Comparable reduction in cholesterol absorption after two different ways of phytosterol administration in humans

Dietary supplements: clinical cholesterol-lowering efficacy and potential mechanisms of action

This review aims to analyse the efficacy of dietary supplements in reducing plasma cholesterol levels. Focusing on evidence from meta-analyses of randomised controlled clinical trials, with an emphasis on potential mechanisms of action as supported by human, animal, and cell studies. Certain dietary supplements including phytosterols, berberine, viscous soluble dietary fibres, garlic supplements, soy protein, specific probiotic strains, and certain polyphenol extracts could significantly reduce plasma total and low-density lipoprotein (LDL) cholesterol levels by 3-25% in hypercholesterolemic patients depending on the type of supplement. They tended to be more effective in reducing plasma LDL cholesterol level in hypercholesterolemic individuals than in normocholesterolemic individuals. These supplements worked by various mechanisms, such as enhancing the excretion of bile acids, inhibiting the absorption of cholesterol in the intestines, increasing the expression of hepatic LDL receptors, suppressing the activity of enzymes involved in cholesterol synthesis, and activating the adenosine monophosphate-activated protein kinase signalling pathway.

Phytosterols and γ-Oryzanol as Cholesterol Solid Phase Modifiers during Digestion

Literature reports that ingestion of phytosterols and γ-oryzanol contributes to cholesterol lowering. Despite in vivo observations, thermodynamic phase equilibria could explain phenomena occurring during digestion leading to such effects. To advance the observations made by previous literature, this study was aimed at describing the complete solid-liquid phase equilibrium diagrams of cholesterol + phytosterol and γ-oryzanol systems by DSC, evaluating them by powder X-ray, microscopy, and thermodynamic modeling. Additionally, this study evaluated the phenomena observed by an in vitro digestibility method. Results confirmed the formation of solid solution in the cholesterol + phytosterols system at any concentration and that cholesterol + γ-oryzanol mixtures formed stable liquid crystalline phases with a significant melting temperature depression. The in vitro protocol supported the idea that the same phenomena can occur during digestion in which mechanochemical forces were probably the mechanisms promoting cholesterol solid phase changes in the presence of such phytocompounds. In this case, these changes could alter cholesterol solubility and possibly its absorption in the gastrointestinal lumen.

Phase behavior of cholesterol in mixtures with hypo- and hypercholesterolemic lipids

Some lipidic bioactives are largely reported to present hypocholesterolemic effects, for example, oleic acid, α-tocopherol, and octacosanol, found in rice-bran, olive, and sunflower oils. In contrast, some saturated and trans-unsaturated lipids found in animal fats or partially hydrogenated oils have been associated with the opposite effect. However, the mechanisms in which these lipids act for lowering or increasing cholesterol are not fully understood. In this context, this work was aimed at a fundamental physicochemical comprehension of how cholesterol phase behavior is affected in mixtures with these compounds. The complete solid-liquid equilibrium (SLE) phase diagrams of these mixtures were depicted by differential scanning calorimetry and microscopy, and also evaluated by the SLE thermodynamic theory. The minimal melting temperature (eutectic points) of the mixtures followed the order: α-tocopherol < oleic acid < elaidic acid < stearic acid < octacosanol. Among all biocompounds, stearic and trans-oleic acids promoted few changes in the normal thermodynamic behavior of cholesterol when in a mixture. In contrast, α-tocopherol induced a significant temperature depression in the system. Furthermore, at high concentrations of cholesterol (>90% molar fraction), the formation of solid solution was observed in all other systems, to a higher degree for oleic acid. The higher interactions of these beneficial compounds and the formation of solid solution that literature associates with the alteration of cholesterol enteric absorption probably correlates with their hypocholesterolemic effects.

Single frequency intake of α-linolenic acid rich phytosterol esters attenuates atherosclerosis risk factors in hamsters fed a high fat diet

Background

Emerging evidence suggested phytosterol esters (PE) exhibited an advantage over naturally occurring phytosterols in reducing atherosclerosis risk factors due to improved fat solubility and compatibility. However, the effects of dietary patterns of PE on lipid-lowering activity were limited and inconsistent. This study aimed to explore the effects of dose and frequency of α-linolenic acid rich phytosterol esters (ALA-PE) on cholesterol and triglyceride metabolism markers focused on intestinal cholesterol absorption and bioconversion of ALA in liver.

Methods

Dose-dependency study Male Syrian golden hamsters were fed high-fat diets (HFD) containing low, medium and high dose of ALA-PE (0.72 %, 2.13 % and 6.39 %) for 6 weeks. The high fat diet contained 89.5 % chow diet, 0.2 % cholesterol, 10 % lard and 0.3 % bile salt.

Dose-frequency study Male Syrian golden hamsters were provided: (I) 0.4 mL/100 g peanut oil by gavage once a day; (II) 0.4 mL/100 g ALA-PE by gavage once a day; (III) 0.2 mL/100 g ALA-PE by gavage twice a day; (IV) 0.133 mL/100 g ALA-PE by gavage three times a day; (V) 0.1 mL/100 g ALA-PE by gavage four times a day for 6 weeks with a high-fat diet simultaneously.

Results

ALA-PE dose-dependently lowered plasma total cholesterol (TC), triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) concentrations with a maximal decrease of 42 %, 59 % and 73 %, respectively (p < 0.05). Compared to HFD, TC, LDL-C and TG concentrations were significantly lower (p < 0.01) in hamsters consumed HFD plus ALA-PE for 1–4 times per day but there were not remarkable differences among different consumption frequencies. No significant changes in plasma antioxidant capacity and lipid peroxidation levels were observed among HFD and HFD plus different doses of ALA-PE groups. The contents of hepatic α-linolenic (ALA), docosapentaenoic (DPA) and docosahexaenoic (DHA) acids were dose-dependently increased in different ALA-PE groups compared to those in HFD group. The abundance of mRNA for intestinal sterol transporters Niemann-Pick C1-Like 1 (NPC1L1), ATP-binding cassette (ABC) transporters ABCG5 and ABCG8 indicated no significant differences among all groups.

Conclusion

ALA-PE dose-dependently improved lipid profile in hamsters fed HFD independent of intestinal ABCG5, ABCG8 and NPC1L1, accompanying by increased conversion of ALA to DPA and DHA in liver. ALA-PE manifested “once a day” lipid-lowering efficacy, highlighting a promising preventive strategy for metabolic syndrome.

Dietary phytosterol does not accumulate in the arterial wall and prevents atherosclerosis of LDLr-KO mice

SCOPE

There have been conflicting reports on the usefulness of phytosterols (PS) in preventing atherosclerosis. We evaluated the effects of dietary PS supplementation in LDLr-KO male mice on the plasma and aorta sterol concentrations and on atherosclerotic lesion development.

METHODS AND RESULTS

Mice were fed a high fat diet (40% of energy) supplemented with or without PS (2% w/w, n = 10). Plasma and arterial wall cholesterol and PS concentrations, lesion area, macrophage infiltration, and mRNA expression from LOX-1, CD36, ABCA1 and ABCG1 in peritoneal macrophages were measured. After 16 weeks, the plasma cholesterol concentration in PS mice was lower than that in the controls (p = 0.02) and in the arterial wall (p = 0.03). Plasma PS concentrations were higher in PS-fed animals than in controls (p < 0.0001); however, the arterial wall PS concentration did not differ between groups. The atherosclerotic lesion area in the PS group (n = 5) was smaller than that in controls (p = 0.0062) and the macrophage area (p = 0.0007). PS correlates negatively with arterial lipid content and macrophage (r = -0.76; p < 0.05). PS supplementation induced lower ABCG1 mRNA expression (p < 0.05).

CONCLUSIONS

Despite inducing an increase in PS plasma concentration, PS supplementation is not associated with its accumulation in the arterial wall and prevents atherosclerotic lesion development.