Effects of a stanol-enriched diet on plasma cholesterol and triglycerides in patients treated with statins

BACKGROUND

Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. It is unclear whether plant stanols in combination with dietary guidance in patients already using optimal doses of statins will further reduce fasting and postprandial lipids compared with standard care.

STUDY DESIGN

This single-blind, randomized study investigated the effect of plant stanols in margarines, combined with a lipid-lowering dietary intervention, in patients already on lipid-lowering medications at maximal doses not reaching their target lipid levels. Nutrition education was based on the stages of change theory. The control group (which served as the standard care control group) was also taking optimal doses of statins. This group received a margarine without plant stanols and a leaflet with Dutch nutrition guidelines. Fasting lipids were measured once in venous samples and postprandial lipemia was assessed by self-measured triglycerides in an outpatient setting. All subjects were given a capillary triglyceride measuring device (Accutrend GCT, Roche Diagnostics, Mannheim, Germany) and were instructed to measure their capillary triglycerides at six fixed time-points throughout the day on three different days. The mean area under the triglyceride curve represented total daylong triglyceridemia, which has been shown to reflect postprandial triglyceridemia. Twenty patients were included, 11 in the intervention group and 9 in the control group.

RESULTS

In the plant stanol group, low-density lipoprotein cholesterol decreased significantly by 15.6% compared with a reduction of only 7.7% in the control group. The daylong triglyceridemia was similar in both groups at the beginning and at the end of the study, and no change was observed by the intervention.

CONCLUSION

Intensive dietary intervention with addition of plant stanols results in clinically relevant reduction of low-density lipoprotein cholesterol in patients optimally treated with statins, compared with similar patients on statins receiving only standard care. The use of a plant stanol-enriched margarine did not decrease postprandial triglyceridemia in these patients.

Improvement of cholesterol levels and reduction of cardiovascular risk via the consumption of phytosterols

Hypercholesterolaemia is one of the main factors contributing to the appearance and progression of CVD, which is the main cause of death in the adult population of industrialized societies. By 2020, projections suggest that it will continue to hold first place, by then causing 37 % of all deaths. Therapeutic life-style changes to reduce cardiovascular risk include dietary modifications, such as the inclusion of phytosterols or plant sterols (known since the 1950s to reduce cholesterol levels). These help prevent the absorption of cholesterol and thus condition a reduction in total cholesterol and LDL-cholesterol levels, and ultimately in cardiovascular mortality. The fat-soluble nature of these sterols rendered margarine one of the best vehicles by which to supply them in the diet. Indeed, margarine was the first food to contain cholesterol-reducing phytosterols to be approved by the EU (in agreement with its regulations on new foods and food ingredients, 258/97/CE). Presently, phytosterols can be emulsified with lecithin and thus delivered in non-fat or low-fat foods and beverages. Margarine and dairy products (yoghurt and milk) enriched in phytosterols have proved better at lowering total cholesterol and LDL-cholesterol levels than have enriched cereals and their derivatives, although all can be of help, depending on the characteristics of each subject. The reduction in carotenoid bioavailability caused by sterols is minimized by increasing fruit and vegetable consumption. Individuals who habitually consume phytosterols should also follow traditional advice such as eating less dietary fat and increasing their physical activity. Phytosterols have been shown to be safe and effective in lowering cholesterol levels in many rigorous studies. In few areas of nutrition is there such consensus. Diet professionals should feel comfortable in prescribing phytosterols/stanols for the treatment of hypercholesterolaemia. They are safe whether taken alone or in combination with cholesterol-reducing drugs, such as statins and fibrates. Reinforcement counselling is essential, as therapy is effective only if compliance is good.

Lack of cholesterol-lowering efficacy of Cuban sugar cane policosanols in hypercholesterolemic persons

BACKGROUND

More than 50 studies have reported substantial reductions in plasma lipid concentrations in response to 2-40 mg Cuban sugar cane policosanol (SCP) mixtures/d. However, several animal and human trials conducted outside of Cuba that used non-Cuban mixtures have failed to reproduce the efficacy of policosanols observed in earlier studies.

OBJECTIVE

The objective was to evaluate lipid-modulating actions of the authentic Cuban SCPs on plasma lipids in healthy hypercholesterolemic volunteers.

DESIGN

Twenty-one volunteers consumed, under supervision, 10 mg SCPs/d or a placebo incorporated in margarine as an afternoon snack, for a period of 28 d with the use of a randomized, double-blind crossover study design. Subjects maintained their habitual diet and physical activity and were weighed daily throughout the study period. Blood was collected at days 1, 2, 28, and 29 of the feeding trial, and lipid concentrations were measured.

RESULTS

Body weights did not vary significantly throughout the trial and did not affect plasma lipid values. No significant difference was observed between treatment and control groups in plasma total, LDL-, HDL-cholesterol, and triacylglycerol concentrations.

CONCLUSION

Present results show no beneficial effects of Cuban SCPs on lipid indicators in hypercholesterolemic persons and question the clinical usefulness of policosanol mixtures as cholesterol-lowering neutraceutical agents.

Effectiveness of customary use of phytosterol/-stanol enriched margarines on blood cholesterol lowering

Postlaunch monitoring of functional foods can encompass monitoring of effectiveness under conditions of customary use. To this end, the effectiveness of phytosterol/-stanol enriched margarine consumption in free-living conditions was investigated with data from the Dutch "Doetinchem cohort study". In total, 4,505 subjects (aged 26-70 years) were examined in 1994-1998 and re-examined during 1999-2003. A general and a food frequency questionnaire and non-fasting blood samples for total and HDL cholesterol determination were obtained. Subjects were stratified into phytosterol/-stanol enriched margarine users (n = 84) and non-users (n = 4,421) based on the re-examination data, as these margarines were available on the Dutch market from 1999 onwards. Mean spontaneous daily use (g +/- SD) of phytosterol-containing margarine (n = 71) was 15 +/- 8 and of phytostanol-containing margarine (n = 13) 9+/-6. After five years, total blood cholesterol had increased with 0.26 mmol/l in non-users while it had not significantly changed in users. The difference in total blood cholesterol change in users versus non-users was -0.30 mmol/l (p < 0.001). The beneficial effect of the phytosterol/-stanol enriched margarine, used under customary conditions can be characterized as a stabilization of cholesterol levels. This is the first report finding a modest beneficial effect on blood cholesterol level under customary conditions thereby partly confirming findings from clinical trials.

Determination of Saturated and Unsaturated Fatty Acids Amount in Leukocyte Membranes from Subjects Fed with Solid and Fluid Oils

Modifications in dietary fatty acid intake might lead to a modification in membrane phospholipid fatty acid composition. The purpose of this study was to investigate relationship between different type of oil consumption and leukocyte membrane phospholipid composition. This study was carried out in subjects utilizing butter (n = 15), margarine (n = 15), fluid oil (n = 15) and mixed types of oils (n = 15) in total 60 subjects. Leukocytes were separated from total blood by dextran sedimentation method. Membrane lipids and proteins were isolated following the cell disruption. Fatty acids of membrane phospholipids were isolated by hydrolysation with phospholipase B under ultrasonic dismembranator. Free fatty acids were identified with gas chromatography at chloroform phase. The results obtained were compared with data obtained by chromatograms of the standards. Results more prominent values of arachidic, dihomo-gamma-linolenic and palmitoleic acids were found in butter-or mixed oil-user groups; eicosadienoic, eicosamonoenoic, dihomo-gamma-linolenic and behenic acids in fluid oil heptanoic, valeric, eicosadienoic and linolenic acids in margarine groups. The fatty acid composition of mixed oil; was similar to butter, while other two oils were so different. From this study, it was concluded that the type of oil consumption might have an influence on phospholipid components of plasma membranes.

Impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children

OBJECTIVE

To assess the impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and on serum 25-hydroxyvitamin D concentration in Finnish 4-year-old children.

DESIGN, SUBJECTS AND METHODS

Two cohorts of children were studied during wintertime, one before (n=82) in 2001-2002 and the other after (n=36) the initiation of fortification in 2003-2004. Dietary intake was estimated by 4-day food records and serum 25-hydroxyvitamin D concentration was analyzed by radioimmunoassay.

RESULTS

The mean intake of vitamin D was higher the after initiation of fortification (mean (95% confidence interval (CI)); 4.5 (3.8-5.1) microg) than before it (2.1 (95% CI 1.8-2.3) microg; P<0.001), although there were no differences in consumption of the main food sources of vitamin D between the two cohorts. The difference between the cohorts was also evident when the intake of vitamin D was adjusted for energy intake (0.78 (95% CI 0.70-0.90) and 0.37 (95% CI 0.32-0.42) microg/MJ after and before fortification, respectively, P<0.001). After fortification, the mean intake approached that recommended, but was achieved by only 30.6% of the children. Equally, the serum 25-hydroxyvitamin D concentration was higher after fortification (64.9 (95% CI 59.7-70.1) nmol/l) compared to prior it (54.7 (95% CI 51.0-58.4) nmol/l; P=0.002).

CONCLUSIONS

The results indicate that the national fortification of fluid milks and margarines with vitamin D safely improved the vitamin D status of children. This approach, in view of the novel health effects beyond bone metabolism, encourages fortification of new food sources with vitamin D or use of vitamin D supplements particularly during wintertime.

Safety evaluation of phytosterol-esters. Part 9: Results of a European post-launch monitoring programme

Phytosterol-esters were developed by Unilever as a cholesterol lowering novel food ingredient for use initially in vegetable oil spreads. In addition to an extensive package of safety studies and clinical studies a programme of post-launch monitoring (PLM) was developed. PLM was used to address the following questions: (a) Is the product use as predicted/recommended? (b) Are the known effects as predicted? (c) Does the product cause unexpected health effects? The overall conclusions from the PLM programme were: the product is being bought by the target population but intakes are less than the original assumptions made in the risk assessment; long-term use of phytosterol-ester enriched spreads results in a reduction in the serum levels of the most lipophilic carotenoids but at current levels of intake this is unlikely to result in reductions in carotenoids that are of biological significance; evaluation of health related consumer complaints have not indicated any unexpected health effects associated with the use of the product in the marketplace. As part of the European approval under Regulation (EC) No. 258/97 on Novel Foods and Food Ingredients the results of the PLM programme had to be submitted to the European Commission (EC) and reviewed by the Scientific Committee on Food (SCF). They concluded that the study provided valuable information, which complemented the pre-market safety evaluation studies, and that the EC mandatory requirement had been met.

Blood lipid responses to plant stanol ester supplementation and aerobic exercise training

The purpose of this study was to determine the independent and combined effects of plant stanol ester (PSE) margarine and aerobic exercise on blood lipid concentrations and related intravascular enzymes in 26 healthy sedentary, middle-aged men and postmenopausal women (age, 53 +/- 8 years; body mass index, 27 +/- 1.0, % fat, 28.5 +/- 2). In a stratified double-blind manner, participants were randomly assigned to either a PSE (n = 17) or a placebo (CON, n = 9) margarine group. Participants supplemented their daily diets with 42 g of margarine spread (PSE = 3 g; CON, PSE = 0 g, of approximately equal energy content) for 9 weeks. During the last 4 weeks of margarine supplementation (MS), participants expended 400 kcal on a treadmill 5 d/wk at 65% of VO(2) reserve (2000 kcal/wk). Fasting blood samples were obtained before initiating and after 4 weeks of MS and after exercise training. All blood samples were analyzed for total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), hepatic lipase, lipoprotein lipase, and cholesterol ester transfer protein activities. Total cholesterol (-10%), low-density lipoprotein cholesterol (-13%), and triglyceride (-18%) concentrations decreased after 4 weeks of MS in the PSE group, but not in the CON group (P < .05 for all). Four weeks of aerobic exercise increased HDL-C by 21% in the CON group (P < .05) and by 4% in the PSE group (P > .05). Total cholesterol-HDL-C ratio decreased significantly (P < .05) in the PSE group, but not in the CON group. No other significant alterations were observed with either PSE or exercise. Our findings suggest that PSE is effective in reducing blood cholesterol concentrations and that exercise can increase HDL-C in middle-aged men and postmenopausal women. Our findings also suggest that PSE supplementation may attenuate the exercise-induced increase in HDL-C.

Consumption of fish, butter and margarine during pregnancy and development of allergic sensitizations in the offspring: role of maternal atopy

It has been suggested that changes in dietary habits, particularly increased consumption of omega-6 polyunsaturated fatty acids (PUFA) and decreased consumption of omega-3 PUFAs may explain the increase in atopic disease seen in recent years. Furthermore, it seems possible that it is mainly prenatal or very early life environmental factors that influence the development of allergic diseases. It has also been suggested that intrauterine risk factors may act differently if mother themselves suffer from allergic disease. The aim of this study was to investigate whether the consumption of fish, butter and margarine during pregnancy might influence the development of allergic sensitizations in the offspring. The study population was divided into the offspring of allergic and non-allergic mothers. This was a retrospective cohort study enrolling 295 offspring of allergic mothers and 693 of non-allergic mothers. Information regarding maternal intake of fish, butter and margarine during pregnancy as well as other prenatal and perinatal confounding factors were retrospectively assessed by parental report via a standardized questionnaire. Atopy was determined by skin-prick tests (SPT) to eight prevalent inhalant allergens and two foods. In the allergic mothers' group there is no clear correlation between maternal intakes of fish, butter and margarine and sensitizations to food or inhalants. In the non-allergic mothers' group there was no correlation between butter and margarine intake and food or inhalant sensitizations. On the contrary, a protective effect of fish intake on SPT positivity was observed. In particular, frequent maternal intake ('2-3 times/wk or more') of fish reduced the risk of food sensitizations by over a third (aOR 0.23; 95% CI: 0.08-0.69). A similar trend, even if not significant, was found for inhalants. Finally, even in the whole study population, i.e. allergic group plus non-allergic group, there was a similar trend between increased consumption of fish and decreased prevalence of SPT positivity for foods. This study shows that frequent intake of fish during pregnancy may contrast the development of SPT sensitizations for foods in the offspring of mothers without atopic disease. Therefore, larger prospective studies are needed, enrolling mothers with and without allergic disease, to confirm these results.

Plant sterol or stanol consumption does not affect erythrocyte osmotic fragility in patients on statin treatment

OBJECTIVE

To assess the effects of plant sterol or stanol ester consumption on their incorporation into erythrocytes and their effects on osmotic fragility of red blood cells.

DESIGN

Double-blind, randomized, placebo-controlled intervention trial.

SUBJECTS AND INTERVENTION

Forty-one subjects on stable statin treatment - who already have increased serum plant sterol and stanol concentrations - first received for 4 weeks a control margarine. For the next 16 weeks, subjects were randomly assigned to one of three possible interventions. Eleven subjects continued with control margarine, 15 subjects with plant sterol ester enriched and 15 subjects with plant stanol ester-enriched margarine. Daily plant sterol or stanol intake was 2.5 g. Erythrocyte haemolysis was measured spectrophotometrically at five different saline concentrations.

RESULTS

Despite significant (P = 0.004) increases of, respectively, 42 and 59% in cholesterol-standardized serum sitosterol and campesterol concentrations in the plant sterol group as compared to the control group, campesterol levels in the red blood cells did not change (P = 0.196). Osmotic fragility did not change significantly (P = 0.757) in the plant sterol and plant stanol groups as compared to the control group.

CONCLUSION

We conclude that plant sterol and stanol ester consumption for 16 weeks does not change osmotic fragility of erythrocytes in statin-treated patients.

SPONSORSHIP

Netherlands Organisation for Health Research and Development (Program Nutrition: Health, Safety and Sustainability, Grant 014-12-010).

Margarine phytosterols decrease the secretion of atherogenic lipoproteins from HepG2 liver and Caco2 intestinal cells

Several studies in humans have demonstrated the hypocholesterolemic effect of plant sterol consumption. It is unclear whether plant sterols regulate lipoprotein metabolism in the liver and intestines, thereby decreasing the levels of circulating atherogenic lipoproteins. We investigated the effect of the three main phytosterols: stigmasterol, campesterol, and beta-sitosterol on lipoprotein production in HepG2 human liver cells and Caco2 human intestinal cells and the mechanisms involved. Cells were incubated for 24h with 50 micromol/L of the different phytosterols or 10 micromol/L of atorvastatin. Very low-density lipoprotein levels (measured by apolipoprotein (apo) B100) in HepG2 cells and chylomicron levels (measured by apoB48) in Caco2 cells were measured using western blotting. Intracellular cholesterol levels were measured using gas chromatography. Analysis was carried out using Student's t-test and ANOVA. Secretion levels of apoB100 significantly decreased by approximately 30% after incubation with all phytosterols compared to control. In addition, cholesterol ester (CE) concentrations significantly decreased when HepG2 cells were incubated with the phytosterols compared to control cells. Secretion of apoB48 from intestinal cells significantly decreased by 15% with stigmasterol, 16% with campesterol and 19% beta-sitosterol compared to control. Collectively the data suggests that plant sterols limit lipid (CE) availability in cells. Decreases in circulating levels of LDL and chylomicron remnants seen in humans with the consumption of margarine phytosterols are possibly due to their effect on lipid production in cells and would therefore reduce the risk of developing cardiovascular disease.

Ratio of lathosterol to campesterol in serum predicts the cholesterol-lowering effect of sitostanol-supplemented margarine

OBJECTIVE

Plant sterol/stanol margarines are recommended as a lipid-lowering dietary supplement in the treatment of hypercholesterolemia. Parameters predicting the individual cholesterol-lowering effect have not been elucidated so far. Therefore, we investigated the responsiveness to sitostanol-supplemented margarine in a specially selected population.

METHODS AND RESULTS

From a total number of 137 male subjects with hypercholesterolemia, eight subjects with the lowest and eight subjects with the highest ratios of lathosterol to campesterol in serum were included in the study. They received 1 g sitostanol-supplemented margarine b.i.d. for four weeks. Serum lipoproteins, the cholesterol precursor lathosterol, the plant sterols campesterol and sitosterol were measured. Subjects with a low ratio of lathosterol to campesterol had a significant decrease of serum total cholesterol (-14.2%; p < 0.01) and LDL cholesterol (-13.8%; p < 0.01; responder). In subjects with a high ratio there was no significant change in total cholesterol and LDL cholesterol (2.2 and 4.3%; non-responder).

CONCLUSION

The ratio of serum lathosterol to campesterol predicts the reduction of total cholesterol and LDL cholesterol during administration of sitostanol-supplemented margarine in patients with mild hypercholesterolemia.

Effects of Fat-Modified Dairy Products on Blood Lipids in Humans in Comparison with Other Fats

BACKGROUND/AIM

Due to its high content of LDL-raising saturated fatty acids (SFA), milk fat has been considered to be hypercholesterolaemic, but it also contains fatty acids and other constituents which seem to have a hypocholesterolaemic effect. Milk fat was modified by feeding cows rapeseed cake, resulting in a reduced content of SFA and an increased content of unsaturated fatty acids. The objective of this study was to investigate the effects of modified milk fat (ModFat) on serum cholesterol fractions, triacylglycerides (TAG) and lipoprotein(a) [LP(a)], compared with regular milk fat (RegFat) and with soft margarine (Marg).

METHOD

Fifteen women and 16 men were enrolled in the intervention study. Nine of the participants were hypercholesterolaemic. Nutrient intake parameters, serum lipids and LP(a) were determined.

RESULTS

The serum concentration of HDL cholesterol increased in the ModFat period, leading to a decreased LDL/HDL ratio in this period. The lowest LP(a) concentrations were measured at the end of the control phase and at the end of the ModFat period. A decreasing tendency of serum TAG concentration was observed in the ModFat period.

CONCLUSION

The fat-modified milk seems to have positive effects on the LDL/HDL ratio and the LP(a) concentrations, both of which have been established as risk factors for coronary heart disease.

How to remove Superglue from the mouth: case report

A 2-year-old boy presented to the emergency department of the Bradford Royal Infirmary with Superglue in his mouth as a result of biting on a tube of glue that lay on the floor. His lips and upper teeth were stuck together and we removed the glue by applying margarine.

Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice

OBJECTIVE

To determine the effectiveness of prescribing 2 g plant sterols/stanols per day as an addition to standard practice in a dietary outpatient clinic.

DESIGN

A randomized parallel design of comparative 12-week interventions.

SUBJECTS/SETTING

Patients referred by a general practitioner to a dietary outpatient clinic for the management of hyperlipidemia were eligible. Twenty-five patients (15 women and 10 men) completed the study.

INTERVENTION

Counseling regarding diet for hyperlipidemia was based on the National Cholesterol Education Program guidelines. The intervention group was instructed to incorporate approximately 25 g/day of margarine, containing plant sterols/stanols, which delivered approximately 2 g plant sterols/stanols.

MAIN OUTCOME MEASURE

Changes in diet, body weight, and serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured.

STATISTICAL ANALYSIS PERFORMED

Changes in dietary and biochemical outcomes were assessed using Student's t test. For nonnormally distributed data, Wilcoxon signed rank test was used, and Mann-Whitney U tests were conducted to determine the proportion of subjects reaching defined goals. The number needed to treat index was used to report effectiveness of the intervention.

RESULTS

Five of 14 subjects in the intervention group compared with 0 of 11 in the control group achieved a reduction in serum cholesterol of >/=15% ( P <.05). Using the number needed to treat index, for each 2.8 patients counseled with routine prescription of plant sterols/stanols, one additional patient would obtain a reduction in cholesterol by >/=15% compared with conventional management. This was achieved without any detrimental effects on the dietary fatty acid profile.

CONCLUSIONS

Routine prescription of margarine containing plant sterol/stanol is an effective strategy in the management of hypercholesterolemic patients in the clinical setting.

Increased intake of fruit and vegetables and a low-fat diet, with and without low-fat plant sterol-enriched spread consumption: effects on plasma lipoprotein and carotenoid metabolism

BACKGROUND

Regular intake of plant sterol (phytosterol)-enriched foods enhances the cholesterol lowering effect of diets. One side effect associated with plant sterol consumption is a modest reduction in plasma carotenoid concentrations. This study investigated the effect of consuming a low-fat National Cholesterol Education Programme (NCEP) Step 1 diet, including a low-fat plant sterol ester (PSE)-enriched spread on cholesterol metabolism to determine if specific dietary advice to increase daily fruit and vegetable intake could prevent reduced plasma carotenoid concentrations.

MATERIALS AND METHODS

In this randomised, crossover double-blind trial, 48 hypercholesterolaemic men received 21 g day(-1) of a low-fat PSE-enriched spread or placebo for 3 weeks, interrupted by 3 weeks washout. Individuals also adhered to a NCEP Step 1 diet and repeated 3-day food diaries monitored adherence. Specific advice was provided to increase dietary fruit and vegetable intakes. Fasting blood samples were collected at pre- and post-intervention for lipoprotein and carotenoid analysis.

RESULTS

Plasma total and low-density lipoprotein (LDL) cholesterol concentrations were significantly (P <0.05) reduced, by 4.6 and 7.1%, respectively, after the PSE-enriched low-fat spread. Plasma apo B concentrations were significantly (P <0.0005) lower after the PSE spread. PSE consumption was also associated with significantly (P <0.05) lower total plasma beta-carotene concentrations, but this change was not significant after lipid standardisation. PSE consumption had no effect on retinol, alpha-carotene, gamma-tocopherol, alpha-tocopherol, lutein, zeaxanthin, beta-crypyoxanthin or lycopene concentrations.

CONCLUSION

Dietary advice to increase daily fruit and vegetable consumption may be effective in preventing a reduction in plasma carotenoid concentrations previously associated with PSE consumption. Further, PSE incorporated in a low-fat spread and consumed as part of a NCEP Step 1 diet are effective in reducing total and LDL cholesterol.

The role of eggs, margarines and fish oils in the nutritional management of coronary artery disease and strokes

Although egg yolk is a rich source of cholesterol, the effect of eggs in raising serum cholesterol is variable and in some subjects there is no effect whatsoever. However, oxidized cholesterol can increase atherosclerosis even with normal serum cholesterol. In order to attenuate oxidation of cholesterol in eggs, it is necessary to limit the degree of heat applied. This means that we should use only soft-boiled eggs which should be almost like water. We can also avoid egg yolk altogether and get a highly nutritious egg food from the egg white alone. The saturated fats from milk products, especially butter, are highly atherogenic. There are available many butter substitutes in the form of margarines. But many of these margarines have hydrogenated vegetable oils which result in the production of trans-fatty acids. The trans-fatty acids are as atherogenic as saturated fats. There are available, however, margarines without the trans-fatty acids. These are found only in large supermarkets. Fish oils contain N3 fatty-acids which, unlike vegetable oils which contain N6 fatty-acids, can prevent atherosclerosis and sudden death by counteracting ventricular arrhythmias, acting as antioxidants, antithrombotic, anti-inflammatory agents, and decreasing triglycerides and blood pressure.

Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread

OBJECTIVE

To study the compliance and changes in plasma lipids, plant sterols, fat-soluble vitamins and carotenoids in children and parents with familial hypercholesterolemia (FH) consuming a plant sterol ester-enriched (PSE) spread.

DESIGN

A 26-week open-label follow-up of children who had previously been studied in a controlled cross-over design. The parents were also included in the open-label arm of the study.

SETTING

Outpatient clinic for treatment of hyperlipidemia.

SUBJECTS

A total of 37 children (7-13 y) and 20 parents (32-51 y) diagnosed with 'definite' or 'possible' heterozygous FH. In all, 19 of the parents, but no children, used statins. All were patients at the Lipid Clinic, National Hospital in Oslo.

INTERVENTIONS

Subjects were recommended to eat 20 g/day of PSE spread as part of their lipid-lowering diet.

RESULTS

The mean intake of PSE spread was 13.7 and 16.5 g/days in the children and parents, respectively, corresponding to 1.2 and 1.5 g of plant sterols. Plasma total cholesterol decreased by 9.1% in both children (P<0.001) and parents (P=0.002). The corresponding decreases in LDL cholesterol were 11.4% (P<0.001) and 11.0% (P=0.012). Increases in serum lathosterol, campesterol and sitosterol, adjusted for total cholesterol, were observed in the children (31, 96, 48%, respectively, P<0.001) at the end of the controlled cross-over period. In the parents, serum campesterol and sitosterol, adjusted for total cholesterol, increased by 92 and 39%, respectively (P< 0.001). Lipid-adjusted serum alpha- and beta-carotene decreased by 17.4% (P=0.008) and 10.9% (P=0.018), respectively, in the children at the end of the controlled PSE period, but increased again during the follow-up. In the parents, serum alpha- and beta-carotene concentrations were unchanged, while serum lutein and lycopene decreased by 7.3% (P=0.037) and 14.6% (P=0.044), respectively.

CONCLUSIONS

Sustained efficacy of cholesterol reduction and long-term compliance of PSE intake were demonstrated in this study.

Dietary Hydrogenated Fat Increases High-Density Lipoprotein apoA-I Catabolism and Decreases Low-Density Lipoprotein apoB-100 Catabolism in Hypercholesterolemic Women

OBJECTIVE

To determine mechanisms contributing to decreased high-density lipoprotein cholesterol (HDL-C) and increased low-density lipoprotein cholesterol (LDL-C) concentrations associated with hydrogenated fat intake, kinetic studies of apoA-I, apoB-100, and apoB-48 were conducted using stable isotopes.

METHODS AND RESULTS

Eight postmenopausal hypercholesterolemic women were provided in random order with 3 diets for 5-week periods. Two-thirds of the fat was soybean oil (unsaturated fat), stick margarine (hydrogenated fat), or butter (saturated fat). Total and LDL-C levels were highest after the saturated diet (P<0.05; saturated versus unsaturated) whereas HDL-C levels were lowest after the hydrogenated diet (P<0.05; hydrogenated versus saturated). Plasma apoA-I levels and pool size (PS) were lower, whereas apoA-I fractional catabolic rate (FCR) was higher after the hydrogenated relative to the saturated diet (P<0.05). LDL apoB-100 levels and PS were significantly higher, whereas LDL apoB-100 FCR was lower with the saturated and hydrogenated relative to the unsaturated diet. There was no significant difference among diets in apoA-I or B-100 production rates or apoB-48 kinetic parameters. HDL-C concentrations were negatively associated with apoA-I FCR (r=-0.56, P=0.03) and LDL-C concentrations were negatively correlated with LDL apoB-100 FCR (r=-0.48, P=0.05).

CONCLUSIONS

The mechanism for the adverse lipoprotein profile observed with hydrogenated fat intake is determined in part by increased apoA-I and decreased LDL apoB-100 catabolism.

Comparison of the effects of dietary plant sterol and stanol esters on lipid metabolism

BACKGROUND AND AIM

To compare the cholesterol-lowering efficacy and other metabolic effects of plant sterol and stanol esters, both of which are commonly used in the dietary management of hypercholesterolaemia.

METHODS AND RESULTS

The cholesterol-lowering efficacy of equivalent intakes of sterol and stanol esters and of different intakes of stanol esters were compared at 1 and 2 months, both in normal subjects and treated patients with familial hypercholesterolaemia. Systemic effects were assessed by measuring serum levels of plant sterols and of lathosterol and 7alpha-hydroxy-cholestenone, indices of sterol absorption and of cholesterol and bile acid synthesis respectively. There were no significant differences during the study between 1.6g daily of sterol and stanol esters in reducing total cholesterol (by 3-7%) or low density lipoprotein cholesterol (by 4-8%), nor between 1.6 and 2.6 g daily of stanol. However, the cholesterol-lowering effect of plant sterol esters was attenuated between 1 and 2 months. This was accompanied by increased serum plant sterols and decreased levels of 7alpha-hydroxy-cholestenone, especially in statin-treated hypercholesterolaemic patients not taking bile acid sequestrants.

CONCLUSIONS

These findings suggest that absorption of dietary plant sterols suppressed bile acid synthesis, thereby diminishing their cholesterol-lowering efficacy. In contrast, plant stanols reduced plant sterol absorption and maintained their cholesterol-lowering efficacy.

Influence of hydrogenated fat and butter on CVD risk factors: remnant-like particles, glucose and insulin, blood pressure and C-reactive protein

Dietary trans fatty acids/partially-hydrogenated fat has been associated with increased risk of developing cardiovascular disease (CVD), possibly greater than predicted from changes in lipoprotein levels. To explore this issue further potential risk factors were assessed in subjects provided with each of six diets in randomized order containing as the major source of fat: soybean oil, semi-liquid margarine, soft margarine, shortening, traditional stick margarine or butter. Plasma fatty acid profiles reflected diet, with triglyceride and phospholipid subfractions affected to a greater extent than cholesteryl ester. Non-fasting LDL-cholesterol levels were 144+/-27, 141+/-27, 146+/-26, 148+/-30, 151+/-29 and 165+/-31 mg/dl (P<0.001) and total cholesterol/HDL-cholesterol ratios were 5.50+/-1.25, 5.54+/-1.50, 5.69+/-1.29, 5.82+/-1.40, 6.11+/-1.30 and 5.94+/-1.43 (P=0.011), respectively, whereas other lipoprotein levels were not significantly different. Remnant-like particles levels were unaffected by dietary fat, either in the fasting or non-fasting state. Differences in fasting insulin and glucose levels were small and would not be predicted to have a large impact on glucose homeostasis. There was no significant effect of dietary fat type on C-reactive protein levels or blood pressure. These data suggest that, as previously demonstrated, the major CVD risk factor adversely affected by dietary trans fatty acids/partially-hydrogenated fat is LDL-cholesterol levels and total cholesterol/HDL-cholesterol ratios.