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Kellogg Company, Science and Technology Center, Battle Creek, MI 49016-3423; * University of Michigan, Department of Biostatistics, School of Public Health, Ann Arbor, MI 48109-2029; VA Medical Center, Lexington, KY 40511; Department of Medicine, University of Minnesota, Minneapolis, MN 55455; # Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada M5C 2T2; Lipid Research Clinic, Department of Medicine, George Washington University Medical Center, Washington, DC 20037; ** Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical Center, Worcester, MA 01655; Department of Nutrition and Dietetics, University of Newcastle, Newcastle, New South Wales, Australia; Department of Human Nutrition, St. Bartholomew's Hospital Medical College, London, United Kingdom 3C1M 6BQ and ## Human Nutrition Unit, University of Sydney, Sydney, New South Wales, Australia
We conducted a meta-analysis to determine the effect of consumption of psyllium-enriched cereal products on blood total cholesterol (TC), LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels and to estimate the magnitude of the effect among 404 adults with mild to moderate hypercholesterolemia (TC of 5.17-7.8 mmol/L) who consumed a low fat diet. Studies of psyllium cereals were identified by a computerized search of MEDLINE and Current Contents and by contacting United States-based food companies involved in psyllium research. Published and unpublished studies were reviewed by one author and considered eligible for inclusion in the meta-analysis if they were conducted in humans, were randomized, controlled experiments, and included a control group that ate cereal providing 
3 g soluble fiber/d. Eight published and four unpublished studies, conducted in four countries, met the criteria. Analysis of a linear model was performed, controlling for sex and age. Female subjects were divided into two groups to provide a rough estimate of the effect of menopausal status (premenopausal = <50 y, postmenopausal = 
50 y) on blood lipids. The meta-analysis showed that subjects who consumed a psyllium cereal had lower TC and LDL-C concentrations [differences of 0.31 mmol/L (5%) and 0.35 mmol/L (9%), respectively] than subjects who ate a control cereal; HDL-C concentrations were unaffected in subjects eating psyllium cereal. There was no effect of sex, age or menopausal status on blood lipids. Results indicate that consuming a psyllium-enriched cereal as part of a low fat diet improves the blood lipid profile of hypercholesterolemic adults over that which can be achieved with a low fat diet alone.
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