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Objective: To test the hypothesis that a high carbohydrate breakfast with breakfast cereal leads to a meaningful reduction in dietary energy intake from fat, especially from saturated fat, and thus lower serum cholesterol levels., Design: An open randomized controlled cross-over trial. The subjects were randomized into intervention breakfast cereal or usual breakfast (control) groups., Setting: Free-living subjects aged 29-71 y in Eastern Finland, Subjects: 224 enrolled, 209 completed the study. The subjects were recruited from a survey of a random population sample and from other sources, and their serum cholesterol was not lower than 5.0 mmol/l. Recruited persons did not have any chronic disease or very low saturated fat intake., Intervention: The cereal group consumed 80 g (men) or 60 g (women) cereal at breakfast and the control group continued their usual dietary habits for six weeks. After a wash out of six weeks, a cross-over with another six week trial period took place. Measurements (including serum samples and a 3 d food record) took place before and after the two trial periods., Results: The intervention period led to 2.5 en% (energy percent units) reduction in saturated fatty acids intake. The reduction in total fat intake was 5.5 en%. This was compensated for by increased intake of carbohydrates. The reduction in saturated fatty acids intake led to modest (but in group 1 significant) 0.15 mmol/l (2.5%) reduction in total serum cholesterol level., Conclusions: The trial showed that regular cereal breakfast can lead to reduced intake of total and saturated fatty acids of the daily diet and consequently to reduction in serum cholesterol level.

We have studied the determinants of total and high density lipoprotein (HDL) cholesterol in young boys from five countries characterized by different lifestyles, dietary consumption profiles and mortality rates from coronary heart disease. All measurements including the estimation of dietary intake, physical activity, body mass index and the concentrations of total and HDL cholesterol were carefully standardized. The mean concentrations of total and HDL cholesterol were higher in the European boys (4.1-4.9 mmol/l and 1.45-1.57 mmol/l, respectively) than in the boys from Ghana and the Philippines (3.3-3.8 mmol/l and 0.93-1.10 mmol/l, respectively). A positive correlation was found between the concentration of total cholesterol and the intake of saturated fatty acids in four out of five countries. The concentration of HDL cholesterol was also related to various dietary variables in some of the groups. Using the regression coefficients from a multiple regression analysis on the pooled data, it could be calculated that on average 24 per cent of the inter-country differences in the levels of total cholesterol is explained by differences in the intakes of saturated fatty acids. Differences between the groups of the different countries in the intakes of carbohydrate explained on average 29 per cent of the differences in the concentrations of HDL cholesterol. The results obtained support the hypothesis that higher concentrations of total and HDL cholesterol are associated with western types of diets rich in saturated fatty acids and relatively poor in complex carbohydrates.