Plus (1937 to 31 August 2016) on 31 August 2016. We also searched ClinicalTrials.gov on 5 July 2017 and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) on 6 July 2017. We checked reference lists of relevant articles and applied no language restrictions.

SELECTION CRITERIA

We selected RCTs assessing the effects of whole grain foods or diets containing whole grains compared to foods or diets with a similar composition, over a minimum of 12 weeks, on cardiovascular disease and related risk factors. Eligible for inclusion were healthy adults, those at increased risk of CVD, or those previously diagnosed with CVD.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies. Data were extracted and quality-checked by one review author and checked by a second review author. A second review author checked the analyses. We assessed treatment effect using mean difference in a fixed-effect model and heterogeneity using the I² statistic and the Chi² test of heterogeneity. We assessed the overall quality of evidence using GRADE with GRADEpro software.

MAIN RESULTS

We included nine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups. We found no studies that reported the effect of whole grain diets on total cardiovascular mortality or cardiovascular events (total myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, total stroke). All included studies reported the effect of whole grain diets on risk factors for cardiovascular disease including blood lipids and blood pressure. All studies were in primary prevention populations and had an unclear or high risk of bias, and no studies had an intervention duration greater than 16 weeks.Overall, we found no difference between whole grain and control groups for total cholesterol (mean difference 0.07, 95% confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722 participants; low-quality evidence).Using GRADE, we assessed the overall quality of the available evidence on cholesterol as low. Four studies were funded by independent national and government funding bodies, while the remaining studies reported funding or partial funding by organisations with commercial interests in cereals.

AUTHORS' CONCLUSIONS

There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short-term interventions, and the overall quality of the evidence was low. There is a need for well-designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors.

Antioxidant Activity of Oat Proteins Derived Peptides in Stressed Hepatic HepG2 Cells

The purpose of this study was to determine, for the first time, antioxidant activities of seven peptides (P1–P7) derived from hydrolysis of oat proteins in a cellular model. In the oxygen radical absorbance capacity (ORAC) assay, it was found that P2 had the highest radical scavenging activity (0.67 ± 0.02 µM Trolox equivalent (TE)/µM peptide) followed by P5, P3, P6, P4, P1, and P7 whose activities were between 0.14–0.61 µM TE/µM). In the hepatic HepG2 cells, none of the peptides was cytotoxic at 20–300 µM. In addition to having the highest ORAC value, P2 was also the most protective (29% increase in cell viability) against 2,2′-azobis(2-methylpropionamidine) dihydrochloride -induced oxidative stress. P1, P6, and P7 protected at a lesser extent, with an 8%–21% increase viability of cells. The protection of cells was attributed to several factors including reduced production of intracellular reactive oxygen species, increased cellular glutathione, and increased activities of three main endogenous antioxidant enzymes.

The effect of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for CVD risk reduction: a systematic review and meta-analysis of randomised-controlled trials

Oats are a rich source of β-glucan, a viscous, soluble fibre recognised for its cholesterol-lowering properties, and are associated with reduced risk of CVD. Our objective was to conduct a systematic review and meta-analysis of randomised-controlled trials (RCT) investigating the cholesterol-lowering potential of oat β-glucan on LDL-cholesterol, non-HDL-cholesterol and apoB for the risk reduction of CVD. MEDLINE, Embase, CINAHL and Cochrane CENTRAL were searched. We included RCT of ≥3 weeks of follow-up, assessing the effect of diets enriched with oat β-glucan compared with controlled diets on LDL-cholesterol, non-HDL-cholesterol or apoB. Two independent reviewers extracted data and assessed study quality and risk of bias. Data were pooled using the generic inverse-variance method with random effects models and expressed as mean differences with 95 % CI. Heterogeneity was assessed by the Cochran's Q statistic and quantified by the I 2-statistic. In total, fifty-eight trials (n 3974) were included. A median dose of 3·5 g/d of oat β-glucan significantly lowered LDL-cholesterol (-0·19; 95 % CI -0·23, -0·14 mmol/l, P<0·00001), non-HDL-cholesterol (-0·20; 95 % CI -0·26, -0·15 mmol/l, P<0·00001) and apoB (-0·03; 95 % CI -0·05, -0·02 g/l, P<0·0001) compared with control interventions. There was evidence for considerable unexplained heterogeneity in the analysis of LDL-cholesterol (I 2=79 %) and non-HDL-cholesterol (I 2=99 %). Pooled analyses showed that oat β-glucan has a lowering effect on LDL-cholesterol, non-HDL-cholesterol and apoB. Inclusion of oat-containing foods may be a strategy for achieving targets in CVD reduction.

Whole-grain and blood lipid changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Whole grains are recognized for their potential role in preventing cardiovascular diseases; however, results from randomized controlled studies on blood lipids are inconsistent, potentially because of compositional differences between individual grain types for some nutrients, including dietary fiber.

OBJECTIVE

Using a meta-analytic approach, we assessed the effect of whole-grain compared with non-whole-grain foods on changes in total cholesterol (TC), LDL cholesterol, HDL cholesterol, and triglycerides.

DESIGN

We conducted a systematic literature search in selected databases. Studies were included if they were randomized controlled comparisons between whole-grain foods and a non-whole-grain control in adults. A total of 6069 articles were screened for eligibility, and data were extracted from 24 studies. Weighted mean differences were calculated, and meta-regression analyses were performed for whole-grain dose, study duration, and baseline TC concentration.

RESULTS

Overall, whole-grain intake lowered LDL cholesterol (weighted difference: -0.09 mmol/L; 95% CI: -0.15, -0.03 mmol/L; P < 0.01) and TC (weighted difference: -0.12 mmol/L; 95% CI: -0.19, -0.05 mmol/L; P < 0.001) compared with the control. Whole-grain oat had the greatest effect on TC (weighted difference: -0.17 mmol/L; 95% CI: -0.10, -0.25 mmol/L; P < 0.001). No effect of whole-grain foods on HDL cholesterol was seen, whereas whole-grain foods tended to lower triglycerides compared with the control (weighted difference: -0.04 mmol/L; 95% CI: -0.08, 0.01; P = 0.10). No association was found between whole-grain dose or baseline TC concentration and any of the outcomes, whereas study duration was positively associated with changes in TC and LDL cholesterol.

CONCLUSIONS

Consumption of whole-grain diets lowers LDL cholesterol and TC, but not HDL cholesterol or triglycerides, compared with consumption of non-whole-grain control diets. Whole-grain oat appears to be the most effective whole grain for lowering cholesterol.

Oats and CVD risk markers: a systematic literature review

High consumption of whole-grain food such as oats is associated with a reduced risk of CVD and type 2 diabetes. The present study aimed to systematically review the literature describing long-term intervention studies that investigated the effects of oats or oat bran on CVD risk factors. The literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Seventy-six articles describing sixty-nine studies met the inclusion criteria. Most studies lacked statistical power to detect a significant effect of oats on any of the risk factors considered: 59 % of studies had less than thirty subjects in the oat intervention group. Out of sixty-four studies that assessed systemic lipid markers, thirty-seven (58 %) and thirty-four (49 %) showed a significant reduction in total cholesterol (2–19 % reduction) and LDL-cholesterol (4–23 % reduction) respectively, mostly in hypercholesterolaemic subjects. Few studies (three and five, respectively) described significant effects on HDL-cholesterol and TAG concentrations. Only three out of twenty-five studies found a reduction in blood pressure after oat consumption. None of the few studies that measured markers of insulin sensitivity and inflammation found any effect after long-term oat consumption. Long-term dietary intake of oats or oat bran has a beneficial effect on blood cholesterol. However, there is no evidence that it favourably modulates insulin sensitivity. It is still unclear whether increased oat consumption significantly affects other risk markers for CVD risk, and comprehensive, adequately powered and controlled intervention trials are required to address this question.

Whole grain and body weight changes in apparently healthy adults: a systematic review and meta-analysis of randomized controlled studies

BACKGROUND

Whole grains have received increased attention for their potential role in weight regulation. A high intake has been associated with smaller weight gain in prospective cohort studies, whereas the evidence from randomized controlled studies has been less consistent.

OBJECTIVE

We assessed the effects of whole-grain compared with non-whole-grain foods on changes in body weight, percentage of body fat, and waist circumference by using a meta-analytic approach.

DESIGN

We conducted a systematic literature search in selected databases. Studies were included in the review if they were randomized controlled studies of whole-grain compared with a non-whole-grain control in adults. A total of 2516 articles were screened for eligibility, and relevant data were extracted from 26 studies. Weighted mean differences were calculated, and a metaregression analysis was performed by using the whole-grain dose (g/d).

RESULTS

Data from 2060 participants were included. Whole-grain intake did not show any effect on body weight (weighted difference: 0.06 kg; 95% CI: -0.09, 0.20 kg; P = 0.45), but a small effect on the percentage of body fat was seen (weighted difference: -0.48%; 95% CI: -0.95%, -0.01%; P = 0.04) compared with that for a control. An examination of the impact of daily whole-grain intake could predict differences between groups, but there was no significant association (β = -0.0013 kg × g/d; 95% CI: -0.011, 0.009 kg × g/d).

CONCLUSIONS

Whole-grain consumption does not decrease body weight compared with control consumption, but a small beneficial effect on body fat may be present. The relatively short duration of intervention studies (≤16 wk) may explain the lack of difference in body weight and fat. Discrepancies between studies may be caused by differences in study design.

Whole grains and health: from theory to practice--highlights of The Grains for Health Foundation's Whole Grains Summit 2012

The Grains for Health Foundation's Whole Grains Summit, held May 19-22, 2012 in Minneapolis, was the first meeting of its kind to convene >300 scientists, educators, food technologists, grain breeders, food manufacturers, marketers, health professionals, and regulators from around the world. Its goals were to identify potential avenues for collaborative efforts and formulate new approaches to whole-grains research and health communications that support global public health and business. This paper summarizes some of the challenges and opportunities that researchers and nutrition educators face in expanding the knowledge base on whole grains and health and in translating and disseminating that knowledge to consumers. The consensus of the summit was that effective, long-term, public-private partnerships are needed to reach across the globe and galvanize the whole-grains community to collaborate effectively in translating whole-grains science into strategies that increase the availability and affordability of more healthful, grain-based food products. A prerequisite of that is the need to build trust among diverse multidisciplinary professionals involved in the growing, producing, marketing, and regulating of whole-grain products and between the grain and public health communities.

Hypolipidemic effect of fruit fibers in rats fed with high dietary fat

The hypolipidemic effect of 10% fruit fibers in rats fed with high-fat diet (HFD) was evaluated. This study was conducted on a total of 50 male Albino rats divided into 10 equal groups fed with different types of dietary fruits. The feeding period lasted for 24 weeks. Fasting blood samples were collected and sera separated and subjected to lipid profile assay and atherogenic index. In addition, total antioxidant activity of different fruits was determined. The results obtained showed that pomegranate had higher content of antioxidants followed by apple, strawberry and guava compared with other fruits. Rats fed with 20% coconut oil showed a highly significant elevation in the levels of serum total cholesterol, low-density lipoprotein cholesterol and atherogenic factor while the level of high-density lipoprotein cholesterol was significantly decreased when compared with control rats. Histological examination revealed that there was a large lipid and cholesterol deposition in the livers of rats fed with HFD. The potential in lowering the levels of plasma total cholesterol and triglyceride is in the following order: pomegranate > apple > strawberry > guava > papaya > mandarin and orange. Accumulation of hepatic lipid droplets was diminished when compared with the HFD group. Also, antiatherogenic is better than the untreated groups. Accordingly these hypolipidemic effects may be due to high-fiber content and antioxidant activity of these fruits.

Support of drug therapy using functional foods and dietary supplements: focus on statin therapy

Functional foods and dietary supplements might have a role in supporting drug therapy. These products may (1) have an additive effect to the effect that a drug has in reducing risk factors associated with certain conditions, (2) contribute to improve risk factors associated with the condition, other than the risk factor that the drug is dealing with, or (3) reduce drug-associated side effects, for example, by restoring depleted compounds or by reducing the necessary dose of the drug. Possible advantages compared with a multidrug therapy are lower drug costs, fewer side effects and increased adherence. In the present review we have focused on the support of statin therapy using functional foods or dietary supplements containing plant sterols and/or stanols, soluble dietary fibre, n-3 PUFA or coenzyme Q10. We conclude that there is substantial evidence that adding plant sterols and/or stanols to statin therapy further reduces total and LDL-cholesterol by roughly 6 and 10 %, respectively. Adding n-3 PUFA to statin therapy leads to a significant reduction in plasma TAG of at least 15 %. Data are insufficient and not conclusive to recommend the use of soluble fibre or coenzyme Q10 in patients on statin therapy and more randomised controlled trials towards these combinations are warranted. Aside from the possible beneficial effects from functional foods or dietary supplements on drug therapy, it is important to examine possible (negative) effects from the combination in the long term, for example, in post-marketing surveillance studies. Moreover, it is important to monitor whether the functional foods and dietary supplements are taken in the recommended amounts to induce significant effects.

Applying the FDA definition of whole grains to the evidence for cardiovascular disease health claims

The U.S. FDA defines whole grains as consisting of the intact, ground, cracked, or flaked fruit of the grains whose principal components, the starchy endosperm, germ, and bran, are present in the same relative proportions as they exist in the intact grain. We evaluated the effect of applying the FDA definition of whole grains to the strength of scientific evidence in support of claims for risk reduction of cardiovascular disease (CVD). We concluded that using the FDA definition for whole grains as a selection criterion is limiting, because the majority of existing studies often use a broader meaning to define whole grains. When considering only whole grain studies that met the FDA definition, we found insufficient scientific evidence to support a claim that whole grain intake reduces the risk of CVD. However, a whole grain and reduced risk of CVD health claim is supported when using a broader concept of whole grain to include studies that considered intake of fiber-rich bran and germ as well as whole grain. This type of analysis is complicated by diversity in nutrients and bioactive components among different types of whole grains.

State of the Art Reviews: The Oatmeal-Cholesterol Connection: 10 Years Later

Ten years have passed since the Food and Drug Administration (FDA) completed their review of the literature pertaining to the consumption of whole-oat sources of soluble fiber and a reduction in blood cholesterol concentrations. Since that time, data have continued to accumulate regarding oat-soluble fiber consumption, cholesterol, and other physiologic vectors related to cardiovascular health. The objective of this review was to compare the findings of more contemporary analyses of the oat and cholesterol-reduction literature to determine if newer information is consistent with the original conclusion reached by the FDA. A number of formal assessments have been conducted subsequent to the FDA review, and virtually all have reached the same conclusion, namely, consumption of oats and oat-based products significantly reduces total cholesterol and low-density lipoprotein cholesterol concentrations without adverse effects on high-density lipoprotein cholesterol or triglyceride concentrations. In addition, a number of new insights about the potential benefits of oats have emerged over the past 10 years. These more recent data indicate that including oats and oat-based products as part of a lifestyle management program may confer health benefits that extend beyond total cholesterol and low-density lipoprotein cholesterol reduction.

State of the Art Reviews: The Oatmeal-Cholesterol Connection: 10 Years Later

Ten years have passed since the Food and Drug Administration (FDA) completed their review of the literature pertaining to the consumption of whole-oat sources of soluble fiber and a reduction in blood cholesterol concentrations. Since that time, data have continued to accumulate regarding oat-soluble fiber consumption, cholesterol, and other physiologic vectors related to cardiovascular health. The objective of this review was to compare the findings of more contemporary analyses of the oat and cholesterol-reduction literature to determine if newer information is consistent with the original conclusion reached by the FDA. A number of formal assessments have been conducted subsequent to the FDA review, and virtually all have reached the same conclusion, namely, consumption of oats and oat-based products significantly reduces total cholesterol and low-density lipoprotein cholesterol concentrations without adverse effects on high-density lipoprotein cholesterol or triglyceride concentrations. In addition, a number of new insights about the potential benefits of oats have emerged over the past 10 years. These more recent data indicate that including oats and oat-based products as part of a lifestyle management program may confer health benefits that extend beyond total cholesterol and low-density lipoprotein cholesterol reduction.

An integrated procedure for the measurement of total dietary fibre (including resistant starch), non-digestible oligosaccharides and available carbohydrates

A method is described for the measurement of dietary fibre, including resistant starch (RS), non-digestible oligosaccharides (NDO) and available carbohydrates. Basically, the sample is incubated with pancreatic alpha-amylase and amyloglucosidase under conditions very similar to those described in AOAC Official Method 2002.02 (RS). Reaction is terminated and high molecular weight resistant polysaccharides are precipitated from solution with alcohol and recovered by filtration. Recovery of RS (for most RS sources) is in line with published data from ileostomy studies. The aqueous ethanol extract is concentrated, desalted and analysed for NDO by high-performance liquid chromatography by a method similar to that described by Okuma (AOAC Method 2001.03), except that for logistical reasons, D-sorbitol is used as the internal standard in place of glycerol. Available carbohydrates, defined as D-glucose, D-fructose, sucrose, the D-glucose component of lactose, maltodextrins and non-resistant starch, are measured as D-glucose plus D-fructose in the sample after hydrolysis of oligosaccharides with a mixture of sucrase/maltase plus beta-galactosidase.

Wholegrain cereals for coronary heart disease

BACKGROUND

There is increasing evidence from observational studies that wholegrains can have a beneficial effect on risk factors for coronary heart disease (CHD).

OBJECTIVES

The primary objective is to review the current evidence from randomised controlled trials (RCTs) that assess the relationship between the consumption of wholegrain foods and the effects on CHD mortality, morbidity and on risk factors for CHD, in participants previously diagnosed with CHD or with existing risk factors for CHD.

SEARCH STRATEGY

We searched CENTRAL (Issue 4, 2005), MEDLINE (1966 to 2005), EMBASE (1980 to 2005), CINAHL (1982 to 2005), ProQuest Digital Dissertations (2004 to 2005). No language restrictions were applied.

SELECTION CRITERIA

We selected randomised controlled trials that assessed the effects of wholegrain foods or diets containing wholegrains, over a minimum of 4 weeks, on CHD and risk factors. Participants included were adults with existing CHD or who had at least one risk factor for CHD, such as abnormal lipids, raised blood pressure or being overweight.

DATA COLLECTION AND ANALYSIS

Two of our research team independently assessed trial quality and extracted data. Authors of the included studies were contacted for additional information where this was appropriate.

MAIN RESULTS

Ten trials met the inclusion criteria. None of the studies found reported the effect of wholegrain diets on CHD mortality or CHD events or morbidity. All 10 included studies reported the effect of wholegrain foods or diets on risk factors for CHD. Studies ranged in duration from 4 to 8 weeks. In eight of the included studies, the wholegrain component was oats. Seven of the eight studies reported lower total and low density lipoproteins (LDL) cholesterol with oatmeal foods than control foods. When the studies were combined in a meta-analysis lower total cholesterol (-0.20 mmol/L, 95% confidence interval (CI) -0.31 to -0.10, P = 0.0001 ) and LDL cholesterol (0.18 mmol/L, 95% CI -0.28 to -0.09, P < 0.0001) were found with oatmeal foods. However, there is a lack of studies on other wholegrains or wholegrain diets.

AUTHORS' CONCLUSIONS

Despite the consistency of effects seen in trials of wholegrain oats, the positive findings should be interpreted cautiously. Many of the trials identified were short term, of poor quality and had insufficient power. Most of the trials were funded by companies with commercial interests in wholegrains. There is a need for well-designed, adequately powered, longer term randomised controlled studies in this area. In particular there is a need for randomised controlled trials on wholegrain foods and diets other than oats.

A randomized controlled trial of dietary fiber intake on serum lipids

OBJECTIVE

Clinical trials have indicated that water-soluble fiber from oats reduces serum cholesterol among hypercholesterolemic patients on a low-fat diet. We examined the effect of dietary fiber intake on serum lipids among persons without hypercholesterolemia.

DESIGN

Randomized controlled trial.

SETTING AND SUBJECTS

We recruited 110 participants who were aged 30-65 years and had a serum cholesterol level < 240 mg/dl from community.

INTERVENTION

Study participants were randomly assigned to receive 8 g per day of water-soluble fiber from oat bran or a control intervention.

RESULTS

At baseline, the mean levels of serum cholesterol and other measured variables were comparable between the high-fiber and control groups. Over the 3-month intervention, mean changes (95% confidence interval (CI)) in total, HDL-, and LDL-cholesterol were -2.42 mg/dl (-8.90 to 4.05 mg/dl; P = 0.46), -0.24 mg/dl (-2.19 to 1.71 mg/dl; P = 0.81), and -1.96 mg/dl (-7.32 to 3.40 mg/dl; P = 0.47) in the fiber group and -0.02 mg/dl (-5.29 to 5.26 mg/dl; P = 0.99), 1.42 mg/dl (-0.74 to 3.59 mg/dl; P = 0.19), and -0.64 mg/dl (-5.30 to 4.03 mg/dl; P = 0.79) in the control group, respectively. The net changes (95% confidence interval) in total, HDL-, and LDL-cholesterol were -2.40 mg/dl (-10.6 to 5.81 mg/dl; P = 0.56), -1.66 mg/dl (-4.55 to 1.22 mg/dl; P = 0.26) and -1.33 mg/dl (-8.33 to 5.68 mg/dl; P = 0.71), respectively.

CONCLUSIONS

Our study does not support the hypothesis that water-soluble fiber intake from oat bran reduces total and LDL-cholesterol in study participants with a normal serum cholesterol level.

Randomized controlled crossover study of the effect of a highly beta-glucan-enriched barley on cardiovascular disease risk factors in mildly hypercholesterolemic men

BACKGROUND

Soluble-fiber beta-glucan derived from oats can reduce cardiovascular disease (CVD) risk through reductions in total and LDL cholesterol. Barley-derived beta-glucan may also improve serum cholesterol, but large quantities are required for clinical significance.

OBJECTIVE

This trial investigated whether a beta-glucan-enriched form of barley can favorably modify cholesterol and other markers of CVD and diabetes risk.

DESIGN

Eighteen mildly hyperlipidemic ( +/- SD: 4.0 +/- 0.6 mmol LDL cholesterol/L) men with a mean (+/- SD) body mass index (in kg/m(2)) of 27.4 +/- 4.6 were randomly assigned in this single-blind, 2 x 4-wk trial to either the treatment arm [8.1-11.9 g beta-glucan/d (scaled to body weight)] or the control arm (isoenergetic dose of 6.5-9.2 g glucose/d). After a washout period of 4 wk, dietary regimens were crossed over. The trial took place in a long-stay metabolic facility, and all foods were provided (38% of energy from fat). Fasted blood samples were collected on days 0, 1, 7, 14, 21, 28, and 29 in both study arms. An oral-glucose-tolerance test was carried out on days 0 and 29.

RESULTS

There was no significant change (Delta) in total (Delta = -0.08 mmol/L, -1.3%), LDL (Delta = -0.15 mmol/L, -3.8%), or HDL (Delta = 0 mmol/L) cholesterol or in triacylglycerol (Delta = 0.18 mmol/L), fasting glucose (Delta = -0.05 mmol/L), or postprandial glucose when analyzed between treatments (P > 0.05; ANOVA).

CONCLUSION

The effect of beta-glucan-enriched barley on lipid profile was highly variable between subjects, and there was no evidence of a clinically significant improvement in CVD risk across this group of mildly hyperlipidemic men.

Whole grains health claims in the USA and other efforts to increase whole-grain consumption

In response to the 1990 Nutrition Labeling and Education Act, the Food and Drug Administration approved seven health claims that addressed the relationship between broad food categories and risk of certain chronic diseases. These claims are based on scientific consensus that includes epidemiological, animal and clinical research. The Food and Drug Administration also established a process to petition for new health claims that address substance-disease relationships supported by adequate scientific and specific regulatory requirements. The whole grain-cancer and heart disease authoritative statement health claim approved in July 1999 followed a completely different process mandated by the Food and Drug Administration Modernization Act of 1997. It is based on an authoritative statement made by a government body that represents scientific consensus and is supported by other scientific agencies and organizations. The scientific basis for the claim published in Diet and Health reflects a comprehensive and deliberative review of epidemiological, animal and human studies by the National Academy of Sciences Committee on Diet and Health. Health claims used on whole grain products can attract the attention of health-conscious consumers and are important tools in communicating health messages. However, the US public consumes substantially fewer whole-grain servings than recommended by US dietary guidance. Reasons given by consumers for not purchasing wholegrain foods include colour, price, softness, texture, moisture content and taste. Developing tastier value-added wholegrain foods along with simple coordinated messages from industry, the scientific community, public health experts and government will help consumers identify, purchase and consume more wholegrain products.

High-soluble-fiber foods in conjunction with a telephone-based, personalized behavior change support service result in favorable changes in lipids and lifestyles after 7 weeks

OBJECTIVE

To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care.

DESIGN

7-week randomized, controlled intervention.

SUBJECTS/SETTING

150 moderately hypercholesterolemic men and women, age range 25 to 70 years.

INTERVENTION

The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Program's (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet.

MAIN OUTCOME MEASURES

Serum lipids and lipoproteins and self-reported lifestyle changes.

STATISTICAL ANALYSES

For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes.

RESULTS

In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P<.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P<.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P<.05). The intervention group reported an increase in exercise vs the usual care group (P<.05). Both intervention and control groups had a minimal reduction (<1%) in body weight compared with baseline (P<.0167).

APPLICATIONS/CONCLUSIONS

A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.

Cereal grains and coronary heart disease

Cereal grains and their products provide around 30% of total energy intake in British adults, (much more than any of the other major food groups). Coronary heart disease (CHD) is the largest single cause of death in Britain and many other Western countries. This review examines the question whether there is a relation between cereal consumption and CHD. Several of the nutrients in cereals have known potential for reducing risk factors for CHD: the linoleic acid, fibre, vitamin E, selenium and folate. Cereals also contain phytoestrogens of the lignan family and several phenolic acids with antioxidant properties. Processing generally reduces the content of these nutrients and bioprotective substances. Although cereals at the farm gate are very low in salt, processed cereal foods, eg bread and some breakfast cereals, are high-salt foods and thus could contribute to raising blood pressure. Human experiments have clearly shown that oat fibre tends to lower plasma total and LDL cholesterol but wheat fibre does not. Rice bran and barley may also lower cholesterol but most people do not eat enough barley to have an effect. Cereal foods with low glycaemic index such as pasta and oats are beneficial for people with diabetes and might lower plasma lipids. Between 1996 and 2001 an accumulation of five very large cohort studies in the USA, Finland and Norway have all reported that subjects consuming relatively large amounts of whole grain cereals have significantly lower rates of CHD. This confirms an earlier report from a small British cohort. The protective effect does not seem to be due to cholesterol-lowering. While cohort studies have shown this consistent protective effect of whole grain cereals, there has been (only one) randomised controlled secondary prevention trial of advice to eat more cereal fibre. In this there was no reduction of the rate of reinfarction. The trial had some weaknesses, eg there were eight different diets, compliance was not checked objectively, and duration was for only 2 y. It appears valid to make health claims (as now permitted by the US FDA) that whole grain cereal foods and oat meal or bran may reduce the risk of CHD.

Cholesterol-lowering effects of dietary fiber: a meta-analysis

BACKGROUND

The effects of dietary soluble fibers on blood cholesterol are uncertain.

OBJECTIVE

This meta-analysis of 67 controlled trials was performed to quantify the cholesterol-lowering effect of major dietary fibers.

DESIGN

Least-squares regression analyses were used to test the effect on blood lipids of pectin, oat bran, guar gum, and psyllium. Independent variables were type and amount of soluble fiber, initial cholesterol concentration, and other important study characteristics.

RESULTS

Soluble fiber, 2-10 g/d, was associated with small but significant decreases in total cholesterol [-0.045 mmol L(-1).g soluble fiber(-1) (95% CI: -0.054, -0.035)] and LDL cholesterol [-0.057 mmol.L(-1).g(-1) (95% CI: -0.070, -0.044)]. The effects on plasma lipids of soluble fiber from oat, psyllium, or pectin were not significantly different. We were unable to compare effects of guar because of the limited number of studies using 2-10 g/d. Triacylglycerols and HDL cholesterol were not significantly influenced by soluble fiber. Lipid changes were independent of study design, treatment length, and background dietary fat content.

CONCLUSIONS

Various soluble fibers reduce total and LDL cholesterol by similar amounts. The effect is small within the practical range of intake. For example, 3 g soluble fiber from oats (3 servings of oatmeal, 28 g each) can decrease total and LDL cholesterol by approximately 0.13 mmol/L. Increasing soluble fiber can make only a small contribution to dietary therapy to lower cholesterol.

Soluble fiber enhances the hypocholesterolemic effect of the step I diet in childhood

BACKGROUND

Psyllium, a water-soluble fiber, has been shown to have a cholesterol-lowering effect in studies of adults. A small number of studies in children have produced variable results.

METHODS

A 12-week, randomized, single-blind, placebo-controlled, parallel clinical trial was conducted to test the effectiveness of psyllium in lowering total (TC) and low-density lipoprotein cholesterol (LDL-C) in 50 healthy 2 to 11 year old children. Children with two baseline LDL-C levels > or = 110 mg/dL were invited to participate in the trial, and were randomly assigned to follow a usual Step I (Control) diet of low dietary fat, saturated fat and cholesterol, or a Step I diet enriched with psyllium. Children consumed two 1-oz boxes of cereal per day, with each box of psyllium-enriched cereal containing 3.2 g of soluble fiber, and each box of placebo cereal containing less than 0.5 g of soluble fiber.

RESULTS

Greater reduction of total and LDL-cholesterol, and increase in HDL-cholesterol were noted after 12 weeks of the psyllium-enriched Step I diet compared to the Step I control diet. Total cholesterol decreased 21 mg/dL for the high fiber group compared with 11.5 mg/dL for the control group. LDL-C decreased 23 mg/dL for the high fiber group compared with 8.5 mg/dL for the control group. HDL-C increased 4 mg/dL for the high fiber group compared with 1 mg/dL for the controls. TC/HDL and LDL/HDL ratios decreased significantly more so for the high fiber group as well.

CONCLUSIONS

In this 12-week study, soluble fiber (psyllium) provided added benefit to the Step I diet in the treatment of hypercholesterolemia.

Mechanism of serum cholesterol reduction by oat bran

Nine normolipidemic young men consumed a constant diet for 2 mo into which oat bran was incorporated during the second month so that we might test the hypotheses that oats lower serum cholesterol concentrations by decreasing bile acid and fat absorption and increasing bile acid synthesis. Bile acid kinetics were determined by measuring the 13C enrichment of serum cholic and chenodeoxycholic acids. Oat bran consumption decreased serum cholesterol levels (p < 0.01) and cholic acid pool size (p < 0.05). Deoxycholic acid pool size (p < 0.01) and the synthesis and fractional turnover rates of both primary bile acids (p < 0.05) increased. Total bile acid pool size did not change. Fecal excretion of total bile acids, the two secondary bile acids and fat increased significantly. The results demonstrate that oat bran lowers serum cholesterol levels in part by altering bile acid metabolism. In addition, the substantial increase in the proportion of the total bile acid pool that was deoxycholic acid is consistent with the hypothesis that oat bran also decreases cholesterol synthesis.

Soluble fiber and serum lipids: a literature review

Although fiber has been increasingly recognized as an important dietary constituent, controversy and confusion still exist about the physiologic effects of fiber. Specifically, the independent ability of dietary fiber to lower serum lipid levels is controversial. The purpose of this article is to review available evidence regarding the impact of soluble fibers on serum lipid levels. Soluble fibers appear to have a greater potential to alter serum lipid levels than do insoluble fibers. Significant reduction in the level of serum total cholesterol by soluble fiber was found in 68 of the 77 (88%) human studies reviewed. Of the studies measuring low-density lipoprotein cholesterol, 41 of 49 (84%) reported significant reductions. No significant changes were reported in 43 of the 57 (75%) studies that reported high-density lipoprotein cholesterol and/or in 50 of the 58 (86%) studies that measured triglyceride levels.

Cholesterol-lowering effect of barley bran flour and oil

OBJECTIVE

To compare the effects of adding barley bran flour and a barley oil extract to a fat-modified diet on serum lipids in persons with hypercholesterolemia.

DESIGN

The basic design of the study was a randomized, 30-day intervention trial. It included a neutral-fiber control group and a 1-week preintervention period for the collection of baseline data.

SUBJECTS

The subjects were 79 men and women with hypercholesterolemia. Subjects had a mean age of 48.2 years, and all completed the study.

INTERVENTION

All participants were instructed to follow the National Cholesterol Education Program (NCEP) step 1 diet and were randomly assigned to one of three treatment groups: 20 g added cellulose, 3 g added barley oil extract, or 30 g added barley bran flour.

MAIN OUTCOME MEASURES

Total serum cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very-low-density lipoprotein cholesterol were measured, along with serum triglycerides, before the intervention, at week 1, at week 3, and at the end of the intervention.

STATISTICAL ANALYSES PERFORMED

Student's paired t test was used to detect significant changes within each treatment group from baseline to the end of the 30-day intervention. In addition, Pearson's correlation coefficients were used to detect significant correlations between the variables measured.

RESULTS

Addition of barley bran flour significantly (P = .0001) decreased total serum cholesterol (-0.60 mmol/L) as did addition of barley oil (-0.50 mmol/L; P = .002) after 30 days of intervention. Similarly, LDL-C decreased 6.5% with addition of barley bran flour (P = .036) and 9.2% with addition of barley oil (P = .003). Total serum cholesterol or LDL-C of the cellulose control group did not decrease significantly over the same period. HDL-C decreased significantly in the cellulose control group and the barley bran flour group (-0.15 mmol/L, P = .012, and -0.15 mmol/L, P = .006, respectively), but not in the barley oil group.

CONCLUSION

We conclude that addition of barley bran flour or barley oil enhances the cholesterol-lowering effect of the NCEP step 1 diet in individuals with hypercholesterolemia.

Randomized, double-blind, placebo-controlled, two-period crossover clinical trial of psyllium fiber in children with hypercholesterolemia

A randomized, double-blind, placebo-controlled, crossover clinical trial was designed to test the efficacy of psyllium fiber in lowering elevated low-density lipoprotein cholesterol (LDL-C) levels in children 5 to 17 years of age. Subjects with LDL-C levels > 2.84 mmol/L (110 mg/dl) after at least 3 months of a low total fat, low saturated fat, low cholesterol diet were enrolled. Two ready-to-eat cereals, with water-soluble psyllium fiber (6 gm/day) and without, were prescribed for 4 to 5 weeks each, with an intervening 2-week washout phase. Reported compliance rates exceeded 80% in the 20 subjects who completed the study. Mean initial total cholesterol, LDL-C, high-density lipoprotein cholesterol, and triglyceride values were 5.23, 3.60, 1.18, and 2.22 mmol/L, respectively. Comparison of the mean changes (from baseline) in lipid values after the two periods of cereal consumption revealed no statistically nor clinically significant differences in total cholesterol, LDL-C, or high-density lipoprotein cholesterol values. Triglyceride levels, however, increased 0.68 mmol/L (26 mg/dl; p < 0.05) after the control cereal in comparison with the psyllium cereal. No significant differences were noted in the children's dietary intake (assessed by 7-day diet records) during the two study periods. Measures of growth (height, weight, and skin-fold thicknesses), and blood vitamin (folic acid; vitamins A, D, and E) and mineral (iron, zinc, and calcium) levels were not affected. In this study, psyllium fiber had no additional lowering effect on total cholesterol or LDL-C levels in children who were already following low total fat, low saturated fat, low cholesterol diets.

The effect of acacia gum and a water-soluble dietary fiber mixture on blood lipids in humans

Water-soluble dietary fibers (WSDF) are generally thought to lower cholesterol. This study compared the cholesterol-lowering effects of a medium viscosity WSDF mixture (psyllium, pectin, guar gum and locust bean gum) with an equal amount of WSDF from acacia gum, which has a lower viscosity. Hypercholesterolemic males (n = 13) and females (n = 16) were randomly assigned to one of two WSDF treatments provided in a low-calorie powder form for mixing into beverages (< 4 kcal/serving). Subjects were instructed to mix powders into their usual beverages and to consume them three times daily (5 g WSDF/serving) for 4 weeks while consuming their typical fat-modified diets. Exercise and body weights were also held constant. The WSDF mixture yielded a 10% decrease in plasma total cholesterol (from 251 +/- 20 to 225 +/- 19 mg/dL; p < 0.01), and a 14% reduction in low-density lipoprotein cholesterol (from 167 +/- 14 to 144 +/- 14 mg/dL; p < 0.001). No significant changes in plasma high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol or triglycerides were observed. In contrast, the acacia gum-treated group showed no change in any plasma lipid parameters. The WSDF treatments did not produce significant changes in mean dietary intakes within or between treatment groups. These data support previous findings that a diet rich in select WSDF can be a useful cholesterol-lowering adjunct to a fat-modified diet, but that caution should be exercised in ascribing cholesterol-lowering efficacy to dietary fibers based solely on their WSDF classification. Finally, WSDF viscosity is a potential cholesterol-lowering factor to be explored further.

Dietary fiber, inulin, and oligofructose: a review comparing their physiological effects

Dietary fiber is a general term. It covers a wide variety of substances that belong to the family of carbohydrates that resist hydrolysis by human alimentary enzymes but are fermented by colonic microflora. The main physiological effects of dietary fiber are primarily on gastric emptying and small intestinal transit time, resulting in an improved glucose tolerance and a decreased digestion of starch: second, on colonic transit time and large bowel functions due to fermentation by ceco-colonic microbial flora or bulking action. The so-called soluble dietary fibers are fermented to a large extent by a wide variety of anaerobic bacteria that result in an increase in bacterial biomass, an increase in fecal mass, a change in intracolonic pH, and production of short chain fatty acids and various gases as metabolic end products. The insoluble fibers are only marginally fermented: they serve almost exclusively as bulking agents that result in shorter transit time and increased fecal mass. The short chain fatty acids resulting from the colonic fermentation of dietary fiber are largely absorbed via the portal blood and reach both the liver and the peripheral tissues. They induce changes in glucose and fat metabolism leading to post-prandial hypoglycemia and long-term hypolipidemia. Inulin and oligofructose are fructans with a degree of polymerization of 2 to 60 and 2 to 20, respectively. Due to the structural conformation of their osidic bridge (beta 2-1), they both resist the hydrolysis by human alimentary enzymes. Moreover, when reaching the colon, both inulin and oligofructose are almost quantitatively fermented almost exclusively by colonic bifidobacteria and bacteroides. Such an extensive fermentation causes an increase in fecal bacterial biomass, a decrease in ceco-colonic pH, and produces a large amount of fermentation products among which the short chain fatty acids that exert systemic effects on lipid metabolism. Thus, both inulin and oligofructose have most of the characteristics of a dietary fiber and the proposal is made to classify them as such. Moreover, they are bifidogenic factors, because, due to still unknown reasons, they are primarily fermented by bifidobacteria. It is concluded from this review that "nondigestible fructo-oligosaccharides," even though they are not included in the carbohydrate fraction that is quantified as dietary fiber by classic analytical methods, have most of the physiological effects of a dietary fiber.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of fat-modified and fruit- and vegetable-enriched diets on blood lipids in the Indian Diet Heart Study

This study was designed to test the efficacy of the administration of fruits and vegetables for 12 weeks as an adjunct to a prudent diet in decreasing blood lipids in 310 (intervention; group A) and 311 (control; group B) patients with risk factors of coronary artery disease (CAD) in a parallel, single-blind fashion. At entry to the study, sex, mean age, body weight, body mass index, systolic and diastolic blood pressures, and blood lipoproteins were comparable between both groups. Tasty fruits and vegetables were given to patients to eat before major meals for better nutrient adherence and adequacy. Dietary intakes were determined by questionnaires and by weighing of fruit and vegetable intake. Fruits and vegetables decreased total cholesterol level by 6.5% and low-density lipoprotein cholesterol level by 7.3% in group A, whereas the levels were unchanged in group B. The high-density lipoprotein cholesterol levels that decreased during the diet stabilization period in both groups, increased by 5.6% in group A after 12 weeks. Serum triglycerides also decreased (7%) more in group A than B. Fasting blood glucose decreased by 6.9% in group A and by 2.6% in group B. The combined effect of a fat-modified diet plus fruits and vegetables was greater than these changes. Because tasty fruits were taken by the patients before meals (when they are hungry) and are easily available at reasonable cost in our marketing and buying capacity, the compliance was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural dietary ingredients (oats and alfalfa) induce covalent DNA modifications (I-compounds) in rat liver and kidney

Mammalian tissue DNA has recently been found, via 32P postlabeling, to contain complex profiles of age-dependent bulky carcinogen adductlike covalent modifications, which have been termed I-compounds, referring to their apparent indigenous origin without exposure to exogenous carcinogens. I-compound patterns are highly species, sex, tissue, and diet specific. As shown here, the presence of certain plant ingredients in diet, i.e., ground oats and alfalfa meal, significantly contributed to the formation of these DNA derivatives. Six groups of weanling female Sprague-Dawley rats were fed one of the following diets for three months: a natural ingredient diet containing neither oats nor alfalfa (Wayne MRH 22/5 Rodent Blox), Wayne diet supplemented with oats or alfalfa or both, a purified semisynthetic diet (AIN-76A), and AIN diet supplemented with oats. The natural ingredient diet produced more complex patterns and higher levels of I-compounds than purified diet in both liver and kidney DNA. Supplementation of either diet with oats elicited the formation of four additional oats-specific I-compounds in liver DNA. Oats and alfalfa, individually and in combination, tended to significantly raise nonpolar and diminish polar I-compound levels. To determine whether the oats-related extra spots were derived from mycotoxin contamination, two groups of rats were fed either Wayne diet or Wayne diet containing zearalenone (0.05 mg/kg) for three weeks. Zearalenone significantly increased the uterine weight but did not induce any DNA adduct formation.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects on serum lipids of adding instant oats to usual American diets

This study was designed as a test of the serum lipid response and dietary adaptation to recommended daily inclusion of instant oats in an otherwise regular diet. Hypercholesterolemic adults were randomly assigned to a control or intervention group. Participants in the intervention group were given packages of instant oats and requested to eat two servings per day (approximately two ounces dry weight), substituting the oats for other carbohydrate foods in order to maintain baseline calorie intake and keep weight stable. Serum lipids were measured in blood collected by venipuncture at baseline, four weeks, and eight weeks. Baseline mean total cholesterol (TC) levels were 6.56 mmol/L and 6.39 mmol/L for intervention and control groups, respectively. After eight weeks, mean serum total cholesterol of the intervention group was lower by -0.40 mmol/L, and mean net difference in TC between the two groups was 0.32 mmol/L (95% CI: 0.09, 0.54). Low-density lipoprotein-cholesterol was similarly reduced with mean net difference of 0.25 mmol/L (95% CI: 0.02, 0.48) between the two groups. Mean soluble fiber intake increased along with slight self-imposed reductions in mean total fat, saturated fat, and dietary cholesterol intake in the intervention group. Neither group changed mean body weight. Daily inclusion of two ounces of oats appeared to facilitate reduction of serum total cholesterol and LDL-C in these hyperlipidemic individuals.

Lowering cholesterol naturally

Patients today are more likely than ever to seek advice about reducing cholesterol levels. Physicians can help by teaching patients how to cut down on saturated fats. However, as Dr. Nash points out, eating habits are difficult to change, especially for those who think that healthy foods have an unpleasant taste. This article discusses several dietary interventions that have been proven to reduce cholesterol levels and thus the risk of coronary artery disease.