TABLE 9.

Body of evidence summaries on breakfast cereals and CVD¹

Evidence statement and components	Grade	Rating	Notes
Regular consumption of oat-, barley- or psyllium-based breakfast cereals can help lower total and LDL cholesterol concentrations	A	—	Body of evidence can be trusted to guide practice
Evidence base		Excellent	6 Level I studies: 3 meta-analysis plus 3 systematic reviews covering over 70 different RCTs (all positive quality)
			3 Level II studies: RCTs (2 servings of oat-based cereals/d) (all positive quality)
Consistency		Excellent	RCTs results show consistent protective effect
Clinical impact		Good	In meta-analyses, reductions ranged from 0.2 to 0.3 mmol/L (total cholesterol) and from 0.1 to 0.35 mmol/L (LDL cholesterol).
Generalizability		Excellent	Populations studied in the body of evidence cover a wide range of ages and countries of residence
Applicability		Excellent	Directly applicable in populations in whom breakfast cereals are consumed regularly
Regular consumption of whole-grain breakfast cereals is associated with lower risk of CVD	C	—	Body of evidence provides some support but care should be taken in its application
Evidence base		Satisfactory	4 Level III studies (3 cohort and 1 case-control) all positive quality)
			1 Level IV study (cross-sectional) (all positive quality)
Consistency		Good	Most studies consistent. Lack of effect in 1 cohort study may be due to low background risk in the vegetarian cohort and limited diet intake data.
Clinical impact		Good	RR for CVD: 0.72–0.80
			OR for IHD incidence: 0.38
Generalizability		Good	Populations studied in the US, UK, and Norway
Applicability		Excellent	Directly applicable in populations in whom breakfast cereals are consumed regularly
Regular consumption of breakfast cereals is associated lower total and LDL-cholesterol concentrations	D	—	Body of evidence is weak and must be applied with caution
Evidence base		Poor	10 Level IV studies (cross-sectional in children and adults) (all positive quality)
Consistency		Good	Mostly consistent effect, but some report effect only with whole-grain cereals
Clinical impact		Satisfactory	Moderate effect: generally 1–7% reduction
Generalizability		Excellent	Populations studied in the body of evidence cover a wide range of ages and countries of residence
Applicability		Excellent	Directly applicable in populations in whom breakfast cereals are consumed regularly

¹CVD, cardiovascular disease; IHD, ischemic heart disease; RCT, randomized controlled trial.