Oats and buckwheat intakes and cardiovascular disease

risk factors in an ethnic minority of China13

Jiang He, Michael J K/ag, Paul K Whelton, Jing-Ping Mo, Jun-Yun Chen, Ming-Chu Qian,
Pei-Sheng Mo, and Guan-Qing He

ABSTRACT The relationship of oats and buckwheat in- diovascular disease risk reduction. Here, the goal is to achieve a
take to cardiovascular disease risk factors was studied in 850 small downward shift in the population distribution of blood
Yi people, an ethnic minority in southwest China. Blood pres- pressure and cholesterol by altering environmental exposures (15).
sure was measured on 3 consecutive days. Serum total choles- Oats, a grain rich in water-soluble fiber, has been shown to
tenol, high-density-lipoprotein (HDL) cholesterol, and tniglyc- lower serum lipids in animal and human experiments. De Groot
enides were measured after a 14-h fast. Oats and buckwheat et al (17) reported in 1963 that 21 male volunteers who ate 140
intakes were assessed by questionnaire. In multiple-regression g rolled oats daily for 3 wk experienced a decrease in their

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analysis, oats intake (100 g/d) was associated with lower body average serum cholesterol from 6.49 to 5.77 mmolfL. Since
mass index (-0.25, in kg/m2; P < 0.05), systolic (-3.1 mm then, most (18-30) but not all (31, 32) clinical trials have
Hg, P < 0.001) and diastolic (- 1.3 mm Hg, P < 0.01) blood demonstrated that intake of oats lowers serum cholesterol in
pressure, and HDL cholesterol (-0.13 mmol/L, P < 0.001). hyperlipidemic patients (18-26) as well as in healthy adults
Buckwheat intake (100 g/d) was associated with lower serum (27-29) and children (30). The relationship between oats intake
total cholesterol (-0.07 mmol/L, P < 0.01) and low-density- and serum lipids has not been well studied in population-based
lipoprotein cholesterol (-0.06 mmol/L, P < 0.05) and a higher samples. In addition, the effect of buckwheat, another cereal
ratio of HDL to total cholesterol (0.01, P < 0.05). These high in water-soluble fiber (33), on serum lipids and blood
findings suggest a role for oats and buckwheat consumption in pressure has not been established.
the prevention and treatment of both hypertension and hypen- The present study investigated the relationship between oats
cholesterolemia. Am J C/in Nutr 1995;61:366-72 and buckwheat intakes and cardiovascular disease risk factors
in an ethnic minority in China-the Yi people.
KEY WORDS Oats, buckwheat, dietary fiber, blood pres-
sure, serum cholesterol
Subjects and methods

Subjects
Introduction
The Yi Migrant Study is a population-based epidemiologic
Although mortality from cardiovascular disease has declined investigation of cardiovascular disease risk factors in the Li-
progressively in the United States during the past three de- angshan Yi People Autonomous Prefecture in southwest China.
cades, it is still the leading cause of death. In 1989 an estimated As part of this study, serum lipids and lipopnoteins, blood
944 688 US residents died of cardiovascular disease, almost as pressure, body weight, dietary habits, physical activity, smok-
many as from all other causes of death combined (1). In many ing, and alcohol consumption were measured in 857 Yi men
economically developing countries, including China, cardio- randomly selected from the community. Details of the study
vascular disease mortality has increased rapidly and has be-
come the leading cause of death (2). 1 From the Welch Center for Prevention, Epidemiology, and Clinical
Elevations of blood pressure (3-5) and serum cholesterol Research, the Johns Hopkins University Medical Institutions, Baltimore; the
(6-8) are widely recognized as major modifiable risk factors Department of Epidemiology, Peking Union Medical College and Chinese
for cardiovascular disease. In addition, pharmacologic therapy Academy of Medical Sciences and the National Center for Clinical Labora-
of hypertension and hypenlipidemia has been well established tories, Beijing; and Liangshan Yi People Autonomous Prefecture Anti-epi-
as a means to prevent cardiovascular disease (9-14). However, demic Station, Xichang City, Sichuan Province, People’s Republic of China.
2 Supported by the Ministry of Public Health, People’s Republic of
it has also become increasingly apparent that altered quality of
China; Outpatient General Research Center grant 5M01RR00722 from the
life, medication toxicity, and costs of medical care limit the
National Institutes of Health; the Quaker Oats Company; and National
usefulness of lifelong drug therapy for hypertension and hy-
Institutes of Health grant RR00035.
perlipidemia (15). Lifestyle modifications, especially dietary
3 Address reprint requests to J He, The Welch Center for Prevention,
interventions, constitute an important and complementary ap- Epidemiology, and Clinical Research, 2024 East Monument Street, Suite
proach to the therapy for hypertension and hyperlipidemia in 2-600, Baltimore, MD 21205-2223.
the individual (15, 16). Dietary interventions assume an even Received April 5, 1994.
more important role in the population-based approach to car- Accepted for publication August 29, 1994.

366 Am J C/in Nutr 1995;61:366-72. Printed in USA. © 1995 American Society for Clinical Nutrition
 OATS AND CARDIOVASCULAR DISEASE 367

population and methods have been described elsewhere (34). blood pressure, blood pressure determinations were repeated
Briefly, the Yi people are an ethnic minority of China who live for all the subjects measured by that observer on that day. Height
principally in a remote mountainous area in southwest China and weight were measured and body mass index [weight (kg)/
and who are mainly engaged in subsistence agriculture. Yi height (m2)] was calculated as an index of obesity (37).
farmers are relatively isolated from the outside world and have Age, race, sex, education level, smoking, medical history
preserved their own language and life style. Traditionally, their (including antihypertensive medication use), and intakes of
main crops have been oats, buckwheat, and potatoes. Because oats and buckwheat were ascertained by local physicians fluent
of limited land resources, Yi farmers now grow and consume in both the Yi and Chinese languages. The intake of oats (and
rice and corn as well. Consumption of meat is limited to buckwheat) was assessed by asking “How many Jin of oats
weddings, funerals, and semiannual celebrations. Less salt is (buckwheat) did you eat in the past year?.” A Jin is a Chinese
consumed than in other areas of China. Starting in the 1950s, unit of measure equivalent to 500 g. Information on diet was
Yi farmers began to migrate to Xichang City, the capital of the also obtained by means of a 24-h dietary recall administered on
Liangshan Yi People Autonomous Prefecture, and to the 3 consecutive days. Agreement between the estimates obtained
county seats of counties in the Prefecture. These urban mi- by these two methods was moderate, with a correlation coef-
grants primarily eat rice, meat, and fresh vegetables with little ficient of 0.41 (P < 0.001) for oats and 0.61 (P < 0.001) for
oats and buckwheat intake. buckwheat. This disagreement is primarily due to variability in
The protocol for this study was reviewed and approved by
intake of these grains. Among the 424 participants who re-
the Chinese Academy of Medical Sciences, Beijing, People’s
ported eating oats during the preceding year, only 65 (15%)
Republic of China, and the Committee on Human Research,
consumed oats at the time of the 3-d dietar” recall. Likewise,
Johns Hopkins School of Hygiene and Public Health, Balti-
only 286 (54%) of 531 participants who att buckwheat in the
more. In accord with customary practice in China at the time of

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past year also included it in their diet at this time. The analyses
the study, informed consent was not obtained.
were based on annual intake of oats and buckwheat, instead of
Methods 24-h dietary recall, to reduce the variability in the estimates of
oats and buckwheat intakes. Intakes of total energy, protein,
Our study was conducted during March, 1989. A blood
fat, saturated fatty acids (SFAs), monounsatunated fatty acids
sample was obtained in the morning after a 14-h fast. Serum
(MUFAs), polyunsaturated fatty acids (PUFAs), cholesterol,
was separated in the field and sent to the county hospital
and total fiber were calculated by using the Sichuan Province
laboratory where it was stoned at -20 #{176}C
until it was air-mailed
section of the Chinese Food Composition Tables (33). In
to the National Center for Clinical Laboratories, Beijing. Se-
addition, oats and buckwheat specimens were collected and
rum total cholesterol, high-density-lipoprotein (HDL) choles-
their fiber content analyzed at the John Stuart Research Labo-
terol, and triglycerides were measured by an enzymatic method
ratonies, Quaker Oats Company, Barrington, IL. Assessment of
(35, 36) (IL Monarch 2000, Instrumentation Laboratory, Lax-
usual physical activity was based on occupational activity
ington, MA). HDL cholesterol was separated from serum by
because leisure-time activity was almost nonexistent.
precipitation after the addition of phosphotungstic acid and mag-
nesium ion. These analytic procedures were standardized and met The 857 Yi people in the present study included 515 Yi

the performance requirements of the Lipoprotein Standardization farmers and 342 Yi migrants. Seven Yi migrants were excluded
Program of the Centers for Disease Control, Atlanta. from the analysis because they had been diagnosed as having
Starting on the day that the blood sample was collected, hyperlipidemia and took oats for therapy. Distributions of body
blood pressure was measured on 3 consecutive days. Before the weight, blood pressure, and serum lipids were examined, by
blood pressure measurement, participants refrained from stren- intake of grains. Intakes of oats and buckwheat were divided
uous activity, smoking, and eating for 30 mm. After a mm- into four groups: no intake and low, middle, and upper tertiles
imum of5 mm ofquiet sitting, blood pressure was measured on of intake. For example, oats intake was categorized as none,
the right arm and recorded to the nearest 2 mm Hg by specially <25 g/d, 25-90 g/d, and >9C g/d. Buckwheat intake was
trained physicians using standard mercury sphygmomanome- categorized as none, <40 g/d, 40-200 g/d, and >200 g/d.
tens. Systolic blood pressure was recorded at the appearance of
the first sound and diastolic pressure at the disappearance of
Statistical analysis
sounds (Korotkoff phase 5). Three measurements of blood
pressure were obtained each day, and the mean of the nine The differences in cardiovascular disease risk factors and
blood pressure readings obtained oven the 3-d period of study dietary nutrients among the oats and buckwheat intake groups
was used in the analysis. The observers were trained by using were examined by analysis of variance. Univaniate and multi-
training tapes from the National Heart, Lung, and Blood Insti- variate linear-regression analyses were used to explore the
tute of the National Institutes of Health. After the training relation of oats and buckwheat intakes to cardiovascular dis-
period, the observers were certified by comparing their blood ease risk factors. Because any beneficial effects of these grains
pressure readings on eight persons (three readings per person) on cardiovascular disease risk factors were hypothesized to be
to those taken by an experienced observer (JH). The differ- mediated through their soluble fiber content, the relation of risk
ences in mean readings between observers were all <2 mm Hg factors to fiber intake was also examined. To account for a
(F test, P > 0.95). During the field work, quality control was possible community effect, additional multivaniate analyses
maintained by having a supervisor repeat the blood pressure were performed by adjusting for two urban areas: Xichang City
measurement on a 10% random sample of subjects every day. and the county seats and rural area of residence (Yi farmers).
If the mean of the three readings differed from those taken by All analyses were performed by using the SAS statistical anal-
the first observer by 5 mm Hg for either systolic or diastolic ysis package (38).
368 HE ET AL

Results cally significant fashion across categories of buckwheat intake,

but did not demonstrate a dose-response relationship (Table 4).
The ages of the 850 participants ranged from 15 to 77 y, with
In contrast, mean low-density-lipoprotein (LDL) cholesterol con-
a mean of 34 y. The study participants were lean, with an centrations were markedly lower, and the ratio of HDL to total
average body mass index of 20.8. The mean systolic and
cholesterol higher, with successively higher buckwheat intakes.
diastolic blood pressures were 107.2 and 66.9 mm Hg, respec-
The results of univaniate and multivaniate linear-regression
tively. Only 21 (2.5%) participants had an elevated blood
analyses of oats and buckwheat intakes on cardiovascular dis-
pressure as defined by a mean systolic or diastolic blood
ease risk factors are shown in Table 5. After adjustment for the
pressure 140 on 90 mm Hg, respectively, and none of the
covaniables listed in the table, oats intake continued to be
study participants were taking antihypertensive medications.
inversely associated with a lower body mass index, as well as
Mean serum total cholesterol (3.86 mmol/L) and triglyceride
with lower systolic and diastolic blood pressure, serum HDL
(1 .55 mmolfL) values were in the low normal range, by West-
cholesterol, ratio of HDL to total cholesterol, and serum tn-
ern standards. Seventy five (8.8%) participants had a total
glyceride. Buckwheat intake was associated with lower levels
cholesterol concentration >5.20 mmol/L. The mean HDL-
of serum total and LDL cholesterol, as well as with a higher
cholesterol concentration was 1 .43 mmol/L and the ratio of
ratio of HDL to total cholesterol. In an analysis adjusted for
HDL to total cholesterol was relatively high at 0.39.
Forty-four percent of the sample had consumed oats and
community of residence, oats intake (100 g/d) was significantly
55% had consumed buckwheat during the preceding year. Of
related to body mass index (/3 = -0.28, P = 0.01), systolic

those who had consumed these foods, the mean daily intake (13 = -2.4 mm Hg, P < 0.0001) and diastolic (/3 - -1.0 mm
was 70.3 g for oats and 137.7 g for buckwheat. Hg, P = 0.04) blood pressure, HDL cholesterol concentration
Distributions of the covariables for oats and buckwheat (13 = -0.12 mmol/L, P < 0.0001), the ratio of HDL to total

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consumption are summarized in Tables 1 and 2. Mean age and cholesterol (/3 = -0.04, P < 0.0001), and triglyceride con-
dietary intakes of fat, cholesterol, and sodium tended to be centration (/3 = -0.09 mmol/L, P = 0.05), whereas buckwheat

lower in persons who ate oats on buckwheat, whereas their intake (100 g/d) was associated with total cholesterol concen-
dietary ratio of polyunsaturated to saturated fatty acids, potas- tration (13 = -0.05 mmol/L, P < 0.05), the ratio of HDL to
sium intake, and alcohol consumption were higher. In addition, total cholesterol (/3 = 0.01, P = 0.004), and LDL cholesterol
dietary energy intake was significantly greater in those who ate concentration (/3 = -0.05 mmol/L, P = 0.03).
buckwheat than in those who did not (Table 2). Yi farmers tended to eat more oats and buckwheat than
Average body mass index, blood pressure, and lipid profile migrants. For example, 49. 1% of those who did not eat oats
by oats and buckwheat intake are presented in Tables 3 and 4. were Yi farmers compared with 91.1% of those who ate >90 g/d.
At higher oats intake, mean body mass index and blood pnes- In separate analyses in the urban and rural groups, however,
sure were lower, in a dose-response pattern (Table 3). Mean similar patterns of associations of grain intake with cardiovascular
serum total cholesterol and low-density-lipopnotein cholesterol disease risk factors were seen in both groups (data not shown).
were also lower in those who ate oats, although mean concen- Because it has been suggested that a threshold effect may
trations were somewhat higher (P > 0.05) in those who ate exist for the effect of oats on the lipid profile, persons who
>90 g/d compared with their counterparts who ate 26-90 g/d. ate 25 g oats/d were compared with those who ate <25 g
Consumption of 25 g oats/d was associated with lower mean oats/d. Findings were similar to the comparisons listed in
HDL-cholesterol concentrations. The ratio of HDL to total Tables 3-5. After adjustment for the covaniables listed in Table
cholesterol varied little by oats intake. 5, systolic blood pressure was 5.3 mm Hg lower, diastolic
Average values for body mass index, systolic and diastolic blood pressure was 1 .8 mm Hg lower, total cholesterol was
blood pressure, and HDL cholesterol also varied in a statisti- 0.21 mmol/L lower, HDL cholesterol was 0.20 mmolfL lower,

TABLE 1
Age and intake of dietary nutrients in 850 study subjects by oats intake’

Oats intakes
Group 1, 0 g/d Group 2, <25 g/d Group 3, 25-90 g/d Group 4, >90 g/d
Covariables (n = 426) (n = 176) (n 125) (n = 123) P

Age (y) 35 ± 132 34 ± 122 34 ± 142 30 ± i3 0.001

Dietary energy (kJ/d) 13100 ± 4121 13515 ± 4577 14481 ± 4661 13042 ± 5561 0.26
Dietary fat (g/d) 84.4 ± 51.425 85.8 ± 58.525 61.8 ± 5492 41.9 ± 40.2’ 0.001
P:S 1.37 ± 1.1625 1.29 ± 1.1125 2.14 ± 1.12 2.08 ± 1.04 0.001
Dietary cholesterol (mg/d) 214 ± 310 186 ± 21725 86 ± 204’ 38 ± 83’ 0.001
Dietary sodium (mgjd) 3539 ± 312725 3851 ± 341425 2304 ± 1974 2738 ± 181 0.001
Dietary potassium (mg/d) 4387 ± 293625 4518 ± 292925 7410 ± 38212 6651 ± 3616 0.001
Alcohol intake (g/d) 25.6 ± 40.124 35.6 ± 52.3 30.5 ± 51.5 41.0 ± 59.9’ 0.003
‘ I ± SD. P:S, polyunsaturated to saturated fatty acid ratio.

2 Significantly different from group 4, P < 0.05.

3 Significantly different from group 1, P < 0.05.

4 Significantly different from group 2, P < 0.05.
5 Significantly different from group 3, P < 0.05.
 OATS AND CARDIOVASCULAR DISEASE 369

TABLE 2
Age and intake of dietary nutrients in 850 study subjects by buckwheat intake’

Buckwheat intakes
Group 1, 0 g1/d Group 2, <40 g/d Group 3, 40-200 g/d Group 4, >200 g/d
Covariables (n = 319) (i = 207) (n = 161) (n = 163) P

Age (y) 36 ± 1323 34 ± 13’ 32 ± 13 30 ± l2 0.0()1

Dietary energy (kJ/d) 12531 ± 41 13235 13498 ± 4448 14017 ± 5059 14485 ± 4762 0.001
Dietary fat (g/d) 82.8 ± 58.723 91.7 ± 55523 60.4 ± 44#{149}74.5 539 ± 41.9 0.001
P:S 1.44 ± 1.17235 1.07 ± 1.0O” 1.86 ± 1.15 2.17 ± 1.06245 0.001
Dietary cholesterol (mg/d) 205 ± 27723 248 ± 33123 84 ± 145 49 ± I l6 0.001
Dietary sodium (mg/d) 3491 ± 3234235 4185 ± 32282 2919 ± 2224’’ 2231 ± 2030245 0.001
Dietary potassium (mg/d) 4020 ± 275923 4084 ± 276623 6547 ± 3288’ 7569 ± 3627245 0.()01
Alcohol intakes (g/d) 20.9 ± 33.2235 31.9 ± 46.824 41.9 ± 4J.545 39.3 ± 57.2 0.0()1

‘ .t ± SD. P:S, polyunsaturated to saturated fatty acid ratio.

2 Significantly different from group 3, P < 0.05.

3 Significantly different from group 4, P < 0.05.

4 Significantly different from group 1, P < 0.05.
5 Significantly different from group 2, P < 0.05.

TABLE 3

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Cardiovascular disease risk factors in 850 study subjects by oats intake’

Oats intakes
Group 1, 0 g/d Group 2, <25 g/d Group 3, 25-90 g/d Group 4, >90 g/d
Variables (n = 426) (n 176) (n 125) (n = 123) P

Body mass index 20.9 ± 2.323 20.9 ± 2.323 20.5 ± 20.1 ± 0.001
Systolic BP (mm Hg) 109.7 ± 12.42 108.5 ± 13.023 103.9 ± 10.6’s 100.4 ± 9924.5 0.001
Diastolic BP (mm Hg) 68.3 ± 10.323 67.2 ± 10.1’ 65.9 ± 62.6 ± 8.9243 0.001
Serum total cholesterol (mmol/L) 4.03 ± 0.9923 399 ± 1.0423 3.45 ± 0.91’ 3.59 ± 0.86’ 0.001
HDL cholesterol (mmol/L) 1.49 ± 0.452 1.48 ± 0.4423 1.34 ± 0.4O’ 1.23 ± 0.28245 0.001
LDL cholesterol (mmol/L) 1.85 ± 0.942 1.78 ± 0.862 1.54 ± 0.85 1.76 ± 0.84 0.01
HDL:total cholesterol 0.39 ± 0.14 0.39 ± 0.14 0.40 ± 0.14 0.36 ± 0.12 0.1
Serum triglyceride (mmol/L) 1.59 ± 0.97 1.67 ± l.01 1.49 ± 0.86 1.32 ± 0.61 0.007
‘ I ± SD. BP, blood pressure. Body mass index in kg/m2.
2 Significantly different from group 3, P < 0.05.

3 Significantly different from group 4, P < 0.05.

4 Significantly different from group 1, P < 0.05.
S Significantly different from group 2, P < 0.05.

and the ratio of HDL to total cholesterol was 0.03 lower (all P < significantly associated with systolic blood pressure, total cho-
0.01) in subjects who had eaten 25 g oats/d compared to those lesterol, and HDL cholesterol, but total fiber was not associated
who had not. Likewise, the adjusted differences between those with blood pressure or lipids.
who had eaten 44J g buckwheat/d and had not or eaten buck-
wheat <40 g/d were -2.6 mm Hg for systolic blood pressure,
-0.22 mmol/L for total cholesterol, -0.24 mmol/L for LDL Discussion
cholesterol, and 0.03 for the ratio of HDL to total cholesterol (all
P < 0.01). Because the population in the present study consumed fairly
Laboratory analysis demonstrated that each 100 g oats con- high amounts of oats and buckwheat from an early age, the
tamed 10.2 g total fiber, 3.9 g soluble fiber, 13.9 g protein, and results seen here probably represent the long-term effect of
9.9 g fat. For each 100 g buckwheat, there were 26.0 g total these grains on cardiovascular disease risk factors. Special
fiber, I .7 g soluble fiber, 9.2 g protein, and 1 .9 g fat. The strengths ofthe present study include its relatively large sample
results of the univaniate and multivariate linear-regression anal- size as well as the availability of detailed information on
yses of total and soluble fibers from oats and buckwheat on dietary consumption and cardiovascular disease risk factors. In
cardiovascular disease risk factors are shown in Table
6. After addition, the fact that the results were from a random sample of
adjustment for the covariables listed in the table, water-soluble free-living men enhances the generalizability of the findings.
fiber was negatively and significantly related to systolic blood The present study identified a significantly lower mean sys-
pressure, serum total cholesterol, and HDL cholesterol, tolic and diastolic blood pressure with progressively higher
whereas total fiber was related negatively to serum total and intakes of oats. This association followed a dose-response
LDL cholesterol. In the multivaniate model adjusted for com- pattern and was independent of age, body mass index, alcohol
munity of residence, water-soluble fiber was negatively and use, as well as dietary intakes of energy, cholesterol, sodium,
370 HE ET AL

TABLE 4
Cardiovascular disease risk factors in 850 study subjects by buckwheat intake’

Buckwheat intakes

Group 1, 0 g/d Group 2, <40 g/d Group 3, 40-200 g/d Group 4, >200 g/d
Variables (n 319) (n 207) (n = 161) (n = 163) P

Body mass index 20.7 ± 2.22 21.3 ± 20.4 ± 2.12 20.5 ± 1.92 0.001
Systolic BP (mm Hg) 107.6 ± 12.3245 111.4 ± 14.1 104.7 ± 10.723 103.4 ± 9.623 0.001
Diastolic BP (mm Hg) 67.6 ± 68.3 ± i0.95 65.8 ± 10.723 64.6 ± 8.523 0.001
Serum total cholesterol (mmol/L) 4.03 ± 1.03 4.10 ± i.O75 3.71 ± 0.85235 3.38 ± 0.782 0.001
HDL cholesterol (mmol/L) 1.37 ± 0442.4 1.52 ± O.44 1.48 ± 0.43’ 1.38 ± 0.3624 0.001
LDL cholesterol (mmollL) 1.99 ± #{216}9545 1.86 ± 0.91 1.57 ± 0.8323 1.43 ± 0.7223 0.001
HDL:total cholesterol 0.35 ± 0.13245 0.39 ± 0.14 0.41 ± 0.14 0.43 ± 0.1523 0.001
Serum triglyceride (mmol/L) 1.50 ± 0.86 1.65 ± 1.06 1.63 ± 0.97 1.47 ± 0.78 0.1
‘ g ± SD. BP, blood pressure. Body mass index in kg/m2.
2 Significantly different from group 2, P < 0.05.
3 Significantly different from group 1, P < 0.05.
4 Significantly different from group 3, P < 0.05.
5 Significantly different from group 4, P < 0.05.

TABLES
Unadjusted and adjusted differences (linear-regression analysis) in cardiovascular disease risk factors for 100-g/d intakes of oats and buckwheat’

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Oats intakes Buckwhe at intakes

Unadjusted Adjusted Unadjusted Adjusted

Variables /3 SE /3 SE f3 SE j3 SE

Body mass index -0.47 0.112 -0.25 0.ii3 -0.09 0.06 0.04 0.06
Systolic BP (mm Hg) -4.3 0.62 -3.1 0.62 -1.2 0.32 -0.3 0.3
Diastolic BP (mm Hg) -2.5 #{149}52 -1.3 54 -0.7 0.2 0.1 0.2
Serum total cholesterol (mmol/L) -0.19 #{216}#{216}52 #{216}4 0.04 -0.17 0.022 -0.07 0.02
HDL cholesterol (mmol/L) -0.13 0.022 -0.13 0.022 -0.01 0.01 -0.00 0.01
LDL cholesterol (mmolIL) -0.03 0.05 0.07 0.05 -0.14 0.022 -0.06 0.02
HDL:total cholesterol -0.01 0.01 -0.03 0.012 0.02 0.00 0.01 0.00
Serum triglyceride (mmolfL) -0.14 #{216}#{149}#{216}54 -0.10 0.O4 -0.01 0.02 0.02 0.02
‘ All analyses adjusted for age and dietary intakes of energy, cholesterol, and alcohol. In addition, body mass index (in kg/m2) was adjusted for dietary
fat and physical activity, blood pressure was adjusted for body mass index and dietary intake of sodium and potassium, and serum lipids were adjusted for
body mass intake, dietary intake of fat, and the ratio of polyunsaturated to saturated fatty acids. BP, blood pressure.
2-4 Statistically significant: 2 p < 0.001, p < 0.05, p < 0.01.

and potassium. Dietary buckwheat was associated with lower clinical trials. Ripsin (46) pooled the results of 12 randomized,
blood pressure in univanate analysis, but this was not the case controlled trials, which had evaluated the lipid-lowering effects
after adjustment for other covaniables. Further analysis mdi- of oats in free-living subjects. The overall effect of oats intake
cated that water-soluble fiber, but not total fiber, was indepen- was to lower serum total cholesterol by 0.15 mmollL (95% CI:
dently related to blood pressure. Previous studies of the asso- -0.22 to -0.09), with a more pronounced effect in persons
ciation between dietary fiber and blood pressure have yielded with a higher intake of oats and a higher initial total serum
inconsistent results (39-41). In clinical trials, oats supplemen- cholesterol concentration. In the present study, after adjustment
tation did not alter blood pressure (22, 23, 31). In all of these for the other covariables, oats intake was not significantly associ-
trials, however, blood pressure was not the primary outcome ated with either serum total or LDL-cholesterol concentrations,
variable and hypertensive patients were excluded (22, 23, 31). but was associated with lower concentrations of HDL cholesterol
A possible mechanism by which oats intake might lower blood and triglyceride.
pressure is through alterations in insulin metabolism. Higher Whether dietary oats lower serum cholesterol concentrations
insulin concentrations and insulin resistance have been linked to by substitution of carbohydrates fon saturated fats or by a direct
higher blood pressures and hypertension (42, 43). In healthy effect of the dietary fiber contained in oats remains an unan-
persons, consumption of oat bran has been demonstrated to lower swered question. Swain et al (3 1) compared the effects of oats
plasma insulin concentrations and to ameliorate insulin resistance and low-fiber wheat diets on serum lipids. Both types of
(44, 45). supplements lowered serum total cholesterol concentrations by
Higher buckwheat intake was associated with lower total and an average of 7-8% compared with baseline. However, a
LDL serum cholesterol, with no effect on HDL cholesterol. decrease in LDL cholesterol in the oats group was accompa-
Thus, the ratio of HDL to total cholesterol was higher at higher nied by a rise in HDL cholesterol. The low-fiber diet, on the
buckwheat intakes, independent of other variables. The asso- other hand, lowered HDL-cholestenol concentrations. The pan-
ciation of oats intake with serum lipids seen in univariate ticipants ate less saturated fat and cholesterol and more poly-
results in the present study is consistent with the results of most unsaturated fat during both periods of supplementation than at
 OATS AND CARDIOVASCULAR DISEASE 371

TABLE 6
Unadjusted and adjusted differences (linear-regression analysis) in cardiovascular disease risk factors for 10-g/d intakes of water-soluble or total fiber
from oats and buckwheat’

Water-sol uble fiber Total fiber

Unadjusted Adjusted Unadjusted Adjusted
Variables f3 SE /3 SE 3 SE 3 SE

Body mass index -0.59 0.172 -0.19 0.18 -0.04 0.02’ 0.00 0.02
Systolic BP (mm Hg) -6.0 0.92 -3.7 1.0 -0.5 0.12 -0.21 0.11
Diastolic BP (mm Hg) -3.5 0.82 1.2 0.7 -0.3 0.i 0.02 0.08
Serum total cholesterol (mmollL) -0.46 0.072 -0.16 0.07 -0.06 0.012 -0.02 0.01
HDL cholesterol (mmolfL) -0.13 0.032 -0.12 0.042 -0.01 0.00 -0.00 0.00
LDL cholesterol (mmolfL) -0.26 0.072 -0.01 0.07 -0.04 0.012 -0.02 0.0i3
HDL:total cholesterol 0.02 0.01 -0.01 0.01 0.005 0.0012 0.002 0.001
Serum triglyceride (mmol/L) -0.14 0.07 -0.07 0.07 -0.01 0.01 0.00 0.01
I All analyses adjusted for age and dietary intake of energy, cholesterol, and alcohol. In addition, body mass index (in kg/rn2) was adjusted for dietary
fat and physical activity, blood pressure was adjusted for body mass index and dietary intake of sodium and potassium, and serum lipids were adjusted for
body mass intake, dietary intake of fat, and the ratio of polyunsaturated to saturated fatty acids. BP, blood pressure.
2-4 Statistically significant: 2 p < 0.001, ? p < 0.05, p < 0.01.

baseline (31). Most (80%) of the study participants were Our study suggests that intake of grains rich in water-soluble

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women and their average serum cholesterol concentration was fiber in the presence of reasonable amounts of total fiber, like
in the desirable range, 4.81 mmollL. Studies in hypercholes- oats and buckwheat, are associated with lower serum choles-
terolemic men, on the other hand, have shown a greater reduc- terol and blood pressure values. These results imply that a
tion in serum lipids with oats than with wheat, rice, on corn high-fiber diet may be a useful part of a lifestyle modification
supplementation (21-24). Recent studies suggest that -glucan, to prevent cardiovascular diseases. The effect of dietary oats on
a water-soluble fiber, is the hypocholesterolemic component in blood pressure and the association of buckwheat intake with
oats (26, 47, 48). In our study, both total and water-soluble cardiovascular disease risk factors should be investigated fun-
fiber from oats and buckwheat were significantly and indepen- ther in clinical trials. U
dently associated with lower serum total cholesterol, even
We express our appreciation to the Department of Public Health and
though the average serum cholesterol in the study population
Anti-epidemic Stations of Liangshan Yi People Autonomous Prefecture,
was low. Soluble fiber may lower serum cholesterol concen- Butuo, Meigu, and Zhaojue counties, the People’s Republic of China, for
trations through several mechanisms. It has been suggested that their help in performing field work, and the National Center for Clinical
soluble fiber binds strongly to bile acids and increases fecal Laboratories, People’s Republic of China, for their help in performing
bile acid excretion (27, 49, 50). The loss of bile acids creates a laboratory work.
demand for cholesterol to facilitate the synthesis of bile acids
and diverts the available cholesterol from lipoprotein synthesis.
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