In May 2012, an oats workshop was held in New York to convene a group of international experts to discuss the implications and applications of oats relative to human health. These diverse experts represented disciplines including, but not limited to, epidemiology, food regulation, nutrition and food science, grain breeding and plant genetics, food processing, medicine and public-health policy. This ensuing series addresses three important aspects pertinent to oats: a brief overview of the dynamics of oats; the spectrum of established and emerging research in agriculture and health; and the options and opportunities for future applications of oats that extend beyond dietary fibre. Oats have many unique chemical properties, potential health benefits, agricultural challenges and nutrition-policy opportunities – but global production of oats appears to be falling. This is occurring despite contemporary research in the development of drought and infestation resistance and climate-adaptive cultivars and assessments of oats’ unique components (such as dietary fibre, lipids, β-glucan and avenanthramides) that may contribute to health benefits. This suggests that oats represent a promising grain in the whole-grains landscape. New insights have been created into benefits beyond cardiovascular health. Modern milling and processing technologies have been developed to retain the nutritive value and functional properties of oats and to assure a consistent foundation for global health policies.

The water-soluble, mixed-linkage β-glucan, a form of soluble dietary fibre, is considered the main biologically active component responsible for the capacity of many oat products to lower postprandial glycaemia and fasting plasma cholesterol in human subjects. The present review discusses the physical and chemical properties of oat β-glucan that are considered important predictors of these beneficial metabolic effects. In vitro modelling and animal and human studies have provided compelling evidence showing that the ability of oat β-glucan to increase the viscosity of digesta in the gastrointestinal tract (GIT) is a primary determinant of its blood-glucose and cholesterol-lowering properties. Therefore, the chemical structure, molecular weight (MW), the rate and extent of dissolution and solution rheology of oat β-glucan are key factors in determining the physiological function of oat-containing foods. The structure and properties of oat β-glucan vary between species and varieties of oats, and are also affected by the growing and storage conditions and processing of oat grain. In addition, the extraction and analysis methods may also contribute to the variations in the structure, MW, hydration and solution rheology of β-glucan obtained from different laboratories. Recent work has demonstrated that β-glucan solubility in foods depends on the source of the material and processing conditions; solubility may also be subject to changes during food preparation and storage (such as freezing). In conclusion, both the amount and MW of β-glucan that are solubilised in the GIT need to be considered when assessing the blood-glucose and cholesterol-lowering properties of oat-containing foods.

A review of epidemiological studies on the intake of oats and oat-based products and its effect on the risk of chronic disease and deaths was performed. Seven studies were identified of cancer risk (two each on prostate and colorectal cancer, and one each on pancreatic, breast and endometrial cancer), and one study on overall mortality. With the exception of a case–control study of pancreatic cancer, all studies were of cohort design: five studies were based on a single cohort from Denmark. The results of most cohort studies suggest a weak protective effect of a high intake of oats on cancer risk (relative risks in the order of 0·9). Potential limitations of the studies are dietary exposure misclassification, low statistical power because of limited exposure contrast and residual confounding. Despite the evidence from experimental and mechanistic studies of a protective effect of oats intake on CVD and diabetes, no epidemiological studies have been conducted on these conditions.

High consumption of whole-grain food such as oats is associated with a reduced risk of CVD and type 2 diabetes. The present study aimed to systematically review the literature describing long-term intervention studies that investigated the effects of oats or oat bran on CVD risk factors. The literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Seventy-six articles describing sixty-nine studies met the inclusion criteria. Most studies lacked statistical power to detect a significant effect of oats on any of the risk factors considered: 59 % of studies had less than thirty subjects in the oat intervention group. Out of sixty-four studies that assessed systemic lipid markers, thirty-seven (58 %) and thirty-four (49 %) showed a significant reduction in total cholesterol (2–19 % reduction) and LDL-cholesterol (4–23 % reduction) respectively, mostly in hypercholesterolaemic subjects. Few studies (three and five, respectively) described significant effects on HDL-cholesterol and TAG concentrations. Only three out of twenty-five studies found a reduction in blood pressure after oat consumption. None of the few studies that measured markers of insulin sensitivity and inflammation found any effect after long-term oat consumption. Long-term dietary intake of oats or oat bran has a beneficial effect on blood cholesterol. However, there is no evidence that it favourably modulates insulin sensitivity. It is still unclear whether increased oat consumption significantly affects other risk markers for CVD risk, and comprehensive, adequately powered and controlled intervention trials are required to address this question.

Whole-grain foods such as oats may protect against colorectal cancer and have benefits on inflammatory bowel disease and coeliac disease. The present study aimed to systematically review the literature describing intervention studies that investigated the effects of oats or oat bran on risk factors for bowel disease. A literature search was conducted using Embase, Medline and the Cochrane library, which identified 654 potential articles. Thirty-eight articles describing twenty-nine studies met the inclusion criteria. Two studies carried out in participants with a history of colorectal adenomas found no effects of increased oat-bran intake on indirect risk makers for colorectal cancer. One of two interventions with oat bran in patients with ulcerative colitis showed small improvements in the patients' conditions. Most of the eleven studies carried out in adults with coeliac disease showed no negative effects of uncontaminated oat consumption. The fourteen studies carried out in volunteers with no history of bowel disease suggest that oats or oat bran can significantly increase stool weight and decrease constipation, but there is a lack of evidence to support a specific effect of oats on bowel function compared with other cereals. A long-term dietary intake of oats or oat bran could benefit inflammatory bowel disorders, but this remains to be proven. A protective effect on colorectal adenoma and cancer incidence has not yet been convincingly shown. The majority of patients with coeliac disease could consume up to 100 g/d of uncontaminated oats, which would increase the acceptability of, and adherence to, a gluten-free diet.

The gut microbiota plays important roles in proper gut function and can contribute to or help prevent disease. Whole grains, including oats, constitute important sources of nutrients for the gut microbiota and contribute to a healthy gut microbiome. In particular, whole grains provide NSP and resistant starch, unsaturated TAG and complex lipids, and phenolics. The composition of these constituents is unique in oats compared with other whole grains. Therefore, oats may contribute distinctive effects on gut health relative to other grains. Studies designed to determine these effects may uncover new human-health benefits of oat consumption.

Oats are undervalued in comparison with wheat, rice and barley, despite their unique composition that includes many of the nutrients required for health and a reduced risk of degenerative disease incidence. Furthermore, oats as whole grain and some of their associated products also contain β-glucan, a complex polysaccharide that has an approved health claim to reduce blood cholesterol levels and reduce the risk of CHD incidence if consumed at ≥ 3 g/d. At the agronomic level, oats exhibit optimal growth in regions of moderate temperature and long day length. In addition, they can tolerate wet weather and acidic soils more effectively than other cereals, such as wheat. Studies have shown that there is diversity in the content and composition of nutrients and health-beneficial components within the available wild and cultivated germplasm and that these are amenable to be enhanced by different agronomic practices as well as are susceptible to climatic variation. The advances in modern plant genetics, developed in sister cereals such as wheat, rice and barley, mean that oat development and exploitation should see an acceleration in the coming decade as they are adopted and applied. These advances include approaches such as genome sequencing, genotyping by sequencing and the allied next-level analytical approaches of RNA sequencing, transcriptome profiling and metabolomics. The collation and coordination of these approaches should lead to the generation of new, tailored oat varieties that are nutritionally enhanced and contain a greater proportion of health-beneficial components that can be translated through into a wide(r) range of consumer products with the ultimate hope of associated benefits to human health and nutrition.

Oats are a uniquely nutritious food as they contain an excellent lipid profile and high amounts of soluble fibre. However, an oat kernel is largely non-digestible and thus must be utilised in milled form to reap its nutritional benefits. Milling is made up of numerous steps, the most important being dehulling to expose the digestible groat, heat processing to inactivate enzymes that cause rancidity, and cutting, rolling or grinding to convert the groat into a product that can be used directly in oatmeal or can be used as a food ingredient in products such as bread, ready-to-eat breakfast cereals and snack bars. Oats can also be processed into oat bran and fibre to obtain high-fibre-containing fractions that can be used in a variety of food products.

Global interest in food policy is emerging in parallel with mounting challenges to the food supply and the rising prevalence of diet-related chronic health conditions. Some of the foundational elements of food policies are agricultural practices, finite resources, as well as economic burdens associated with a growing and ageing population. At the intersection of these interests is the need for policy synchronisation and a better understanding of the dynamics within local, regional and national government decision-making that ultimately affect the wellness of the populous and the safety, quality, affordability and quantity of the food supply. Policies, synchronised or not, need to be implemented and, for the food industry, this has seen a myriad of approaches with respect to condensing complex nutritional information and health claims. These include front and/or back of pack labelling, traffic light systems, etc. but in general there is little uniformity at the more regional and global scales. This translation of the nutritional and health-beneficial messages accompanying specific products to the consumer will undoubtedly be an area of intense activity, and hopefully interaction with policy makers, as the food industry continues to become a more global industry.

A large body of clinical evidence suggests that the consumption of 3 g or more per d of β-glucan from oats or barley, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD. The unique chemical and physical properties of oats and physiological responses to oat consumption contribute to their demonstrated health benefits; other health attributes are still under evaluation. Many of these benefits, such as those associated with a reduced risk of CVD, are codified in health claims by several regulatory agencies, such as the Food and Drug Administration in the USA and the European Food Safety Authority in Europe. Despite these oat–health relationships, an apparent decline in agricultural production, the presence of an array of plant pathogens, and dynamics of climatic conditions may preclude the availability and subsequent consumption of this commodity worldwide. Therefore, it is incumbent on scientists from multiple disciplines to advance research in a spectrum of arenas, including physico-chemical properties of oats, the impact of oats on an array of non-communicable diseases and human microbiome, agricultural practices and environments, and processing technologies that contribute to global food policies.