The effects of cereal β-glucans on cardiovascular risk factors and the role of the gut microbiome

Figures & data

Figure 1. (a) β-Glucan structure from cereals sources (oats, barley), linear β-1,3 or β-1,4 backbone with no branching, (b) β-glucan structure from fungus or yeast; β-1,3 backbone with β-1,6 branches (Kaur et al. 2019).

Figure 2. The proposed mechanisms of action of β-glucans on CVD risk parameters; elevated BP and cholesterol with the interaction of the microbiome and potentially other metabolic factors (adapted and modified by Schmidt 2022).

Table 1. A summary and timeline of key studies to date investigating serum lipids and cholesterol metabolism outcomes as reported in: (a) systematic reviews and meta-analyses, (b) human studies and (c) animal studies.

Reference	Study Design	Biomarker	Source	Study Outcome
a. Systematic Reviews and Meta-Analyses
Ripsin et al. 1992	Meta-analysis of 20 RCTs investigating the hypothesis that oat consumption lowers TC.	Cholesterol	Oat, 3 g/d	Reduced TC by −0.13 mmol/L with β-Glucan concentrations of 3 g/d. Larger reductions observed among participants with higher blood cholesterol levels at baseline (≥5.9 mmol/L)
Talati et al. 2009	Meta-analysis investigating the effects of barley derived soluble fiber on serum lipids in adults; both healthy and with hypercholesterolemia (n = 391).	Cholesterol	Barley 3–10 g/d, 4- 12wks	Barley intake significantly lowered TC (MD: −13.38 mg/dL; 95% CI, −18.46 to −8.31 mg/dL), LDL-C, (MD: −10.02 mg/dL; 95% CI, −14.03 to −6.00 mg/dL) and triglycerides (MD: −11.83 mg/dL; 95% CI, −20.12 to −3.55 mg/dL) but did not appear to significantly alter HDL-C (p = 0.07).
AbuMweis, Jew, and Ames 2020	Meta-analysis of 11 RCTs examining the lipid-lowering capacity of barley derived β-Glucans.	Blood Lipids	Barley	Barley derived β-Glucans reduced TC and LDL-C concentrations 0.30 mmol/L (95% CI: −0.39 to −0.21, p < 0.00001) and 0.27 mmol/L (95% CI: −0.34 to −0.20, p < 0.00001), respectively, compared with control. No dose-dependent response was observed.
Tiwari and Cummins 2011	Meta-analysis of 126 studies that examined the effect of β-Glucan intake of 3 g/d on measures of blood cholesterol.	Cholesterol	Oat and Barley, 3 g/d	Significant reduction of TC (−0.85 to −0.34), LDL-C (−0.96 to −0.36), and triglycerides (−0.15 to 0.07) following consumption of oat and barley β-Glucans and observed a dose-dependent response in participants with elevated cholesterol.
Threapleton et al. 2013	Systematic review and meta-analysis of 22 cohort studies investigating dietary fiber intake and risk of CVD. Fiber sources included; insoluble fiber, cereal, vegetable and fruit fiber.	CVD Risk	Dietary Fiber	Dietary fiber intake inversely associated with risk of CVD (risk ratio 0.91 per 7 g/d (95% CI: 0.88 to 0.94).
Whitehead et al. 2014	Meta-analysis of 28 RCTs comparing oat β-Glucan recommended dose of 3 g/d with doses of >3 g/d.	Cholesterol	Oat, 3 g/d vs >3 g/d	Found that increasing the recommended dose (>3 g/d) resulted in further reductions of LDL-C (−0.25 mmol/L (95% CI: 0.20, 0.30; p < 0.0001) and TC (−0.30 mmol/L (95% CI: 0.24, 0.35; p < 0.0001) vs. control diet.
Thies et al. 2014	Systematic Review of 64 observational studies investigating long-term interventions (2 wks–6 mts) that examined the effects of oat derived β-Glucans on CVD risk factors.	Cholesterol Blood Pressure	Oat	Significantly reduced TC (2–19%) in 37 studies and LDL-C (4–23%) in 34 studies, mostly in participants with elevated cholesterol at baseline. Reduced SBP (4–6%) in 3 of the studies. 41 studies had n < 30).
Zhu et al. 2015	Meta-analysis of 17 RCTs (n = 916) investigating the effects of β-Glucan consumption in participants with raised cholesterol.	Cholesterol	Oat, Barley	Significantly reduced TC (MD: −0.26 mmol/L; 95% CI, −0.33 to −0.18; p < 0.00001) and LDL-C (MD: −0.21 mmol/L; 95% CI, −0.27 to −0.14; p < 0.00001) in participants with hypercholesterolemia after β-Glucan consumption.
Ho et al. 2016	Systematic review and meta-analysis of 14 RCTs (n = 615) investigating the effect of barley β-Glucan (6.5–6.9g/d) on LDL-C, non-HDL-C and apoB for CVD risk reduction after a median duration of 4 wks.	Cholesterol	Barley, 6.5–6.9g/d, 4wks	Significantly reduced LDL-C (MD: −0.25 mmol/L, 95% CI: −0.30, −0.20) and non-HDL-C (MD: −0.31 mmol/L, 95% CI: −0.39, −0.23), No significant changes to apoB levels, compared with control diets.
Hartley et al. 2016	A systematic review of 23 RCTs, (n = 1513) investigating the effectiveness of dietary fiber for the primary prevention of CVD.	Cholesterol Blood Pressure	Dietary Fiber	Significantly reduced TC and LDL-C concentrations (MD: −0.23 mmol/L and −0.14 mmol/L respectively) with increased dietary fiber intake, in 17 of the trials (n = 1067). Significantly reduced DBP (MD: −1.77 mmHg) and slight reduction in SBP (MD: −1.92 mmHg) observed in 10 trials (n = 661).
Hui et al. 2019	Network meta-analysis of 55 intervention trials (n = 3900) comparing the effects and rank of different whole grains and bran on circulating lipids.	Serum Lipids	Oat	Significant reduction in TC (- 0.35 mmol/L (95% CI − 0.47, − 0.23 mmol/L) and LDL-C (- 0.32 mmol/L (95% CI − 0.44, − 0.19 mmol/L), after oat bran intervention compared with control.
De Morais Junior et al. 2022	A systematic review and meta-analysis of 28 RCTs with parallel-arm or crossover blinded interventions, ≥ 2 wk in duration, looking at hyperlipidemic or non-hyperlipidemic men and women ≥18 years of age (n = 1494), compared oat or isolated β-glucan with a placebo/control group.	Serum Lipids	Oat	It was found that both oat and isolated β-glucan interventions improved lipid profiles. Oat interventions TC (−0.61, 95% CI: −0.84; −0.39, p < 0.00001, and −0.70, 95% CI: −1.07; −0.34, p = 0.0002, respectively) and LDL (−0.51, 95% CI: −0.71; −0.31, p < 0.00001, and −0.38, 95% CI: −0.60; −0.15, p = 0.001, respectively). Additionally, isolated β-glucan interventions from parallel-arm studies decreased TC (−0.73, 95% CI: −1.01; −0.45, p < 0.00001), LDL (−0.58, 95% CI: −0.85; −0.32, p < 0.0001) and triglycerides (−0.30, 95% CI: −0.49; −0.12, p = 0.001). HDL was not altered by either oat or isolated β-glucan (p > 0.05).
b. Human Studies
Keys, Anderson, and Grande 1960	Controlled experiments investigating diet types and blood lipids in men (n = 28) aged 41–63 yr, during a 6wk period.	Serum Lipids	Dietary Fiber	First demonstration of dietary fiber having protective effects against CVD through the reduction of serum lipids.
De Groot et al. 1960	Study that substituted white bread for oat bread in healthy men.	Cholesterol	Oat	Found a lowering effect of oat β-Glucans on blood cholesterol levels by 11% after 3 wks.
Davidson et al. 1991	A dose-controlled study (n = 156) on adults with (30–65 yr) hypercholesterolemia (LDL-C levels >3.37 mmol/L) randomized to consume various amounts of oat derived β-Glucans.	Cholesterol	Oat Bran, 56 g/d	Significantly reduced TC and LDL-C concentrations after 6 wks − 15.9% reduction in LDL-C in those consuming oat bran.
Lia et al. 1995	Study investigating excretion patterns in ileostomy patients (n = 9) given oat-bran bread with and without a β-Glucan-degrading enzyme (β-Glucanase).	Cholesterol	Oat Bran Bread, 12.5 g/d	Found a 53% higher excretion of bile acids over 24 hrs among those consuming intact oat-derived β-Glucans (12.5 g/d) compared to the β-Glucanase group (p < 0.05).
Jenkins et al. 2002	Randomized crossover study on adults with hyperlipidemia (n = 68) investigating the efficacy of the dose approved by the FDA of 3 g/d β-Glucan consumption for reducing risk factors for CVD.	Cholesterol Blood Pressure	Oat, 8 g/d, 4wks	Reported reduced TC (2.1 ± 0.7%; p = 0.003), TC: HDL-C (2.9 ± 0.8%; p = 0.001), LDL: HDL-C (2.4 ± 1.0%; p = 0.015), and ApoB : A-I (1.4 ± 0.8%; p = 0.076) and small reductions in BP in the dietary fiber fed group (8 g/d over 4 wks) compared with the control group.
Behall, Scholfield, and Hallfrisch 2004	Study investigating the effects of barley β-Glucans intake on CVD risk factors compared with various soluble dietary fibers in adults (n = 25) with hyperlipidemia and a BMI range of 25–37 kg/m².	Serum Lipids	Barley, 3 g/d and 6 g/d	Reduced LDL-C by 13.8% and 17.4% with higher intakes of barley β-Glucans consumed (3 and 6 g, respectively).
Queenan et al. 2007	RCT examining the effects of concentrated oat β-Glucans on CVD risk factors and comparison of fermentability with other soluble dietary fibers (n = 75) with raised cholesterol given 6 g/d oat β-Glucan or control for 6 wks.	Cholesterol	Oat, 6 g/d. 6wks	Significant reductions in TC (−0.3 ± 0.1 mmol/L) and LDL-C (−0.3 ± 0.1 mmol/L) were observed. Reduction in LDL-C were significantly greater than in the control group (p = 0.03). Production of butyrate from oat β-Glucan higher than from inulin and guar gum.
Wolever et al. 2010	Randomized, double-blind parallel clinical trial examining the physicochemical properties of oat β-Glucan affecting the ability to reduce serum LDL-C of adults (n = 367) given 3/4 g/d oat β-glucans in extruded cereals with controlled Mw ranges for 28 days.	Cholesterol	Oat, 3 g/d and 4 g/d, 28 days	LDL-C significantly reduced with 3 g high-Mw, 4 g medium-Mw, and 3 g medium-Mw oat β-Glucan cereals by 0.21 (5.5%; 95% CI: −0.11, −0.30; p = 0.002), 0.26 (6.5%; 95% CI: −0.14, −0.37; p = 0.0007), and 0.19 (4.7%; 95% CI: −0.08, −0.30; p = 0.01) mmol/L, respectively, when compared with control.
Wang et al. 2014	Controlled, single-blinded, randomized crossover study investigated individuals with mild hypercholesterolemia (n = 22) given either a treatment diet containing 3 g/d high Mw, 3 g/d low Mw, 5 g/d low Mw barley β-Glucan, or control diet for 5 wks.	Cholesterol Microbiota	Barley, 3 g/d, 5wks	Decreased Firmicutes (77.7% vs. 88.8%) and increased Bacteroidetes (18.2% vs. 10.0%) with 3 g/d high Mw β-Glucan compared to control diet (p < 0.001).
De Angelis et al. 2015	Study comparing the effects of 3 g/d of barley β-Glucans dietary intervention for 2mts on fecal microbiota of 26 healthy participants.	Microbiota Cholesterol	Barley, 3 g/d, 2mts	Increased levels of Roseburia hominis, Clostridiaceae and Ruminococcus sp., and reduced Firmicutes and Fusobacteria. Increase in SCFAs 2-methyl-propanoic, acetic, butyric, and propionic acids.
Connolly et al. 2016	Randomized crossover dietary intervention trial examining the effect of consuming oat β-Glucans (45 g/d) for 12 wks) on the microbiota and cardiometabolic risk factors of individuals at risk of developing cardio-metabolic disease (n = 32).	Serum Lipids Microbiota	Oat, 45 g/d, 12wks	Prebiotic effect on gut microbiota composition, due to a significant increase in fecal bifidobacteria (p = 0.0001), lactobacilli (p = 0.001) and total bacterial count (p = 0.008). Reduced TC (p = 0.0001) and LDL-C (p = 0.02) after oat intervention compared with control group.
Wang et al. 2016	RCT with cross-over design of adults with mild hypercholesterolemia (n = 30; 12 men and 18 women, aged 27–78 yr) consuming 3 or 5 g/d intact/partially hydrolyzed barley β-Glucans or a control diet.	Cholesterol	Barley, 3 g/d and 5 g/d	Intact barley β-Glucans significantly lowered TC (–0.12 mmol/L), compared to the control diet. LDL-C, HDL-C and TG were not significantly affected by partially hydrolyzed barley β-Glucans (p = 0.0046).
Cosola et al. 2017	Pilot study investigating the association between β-Glucan supplementation and P-Cresyl Sulfate (pCS) levels and endothelial vascular reactivity in healthy adults (n = 26) after a 2-month dietary intervention (3 g/d).	Serum Lipids Microbiota	Barley, 3 g/d, 2mts	Increased SCFA production, and decrease in pCS associated with a saccharolytic shift in the gut microbiota metabolism. Improved endothelial vascular reactivity and significantly reduced TC (183.8 ± 30.3 mg/dl CI: [171.0–196.6] p < 0.001) and LDL-C (107.4 ± 25.2 mg/dl; CI: [96.7–118.0] p = 0.003), compared to the control diet.
c. Animal Studies
Hara et al. 1999	Experimental study in rats investigating the effects of dietary consumption of SCFAs (acetic, propionic, and butyric acids) on hepatic and intestinal cholesterol synthesis.	Cholesterol	SCFAs	Significantly decreased In vivo cholesterol synthesis rates in both the liver and intestine (−3 mmol/L and −0.5 mmol/L respectively) in the SCFA group.
Drzikova, Dongowski, and Gebhardt 2005	Animal study investigating the effects of oat based dietary fiber on serum lipids, microbiota and SCFA production in rats fed 500 g oat-based products/kg for 6 wks.	Cholesterol Microbiota	Dietary Fiber Oat, 500 g/kg, 6wks	Serum TC decreased in the oat fed groups (p = 0·05). Bifidobacteria were higher in test groups (p = 0·001) and coliforms were lower (p = 0·05) compared with control diet.
Bae et al. 2010	Animal study investigating 2 groups of rats fed high-cholesterol diets comparing β-Glucan supplements with the addition of β-Glucan hydrolysate.	Cholesterol	β-Glucan hydrolysate	Significantly reduced levels (p < 0.05) of LDL (25–31%) and VLDL (0.2–23%) cholesterol in both groups. Observed a significantly lower triglyceride level in group fed β-Glucan hydrolysate (p < 0.05), along with greater fecal bile acid and cholesterol excretion.
Ryan et al. 2017	Animal study investigating the effect of common pharmaceutical and nutritional CVD interventions on the gut microbiome using two groups of ApoE-deficient mice given a high-fat and high-cholesterol diet with one group given oat β-Glucan and the other group given Simvastatin.	Serum Lipids Microbiota	Oat	Prebiotic effects on the cecal microbiota through stimulation of Verrucomicrobia including Akkermansia in the oat β‐Glucan group. Reduced circulating triglyceride levels (p < 0.05), reduced extent of plaque build-up and atherogenesis.
Alharbi, Algonaiman, and Barakat 2022	Animal study to investigate the ameliorative and antioxidative stress effects of probiotic-enriched fermented oat (FOE) or fermented oat with honey (HFOE) extracts on streptozotocin-induced diabetes in rats	Blood glucose ( Serum lipids Liver and kidney function Reduced glutathione (GSH) Catalase (CAT), superoxide dismutase (SOD) Malonaldehyde (MDA)	Oat	Hypolipidemic potential of HFOE, improved liver and kidney function, significantly enhanced GSH, CAT, SOD, and MDA

Studies are presented in each section in chronological order.

Table 2. A Summary and timeline of key studies to date investigating the effects of cereal β-glucans on blood pressure as reported in: (a) systematic reviews and meta-analyses, (b) human studies and (c) animal studies.

Reference	Study Design	Biomarker	Source	Study Outcome
a. Systematic Reviews and Meta-Analysis
Whelton et al. 2005	Meta-analysis of 25RCTs investigating the effect of dietary fiber intake for ≥ 8 wk on BP in patients with hypertension at baseline.	Blood Pressure	Dietary Fiber	Significantly reduced SBP (MD: −5.95 mmHg, 95% CI, −9.50 to −2.40) and DBP (MD: −4.20 mmHg, 95% CI, −6.55 to −1.85) among patients with hypertension compared with control. Reduced SBP (SBP MD: −3.12 mmHg, 95% CI, −5.68 to −0.56) and DBP (MD: −2.57 mmHg, 95% CI, −4.01 to −1.14) observed in longer term trials.
Streppel et al. 2005	Meta-analysis of 24 randomized placebo-controlled trials investigating the effect of dietary fiber (avg. dose 11.5 g/d) on BP in adults (n = 1404), median age of 42 yr.	Blood Pressure	Dietary Fiber, 11.5 g/d	Reduced SBP by −1.13 mmHg (95% CI: −2.49 to 0.23) and DBP by −1.26 mmHg (–2.04 to −0.48).
Threapleton et al. 2013	Systematic review and meta-analysis of 22 cohort studies investigating dietary fiber intake and risk of CVD. Fiber sources included; insoluble fiber, fiber from cereal, vegetable, and fruit sources.	CVD Risk	Dietary Fiber	Dietary fiber intake inversely associated with CVD risk (risk ratio 0.91 per 7 g/d (95% CI: 0.88 to 0.94).
Thies et al. 2014	Systematic literature review of 64 observational studies investigating long-term (2 wk–6 mts) interventions that examined the effects of oat derived β-Glucans on CVD risk factors.	Cholesterol Blood Pressure	Oat	Significant reduction in TC (2–19%) in 37 studies and LDL-C (4–23%) in 34 studies, mostly in participants with elevated cholesterol at baseline. Reduced SBP (4–6%) after β-Glucan consumption in 3 of the studies. 41 studies had n < 30.
Evans et al. 2015	A systematic review and meta-analysis of 28 RCTs investigating the effects of dietary fiber type on blood pressure.	Blood Pressure	Dietary Fiber, 4 g/d	Diets rich in β-Glucans (4 g/d) reduced SBP by 2.9 mmHg (95% CI 0.9 to 4.9 mmHg) and DBP by 1.5 mmHg (95% CI 0.2 to 2.7 mmHg).
Hartley et al. 2016	A systematic review of 23 RCTs, (n = 1513) investigating the effectiveness of dietary fiber for the primary prevention of CVD.	Cholesterol Blood Pressure	Dietary Fiber	Significantly reduced TC and LDL-C concentrations (MD: −0.23 mmol/L and −0.14 mmol/L respectively) with increased dietary fiber intake in 17 of the trials (n = 1067). Significantly reduced DBP (MD: −1.77 mmHg), slight reduction in SBP (MD: −1.92 mmHg) observed in 10 trials (n = 661), findings were not statistically significant.
Khan et al. 2018	Systematic review and meta-analysis of 43 RCTs examined the effect of viscous soluble fiber consumption for ≥4 wk on SBP (22 studies, n = 1430) and DBP (21 studies, n = 1343).	Blood Pressure	Dietary Fiber, 8.7 g/d, 7wk	Reduced SBP (MD: −1.59 mmHg and DBP (MD: −0.39 mmHg [95% CI: −0.76 − 0.01]) at a median dose of 8.7 g/d (1.45–30 g/d) over a median follow-up of 7 wk. Reductions in SBP were only observed using psyllium fiber (MD: −2.39 mmHg [95% CI: −4.62 − 0.17]).
b. Human Studies
Jenkins et al. 2002	Randomized crossover study on adults with hyperlipidemia (n = 68) investigating the efficacy of the dose approved by the FDA of 3 g/d β-Glucan consumption for reducing serum lipid risk factors for CVD.	Cholesterol Blood Pressure	Oat, 8 g/d, 4wk	Reduced TC (2.1 ± 0.7%; p = 0.003), TC: HDL-C (2.9 ± 0.8%; p = 0.001), LDL: HDL-C (2.4 ± 1.0%; p = 0.015), and Apo B:A-I (1.4 ± 0.8%; p = 0.076) and small reductions in BP in the dietary fiber fed group (8 g/d over 4 wk) compared with control group.
He et al. 2004	Randomized double-blind placebo-controlled trial on adults with untreated hypertension (n = 110) given 8 g/d oat bran β-Glucan over 12 wk.	Blood Pressure	Oat, 8 g/d, 12wk	Reported significantly reduced SBP [MD: −1.8 mmHg (95% CI: −4.3 to 0.8, p = 0.17)] and DBP [MD: 1.2 mmHg (95% CI: −3.0 to 0.5, p = 0.17)] in comparison to the control group.
Maki et al. 2007	Randomized, double-blind, controlled clinical trial examined the effects of oat β-Glucans on BP outcomes on adults with elevated BP (n = 97).	Blood Pressure	Oat	Reduced SBP (8.3 mmHg, p = 0.008) and DBP (3.9 mmHg, p = 0.018) in the β-Glucan intervention group among subjects with BMI > median (31.5 kg/m2) compared to the control group.
Tighe et al. 2010	RCT investigating the effect of 3 portions of whole-grain foods or 120 g/d for 12 wk on CVD risk markers including BP in healthy middle-aged adults (n = 206).	Blood Pressure	Oat, 120 g/d, 12wk	Significantly reduced SBP (5–6 mmHg) compared with refined cereals group (p = 0.01)
c. Animal Studies
Lee, Lee, and Kim 2020	Animal study investigating a potential mechanism of action of β-Glucans exhibiting antihypertensive properties in mice.	Blood Pressure	Barley, Mushrooms, Yeast, 100 mg/d	β-Glucans (100mg/d) induced the expression of corin and ANP, and increased natriuresis, (regulating water-sodium balance and BP control).
Raj et al. 2023	Animal study investigating the cardiovascular benefits of an oat beta-glucan extract in male and female spontaneously hypertensive rats when used with an anti-hypertensive medication, hydrochlorothiazide	Blood pressure, cardiac remodeling, and cardiac dysfunction	Oats, 305 mg/kg/day alone or combined with hydrochlorothiazide (20 mg/kg/day)	Treatments with beta-glucan and hydrochlorothiazide were able to prevent high blood pressure, cardiac dysfunction, and alterations in malondialdehyde (MDA), angiotensin II, and norepinephrine

Studies are presented in each section in chronological order.

Kaur, R., M. Sharma, D. Ji, M. Xu, and D. Agyei. 2019. Structural features, modification, and functionalities of beta-glucan. Fibers 8 (1):1. doi: 10.3390/fib8010001.

 Web of Science ®Google Scholar

Schmidt, M. 2022. Cereal beta-glucans: An underutilized health endorsing food ingredient. Critical Reviews in Food Science and Nutrition 62 (12):3281–300. doi: 10.1080/10408398.2020.1864619.

 PubMed Web of Science ®Google Scholar

Ripsin, C. M., J. M. Keenan, D. R. Jacobs, P. J. Elmer, R. R. Welch, L. Van Horn, K. Liu, W. H. Turnbull, F. W. Thye, and M. Kestin. 1992. Oat products and lipid lowering: A meta-analysis. JAMA 267 (24):3317–25.

 PubMed Web of Science ®Google Scholar

Talati, R., W. L. Baker, M. S. Pabilonia, C. M. White, and C. Coleman. 2009. The effects of barley-derived soluble fibre on serum lipids. Annals of Family Medicine 7 (2):157–63. doi: 10.1370/afm.917.

 PubMed Web of Science ®Google Scholar

AbuMweis, S. S., S. Jew, and N. P. Ames. 2020. β-glucan from barley and its lipid-lowering capacity: A meta-analysis of randomized, controlled trials. European Journal of Clinical Nutrition 64 (12):1472–80. doi: 10.1038/ejcn.2010.178.

 Google Scholar

Tiwari, U., and E. Cummins. 2011. Meta-analysis of the effect of b-glucan intake on blood cholesterol and glucose levels. Nutrition (Burbank, Los Angeles County, Calif.) 27 (10):1008–16. doi: 10.1016/j.nut.2010.11.006.

 PubMed Web of Science ®Google Scholar

Threapleton, D. E., D. C. Greenwood, C. E. L. Evans, C. L. Cleghorn, C. Nykjaer, C. Woodhead, J. E. Cade, C. P. Gale, and V. J. Burley. 2013. Dietary fibre intake and risk of cardiovascular disease: Systematic review and meta-analysis. BMJ (Clinical Research ed.) 347 (dec19 2):f6879–f6879. doi: 10.1136/bmj.f6879.

 PubMedGoogle Scholar

Whitehead, A., E. J. Beck, S. Tosh, and T. M. S. Wolever. 2014. Cholesterol-lowering effects of oat b-glucan: A meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition 100 (6):1413–21. doi: 10.3945/ajcn.114.086108.

 PubMed Web of Science ®Google Scholar

Thies, F., L. F. Masson, P. Boffetta, and P. Kris-Etherton. 2014. Oats and CVD risk markers: A systematic literature review. The British Journal of Nutrition 112 Suppl 2:S19–S30. doi: 10.1017/S0007114514002281.

 PubMed Web of Science ®Google Scholar

Zhu, X., X. Sun, M. Wang, C. Zhang, Y. Cao, G. Mo, J. Liang, and S. Zhu. 2015. Quantitative assessment of the effects of beta-glucan consumption on serum lipid profile and glucose level in hypercholesterolemic subjects. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD 25 (8):714–23. Aug doi: 10.1016/j.numecd.2015.04.008.

 PubMed Web of Science ®Google Scholar

Ho, H. V., J. L. Sievenpiper, A. Zurbau, M. S. Blanco, E. Jovanovski, F. Au-Yeung, A. L. Jenkins, and V. Vuksan. 2016. A systematic review and meta-analysis of randomized controlled trials of the effect of barley β-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reduction. European Journal of Clinical Nutrition 70 (11):1239–45. doi: 10.1038/ejcn.2016.89.

 PubMed Web of Science ®Google Scholar

Hartley, L., M. D. May, E. Loveman, J. L. Colquitt, and K. Rees. 2016. Dietary fibre for the primary prevention of cardiovascular disease. The Cochrane Database of Systematic Reviews 2016 (1):CD011472. Jan 7

 PubMedGoogle Scholar

Hui, S., K. Liu, H. Lang, Y. Liu, X. Wang, X. Zhu, S. Doucette, L. Yi, and M. Mi. 2019. Comparative effects of different whole grains and brans on blood lipid: A network meta-analysis. European Journal of Nutrition 58 (7):2779–87. doi: 10.1007/s00394-018-1827-6.

 PubMed Web of Science ®Google Scholar

Keys, A., J. T. Anderson, and F. Grande. 1960. Diet-type (fats constant) and blood lipids in man. The Journal of Nutrition 70 (2):257–66. doi: 10.1093/jn/70.2.257.

 PubMed Web of Science ®Google Scholar

Davidson, M. H., L. D. Dugan, J. H. Burns, J. Bova, K. Story, and K. B. Drennan. 1991. The hypocholesterolemic effects of b-glucan in oatmeal and oat bran: A dose-controlled study. JAMA 265 (14):1833–9. doi: 10.1001/jama.1991.03460140061027.

 PubMed Web of Science ®Google Scholar

Lia, A., G. Hallmans, A. S. Sandberg, B. Sundberg, P. Aman, and H. Andersson. 1995. Oat beta-glucan increases bile excretion and a fibre rich barley fracton increases cholesterol excretion in ileostomy subjects. The American Journal of Clinical Nutrition 62 (6):1245–51. doi: 10.1093/ajcn/62.6.1245.

 PubMed Web of Science ®Google Scholar

Jenkins, D. J. A., C. W. C. Kendall, V. Vuksan, E. Vidgen, T. Parker, D. Faulkner, C. C. Mehling, M. Garsetti, G. Testolin, S. C. Cunnane, et al. 2002. Soluble fiber intake at a dose approved by the US Food and Drug Administration for a claim of health benefits: Serum lipid risk factors for cardiovascular disease assessed in a randomized controlled crossover trial. The American Journal of Clinical Nutrition 75 (5):834–9. doi: 10.1093/ajcn/75.5.834.

 PubMed Web of Science ®Google Scholar

Behall, K. M., D. J. Scholfield, and J. Hallfrisch. 2004. Diets containing barley significantly reduce lipids in mildly hypercholesterolemic men and women. The American Journal of Clinical Nutrition 80 (5):1185–93. doi: 10.1093/ajcn/80.5.1185.

 PubMed Web of Science ®Google Scholar

Queenan, K. M., M. L. Stewart, K. N. Smith, W. Thomas, R. G. Fulcher, and J. L. Slavin. 2007. Concentrated oat beta-glucan, a fermentable fiber, lowers serum cholesterol in hypercholesterolemic adults in a randomized controlled trial. Nutrition Journal 6 (1):6. doi: 10.1186/1475-2891-6-6.

 PubMedGoogle Scholar

Wolever, T. M., S. M. Tosh, A. L. Gibbs, J. Brand-Miller, A. M. Duncan, V. Hart, B. Lamarche, B. A. Thomson, R. Duss, and P. J. Wood. 2010. Physicochemical properties of oat β-glucan influence its ability to reduce serum LDL cholesterol in humans: A randomized clinical trial. The American Journal of Clinical Nutrition 92 (4):723–32. doi: 10.3945/ajcn.2010.29174.

 PubMed Web of Science ®Google Scholar

Wang, Y., N. Ames, S. Li, P. Jones, and E. Khafipour. 2014. High molecular weight barley β-glucan supports bacterial populations beneficial for gut health (647.45). FASEB Journal. 28 (1).

 Google Scholar

De Angelis, M., E. Montemurno, L. Vannini, C. Cosola, N. Cavallo, G. Gozzi, V. Maranzano, R. Di Cagno, M. Gobbetti, L. Gesualdo, et al. 2015. Effect of whole-grain barley on the human fecal microbiota and metabolome. Applied and Environmental Microbiology 81 (22):7945–56. doi: 10.1128/AEM.02507-15.

 PubMed Web of Science ®Google Scholar

Connolly, M. L., X. Tzounis, K. M. Tuohy, and J. A. Lovegrove. 2016. Hypocholesterolemic and prebiotic effects of a whole-grain oat-based granola breakfast cereal in a cardio-metabolic "at risk" population. Frontiers in Microbiology 7:1675. doi: 10.3389/fmicb.2016.01675.

 PubMed Web of Science ®Google Scholar

Wang, Y., N. P. Ames, H. M. Tun, S. M. Tosh, P. J. Jones, and E. Khafipour. 2016. High molecular weight barley b-glucan alters gut microbiota toward reduced cardiovascular disease risk. Frontiers in Microbiology 7:129. doi: 10.3389/fmicb.2016.00129.

 PubMed Web of Science ®Google Scholar

Cosola, C., M. De Angelis, M. Rocchetti, E. Montemurno, V. Maranzano, G. Dalfino, C. Manno, A. Zito, M. Gesualdo, M. Ciccone, et al. 2017. Beta-glucans supplementation associates with reduction in P-cresyl sulfate levels and improved endothelial vascular reactivity in healthy individuals. PLoS One 12 (1):0169635. 20

 Google Scholar

Hara, H., S. Haga, Y. Aoyama, and S. Kiriyama. 1999. Short-chain fatty acids suppress cholesterol synthesis in rat liver and intestine. The Journal of Nutrition 129 (5):942–8. doi: 10.1093/jn/129.5.942.

 PubMed Web of Science ®Google Scholar

Drzikova, B., G. Dongowski, and E. Gebhardt. 2005. Dietary fibre-rich oat-based products affect serum lipids, microbiota, formation of short-chain fatty acids and steroids in rats. The British Journal of Nutrition 94 (6):1012–25. doi: 10.1079/bjn20051577.

 PubMed Web of Science ®Google Scholar

Bae, I. Y., S. M. Kim, S. Lee, and H. G. Lee. 2010. Effect of enzymatic hydrolysis on cholesterol lowering activity of oat beta-glucan. New Biotechnology 27 (1):85–8. doi: 10.1016/j.nbt.2009.11.003.

 PubMed Web of Science ®Google Scholar

Ryan, P. M., L. E. E. London, T. C. Bjorndahl, R. Mandal, K. Murphy, G. F. Fitzgerald, F. Shanahan, R. P. Ross, D. S. Wishart, N. M. Caplice, et al. 2017. Microbiome and metabolome modifying effects of several cardiovascular disease interventions in apo-E−/− mice. Microbiome. Microbiome 5 (1):30. doi: 10.1186/s40168-017-0246-x.

 PubMedGoogle Scholar

Alharbi, H. F., R. Algonaiman, and H. Barakat. 2022. Ameliorative and antioxidative potential of Lactobacillus plantarum-fermented oat (Avena sativa) and fermented oat supplemented with Sidr honey against streptozotocin-induced type 2 diabetes in rats. Antioxidants 11 (6):1122. doi: 10.3390/antiox11061122.

 Web of Science ®Google Scholar

Whelton, S. P., A. D. Hyre, B. Pedersen, Y. Yi, P. K. Whelton, and J. He. 2005. Effect of dietary fiber intake on blood pressure: A meta-analysis of randomized, controlled clinical trials. Journal of Hypertension 23 (3):475–81. doi: 10.1097/01.hjh.0000160199.51158.cf.

 PubMed Web of Science ®Google Scholar

Streppel, M. T., L. R. Arends, P. van ‘t Veer, D. E. Grobbee, and J. M. Geleijnse. 2005. Dietary fiber and blood pressure: A meta-analysis of randomized placebo-controlled trials. Archives of Internal Medicine 165 (2):150–6. doi: 10.1001/archinte.165.2.150.

 PubMedGoogle Scholar

Evans, C., D. Greenwood, D. Threapleton, C. Cleghorn, C. Nykjaer, C. Woodhead, C. Gale, and V. Burley. 2015. Effects of dietary fibre type on blood pressure. Journal of Hypertension 33 (5):897–911. doi: 10.1097/HJH.0000000000000515.

 PubMed Web of Science ®Google Scholar

Khan, K., E. Jovanovski, H. V. T. Ho, A. C. R. Marques, A. Zurbau, S. B. Mejia, J. L. Sievenpiper, and V. Vuksan. 2018. The effect of viscous soluble fibre on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Nutrition, Metabolism, and Cardiovascular Diseases: NMCD 28 (1):3–13. doi: 10.1016/j.numecd.2017.09.007.

 PubMed Web of Science ®Google Scholar

He, J., R. H. Streiffer, P. Muntner, M. A. Krousel-Wood, and P. K. Whelton. 2004. Effect of dietary fiber intake on blood pressure: A randomized, double-blind, placebo-controlled trial. Journal of Hypertension 22 (1):73–80. doi: 10.1097/00004872-200401000-00015.

 PubMed Web of Science ®Google Scholar

Maki, K. C., R. Galant, P. Samuel, J. Tesser, M. S. Witchger, J. D. Ribaya-Mercado, J. B. Blumberg, and J. Geohas. 2007. Effects of consuming foods containing oat beta-glucan on blood pressure, carbohydrate metabolism and biomarkers of oxidative stress in men and women with elevated blood pressure. European Journal of Clinical Nutrition 61 (6):786–95. doi: 10.1038/sj.ejcn.1602562.

 PubMed Web of Science ®Google Scholar

Tighe, P., G. Duthie, N. Vaughan, J. Brittenden, W. G. Simpson, S. Duthie, W. Mutch, K. Wahle, G. Horgan, and F. Thies. 2010. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: A randomized controlled trial. The American Journal of Clinical Nutrition 92 (4):733–40. doi: 10.3945/ajcn.2010.29417.

 PubMed Web of Science ®Google Scholar

Lee, S. J., D. H. Lee, and H. W. Kim. 2020. Novel antihypertension mechanism of β-glucan by corin and ANP-mediated natriuresis in mice. Mycobiology 48 (5):399–409. doi: 10.1080/12298093.2020.1812150.

 PubMed Web of Science ®Google Scholar

Raj, P., K. Sayfee, L. Yu, A. Sabra, C. Wijekoon, L. Malunga, S. J. Thandapilly, and T. Netticadan. 2023. Oat beta-glucan alone and in combination with hydrochlorothiazide lowers high blood pressure in male but not female spontaneously hypertensive rats. Nutrients 15 (14):3180. doi: 10.3390/nu15143180.

 PubMed Web of Science ®Google Scholar