Human Nutrition and Metabolism

An Oat-Containing Hypocaloric Diet Reduces Systolic Blood Pressure and

Improves Lipid Profile beyond Effects of Weight Loss in Men and Women1
Edward Saltzman,2 Sai Krupa Das, Alice H. Lichtenstein, Gerard E. Dallal,
Alberto Corrales, Ernst J. Schaefer, Andrew S. Greenberg and Susan B. Roberts
The Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging
at Tufts University, Boston, Massachusetts 02111

KEY WORDS:

weight loss

oats

blood pressure

Cardiovascular disease (CVD)3 continues to be the major

cause of morbidity and death in industrialized society. Hypertension, dyslipidemia and excess body weight are among the
most potent accepted risk factors for CVD. Weight loss has
beneficial effects on blood pressure, lipids and glucose control,
and weight loss in the range of 510% of initial weight can
confer significant improvement in these variables (Mertens
and Van Gall 2000, National Institutes of Health 1998, Trials
of Hypertension Prevention Collaborative Research Group
1992,Wadden et al. 1999). In population studies, dietary factors, such as consumption of a vegetarian diet or a diet high in
cereal fiber, fruits and vegetables, also appear to be associated
with reduced risk for hypertension, dyslipidemia and CVD
itself (Beilin 1994, Dwyer 1988, He et al. 1994, Rimm et al.
1996). Identification of such factors has stimulated considerable research effort directed toward the prevention of CVD

cholesterol

humans

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ABSTRACT Hypertension, dyslipidemia and overweight contribute substantially to cardiovascular disease risk.
One of the most effective methods for improving high blood pressure and lipid profiles is loss of excess weight.
Other recommendations for reducing cardiovascular risk include changes in dietary micronutrient, macronutrient
and fiber intakes. To better define a diet for reduction in cardiovascular risk, 43 adults (body mass index 26.4 3.3,
range 20.533.9 kg/m2) participated in an 8-wk study to determine the effects of two diets on weight, blood
pressure, lipids and insulin sensitivity. For 2 wk, weight was maintained and all subjects consumed a control diet.
For the next 6 wk, subjects consumed one of two hypocaloric diets (maintenance energy minus 4.2 MJ/d): the
control diet (n 21) or a diet containing oats [45 g/(4.2 MJ dietary energy d), n 22]. There was no significant
difference between groups in changes in weight loss (control 4.0 1.1 kg, oats 3.9 1.6 kg, P 0.8). The oats
diet resulted in greater decreases in mean systolic blood pressure (oats 6 7 mm Hg, control 1 10 mm Hg,
P 0.026), whereas diastolic blood pressure change did not differ between the two groups (oats 4 6 mm Hg,
control 3 5 mm Hg, P 0.8). The oat diet resulted in significantly greater decreases in total cholesterol (oats
0.87 0.47 mmol/L, control 0.34 0.5 mmol/L, P 0.003) and LDL cholesterol (oats 0.6 0.41 mmol/L,
control 0.2 0.41mmol/L, P 0.008). In summary, a hypocaloric diet containing oats consumed over 6 wk
resulted in greater improvements in systolic blood pressure and lipid profile than did a hypocaloric diet without
oats. J. Nutr. 131: 14651470, 2001.

and its risk factors through diet modification. In many circumstances, dietary interventions have been shown to have salutary effects on hypertension and hyperlipidemia (Anderson et
al. 2000, Appel et al. 1997, Stevens et al. 1993), but definition
of the most beneficial regimens remains controversial. Despite
the success observed in some of these trials due to the manipulation of specific nutrients or the provision of specific supplements, it remains likely that the benefit obtained by a
complex diet cannot be reproduced through the manipulation
of individual nutrients in an unhealthful diet. The recent
Dietary Approaches to Stop Hypertension (DASH) report
(Appel et al. 1997) underscores that food-based (not supplement-based) interventions can be highly effective in lowering
blood pressure.
Although the benefits observed with complex diets are
likely not attributable to single nutrients, it remains possible
that particular classes of food or individual foods can confer
particular benefit. In addition, the introduction of individual
dietary classes or constituents may be preferable to broader
dietary changes in terms of changing dietary behaviors. Thus,
definition of the beneficial individual constituents of a complex diet is needed. One such possible constituent is oats, a
whole-grain cereal that is rich in soluble fiber. The effects of
oats on lipid metabolism are well documented (Ripsin 1992),
and there is a growing body of literature to suggest that oats

1
Supported by in part by an unrestricted gift from the Quaker Oats Company
(Barrington, IL), in part by National Institutes of Health Grant AG12829 and in part
by U.S. Department of Agriculture contract 53-3K06-5-10.
2
To whom correspondence should be addressed at Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University,
711 Washington St., Boston, MA 02111. E-mail: esaltzman@hnrc.tufts.edu
3
Abbreviations used: BMI, body mass index; CVD, cardiovascular disease;
DBP, diastolic blood pressure; MRU, Metabolic Research Unit; RDA, Recommended Dietary Allowance; SBP, systolic blood pressure.

0022-3166/01 $3.00 2001 American Society for Nutritional Sciences.

Manuscript received 10 August 2000. Initial review completed 3 September 2000. Revision accepted 30 January 2001.
1465

SALTZMAN ET AL.

1466

MATERIALS AND METHODS

Subjects. Subjects were recruited for a trial assessing the effects
of hypocaloric diets with and without oats on body weight, blood
pressure and blood lipids, as well as on measures of energy regulation.
Because one purpose of the trial was to measure energy regulation in
healthy adults, subjects were not specifically recruited on the basis of
preexisting hypertension or dyslipidemia. The weight range of subjects was limited to a body mass index (BMI) of 20 35 kg/m2, which
was chosen to allow a comparison of study variables in normal-weight
individuals with those in overweight or mildly to moderately obese
individuals. In addition, the influence of age was assessed by comparing responses in younger (age 18 30 y) and older (age 60 75 y) age
groups. To ensure similar characteristics in the two diet groups,
subjects were randomized on the basis of age and gender and, in
younger subjects, by BMI ( or 25 kg/m2).
The subjects were 43 healthy weight-stable men and women
(Table 1). None smoked or had a history of recent serious acute or
chronic disease, and all were judged to be healthy on the basis of
routine screening physical examination and blood tests. At screening,
subjects had a systolic blood pressure (SBP) of 150 mm Hg and a
diastolic blood pressure (DBP) of 90 mm Hg. Subjects reported
habitually consuming ethanol of 30 g/d and scored 10 on a dietary
restraint scale (Stunkard and Messick 1985) administered at screening. Subjects taking any medication known to influence body weight
or blood pressure, those with a significant history of eating disorders
and those who reported strenuous exercise for 1 h/d were excluded.
The study was approved by the Human Investigation Review Committee of Tufts University School of Medicine and New England
Medical Center, and written informed consent was obtained from all
subjects.
Study protocol. The study was conducted at the Metabolic Research Unit (MRU) of the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University.
The 8-wk protocol was divided into a 2-wk weight-maintenance
phase (phase 1) followed by a 6-wk weight-loss phase (phase 2).
During both phases, all food and caloric beverages were provided to
subjects at the MRU. In phase 1, all subjects consumed the same diet
of usual food items (control diet), and the level of energy intake
needed to maintain body weight was determined over wk 1 and held
constant over wk 2. In phase 2, subjects were provided a diet calculated to contain maintenance energy needs minus 4.2 MJ/d. However,
a decrease of 4.2 MJ was thought to be too severe for seven subjects

TABLE 1
Initial (phase 1) subject characteristics1,2

n
Gender, M/F
Age, y
Young subjects, n
Age range, y
Older subjects, n
Age range, y
Weight, kg
BMI, kg/m2
Body Fat, g/100 g weight
SBP, mm Hg
DBP, mm Hg
VO2max, mL min1 kg1

Control group

Oats group

21
9/12
44.1 21.3
12 (M/F 5:7)
1930
9 (M/F 4:5)
6472
78.0 14.5
26.7 3.2
31.3 9.5
118 15
70 8
38.2 15.6

22
11/11
45.1 22.7
12 (M/F 6:6)
2230
10 (M/F 5:5)
6578
74.9 14.5
26.1 3.4
31.7 10.0
117 9
72 6
32.8 12.7

1 Values are means SD; means did not differ.

2 Values are for young and older subjects combined, unless other-

wise noted.
3 BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure.

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also lower blood pressure or help prevent CVD. Population

studies suggest that diets rich in oats (He et al. 1994) or other
foods containing soluble fiber (Pietinen et al. 1996) are associated with lower levels of blood pressure or rates of coronary
disease. The few intervention trials examining the effect of
oats on blood pressure have been inconclusive (Kestin et al.
1990, Swain et al. 1990), and supplementation trials of soluble
fiber have inconsistently reported beneficial effects on blood
pressure (Krotkiewski 1984, Rossner et al. 1988, Saltzman and
Roberts 1997). However, the amount of oats may have been
inadequate in these trials to achieve the desired effect, as trials
using large doses of foods or soluble fiber have more consistently demonstrated a blood pressure effect (Krotkiewski 1984,
Singh et al. 1993). Also, oat or oat fiber consumption has been
shown to reduce postprandial glucose and insulin concentrations (Braaten et al. 1991 and 1994), and the reduction in
insulin concentration may provide a mechanism by which
blood pressure could be reduced in response to oat consumption (Tuck 1992).
We therefore hypothesized that a diet designed for weight
loss that contained oats would produce greater improvements
in blood pressure and lipid profiles than a hypocaloric diet
without oats. To test this hypothesis, subjects consumed hypocaloric diets with or without oats for 6 wk and demonstrated
that a diet containing oats resulted in improvements in a
number of CVD risk factors compared with a control diet.

whose initial maintenance requirements were low, and smaller decreases of 3.33.7 MJ were used. In phase 2, subjects consumed one of
two study diets: the oats group received a hypocaloric diet containing
oats (45 g dry weight/4.2 MJ dietary energy, roughly equivalent to 1.5
servings of oatmeal/4.2 MJ), and the control group continued to
consume the same diet as in phase 1. During phase 2, a daily
multivitamin containing the Recommended Daily Allowance (RDA)
for most vitamins (but not containing minerals) was provided because
some subjects had energy intakes that were sufficiently low to preclude intake of the RDA of vitamins from provided food.
During each phase, measures of body weight, body composition,
energy expenditure, blood pressure, blood tests for metabolic variables
and 24-h urine collections were conducted. Subjects slept in the
MRU on nights preceding testing but were otherwise permitted to
reside at home. They were encouraged to continue their usual levels
of physical activity throughout the 8-wk protocol.
Diets. All food and energy-containing beverages were provided
to the subjects. Three meals and one snack were consumed each day.
Subjects were required to eat at least four meals per week in the
center and were given other meals for carry-out. After wk 1, subjects
were required to consume all food and beverages and to rinse and
scrape as well as return food containers.
For phase 1, initial energy needs were predicted using the RDA for
energy (National Research Council 1989) with appropriate activity
factors applied. Protein was provided as 1.1 g/kg body. Nonprotein
energy was provided as carbohydrate (54% of total energy) and fat
(35% of total energy) (Table 2). Total energy was adjusted daily over
1 wk to maintain weight within 500 g of d 1. The average daily energy
provided over the 1st 7 d was then provided daily to subjects for the
2nd wk. During this 2nd wk, subjects were required to consume all
food. In the rare event of weight changes of 500 g in phase 2, energy
intake was again adjusted.
During phase 2, subjects were provided with their average daily
weight-maintenance energy intake (as determined in phase 1) minus
4.2 MJ/d. Protein intakes remained constant, as did the proportion of
nonprotein energy from carbohydrate and fat. Subjects were randomized to consume either a diet containing oats (oats, 45 g/4.2 MJ daily
energy) or the control diet (Table 3). The dose of oats was chosen to
reflect an amount that could be reasonably consumed by free-living
persons and, based on prior trials, reflected a range that would be
likely to benefit blood lipids (Ripsin 1992). Diets were matched for
insoluble fiber, protein, carbohydrate and fat. Dietary sodium and
potassium were held constant at each subjects level of intake in
phase 1, and subjects could consume the same amount of caffeinated
beverages as consumed in phase 1. Oats were in the form of Quaker
Quick Oats (The Quaker Oat Company, Barrington, IL), and all oats

OATS IMPROVE BLOOD PRESSURE AND LIPIDS

1467

TABLE 2
Daily nutrient intake by phase and diet1,2,3
Control group
Phase 1

Oats group
Phase 2

Phase 1

Phase 2

11.323 2.930

7.645 3.181

81 15
363 102
107 29
34 11
36 9
30 7
17.3 4.7
5.0 1.3

79 16
229 108
67 32
20 10
23 11
19 9
16.3 6.9
7.2 3.0

257 53
3380 713
2534 504
863 182
312 69
1376 263

173 41
3355 718
2516 520
557 242
289 101
1250 378

MJ/d
11.653 3.090

Energy

7.833 3.219
g/d

83 15
375 107
110 31
35 10
36 10
31 9
17.2 4.4
5.0 1.2

Protein
Carbohydrate
Fat
Polyunsaturated fatty acids
Monounsaturated fatty acids
Saturated fatty acids
Total fiber
Soluble fiber

82 16
234 112
69 33
22 10
23 11
19 9
12.5 5.1
3.5 1.4
mg/d
225 53
3258 794
2525 533
660 249
252 82
1191 315

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268 60
3333 757
2549 487
869 166
310 63
1381 251

Cholesterol
Sodium
Potassium
Calcium
Magnesium
Phosphorus

1 Values are means SD for all subjects, n 43.

2 Phase 1 (wk 12) or phase 2 (wk 3 8).
3 During phase 1, both the control and oat groups consumed the control diet, whereas during phase 2, different (control or oat) diets were

consumed.

used were from the same lot to minimize variation in nutrient and
fiber content. Oats were provided in the form of hot cereal or were
incorporated into other food items (e.g., breads and casseroles) eaten
at other meals. The oat diet contained oats in all meals and snacks.
Nutrient composition of the diets was calculated using standard
dietary composition software (NDS 93 Version 2.4; Minnesota Nutrition Data System, Nutrition Coordination Center, University of
Minnesota, Minneapolis, MN).
Body weight and composition. Body weight was measured under
standardized conditions with an electronic digital scale to 0.01 kg,
and body height was measured by fixed-wall stadiometer. Body composition was determined by hydrodensitometry after an overnight

TABLE 3
Menu items (all food) consumed during
phase 2 hypocaloric diets
Oats group
Berry drink with oatmeal
Oatmeal
Oat muffin
Corn flakes
Ham/turkey sandwich on oat
bread
Tuna sandwich on oat bread
Green salad
Chicken gumbo with oats
Oatburger
Spaghetti and oatballs
Spice cookies with oats
Chocolate cookies with oats
Custard with oats

Control group
Berry drink with wheat bran
Cream of Wheat
Wheat muffin
Corn flakes
Ham/turkey sandwich on white
bread
Tuna sandwich on white bread
Green salad
Chicken gumbo
Baked chicken with rice pilaf
Spaghetti and meatballs
Spice cookies
Chocolate cookies
Custard

fast: twice during phase 1 and twice during the last days of phase 2.
Measurements were repeated until at least three measures of body fat
were within 2% of each other, and fat-free mass was calculated
according to the equations of Siri (1961).
Blood pressure and maximal aerobic capacity. Blood pressure
was determined each residence day and at each outpatient visit to the
MRU and was measured after quiet sitting by nursing staff using a
standard aneroid mercury sphygmomanometer and by noting the first
and fifth Korotkoff sounds. To evaluate the effect of phase 2 diet on
blood pressure, initial and final SBP and DBP were defined as averages
of each in wk 2 (phase 1) and wk 8 (phase 2), respectively. Changes
in blood pressure (SBP and DBP) were defined as phase 2minus
phase 1 values.
O2max) was determined during phase
Maximal aerobic capacity (V
1 with a graded exercise treadmill test using a standard Bruce protocol
(Vogel et al. 1986) with collection of expired gases.
Metabolic parameters. Blood was collected via venipuncture
and after the placement of intravenous catheters (for metabolic tests)
twice during phase 1 and again for similar measurements at the end
of phase 2 (wk 8). Unless otherwise noted, all fasting samples were
combined to reflect an average value for each phase.
Plasma glucose (Hexokinase/Glucose-6-Phosphate Dehydrogenase method; Roche Diagnostic Systems, Branchburg, NJ) and insulin (radioimmunoassay, DA 125I Insulin Kit; ICN Biomedical, Costa
Mesa, CA) were measured after a 12-h overnight fast twice during
phase 1 and twice during the final week of phase 2 (wk 8), and values
were averaged for each phase. Because changes in fasting insulin and
glucose may be insensitive indicators of changes in insulin sensitivity,
additional models to estimate insulin sensitivity in the fasting and fed
states were used. Insulin resistance was calculated according to the
homeostatic model assessment, where insulin resistance (fasting
glucose fasting insulin)/22.5 (Matthews et al. 1985). In addition, a
2-h 75-g oral glucose tolerance test was performed once in phase 1
(wk 2) and once at the end of phase 2 (wk 8), and estimates of whole
body insulin sensitivity were calculated according to the model of

SALTZMAN ET AL.

1468

RESULTS
Details of the subjects are given in Table 1. There were no
significant differences between the two diet groups in age,
initial weight and BMI or initial percent body fat. Over phase
2, both diet groups demonstrated a similar weight change
(control 4.0 1.1 kg, oats 3.9 1.6 kg, difference
between groups P 0.8), which was consistent with the
weight loss predicted by a deficit of 4.2 MJ/d for 42 d (Saltzman and Roberts 1995 and 1996), suggesting that overall
compliance with both diets was good. There were no significant differences between diet groups in weight change as a
percentage of initial weight (control 5.3 1.6%, oats 5.5
2.8%, P 0.76) or in change in fat mass (control 2.7
1.6 kg, oats 2.5 1.3 kg, P 0.65). In addition, there
were no effects of initial BMI, initial percent body fat, age or
gender on weight loss, nor were there significant diet age or
diet gender interactions on weight loss.
Mean baseline blood pressures were in the normotensive
range (Table 1). Within each diet group, paired t tests showed
that DBP decreased significantly from phase 1 to phase 2
(DBP: control 3 5 mm Hg, P 0.013, oats 4 6 mm
Hg, P 0.007, difference between oats and control P 0.04)
(Table 4). By similar analyses, SBP decreased significantly
only in the oats group (SBP: control 1 10 mm Hg, P
0.7, oats 6 7mm Hg, P 0.0001). ANCOVA to
determine the effect of diet on blood pressure in phase 2 while
controlling for initial blood pressure, initial BMI and weight
lost (absolute and percent initial) revealed a significant advantage of the oat diet compared with the control diet on
decreases in SBP (P 0.026) but not DBP (P 0.8), suggesting an effect of diet on SBP independent of weight loss.
There were no significant differences in urinary sodium excre-

TABLE 4
Blood pressure and metabolic variables in subjects at
baseline (phase 1) and after phase 21
Control group
Phase 1
SBP,2 mm Hg
DBP, mm Hg
Fasting glucose, mmol/L
Fasting insulin, pmol/L
HOMA IR,3
(mmol L1) (U mL1)
Insulin sensitivity,3
(mg dL1) (U mL1)
Triglycerides, mmol/L
Total cholesterol, mmol/L
VLDL cholesterol, mmol/L
LDL cholesterol, mmol/L
HDL cholesterol, mmol/L
Phase 2 minus phase 14
SBP
DBP
Fasting glucose, mmol/L
Fasting insulin, pmol/L
HOMA IR,3
(mmol L1) (U mL1)
Insulin sensitivity,3
(mg dL1) (U mL1)
Triglycerides, mmol/L
Total cholesterol, mmol/L
VLDL cholesterol, mmol/L
LDL cholesterol, mmol/L
HDL cholesterol, mmol/L

Oats group

118 15
70 8
4.82 0.38
115.5 48.1

117 9
72 6
4.82 0.38
127.7 36.6

3.8 2.5

4.2 1.4

3.5 1.3
0.94 0.36
4.4 0.98
0.44 0.16
2.79 0.83
1.17 0.28

3.3 1.6
1.23 0.6
4.88 0.87
0.56 0.27
3.16 0.77
1.15 0.2

1 10
3 5
0.005 0.9
9.3 46.7

6 7*
4 6
0.21 0.29
28.7 26.5

0.5 2.1

1.1 1.2

0.5 1.2
0.22 0.23
0.34 0.5
0.1 0.1
0.2 0.41
0.04 0.14

0.6 1.0
0.36 0.36
0.87 0.47*
0.16 0.17
0.6 0.41*
0.09 0.13

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Matsuda and DeFronzo (1999), where insulin sensitivity 10,000/

square root of [(fasting insulin fasting glucose) (mean glucose
mean insulin during oral glucose tolerance test)].
Plasma lipids and lipoproteins were determined during phase 1
and phase 2 (wk 8) from fasting blood samples collected in tubes
containing EDTA. HDL was prepared after precipitation of apolipoprotein B containing lipoproteins with dextran sulfate-magnesium
chloride from plasma (Warnick 1982). Total cholesterol and triglycerides were determined by automated methods (Abbott Spectrum
CCX Analyzer; Abbott, Dallas, TX) using enzymatic reagents (Abbott A-GENT). Lipid assays were standardized through the Lipid
Standardization Program of the Centers for Disease Control and
Prevention, and CVs for all lipid assays between and within runs were
2.5%. LDL cholesterol was estimated by the Friedewald formula
(Friedewald et al. 1972).
Three consecutive 24-h collections of urine were conducted in wk
5 and repeated in wk 7 or 8. Urinary sodium and potassium were
analyzed by direct current plasma spectrometry (Spectra-Span VI;
Beckman Instruments, Fullerton, CA); concentrations of urinary
sodium and potassium were determined for each 24-h collection, and
the 3 consecutive days averaged. There were no significant differences
between averages for the two time points (wk 5 versus wk 7 or 8), so
both were averaged to provide a single value for phase 2.
Statistical analysis. Data are expressed as means SD unless
otherwise noted. Students t test for independent samples was used to
compare the two treatment groups at baseline and to compare mean
change scores between the two groups. ANCOVA was used to adjust
differences for age and gender and to assess interactions of treatment
with diet and gender. When statistically significant interactions were
found, the treatment effect was assessed separately for each treatment
group by using Students t test for paired samples. Differences were
considered statistically significant if the observed significance level
was P 0.05. Statistical calculations were performed with SYSTAT
Version 9 (SPSS, Chicago, IL).

1 Values are means SD for all subjects, n 43; * P 0.05 between

control and oats groups.
2 SBP, systolic blood pressure; DBP, diastolic blood pressure;
HOMA IR, insulin resistance by homeostatic model assessment
method.
3 See text for methods of calculation.
4 indicates phase 2 (wk 8) phase 1 (wk 12).

tion between diet groups (oats 2769 814 mg/d, control 2498
732 mg/d).
Baseline values and changes in lipids, glucose and insulin
are shown in Table 4. All variables demonstrated changes
predicted by weight loss, and all tended to decrease more in
subjects consuming the oat diet, but significant advantages of
the oat diet were found for only total and LDL cholesterol
concentrations (P 0.003 and P 0.008, respectively).
DISCUSSION

The consumption of a hypocaloric diet containing oats over

6 wk resulted in greater decreases in SBP, total cholesterol and
LDL cholesterol than did a similar diet without oats. Weight
loss is often advocated as a first-line treatment for hypertension and hypercholesterolemia, and the identification of
weight-loss diets likely to maximize the effects on blood pressure and blood lipids is of considerable importance. In this
normotensive population, a hypocaloric diet containing oats
was associated with a decrease in SBP of 6 mm Hg and a net
advantage over the control diet of 5 mm Hg. Although it
remains unclear whether similar effects would be observed in
other populations, on a population-wide basis, sustained decreases in SBP of this magnitude would be likely to result in
considerable prevention of CVD (Applegate 1992).
The magnitude of changes in SBP and DBP in this study are

OATS IMPROVE BLOOD PRESSURE AND LIPIDS

effects on lipids and blood pressure would persist after weight

stabilization.
It is important to stress that these results do not justify the
recommendation of oats in an unhealthy diet as a supplement
to lower blood pressure and lipids during weight loss. The
inclusion of oats in a diet that is also low in fat and rich in fruit
and vegetables does, however, appear to be promising in promoting improved risk factors for CVD (Rimm et al. 1996).
The ease with which oats can be incorporated into such a diet
was initially surprising to us; further, the oat diet was accepted
readily and no gastrointestinal complaints were noted. The
optimal dose and frequency of oat consumption are issues that
will require further investigation.
In summary, a weight-loss diet containing oats was associated with favorable decreases in SBP and blood lipids compared with a control diet without oats. Further work is needed
to determine whether the benefits observed here can be maintained during weight maintenance after weight loss and whether
specific populations, such as those who are overweight, hypertensive or hypercholesterolemic, will respond similarly.
ACKNOWLEDGMENTS

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consistent with the range observed in other nutritional interventions to decrease blood pressure, including those designed
to reduce body weight and those such as the DASH diet
(Appel et al. 1997). These interventions have been shown to
most effectively reduce blood pressure in hypertensive patients
and to have less consistent effects in normotensive subjects
(Mertens and Van Gall 2000). Thus, a hypocaloric diet containing oats consumed by hypertensive subjects may reduce
blood pressure to an even greater extent than observed in this
study: this hypothesis, however, remains untested. Also, the
subjects in this trial had overall favorable lipid profiles, and it
is possible that the inclusion of oats in a hypocaloric diet
would be more effective in those with mild to moderate
dyslipidemia.
Because overweight and increasing age are associated with
increases in blood pressure and hyperlipidemia, it would be
important to determine whether a diet such as that used in this
study was effective in older populations. Unfortunately, the
number of elderly subjects in this study, as well as their
relatively normal blood pressures and lipid profiles, did not
permit such an analysis, and further work is needed to address
these issues. Systolic hypertension may be associated with
increasing morbidity rates in older persons (Applegate 1992),
so an intervention that reduces SBP, as found in the present
study, may be of particular importance.
Diets rich in oats or similar foods have also been associated
with lower blood pressure in epidemiologic studies (He et al.
1994, Pietinen et al. 1996), but the intervention trials to date
that used oats or soluble fiber have inconsistently improved
blood pressure when compared with control diets (Saltzman
and Roberts 1997). The reasons for this inconsistency remain
unclear, but potential factors include the type of fiber and its
viscosity, the physical form of fiber provided (as part of whole
foods or as an isolate), when fiber is consumed (both the
frequency and whether consumed with other food) and the
dose. It should be noted that the present study incorporated
soluble fiber as a whole food, in conjunction with the consumption of other food, at doses intermediate to those of
existing trials and more frequently than in most prior trials.
The mechanisms by which an oat-containing diet could
confer an advantage in decreasing SBP remain unclear. When
the macronutrients and micronutrients considered to potentially influence blood pressure are examined, the only substantial difference between the diets was, again, in soluble fiber.
However, the mechanisms underlying the effects of diet are
unclear. Insulin resistance has been proposed to influence
blood pressure via several means, including direct effects on
sympathetic tone and effects on natriuresis. In this study, a
nonsignificant trend (P 0.09) for a greater diminution in
fasting insulin was observed with the oat diet, but there was no
significant correlation (data not shown) between insulin and
blood pressure changes. Also, in this trial there was no significant difference in sodium excretion between diet groups.
In this study, the combination of weight loss along with the
inclusion of oats appeared to have an additive influence on
reducing lipid concentrations. It remains unclear whether the
advantages of continued consumption of the oat diet would be
associated with lipid (as well as blood pressure) benefits after
weight stabilization. A review of existing data on effects of
weight loss on these variables suggests that benefits occur early
in weight reduction and are at least in part due to negative
energy balance and that lipid-lowering effects may partially
wane over time despite continued weight loss or maintenance
(Mertens and Van Gall 2000, Trials of Hypertension Prevention Collaborative Research Group 1992, Wadden et al.
1999). Further investigation is required to determine whether

1469

We thank the study volunteers, the staff of the MRU and the staff
of the Nutritional Evaluation Laboratory of the Human Nutrition
Research Center.

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