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Lipids Significantly Reduced by Diets Containing Barley in Moderately Hypercholesterolemic Men

Diet & Human Performance Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture

Address reprint requests to: Kay Behall, Ph.D., Building 307B, Room 220, Beltsville Human Nutrition Research Center, Beltsville, MD 20705. E-mail: behall{at}bhnrc.arsusda.gov

	ABSTRACT

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Objective: To determine whether barley, as the soluble fiber source, would beneficially change cardiovascular risk factors. Soluble fiber from oats has been recognized as beneficial in decreasing blood cholesterol levels. Although barley contains high amounts of soluble fiber, it is not consumed as extensively as oats.

Methods: Eighteen moderately hypercholesterolemic men (28–62 y) consumed a controlled equilibration diet (Step 1, 30% fat, 55% carbohydrate, 15% protein, < 300 mg cholesterol) for 2 weeks followed by the diet with about 20% of energy replaced with brown rice/whole wheat, barley & brown rice/whole wheat or barley (< 0.4 g, 3 g and 6 g added soluble fiber/2800 kcal, respectively) for 5 weeks in a Latin square design. Fasting blood was drawn twice weekly. Total cholesterol, HDL cholesterol, and triacylglycerols were measured enzymatically and lipid fractions were measured by nuclear magnetic resonance spectroscopy.

Results: Compared with prestudy concentrations, total cholesterol (14%, 17%, and 20%, respectively) and LDL cholesterol (17%, 17%, and 24%, respectively) were significantly lower (p < 0.0001) after the low, medium, and high-soluble fiber diets. Triacylglycerol was 6%, 10%, and 16% lower (p = 0.09) whereas HDL cholesterol (9%, 7%, and 18%) was higher (p < 0.001) after the experimental diets. Total cholesterol and LDL cholesterol after the high-soluble fiber diet were significantly lower than concentrations after the low- or medium-soluble fiber diets. Mean LDL particle number significantly decreased (p < 0.007) and the large LDL cholesterol fraction showed a trend toward lower concentrations (p = 0.06).

Conclusion: Increasing soluble fiber through consumption of barley in a healthy diet can reduce cardiovascular risk factors.

Key words: barley, beta-glucans, whole grains, cholesterol, triacylglycerols

	INTRODUCTION

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Consumption of diets high in whole grains has been reported to have beneficial health effects such as a reduced risk of cancer [1], cardiovascular disease [2,3], and noninsulin-dependent diabetes mellitus [4,5]. These results have been attributed to the effects of the fiber content of whole-grain foods on risk factors for these diseases, including blood glucose [6], insulin [7], and cholesterol [8,9]. Other more general beneficial physiological effects of consumption of whole grains include reduced transit time for foods, which may reduce risk of colon cancer [10,11], and reduced absorption of nutrients [12,13], which may reduce glucose and insulin responses and risk of obesity [14].

The U.S. Food and Drug Administration allows three health claims related to grain intakes [15]. One claim is that low-fat diets rich in fiber-containing grain products, fruits, and vegetables may reduce risk of some types of cancer. A second claim allows the statement that consumption of soluble fiber from oats or psyllium in a diet low in saturated fat and cholesterol may reduce the risk of heart disease. A specific claim for whole-grain foods allows the statement that low-fat diets rich in whole-grain foods and other plant foods may reduce the risk of heart disease and certain cancers.

Numerous studies have demonstrated that whole grains that are high in soluble fiber, such as oats, are more effective in lowering blood cholesterol than are grains in which fibers are predominantly insoluble, such as wheat or rice [16–19]. Epidemiological studies often combined several food sources that contain fiber (such as all cereals plus grains, all fruits plus all vegetables), making it difficult to determine the specific beneficial dietary component. Clinical studies testing the effects of soluble fibers have used oats or psyllium even though barley contains as much or more soluble fiber [20]. Many of the studies in humans have added either fiber supplements or fiber-containing foods to self-selected diets. The purpose of this study was to examine the effects of the consumption of various amounts of soluble fiber from barley in a controlled whole-grain diet on risk factors for coronary heart disease in moderately hypercholesterolemic men.

	MATERIALS AND METHODS

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Subjects
The study was approved by the Johns Hopkins School of Public Health Institutional Review Board. Mildly hypercholesterolemic men were recruited for this study based on their being weight stable for 6 months before the study and not taking medication known to affect lipid metabolism or blood pressure. Written informed consent was obtained from each subject after an oral explanation of the study.

Blood and urine were collected before the study for a general clinical screening to select men with moderately elevated cholesterol but no other conditions that would affect lipid or glucose metabolism. Heights and weights were measured and duplicate blood pressure readings were taken. Subjects filled out a health history questionnaire. Physicians from Johns Hopkins University School of Public Health evaluated the health history and clinical screening values for underlying disease before subjects were accepted for study participation and provided medical supervision throughout the study.

Twenty-one men with moderately elevated plasma cholesterol concentrations were selected for the study. Two subjects withdrew during the first week; one had an international business-related trip and one withdrew because he was not willing to comply with the regimen of the study. Another subject withdrew during the adaptation period after an automobile accident made transportation to the center for meals difficult. Prestudy characteristics of the 18 men completing at least one experimental diet are listed in Table 1. One subject completed 2 and two subjects completed 3 of the 4 periods. Two of the 18 subjects lost significant weight at the beginning so that weights during all three whole-grain diets were less than initial weights or weight after the Step 1 equilibration diet. Prestudy characteristics of the 16 men who were weight stable are listed separately in Table 1.

	RESULTS

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Some gastrointestinal discomfort was noted by some of the subjects during the equilibration period when a diet higher in fiber than was typical was consumed. The major complaint was that there was too much food and that subjects had a very full feeling after eating. More subjects complained about bloating and flatulence with the high-soluble fiber diet.

Average body weights varied by a little more than 1 kg from the initial weight to the end of the Step 1 equilibration period, a difference that was statistically significant (p < 0.038). Subjects’ average weight after consuming all three whole-grain diets was less than initial weights or weights after the Step 1 equilibration diet. Two of the 18 subjects were responsible for most of the weight change. The weights of the remaining subjects did not significantly change throughout the study (p < 0.192).

Total plasma cholesterol concentrations with and without subjects who lost weight was significantly affected by the diet consumed (p < 0.0001, Table 5) and by the length of time (by week, p < 0.001; data not shown) the diet was consumed. No interaction between diet and week was observed (p = 0.912). The cholesterol concentrations on average did not significantly decrease until the fourth week of each period. Compared with prestudy concentrations (Table 1), total cholesterol was 4% lower (p < 0.026) after consumption of the Step 1 diet. Total cholesterol was significantly lower than prestudy concentrations (14%, 17%, and 20%, respectively; p < 0.001) after subjects consumed the low-, medium-, and high-soluble fiber diets. Total cholesterol concentrations after the high soluble fiber diet were significantly lower than those after the low- or medium-soluble fiber diets. Including the two subjects who lost weight did not change the level of statistical significance nor the differences between the diets. Means including the subjects who lost weight (Table 5) did not appreciably differ from those of the weight stable group. Calculated LDL cholesterol concentrations followed the same significant (p < 0.0001) pattern of reduction that was observed for total cholesterol. Compared with prestudy concentrations, LDL cholesterol was 4% lower after the Step 1 diet and significantly lower (17%, 17%, and 24%, respectively; p < 0.001) after subjects consumed the low-, medium-, and high-soluble fiber diets. LDL cholesterol concentrations after the high-soluble fiber diet were significantly lower that those after the low- or medium soluble fiber diets. The level of statistical significance, the differences between the diets and relative mean concentrations were unchanged when the two subjects who lost weight were included (Table 5).

Overall triacylglycerol concentrations tended to decline (p = 0.0525, weight-stable subjects; p = 0.0178, all subjects) from the prestudy and Step 1 concentrations (Tables 1 and 5). Compared with prestudy concentrations, triacylglycerol concentrations were 3% lower after the Step 1 diet. Triacylglycerol concentrations were 6%, 10%, and 16% lower after the low-, medium-, and high-soluble fiber diets than before the study and were significantly lower after the high-soluble fiber diet than before the study and after the Step 1 period in both the weight stable group and total subject group. Although triacylglycerol concentrations decreased with increasing soluble fiber, concentrations after the low-, medium- and high-soluble fiber diets were not significantly different.

Lipid fraction concentrations presented in Table 6 includes all study subjects. The level of statistical significance, the differences between diet means and relative mean concentrations of lipid fractions with and without the two subjects who lost weight were equivalent. Concentrations of large, intermediate, and small fractions of VLDL or LDL cholesterol prestudy and after the Step 1 and three experimental diets were not significantly different. VLDL and LDL cholesterol lipid fractions after the low-, medium and high soluble fiber diets were not different. The concentration of small HDL cholesterol fractions after the experimental diets were significantly lower than the prestudy concentrations. Intermediate HDL cholesterol fractions after the experimental diets were significantly lower than concentrations after the Step 1 diet. However, these differences in HDL were not fiber specific. The large HDL particle concentrations did not significantly vary with diet.

	DISCUSSION

 
Most research studies using food as the soluble fiber source have fed oats or oat products [2,12,17,18,25–32]. Some controlled feeding studies compared a high-fiber diet with a low-fiber diet. Many studies supplemented a self-selected diet with added fiber with and without controlling or monitoring other dietary factors. Significantly lower total cholesterol [2,25–27] and LDL cholesterol [2,25–27] concentrations have been reported after the consumption of oat bran compared to wheat bran or rice bran added to the self-selected diets of hypercholesterolemic subjects. Generally, no significant change was reported in triacylglycerols [2,25,28] or HDL cholesterol [2,26–28] concentrations in these subjects with the inclusion of oatmeal or oat bran in the diet. The lipids of normolipemic subjects usually do not decrease with the addition of soluble fibers to their diet [2,29,33,34].

Relatively few studies have reported the ß-glucan content of the diet [2,8,16,30–32]. A reduction in total and LDL cholesterol from prestudy and maintenance diet concentrations was reported [8] after two levels of soluble oat extract (1.8 or 7.2 g ß-glucan/day) were consumed by moderately hypercholesterolemic men and women for 5 weeks each. The greatest percentage decrease in total and LDL cholesterol occurred after the higher ß-glucan intake. Davidson et al. [30] reported total cholesterol and LDL cholesterol were significantly lower after the 28–84 g (1–3 oz) of oatmeal or oat bran as the ß-glucan source than after the farina. The greatest percentage change from baseline value occurred when 56 g oat bran (4.0 g ß-glucan), 84 g oatmeal (3.6 g ß-glucan), or 84 g oat bran (6.0 g ß-glucan) were consumed, ß-glucan intakes similar to that in our medium and high soluble fiber diets. However, Mackay and Ball [31] and Törrönen et al. [32] did not observe statistically significant decreases in total cholesterol [31,32], LDL cholesterol [31,32] after diets containing 1.9, 3.0, or 11.2 g ß-glucan/day. These authors observed a significantly higher [31] and no difference [32] in HDL cholesterol concentrations. Jenkins et al. [16] supplemented diets of moderately hypercholesterolemic men and women consuming a self-selected Step II diet with high-fiber foods so that average soluble fiber was increased by 8 g/day compared to the diet with control foods. Compared to the control diet, total cholesterol and the ratios of total:HDL cholesterol and LDL:HDL cholesterol were significantly lower after the higher soluble fiber diet. Our results using a controlled Step 1 diet with 3 or 6 g soluble fiber/d were similar even though different soluble fiber sources were used on the two studies. Brown et al. [35] performed a meta-analysis of 67 controlled studies and calculated that for each gram of soluble fiber from oats, psyllium, or pectin, total and LDL cholesterol decreased by approximately 1.55 mg/dL (0.04 mmol/L). The meta-analysis showed no significant change in triacylglycerols and HDL cholesterol. The observed changes appeared to be independent of study design, treatment length, and dietary fat content.

Only one study has reported the effect of fiber on lipid subclass and particle numbers [36]. Overweight men consuming an oat (14 g dietary fiber/day, 5.5 g ß-glucan) or wheat supplement (14 g dietary fiber/day) for 12 weeks had a significant reduction (p < 0.05) in LDL cholesterol concentration, LDL particle number, and the ratio of LDL to HDL cholesterol from prestudy concentrations after the oats whereas the lipids increased after the wheat. Total cholesterol, triacylglycerols, and VLDL cholesterol showed the same pattern as LDL cholesterol but the differences were not significant (p < 0.08, p < 0.07, p < 0.08, respectively). Concentrations of HDL cholesterol and HDL cholesterol subclasses and diameters of LDL, HDL, and VLDL particles were not significant by diet type. The authors suggested that the decrease in small dense LDL cholesterol concentration and LDL particle number without changes in triacylglycerols or HDL cholesterol concentrations may contribute to the beneficial effect of oat fiber on cardiovascular disease. We observed similar pattern in the reduction of LDL particle number and concentration. However, we also observed some reduction in the intermediate and small HDL cholesterol subclasses. Freedman et al. [37] reported that men with relatively high concentrations of either small HDL or large VLDL particles were 3–4 times more likely to have extensive coronary artery disease than men with concentrations below average. Campos et al. [38] reported a significant association between large LDL size and coronary artery disease in normolipidemic men; large LDL particles were more prevalent in men with coronary artery disease (43%) than in control subjects (25%). The reduction in small HDL concentrations and LDL cholesterol particles we observed after subjects consumed the high-soluble fiber diet indicates an improvement in this risk factor.

Few studies have used barley as the source of ß-glucan in the diet and most did not report the soluble fiber content of the diets. Similar to our findings the addition of barley to the diet resulted in lower total and LDL-cholesterol compared to concentrations prestudy or after a control grain. Newman et al. [34] reported men consuming 42 g dietary fiber for 4 weeks from wheat or barley had total and LDL cholesterol higher after the wheat products and lower after the barley products compared with prestudy concentrations. No decrease was observed in the men who had normal cholesterol concentrations before the addition of the barley. When oats or barley were consumed for 6 weeks by moderately hypercholesterolemic men and women [39], total and LDL cholesterol were lower after both grains. No significant difference between the two grains was observed, an indication that soluble fiber and not the source was critical in lipid reduction. A 50/50 mix of rice and barley (similar to the mixture in our medium diet containing 3.0 g beta glucan) consumed twice daily for 2–4 weeks resulted in significant decreases in total cholesterol, LDL cholesterol, LDL lipoproteins, and VLDL lipoproteins of hypercholesterolemic men and women, but not normolipemic subjects, from prestudy concentrations [33]. Lupton et al. [19] fed supplements of barley bran flour (30 g/day), barley oil (3 g/day), or cellulose (20 g/day) to hypercholesterolemic men and women following a Step 1 diet. Similar to our results, the addition of the barley bran flour and barley oil resulted in a significant decrease in total cholesterol (p < 0.0001 and p < 0.002, respectively) and LDL cholesterol (p < 0.036 and p < 0.003, respectively) whereas no change was observed after cellulose. Unlike our findings, HDL cholesterol decreased after the barley bran flour groups (p < 0.006). This may have been due, in part, to their subjects consuming approximately half the barley consumed by our subjects on the medium diet. McIntosh et al. [20] fed mildly hypercholesterolemic men barley or wheat products for 4 weeks. The diets averaged 25 g insoluble fiber and 13.4 g soluble fiber, which included 1.5 g and 8.0 g ß-glucan, respectively, from the wheat and barley diets. Total cholesterol (p < 0.05) and LDL cholesterol (p < 0.05) were significantly lower after the barley diet than the wheat diet but triacylglycerols did not significantly change.

Several mechanisms have been suggested for the lowered cholesterol after increased soluble fiber consumption, including increased excretion of bile acids or neutral sterols, increased catabolism of LDL cholesterol, and reduced fat absorption [40–42]. Increased viscosity of the gastric and intestinal contents can delay gastric emptying, decrease nutrient absorption, and interfere with micelle formation. Soluble fibers have been shown to be fermented in the colon [40–42], giving rise to short-chain fatty acids that can be absorbed and may inhibit hepatic cholesterol synthesis. Reduced cholesterol concentrations have also been associated with decreased postprandial insulin concentrations observed after soluble fiber ingestion [40]. In addition to the soluble fiber, barley contains a wide range of phytochemicals, some of which are being investigated for their effect on metabolism. A combination of factors and mechanisms appears to contribute to the reduction of lipids observed after consumption of barley.

	CONCLUSION

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Overall, the subjects’ cardiovascular risk factors improved with decreased total cholesterol, LDL cholesterol (especially large particle number), and ratio of total cholesterol to HDL cholesterol. The highest soluble fiber intake had the greatest effect on total and LDL cholesterol. These results indicate that the addition of barley to a healthy diet can reduce risk of cardiovascular disease.

	FOOTNOTES

TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 
Research was supported by intramural Agricultural Research funds. Barley was provided by the National Barley Foods Council, Spokane, Washington.

Received February 28, 2003. Accepted July 30, 2003.

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TOP FOOTNOTES ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS CONCLUSION REFERENCES

 

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