Use of phytosterol-fortified foods to improve LDL cholesterol levels: A systematic review and meta-analysis

The dichotomy between functional and functionalized foods - A critical characterization of concepts

Diet is one of the main drivers of non-communicable chronic diseases (NCD). Modifying the food supply may be an attractive strategy for promoting health and reducing NCD risk. The intentional modification, processing, enrichment, or fortification of foods to produce "functional foods" currently varies according to legal definitions and existing regulatory frameworks, initially intended function, and production methods. This review critically appraises the existing definitions and concepts applied to functional foods, proposing a new concept of "functionalized foods". The conceptual difference between the two categories is that the term "functional foods" is used for products validated for human health through controlled trials, while "functionalized foods" is used for food products obtained through enrichment or (bio)fortification that lack such a validation, yet. Consequently, the review aims to establish a framework for better understanding the range of existing products, enhancing communication, and promoting a more accurate interpretation of the functional food landscape.

Development of chitosan based oleogel using emulsion template approach: Characterization and application as fat-replacer in cookies

The present study aimed to enhance the fat quality of bakery products by incorporating an oleogel enriched with unsaturated fatty acids and nutraceuticals. The efficacy of cross-linking chitosan with vanillin was evaluated using an emulsion-template technique. This approach utilized a blend of rice bran oil and soybean oil fortified with β-sitosterol, which partially replaced conventional shortening in cookie formulations. FTIR spectroscopy confirmed that cross-linking occurred due to the formation of a Schiff base through the reaction between the aldehyde group of vanillin and the amino group of chitosan. Rheological characterization revealed that the oleogel C2P2.5 (2.5 % β-sitosterol in the oil phase) exhibited greater strength than C2P5 (5 % β-sitosterol in the oil phase). Additionally, C2P2.5 demonstrated higher structural recovery than C2P5, indicating superior re-stabilization ability following mechanical deformation. The microscopical analysis showed a firmly packed structure of a continuous 3D network due to intermolecular cross-linking holding the oil. CLSM revealed phase reversal during emulsion formation due to an increase in β-sitosterol concentration in the oil phase interfering with cross-linking. As a result, the strength of oleogel C2P5 was reduced. The fatty acid profile of the oleogel was similar to that of the stock oil, confirming the effectiveness of the structuring technique. These oleogels were used to replace 25 % and 50 % of conventional shortening in cookies, which were subsequently characterized using texture analysis, FTIR spectroscopy, and SEM. With a 50 % replacement, trans-fat content in the cookies was reduced by half, demonstrating that oleogels offer a healthier alternative to conventional bakery shortenings. Collectively, oleogels enriched with unsaturated fatty acids and nutraceuticals, combined with chitosan cross-linking, provide a promising alternative to conventional shortening in bakery products, improving fat quality and reducing trans-fat content.

Anti-inflammatory activity of plant sterols in a co-culture model of intestinal inflammation: focus on food-matrix effect

This study investigates the gut anti-inflammatory activity of a plant sterol (PS) food supplement (PS-FS), alongside PS-enriched milk-based fruit beverage and PS-enriched rye bread. A co-culture model based on a dual-chamber system with differentiated intestinal-like Caco-2 cells (apical) and RAW264.7 macrophages (basolateral) was used. The bioaccessible fractions (BF) of the samples were obtained after INFOGEST 2.0 simulated gastrointestinal digestion. The BF were added to the apical part (diluted 1/20 v/v with culture medium to avoid cytotoxicity) for 90 min, followed by stimulation with lipopolysaccharide (LPS) (1 μg mL-1, 24 h) on the basolateral side. The pharmacological interaction between samples and budesonide (1 μM, 90 min) was evaluated. Results indicate that PS-FS significantly attenuated LPS-induced secretion of IL-8 (28%) by Caco-2 cells, and TNF-α (9%) and IL-6 (54%) by RAW264.7 macrophages, whereas PS-enriched beverage and bread did not exhibit protective effects. Additionally, PS-FS demonstrated an improvement in oxidative status in Caco-2 cells, evidenced by reduced levels of reactive oxygen species (47%), iNOS protein expression (27%), and nitrite/nitrate secretion (27%). Mechanistically, PS-FS inhibited the NF-κB-COX-2-PGE2 signaling pathway in macrophages, resulting in decreased NF-κB p65 nuclear translocation (39%), COX-2 protein expression (32%), and PGE2 production (27%). Co-treatment with budesonide and PS-FS displayed an antagonistic effect (combination index 0.38-0.63). This study demonstrates the potent intestinal anti-inflammatory activity of a PS-FS, positioning it as a promising nutraceutical product for the management of inflammatory bowel diseases. However, the food matrix of the milk-based fruit beverage and rye bread appear to interfere with the anti-inflammatory activity of PS.

Are oilseeds a new alternative protein source for human nutrition?

This review focuses on the potential use, nutritional value and beneficial health effects of oilseeds as a source of food protein. The process of extracting oil from oilseeds produces a by-product that is rich in proteins and other valuable nutritional and bioactive components. This product is primarily used for animal feed. However, as the demand for proteins continues to rise, plant-based proteins have a real success in food applications. Among the different plant protein sources, oilseeds could be used as an alternative protein source for human diet. The data we have so far show that oilseeds present a protein content of up to 40% and a relatively well-balanced profile of amino acids with sulphur-containing amino acids. Nevertheless, they tend to be deficient in lysine and rich in anti-nutritional factors (ANFs), which therefore means they have lower anabolic potential than animal proteins. To enhance their nutritional value, oilseed proteins can be combined with other protein sources and subjected to processes such as dehulling, heating, soaking, germination or fermentation to reduce their ANFs and improve protein digestibility. Furthermore, due to their bioactive peptides, oilseeds can also bring health benefits, particularly in the prevention and treatment of diabetes, obesity and cardiovascular diseases. However, additional nutritional data are needed before oilseeds can be endorsed as a protein source for humans.

Diet and Lipid-Lowering Nutraceuticals in Pediatric Patients with Familial Hypercholesterolemia

Familial hypercholesterolemia is a genetically determined disease characterized by elevated plasma total and LDL cholesterol levels from the very first years of life, leading to early atherosclerosis. Nutritional intervention is the first-line treatment, complemented with nutraceuticals and drug therapy when necessary. Nutraceuticals with a lipid-lowering effect have been extensively studied in the past few decades, and have been recently included in international guidelines as a complement to nutritional and pharmacological treatment in subjects with dyslipidemia. In this review, we explore current nutritional interventions for dyslipidemia in childhood, with a specific focus on the main nutraceuticals studied for treating severe dyslipidemia in pediatric patients. Additionally, we briefly describe their primary mechanisms of action and highlight the advantages and risks associated with the use of lipid-lowering nutraceuticals in childhood.

The effect of phytosterol supplementation on lipid profile: A critical umbrella review of interventional meta-analyses

Despite multiple investigations assessing the impact of phytosterol supplementation on serum lipid levels, there is still a great deal of debate regarding the benefits of this intervention in the management of dyslipidemia. Therefore, we aimed at clarifying this dilemma by conducting the present umbrella review of interventional meta-analyses. Scopus, PubMed, Web of Science, and EMBASE were used to search for pertinent publications on the effect of phytosterol supplementation on the lipid profile in humans up to June 2023. To compute the overall effect size (ES) and confidence intervals (CI), the random-effects model was used. The I2 statistic and Cochrane's Q-test were applied to estimate the heterogeneity among the studies. Seventeen meta-analyses with 23 study arms were included in the umbrella meta-analysis. Data pooled from the 23 eligible arms revealed that phytosterol supplementation reduces low-density lipoprotein cholesterol (LDL-C) (ES = -11.47 mg/dL; 95% CI: -12.76, -10.17, p < 0.001), total cholesterol (TC) (ES = -13.02 mg/dL; 95% CI: -15.68, -10.37, p < 0.001), and triglyceride (TG) (ES = -3.77 mg/dL; 95% CI: -6.04, -1.51, p = 0.001). Subgroup analyses showed that phytosterol administration with dosage ≥2 g/day and duration over 8 weeks and in hypercholesterolemic subjects was more likely to decrease LDL-C, TC, and TG. Phytosterol administration did not significantly modify HDL-C (ES = 0.18 mg/dL; 95% CI: -0.13, -0.51, p = 258) levels when compared to controls. The present umbrella meta-analysis confirms that phytosterol administration significantly reduces LDL-C, TC, and TG, with a greater effect with doses of ≥2 g/day and treatment duration >8 weeks, suggesting its possible application as a complementary therapy for cardiovascular risk reduction. Further studies are needed to determine the efficacy of phytosterols in patients with specific health conditions, as well as to ascertain the adverse effects, the maximum tolerable dose, and the maximum recommended duration of phytosterol administration.

Plant Sterols and Stanols for Pediatric Patients with Increased Cardiovascular Risk

The atherosclerotic process begins in childhood and progresses throughout adult age. Hypercholesterolemia, especially familial hypercholesterolemia (FH) and metabolic dysfunctions linked to weight excess and obesity, are the main atherosclerosis risk factors in pediatric patients and can be detected and treated starting from childhood. Nutritional intervention and a healthy-heart lifestyle are cornerstones and first-line treatments, with which, if necessary, drug therapy should be associated. For several years, functional foods enriched with plant sterols and stanols have been studied in the treatment of hypercholesterolemia, mainly as nutritional complements that can reduce LDL cholesterol; however, there is a lack of randomized controlled trials defining their long-term efficacy and safety, especially in pediatric age. This review aims to evaluate what the main published studies on sterols and stanols in pediatric subjects with dyslipidemia have taught us, providing an updated picture of the possible use of these dietary supplements in children and adolescents with dyslipidemia and increased cardiovascular risk. Nowadays, we can state that plant sterols and stanols should be considered as a valuable therapy in pediatric patients with hypercholesterolemia, bearing in mind that nutritional and lifestyle counseling and, when necessary, pharmacologic therapy, are the cornerstones of the treatment in developmental age.

The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study

Plant sterols are well-known natural lipid-lowering agents. The DESCO (Diet and plant sterols in the control of cholesterolemia) study was a single-center, randomized, double-blind, placebo-controlled, two-way crossover clinical trial designed to investigate the effect of a once-a-day ready-to-drink dietary supplement containing 2.5 g of phytosterols on the lipid profile, also in relation to the quality of the diet, in a cohort of 50 Italian individuals with polygenic hypercholesterolemia and low global cardiovascular risk. Eligible individuals were enrolled in a run-in period of 2 weeks. Then, participants who qualified for continuation in the study were randomly allocated (1:1) to a 3-week treatment with either phytosterols or placebo. After a 2-week washout period, enrolled individuals were crossed over to receive the alternative treatment. Dietary supplementation with phytosterols was associated with significant improvement in plasma levels of total cholesterol (TC; -11.8 ± 4.0 mg/dL, p = 0.016), low-density lipoprotein cholesterol (LDL-C; -7.8 ± 7.7 mg/dL, p = 0.021), and apolipoprotein B-100 (Apo B-100, -3.7 ± 4.1 mg/dL, p = 0.048) compared to baseline. The changes in TC and LDL-C were also significant compared to placebo, and greater adherence to the Mediterranean diet was significantly associated with greater reductions in LDL-C. Dietary supplementation with phytosterols was well tolerated and adherence to treatment was high. According to the findings of DESCO, the once-a-day ready-to-drink dietary supplement we tested is able to quickly and significantly decrease plasma levels of TC, LDL-C, and Apo B-100, with a greater effect in individuals more adhering to the Mediterranean dietary pattern.