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Nattagh-Eshtivani E, Barghchi H, Pahlavani N, Barati M, Amiri Y, Fadel A, Khosravi M, Talebi S, Arzhang P, Ziaei R, Ghavami A. Biological and pharmacological effects and nutritional impact of phytosterols: A comprehensive review. Phytother Res 2021; 36:299-322. [PMID: 34729825 DOI: 10.1002/ptr.7312] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 12/20/2022]
Abstract
Phytosterols (PSs), classified into plant sterols and stanols, are bioactive compounds found in foods of plant origin. PSs have been proposed to exert a wide number of pharmacological properties, including the potential to reduce total and low-density lipoprotein (LDL) cholesterol levels and thereby decreasing the risk of cardiovascular diseases. Other health-promoting effects of PSs include anti-obesity, anti-diabetic, anti-microbial, anti-inflammatory, and immunomodulatory effects. Also, anticancer effects have been strongly suggested, as phytosterol-rich diets may reduce the risk of cancer by 20%. The aim of this review is to provide a general overview of the available evidence regarding the beneficial physiological and pharmacological activities of PSs, with special emphasis on their therapeutic potential for human health and safety. Also, we will explore the factors that influence the physiologic response to PSs.
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Affiliation(s)
- Elyas Nattagh-Eshtivani
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hanieh Barghchi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naseh Pahlavani
- Nutrition and Biochemistry Department, School of Medicine, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.,Department of Clinical Biochemistry and Nutrition, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mehdi Barati
- Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yasaman Amiri
- Medical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abdulmannan Fadel
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Maryam Khosravi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeedeh Talebi
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pishva Arzhang
- Department of Biochemistry and Diet Therapy, Faculty of Nutritional Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rahele Ziaei
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abed Ghavami
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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2
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Pereira TS, Fonseca FAH, Fonseca MIH, Martins CM, Fonseca HAR, Fonzar WT, Goulart AC, Bensenor IM, Lotufo PA, Izar MC. Phytosterol consumption and markers of subclinical atherosclerosis: Cross-sectional results from ELSA-Brasil. Nutr Metab Cardiovasc Dis 2021; 31:1756-1766. [PMID: 33965299 DOI: 10.1016/j.numecd.2021.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/16/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Phytosterol (PS) consumption is associated with lower total and LDL-cholesterol (LDL-c) concentrations, but its impact on cardiovascular risk is unclear. This study assessed the effect of usual intake of PS on markers of subclinical atherosclerosis in the Longitudinal Study of Adult Health (ELSA-Brasil). METHODS AND RESULTS This cross-sectional study included 2560 participants of ELSA-Brasil, aged 48 (43-54) years, with available food frequency questionnaires (FFQ), coronary artery calcium (CAC) scores, carotid intima media thickness (cIMT), and carotid-femoral pulse wave velocity (cf-PWV), at baseline. Several logistic and linear regression models were used, and significance level was set at a P < 0.05. Mean values (SD) for PS consumption were 256 (198) mg/day, CAC 22.78 (110.54) Agatston Units, cf-PWV 9.07 (1.60) m/s and cIMT 0.57 (0.12) mm. PS consumption in Q4 was associated with lower total- and LDL-c levels, and with higher percentiles of cf-PWV (P < 0.001). Proportion of subjects in Q4 of PS consumption was 1.5 times higher among individuals in cf-PWV Q4, than in Q1 (P = 0.002, for comparisons among quartiles). There was a trend (P = 0.003) for higher cf-PWV with higher PS intake. In crude logistic and linear regressions, PS intake was associated with cf-PWV. In the adjusted models, these associations disappeared. No associations were found between PS and cIMT or CAC. CONCLUSIONS In this large and apparently healthy cross-sectional sample from ELSA-Brasil, usual PS consumption was associated with lower total- and LDL-cholesterol, but not with markers of subclinical atherosclerosis.
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Affiliation(s)
- Tuany S Pereira
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Francisco A H Fonseca
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | | | - Celma M Martins
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Henrique A R Fonseca
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Waleria T Fonzar
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Alessandra C Goulart
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Isabela M Bensenor
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Paulo A Lotufo
- Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Universidade de São Paulo, Brazil
| | - Maria Cristina Izar
- Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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Gleize B, Hiolle M, Meunier N, Pereira B, Richard R, Savary‐Auzeloux I, Buffière C, Peyron M, Halimi C, Caris‐Veyrat C, Nau F, Reboul E. Food Structure Modulates the Bioavailability of Triglycerides and Vitamin D, and Partly That of Lutein: A Randomized Trial with a Crossover Design in Adults. Mol Nutr Food Res 2020; 64:e2000228. [DOI: 10.1002/mnfr.202000228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/10/2020] [Indexed: 01/12/2023]
Affiliation(s)
| | - Manon Hiolle
- STLO, INRAE AGROCAMPUS OUEST Rennes 35042 France
| | - Nathalie Meunier
- CHU Clermont‐Ferrand Centre de Recherche en Nutrition Humaine Auvergne Clermont‐Ferrand 63000 France
| | - Bruno Pereira
- CHU Clermont‐Ferrand DRCI Clermont‐Ferrand 63000 France
| | - Ruddy Richard
- CHU Clermont‐Ferrand Centre de Recherche en Nutrition Humaine Auvergne Clermont‐Ferrand 63000 France
- CHU Clermont‐Ferrand DRCI Clermont‐Ferrand 63000 France
| | - Isabelle Savary‐Auzeloux
- INRAE, Unité de Nutrition Humaine, UMR1019 University Clermont Auvergne Clermont‐Ferrand F‐63000 France
| | - Caroline Buffière
- INRAE, Unité de Nutrition Humaine, UMR1019 University Clermont Auvergne Clermont‐Ferrand F‐63000 France
| | - Marie‐Agnès Peyron
- INRAE, Unité de Nutrition Humaine, UMR1019 University Clermont Auvergne Clermont‐Ferrand F‐63000 France
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Maurya VK, Singh J, Ranjan V, Gothandam KM, Bohn T, Pareek S. Factors affecting the fate of β-carotene in the human gastrointestinal tract: A narrative review. INT J VITAM NUTR RES 2020; 92:385-405. [PMID: 32781911 DOI: 10.1024/0300-9831/a000674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Carotenoids and their metabolites play crucial roles in human health such as in immunity, cell differentiation, embryonic development, maintenance of plasma membrane integrity, and gastrointestinal functions, in addition to counteracting night blindness and other eye-related diseases. However, carotenoid bioavailability is highly variable and often low. The bioavailability of β-carotene, among the most frequently consumed carotenoid from the diet, is determined by food matrix related factors such as carotenoid dose, its location in food the matrix, the physical state in food, the presence of other food compounds in the matrix such as dietary fiber, dietary lipids, other micronutrients present such as minerals, and food processing, influencing also the size of food particles, and the presence of absorption inhibitors (fat replacers and anti-obesity drugs) or enhancers (nano-/micro-formulations). However, also host-related factors such as physiochemical interactions by gastrointestinal secretions (enzyme and salts) and other host-related factors such as surgery, age, disease, obesity, and genetic variations have shown to play a role. This review contributes to the knowledge regarding factors affecting the bioavailability of β-carotene (food and host-relegated), as well as highlights in vitro models employed to evaluate β-carotene bioavailability aspects.
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Affiliation(s)
- Vaibhav Kumar Maurya
- Department of Basic and Applied Science, National Institute of Food Technology, Entrepreneurship and Management, Kundli, Sonepat 131 028, Haryana, India
| | - Jagmeet Singh
- Department of Agriculture and Environmental Sciences, National Institute of Food Technology Entrepreneurship and Management, Kundli, Sonepat 131 028, Haryana, India
| | - Vijay Ranjan
- Department of Agriculture and Environmental Sciences, National Institute of Food Technology Entrepreneurship and Management, Kundli, Sonepat 131 028, Haryana, India
| | | | - Torsten Bohn
- Luxembourg Institute of Health (LIH), Department of Population Health, Nutrition and Health Group, L-1445 Strassen, Luxembourg
| | - Sunil Pareek
- Department of Agriculture and Environmental Sciences, National Institute of Food Technology Entrepreneurship and Management, Kundli, Sonepat 131 028, Haryana, India
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Gomes Silva M, Santos V, Fernandes G, Calligaris G, Santana M, Cardoso L, Ribeiro A. Physical approach for a quantitative analysis of the phytosterols in free phytosterol-oil blends by X-ray Rietveld method. Food Res Int 2019; 124:2-15. [DOI: 10.1016/j.foodres.2019.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/17/2019] [Accepted: 04/03/2019] [Indexed: 01/25/2023]
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7
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Cholesterol-reducing effect of ergosterol is modulated via inhibition of cholesterol absorption and promotion of cholesterol excretion. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.04.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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8
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Phytosterol crystallisation within bulk and dispersed triacylglycerol matrices as influenced by oil droplet size and low molecular weight surfactant addition. Food Chem 2018; 264:24-33. [DOI: 10.1016/j.foodchem.2018.04.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
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9
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Duong S, Strobel N, Buddhadasa S, Stockham K, Auldist MJ, Wales WJ, Moate PJ, Orbell JD, Cran MJ. Influence of acid hydrolysis, saponification and sample clean-up on the measurement of phytosterols in dairy cattle feed using GC-MS and GC with flame ionization detection. J Sep Sci 2018; 41:3467-3476. [DOI: 10.1002/jssc.201800484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/06/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Samantha Duong
- Institute for Sustainable Industries and Liveable Cities; Victoria University; Melbourne Australia
| | - Norbert Strobel
- Australian Government; National Measurement Institute; Port Melbourne Australia
| | - Saman Buddhadasa
- Australian Government; National Measurement Institute; Port Melbourne Australia
| | - Katherine Stockham
- Australian Government; National Measurement Institute; Port Melbourne Australia
| | - Martin J. Auldist
- Australian Government; Department of Economic Development, Jobs, Transport and Resources; Ellinbank Australia
| | - William J. Wales
- Australian Government; Department of Economic Development, Jobs, Transport and Resources; Ellinbank Australia
| | - Peter J. Moate
- Australian Government; Department of Economic Development, Jobs, Transport and Resources; Ellinbank Australia
| | - John D. Orbell
- Institute for Sustainable Industries and Liveable Cities; Victoria University; Melbourne Australia
| | - Marlene J. Cran
- Institute for Sustainable Industries and Liveable Cities; Victoria University; Melbourne Australia
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Boso S, Gago P, Santiago JL, Rodríguez-Canas E, Martínez MC. New monovarietal grape seed oils derived from white grape bagasse generated on an industrial scale at a winemaking plant. Lebensm Wiss Technol 2018. [DOI: 10.1016/j.lwt.2018.02.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Desmarchelier C, Borel P. Overview of carotenoid bioavailability determinants: From dietary factors to host genetic variations. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2017.03.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Fardet A, Morise A, Kalonji E, Margaritis I, Mariotti F. Influence of phytosterol and phytostanol food supplementation on plasma liposoluble vitamins and provitamin A carotenoid levels in humans: An updated review of the evidence. Crit Rev Food Sci Nutr 2017; 57:1906-1921. [PMID: 26193046 DOI: 10.1080/10408398.2015.1033611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Phytosterols and phytostanols (PAP) compete with cholesterol absorption in the intestine, resulting in a 5-15%-reduction in plasma total and LDL cholesterol. An important issue is the PAP potential to reduce the plasma concentrations of fat-soluble vitamins and provitamin A carotenoids. Here, an update of the scientific evidence is reviewed to evaluate plant PAP-enriched foods impact on plasma fat-soluble vitamins and carotenoid levels, and to discuss potential implications in terms of cardiovascular risk. Based on 49 human interventional and 3 bioavailability studies, results showed that regular consumption, particularly over the long term, of foods fortified with PAP as recommended in labeling does not significantly impact plasma vitamins A, D, and K concentration. A 10% significant median reduction was observed for α-tocopherol. Concerning carotenoids, while 13 studies did not demonstrate statistically significant plasma β-carotene reduction, 20 studies showed significant reductions, with median effect size of -24%. This decline can be mitigated or offset by increased fruits and vegetables consumption. Furthermore, higher cardiovascular risk was observed for differences in plasma β-carotene concentration of the same magnitude as the estimated average decrease by PAP consumption. These results are supported by the only study of β-carotene bioavailability showing decrease in absorption by phytosterols daily intake.
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Affiliation(s)
- Anthony Fardet
- a INRA, JRU 1019, UNH, CRNH Auvergne, F-63000 Clermont-Ferrand & Clermont Université, Université d'Auvergne, Unité de Nutrition Humaine , Clermont - Ferrand , France
| | - Anne Morise
- b ANSES, Unité d'Evaluation de Risques liés à la Nutrition , Maison-Alfort , France
| | - Esther Kalonji
- b ANSES, Unité d'Evaluation de Risques liés à la Nutrition , Maison-Alfort , France
| | - Irène Margaritis
- b ANSES, Unité d'Evaluation de Risques liés à la Nutrition , Maison-Alfort , France
| | - François Mariotti
- c AgroParisTech, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior , Paris , France.,d INRA, CRNH-IdF, UMR914 Nutrition Physiology and Ingestive Behavior , Paris , France
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13
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Ras RT, Koppenol WP, Garczarek U, Otten-Hofman A, Fuchs D, Wagner F, Trautwein EA. Increases in plasma plant sterols stabilize within four weeks of plant sterol intake and are independent of cholesterol metabolism. Nutr Metab Cardiovasc Dis 2016; 26:302-309. [PMID: 26806045 DOI: 10.1016/j.numecd.2015.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/19/2015] [Accepted: 11/13/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Plant sterols (PS) lower plasma LDL-cholesterol through partial inhibition of intestinal cholesterol absorption. Although PS themselves are poorly absorbed, increased intakes of PS result in elevated plasma concentrations. In this paper, we report time curves of changes in plasma PS during 12 weeks of PS intake. Furthermore, the impact of cholesterol synthesis and absorption on changes in plasma PS is explored. METHODS AND RESULTS The study was a double-blind, randomized, placebo-controlled, parallel-group study with the main aim to investigate the effects of PS on vascular function (clinicaltrials.gov: NCT01803178). Hypercholesterolemic but otherwise healthy men and women (n = 240) consumed low-fat spreads without or with added PS (3 g/d) for 12 weeks after a 4-week run-in period. Blood sampling was performed at week 0, 4, 8 and 12. Basal cholesterol-standardized concentrations of lathosterol and sitosterol + campesterol were used as markers of cholesterol synthesis and absorption, respectively. In the PS group, plasma sitosterol and campesterol concentrations increased within the first 4 weeks of intervention by 69% (95%CI: 58; 82) starting at 7.2 μmol/L and by 28% (95%CI: 19; 39) starting at 11.4 μmol/L, respectively, and remained stable during the following 8 weeks. Placebo-corrected increases in plasma PS were not significantly different between high and low cholesterol synthesizers (P-values >0.05). Between high and low cholesterol absorbers, no significant differences were observed, except for the cholesterol-standardized sum of four major plasma PS (sitosterol, campesterol, brassicasterol and stigmasterol) showing larger increases in low absorbers (78.3% (95%CI: 51.7; 109.5)) compared to high absorbers (40.8% (95%CI: 19.9; 65.5)). CONCLUSIONS Increases in plasma PS stabilize within 4 weeks of PS intake and do not seem impacted by basal cholesterol synthesis or absorption efficiency. This study was registered at clinicaltrials.gov (NCT01803178).
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Affiliation(s)
- R T Ras
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands.
| | - W P Koppenol
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands
| | - U Garczarek
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands
| | - A Otten-Hofman
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands
| | - D Fuchs
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands
| | - F Wagner
- Charité Research Organisation, Berlin, Germany
| | - E A Trautwein
- Unilever Research and Development Vlaardingen, Vlaardingen, the Netherlands
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Promtes K, Kupradinun P, Rungsipipat A, Tuntipopipat S, Butryee C. Chemopreventive Effects of Eryngium foetidum L. Leaves on COX-2 Reduction in Mice Induced Colorectal Carcinogenesis. Nutr Cancer 2016; 68:144-53. [PMID: 26771664 DOI: 10.1080/01635581.2016.1115103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To investigate the potential effects of Eryngium foetidum Linn. leaves (EF) in colitis-induced colorectal carcinogenesis in mice by azoxymethane (AOM) and dextran sulfate sodium (DSS), 39 ICR male mice were studied and divided into 6 groups. The mice were received a modified AIN-76 diet in Group 1, whereas Group 2 was given an AOM, DSS, and AIN-76 diet. Groups 3 and 4 were fed with 0.8% and 3.2% freeze-dried EF with AIN-76 diets, for 5 wk. Groups 5 and 6 were fed with 0.8% and 3.2% EF diets for 5 wk during AOM/DSS administration. The mice were necropsied at Week 20 and their colons were collected. The results indicated that the incidences of tumors in Groups 2, 5, and 6 was 100%, 75%, and 88%, with multiplicities (mean ±SE) of 3.75 ±0.92, 2.38 ± 0.96 and 4.25 ± 0.79, respectively. Interestingly, there was a significant difference in COX-2 expression in mice received 3.2% EF in their diet, but the proliferative cell nuclear antigen index and iNOS protein expression were not significantly different. We concluded that EF at a dose level of 3.2% in their diet had a preventive effect on colorectal carcinogenesis via the proinflammatory cytokine, COX-2.
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Affiliation(s)
- Kamonwan Promtes
- a Institute of Nutrition, Mahidol University , Nakhon Pathom , Thailand
| | | | - Anudep Rungsipipat
- c Companion Animal Cancer Research Unit, Department of Veterinary Pathology, Faculty of Veterinary Science, Chulalongkorn University , Bangkok , Thailand
| | | | - Chaniphun Butryee
- a Institute of Nutrition, Mahidol University , Nakhon Pathom , Thailand
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Botelho PB, Guimarães JP, Mariano KR, Afonso MDS, Koike MK, Lottenberg AMP, Castro IA. Effect of echium oil combined with phytosterols on biomarkers of atherosclerosis in LDLr-knockout mice: Echium oil is a potential alternative to marine oils for use in functional foods. EUR J LIPID SCI TECH 2015. [DOI: 10.1002/ejlt.201500004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Patrícia Borges Botelho
- LADAF; Department of Food and Experimental Nutrition; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo Brazil
| | - Jéssica Pereira Guimarães
- LADAF; Department of Food and Experimental Nutrition; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo Brazil
| | - Karina Rocha Mariano
- LADAF; Department of Food and Experimental Nutrition; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo Brazil
| | - Milessa da Silva Afonso
- Lipids Laboratory (LIM 10); Faculty of Medical Sciences; University of São Paulo. Av. Dr. Arnaldo; São Paulo Brazil
| | - Márcia Kiyomi Koike
- Lipids Laboratory (LIM 10); Faculty of Medical Sciences; University of São Paulo. Av. Dr. Arnaldo; São Paulo Brazil
| | - Ana Maria Pita Lottenberg
- Lipids Laboratory (LIM 10); Faculty of Medical Sciences; University of São Paulo. Av. Dr. Arnaldo; São Paulo Brazil
| | - Inar Alves Castro
- LADAF; Department of Food and Experimental Nutrition; Faculty of Pharmaceutical Sciences; University of São Paulo; São Paulo Brazil
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16
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Ramprasath VR, Jenkins DJA, Lamarche B, Kendall CWC, Faulkner D, Cermakova L, Couture P, Ireland C, Abdulnour S, Patel D, Bashyam B, Srichaikul K, de Souza RJ, Vidgen E, Josse RG, Leiter LA, Connelly PW, Frohlich J, Jones PJH. Consumption of a dietary portfolio of cholesterol lowering foods improves blood lipids without affecting concentrations of fat soluble compounds. Nutr J 2014; 13:101. [PMID: 25326876 PMCID: PMC4223745 DOI: 10.1186/1475-2891-13-101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/07/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Consumption of a cholesterol lowering dietary portfolio including plant sterols (PS), viscous fibre, soy proteins and nuts for 6 months improves blood lipid profile. Plant sterols reduce blood cholesterol by inhibiting intestinal cholesterol absorption and concerns have been raised whether PS consumption reduces fat soluble vitamin absorption. OBJECTIVE The objective was to determine effects of consumption of a cholesterol lowering dietary portfolio on circulating concentrations of PS and fat soluble vitamins. METHODS Using a parallel design study, 351 hyperlipidemic participants from 4 centres across Canada were randomized to 1 of 3 groups. Participants followed dietary advice with control or portfolio diet. Participants on routine and intensive portfolio involved 2 and 7 clinic visits, respectively, over 6 months. RESULTS No changes in plasma concentrations of α and γ tocopherol, lutein, lycopene and retinol, but decreased β-carotene concentrations were observed with intensive (week 12: p = 0.045; week 24: p = 0.039) and routine (week 12: p = 0.031; week 24: p = 0.078) portfolio groups compared to control. However, cholesterol adjusted β-carotene and fat soluble compound concentrations were not different compared to control. Plasma PS concentrations were increased with intensive (campesterol:p = 0.012; β-sitosterol:p = 0.035) and routine (campesterol: p = 0.034; β-sitosterol: p = 0.080) portfolio groups compared to control. Plasma cholesterol-adjusted campesterol and β-sitosterol concentrations were negatively correlated (p < 0.001) with total and LDL-C levels. CONCLUSION Results demonstrate that consuming a portfolio diet reduces serum total and LDL-C levels while increasing PS values, without altering fat soluble compounds concentrations. The extent of increments of PS with the current study are not deleterious and also maintaining optimum levels of fat soluble vitamins are of paramount necessity to maintain overall metabolism and health. Results indicate portfolio diet as one of the best options for CVD risk reduction. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00438425.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Peter J H Jones
- Richardson Centre for Functional Foods and Nutraceuticals, Winnipeg, MB R3T 2 N2, Canada.
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Wang H, Blumberg JB, Chen CYO, Choi SW, Corcoran MP, Harris SS, Jacques PF, Kristo AS, Lai CQ, Lamon-Fava S, Matthan NR, McKay DL, Meydani M, Parnell LD, Prokopy MP, Scott TM, Lichtenstein AH. Dietary modulators of statin efficacy in cardiovascular disease and cognition. Mol Aspects Med 2014; 38:1-53. [PMID: 24813475 DOI: 10.1016/j.mam.2014.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/14/2014] [Accepted: 04/14/2014] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease remains the leading cause of morbidity and mortality in the United States and other developed countries, and is fast growing in developing countries, particularly as life expectancy in all parts of the world increases. Current recommendations for the prevention of cardiovascular disease issued jointly from the American Academy of Cardiology and American Heart Association emphasize that lifestyle modification should be incorporated into any treatment plan, including those on statin drugs. However, there is a dearth of data on the interaction between diet and statins with respect to additive, complementary or antagonistic effects. This review collates the available data on the interaction of statins and dietary patterns, cognition, genetics and individual nutrients, including vitamin D, niacin, omega-3 fatty acids, fiber, phytochemicals (polyphenols and stanols) and alcohol. Of note, although the available data is summarized, the scope is limited, conflicting and disparate. In some cases it is likely there is unrecognized synergism. Virtually no data are available describing the interactions of statins with dietary components or dietary pattern in subgroups of the population, particularly those who may benefit most were positive effects identified. Hence, it is virtually impossible to draw any firm conclusions at this time. Nevertheless, this area is important because were the effects of statins and diet additive or synergistic harnessing the effect could potentially lead to the use of a lower intensity statin or dose.
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Affiliation(s)
- Huifen Wang
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jeffrey B Blumberg
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - C-Y Oliver Chen
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sang-Woon Choi
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Michael P Corcoran
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Susan S Harris
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Paul F Jacques
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Aleksandra S Kristo
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Chao-Qiang Lai
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Stefania Lamon-Fava
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Diane L McKay
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mohsen Meydani
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Laurence D Parnell
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Max P Prokopy
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Tammy M Scott
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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McKenney JM, Jenks BH, Shneyvas E, Brooks JR, Shenoy SF, Cook CM, Maki KC. A Softgel Dietary Supplement Containing Esterified Plant Sterols and Stanols Improves the Blood Lipid Profile of Adults with Primary Hypercholesterolemia: A Randomized, Double-Blind, Placebo-Controlled Replication Study. J Acad Nutr Diet 2014; 114:244-249. [DOI: 10.1016/j.jand.2013.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Rondanelli M, Monteferrario F, Faliva MA, Perna S, Antoniello N. Key points for maximum effectiveness and safety for cholesterol-lowering properties of plant sterols and use in the treatment of metabolic syndrome. JOURNAL OF THE SCIENCE OF FOOD AND AGRICULTURE 2013; 93:2605-2610. [PMID: 23584958 DOI: 10.1002/jsfa.6174] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 04/02/2013] [Accepted: 04/12/2013] [Indexed: 06/02/2023]
Abstract
According to the American Diabetes Association and the Adult Treatment Panel III, the starting point for treating metabolic syndrome (MS) is a change of lifestyle. In addition, action on the main symptoms of MS by means of dietary supplements, can be helpful in view of the chronic course of the disease. The term 'phytosterols' refers to sterols and stanols composed of lipophilic triterpenes, a family that is widely distributed in the plant kingdom and whose cholesterol-lowering properties have been amply demonstrated. In the light of the recent literature, the key points for maximum effectiveness and safety of sterols are the following. (A) Plant sterols should be taken with meals: clinical trials have shown that when plant sterols are consumed close to mealtimes, low-density lipoprotein cholesterol may decrease by 9.4%, while when they are taken between meals, the reduction is about 6%. (B) The optimal dosage is 2-2.5 g day(-1) in a single dose. More than 3 g day(-1) has not been found to have any additional beneficial effect and increases the risk of side effects. (C) The food matrix used to dissolve the phytosterols should contain a certain amount of fat. A milk-based matrix appears optimal from this point of view.
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Affiliation(s)
- Mariangela Rondanelli
- Human Nutrition Section, Health Sciences Department, University of Pavia, Azienda di Servizi alla Persona, Pavia, Italy
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Kunces LJ, Cusack LK, Kupchak BR, Volk BM, Freidenreich DJ, Aristizabal JC, Saenz C, Pei R, Guo Y, Fernandez ML, Bruno RS, Maresh CM, Kraemer WJ, Pronczuk A, Hayes KC, Volek JS. Triglyceride Recrystallized Phytosterols in Fat-Free Milk Improve Lipoprotein Profiles More Than Unmodified Free Phytosterols in Hypercholesterolemic Men and Women. J Am Coll Nutr 2013; 32:234-42. [DOI: 10.1080/07315724.2013.816597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Progress and prospective of plant sterol and plant stanol research: Report of the Maastricht meeting. Atherosclerosis 2012; 225:521-33. [DOI: 10.1016/j.atherosclerosis.2012.09.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/16/2012] [Indexed: 12/29/2022]
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22
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García-Llatas G, Vidal C, Cilla A, Barberá R, Lagarda MJ. Simultaneous quantification of serum phytosterols and cholesterol precursors using a simple gas chromatographic method. EUR J LIPID SCI TECH 2012. [DOI: 10.1002/ejlt.201100331] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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23
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Leong WF, Lai OM, Long K, Che Man YB, Misran M, Tan CP. Preparation and characterisation of water-soluble phytosterol nanodispersions. Food Chem 2011. [DOI: 10.1016/j.foodchem.2011.04.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Abstract
The cholesterol-lowering effect of plant sterols was first discovered in the early 1950s. However, it is only recently that plant sterols have become clinically important, when advances in food-technology have made it possible to combine sterols with a variety of food products including margarines, yogurts, fruit juices and cereal bars. We review the clinical trial evidence of lipid-lowering efficacy of plant sterols and discuss their implications in routine clinical practice. To generate the evidence we searched the Pubmed database for English language literature, using relevant keywords and medical subject heading (MeSH) terms, and extracted the findings from recently published studies and meta-analyses on this topic. Our findings suggest that the short-term use of food supplements rich in plant sterols is a safe and effective strategy; to maximize the benefits of dietary and lifestyle therapy, either with or without statin therapy, among majority of dyslipidemic patients with need for additional lipid-lowering.
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Affiliation(s)
- A K Gupta
- International Centre for Circulatory Health, National Heart & Lung Institute, Imperial College London, 59-61 North Wharf Road, London, UK.
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25
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Egg consumption as part of an energy-restricted high-protein diet improves blood lipid and blood glucose profiles in individuals with type 2 diabetes. Br J Nutr 2010; 105:584-92. [DOI: 10.1017/s0007114510003983] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The role of dietary cholesterol in people with diabetes has been little studied. We investigated the effect of a hypoenergetic high-protein high-cholesterol (HPHchol) diet compared to a similar amount of animal protein (high-protein low-cholesterol, HPLchol) on plasma lipids, glycaemic control and cardiovascular risk markers in individuals with type 2 diabetes. A total of sixty-five participants with type 2 diabetes or impaired glucose tolerance (age 54·4 (sd8·2) years; BMI 34·1 (sd4·8) kg/m2; LDL-cholesterol (LDL-C) 2·67 (sd0·10) mmol/l) were randomised to either HPHchol or HPLchol. Both hypoenergetic dietary interventions (6–7 MJ; 1·4–1·7 Mcal) and total carbohydrate:protein:fat ratio of 40:30:30 % were similar but differed in cholesterol content (HPHchol, 590 mg cholesterol; HPLchol, 213 mg cholesterol). HPHchol participants consumed two eggs per d, whereas HPHchol participants replaced the eggs with 100 g of lean animal protein. After 12 weeks, weight loss was 6·0 (sd0·4) kg (P < 0·001). LDL-C and homocysteine remained unchanged. All the subjects reduced total cholesterol ( − 0·3 (sd0·1) mmol/l,P < 0·001), TAG ( − 0·4 (sd0·1) mmol/l,P < 0·001), non-HDL-cholesterol (HDL-C, − 0·4 (sd0·1) mmol/l,P < 0·001), apo-B ( − 0·04 (sd0·02) mmol/l,P < 0·01), HbA1c ( − 0·6 (sd0·1) %,P < 0·001), fasting blood glucose ( − 0·5 (sd0·2) mmol/l,P < 0·01), fasting insulin ( − 1·7 (sd0·7) mIU/l,P < 0·01), systolic blood pressure ( − 7·6 (sd1·7) mmHg,P < 0·001) and diastolic blood pressure ( − 4·6 (sd1·0) mmHg;P < 0·001). Significance was not altered by diet, sex, medication or amount of weight loss. HDL-C increased on HPHchol (+0·02 (sd0·02) mmol/l) and decreased on HPLchol ( − 0·07 (sd0·03) mmol/l,P < 0·05). Plasma folate and lutein increased more on HPHchol (P < 0·05). These results suggest that a high-protein energy-restricted diet high in cholesterol from eggs improved glycaemic and lipid profiles, blood pressure and apo-B in individuals with type 2 diabetes.
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Response Surface Modeling of Processing Parameters for the Preparation of Phytosterol Nanodispersions Using an Emulsification–Evaporation Technique. J AM OIL CHEM SOC 2010. [DOI: 10.1007/s11746-010-1714-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Mensink RP, de Jong A, Lütjohann D, Haenen GR, Plat J. Plant stanols dose-dependently decrease LDL-cholesterol concentrations, but not cholesterol-standardized fat-soluble antioxidant concentrations, at intakes up to 9 g/d. Am J Clin Nutr 2010; 92:24-33. [PMID: 20504972 DOI: 10.3945/ajcn.2009.29143] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unclear whether plant stanols lower serum LDL-cholesterol concentrations and cholesterol-standardized fat-soluble antioxidant concentrations dose-dependently when consumption exceeds the recommended daily intakes of 2.0-3.0 g. OBJECTIVE The objective was to study the relation between plant stanols provided as plant stanol esters on changes in serum concentrations of LDL cholesterol and fat-soluble antioxidants. DESIGN Healthy subjects (n = 93) with slightly elevated serum total cholesterol concentrations (5.0-8.0 mmol/L) received, after a 3-wk run-in period, control products (n = 22) or products (margarine and soy-based yogurt) providing 3 g (n = 24), 6 g (n = 22), or 9 g (n = 25) plant stanols provided as fatty acid esters for 4 wk. RESULTS Serum LDL cholesterol decreased dose-dependently. Compared with control, decreases in the 3-g group were 0.32 mmol/L (7.4%; P = 0.005 after adjustment for multiple comparisons). An intake of 6 g plant stanols caused an additional decrease of 0.18 mmol/L (4.5%; P = 0.100 compared with the 3-g group). In the 9-g group, a further decrease of 0.22 mmol/L (5.4%) was observed (P = 0.048 compared with the 6-g group). Serum LDL-cholesterol concentrations were lowered by 17.4% in the 9-g group compared with the control group. No effects on cholesterol-standardized beta-carotene concentrations were observed. Even the change of -0.01 mumol/mmol cholesterol (or -9.2%; P = 0.341) in the 3-g group compared with the control group was not statistically significant because of the large variation in response. Serum HDL-cholesterol and triacylglycerol concentrations, cholesterol-standardized alpha-tocopherol and lutein concentrations, and plasma markers reflecting liver and renal function were not affected. CONCLUSIONS Daily consumption of plant stanols up to 9 g reduces serum LDL-cholesterol concentrations linearly up to 17.4%. For cholesterol-standardized fat-soluble antioxidant concentrations, such a relation could not be ascertained.
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Affiliation(s)
- Ronald P Mensink
- Department of Human Biology, Maastricht University, Maastricht, Netherlands.
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Nijjar PS, Burke FM, Bloesch A, Rader DJ. Role of dietary supplements in lowering low-density lipoprotein cholesterol: A review. J Clin Lipidol 2010; 4:248-58. [DOI: 10.1016/j.jacl.2010.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/30/2010] [Accepted: 07/01/2010] [Indexed: 12/16/2022]
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Effects of phytosterol ester-enriched low-fat milk on serum lipoprotein profile in mildly hypercholesterolaemic patients are not related to dietary cholesterol or saturated fat intake. Br J Nutr 2010; 104:1018-25. [DOI: 10.1017/s0007114510001686] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Phytosterols (PS) are recommended to reduce LDL-cholesterol. However, the influence of cholesterol and fat intake on the lipid-lowering effect of PS in mildly hypercholesterolaemia is unclear. Thus, the aim of the present study was to evaluate whether the efficacy of PS is related to the composition of saturated fat and dietary cholesterol intake. Additionally, serum carotenoid content was analysed to evaluate to what extent it was undermined by PS. This was a 3-month randomised, parallel trial with a three-arm design. Patients were divided into three groups: healthy diet (n24), healthy diet+PS (n31) and free diet+PS (n29), receiving 2 g/d of PS. Healthy and free diets were characterised by a daily ingestion of 6·8 % of saturated fat and 194·4 mg of cholesterol and 12·7 % of saturated fat and 268·1 mg of cholesterol, respectively. After PS therapy, patients receiving the healthy diet+PS or a free diet+PS exhibited a similar reduction in total cholesterol (6·7 and 5·5 %), LDL-cholesterol (9·6 and 7·0 %), non-HDL-cholesterol (12·2 and 8·9 %) and apo B-100/apo A-I ratio (11·5 and 11·6 %), respectively. In patients following the healthy diet, (β-carotene concentration rose by 26·9 %, whereas the β-carotene and lycopene levels dropped by 21·0 and 22·8 % in the group receiving the free diet+PS, respectively. No change was observed in carotenoid levels in healthy diet+PS group. In conclusion, the efficacy of PS in relation to lipoprotein profile is not influenced by saturated fat or dietary cholesterol intake, which confirms the positive effect of healthy diet therapy in improving the negative effects that PS exert on carotenoid levels.
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30
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Derdemezis CS, Filippatos TD, Mikhailidis DP, Elisaf MS. Review article: effects of plant sterols and stanols beyond low-density lipoprotein cholesterol lowering. J Cardiovasc Pharmacol Ther 2010; 15:120-34. [PMID: 20200328 DOI: 10.1177/1074248409357921] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Consumption of foods and supplements enriched with plant sterols/stanols (PS) may help reduce low-density lipoprotein cholesterol (LDL-C) levels. In this review, we consider the effects of PS beyond LDL-C lowering. Plant sterols/stanols exert beneficial effects on other lipid variables, such as apolipoprotein (apo) B/apoAI ratio and, in some studies, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Plant sterols/stanols may also affect inflammatory markers, coagulation parameters, as well as platelet and endothelial function. Evidence also exists about a beneficial effect on oxidative stress, but this does not seem to be of greater degree than that expected from the LDL-C lowering. Many of these effects have been demonstrated in vitro and animal models. Some in vitro effects cannot be seen in vivo or in humans at usual doses. The epidemiological studies that evaluated the association of plasma PS concentration with cardiovascular disease (CVD) risk do not provide a definitive answer. Long-term randomized placebo-controlled studies are required to clarify the effects of supplementation with PS on CVD risk and progression of atherosclerosis.
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Affiliation(s)
- Christos S Derdemezis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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31
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Gylling H, Hallikainen M, Nissinen MJ, Simonen P, Miettinen TA. Very high plant stanol intake and serum plant stanols and non-cholesterol sterols. Eur J Nutr 2010; 49:111-7. [PMID: 19774436 DOI: 10.1007/s00394-009-0055-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 09/05/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Today, consumers meet abundant supply of functional foods with plant stanol increments for serum cholesterol lowering purposes. However, efficacy and safety of plant stanols intake beyond 4 g/day have remained unexplored. AIM OF THE STUDY We evaluated the effects of very high daily intake of plant stanols (8.8 g/day) as esters on cholesterol metabolism, and serum levels of plant sterols and stanols. METHODS In a randomized, double-blind, parallel study of 49 hypercholesterolemic subjects (mean age 62 years, range 41-73) consumed a test diet without (control, n = 24), and with added plant stanol esters (staest, n = 25) over 10 weeks followed by 4 weeks on home diet. Serum lipids, lipoprotein lipids, and non-cholesterol sterols were determined at baseline, during intervention, and 4 weeks afterwards. Cholesterol precursor sterol lathosterol reflected cholesterol synthesis, and serum plant sterols and cholestanol mirrored cholesterol absorption. RESULTS When compared with controls, 8.8 g/day of plant stanols reduced serum and LDL cholesterol by 12 and 17% (P < 0.01 for both). Synthesis marker lathosterol was increased by 30%, while absorption markers decreased up to 62% when compared with controls (P < 0.001 for both). Serum plant stanols increased slightly, but significantly compared with controls (serum sitostanol during intervention, controls: 16 +/- 1 microg/dL, staest: 37 +/- 2 microg/dL, serum campestanol during intervention, controls: 0.5 +/- 0 microg/dL, staest: 9 +/- 1 microg/dL, P < 0.001 for both). Changes in serum cholesterol, non-cholesterol sterols, and plant stanols were normalized during post-treatment weeks. CONCLUSIONS Serum plant stanol levels remained at comparable low levels as in studies with daily intake of 2-3 g, and were normalized in 4 weeks suggesting that daily intake of 8.8 g of plant stanols might not increase systemic availability of plant stanols, but reduces effectively serum cholesterol and plant sterol levels.
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Affiliation(s)
- Helena Gylling
- Department of Clinical Nutrition, University of Kuopio, Kuopio, Finland.
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32
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Micallef MA, Garg ML. Beyond blood lipids: phytosterols, statins and omega-3 polyunsaturated fatty acid therapy for hyperlipidemia. J Nutr Biochem 2009; 20:927-39. [DOI: 10.1016/j.jnutbio.2009.06.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 05/26/2009] [Accepted: 06/19/2009] [Indexed: 11/16/2022]
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The effect of a very high daily plant stanol ester intake on serum lipids, carotenoids, and fat-soluble vitamins. Clin Nutr 2009; 29:112-8. [PMID: 19709787 DOI: 10.1016/j.clnu.2009.08.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/24/2009] [Accepted: 08/05/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Intake of 2-3 g/d of plant stanols as esters lowers LDL cholesterol level, but there is no information about the efficacy and safety of a respective very high daily intake. We studied the effects of 8.8 g/d of plant stanols as esters on serum lipids and safety variables in subjects with mild to moderate hypercholesterolemia. METHODS In a randomized, double-blind, placebo-controlled study the intervention (n=25) and control (n=24) groups consumed spread and drink enriched or not with plant stanol esters for 10 weeks. RESULTS Plant stanols reduced serum total and LDL cholesterol concentrations by 12.8 and 17.3% from baseline and by 12.0 and 17.1% from controls (P<0.01 for all). Liver enzymes, markers of hemolysis, and blood cells were unchanged. Serum vitamins A, D, and gamma-tocopherol concentrations, and the ratios of alpha-tocopherol to cholesterol were unchanged. Serum beta-carotene concentrations decreased significantly from baseline and were different from controls even when adjusted for cholesterol. Serum alpha-carotene concentration and alpha-carotene/cholesterol ratio were not different from controls. CONCLUSIONS High intake of plant stanols reduced LDL cholesterol values without any other side effects than reduction of serum beta-carotene concentration. However, the end product, serum vitamin A levels, were unchanged. The results suggest that plant stanol ester intake can be increased to induce a greater cholesterol lowering effect.
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Carr TP, Krogstrand KLS, Schlegel VL, Fernandez ML. Stearate-enriched plant sterol esters lower serum LDL cholesterol concentration in normo- and hypercholesterolemic adults. J Nutr 2009; 139:1445-50. [PMID: 19535421 DOI: 10.3945/jn.109.106328] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Studies in our laboratory have previously demonstrated in hamsters a superior cholesterol-lowering ability of plant sterol (PS) esters enriched in stearate compared with linoleate. We therefore conducted a randomized, double-blind, 2-group parallel, placebo-controlled study to test the cholesterol-lowering properties of stearate-enriched PS esters in normo- and hypercholesterolemic adults. Thirty-two adults, 16 per group with equal number of males and females in each group, participated in the 4-wk study. Participants consumed 3 g/d (1 g three times per day with meals) of either PS esters or placebo delivered in capsules. Serum LDL cholesterol concentration significantly decreased 0.42 mmol/L (11%) and the LDL:HDL cholesterol ratio decreased 10% with PS ester supplementation, whereas LDL particle size and lipoprotein subclass particle concentrations (as measured by NMR) were not affected. The percent change in LDL cholesterol was positively correlated with baseline lathosterol concentration (r = 0.729; P = 0.0014), indicating an association between the magnitude of LDL change and the rate of whole-body cholesterol synthesis. Serum campesterol (but not sitosterol) concentration significantly increased in the PS ester group. Serum tocopherol, retinol, and beta-carotene concentrations were not affected by PS ester supplementation. Thus, our findings demonstrate the usefulness of a novel stearate-enriched PS ester compound in decreasing LDL cholesterol in both normo- and hypercholesterolemic adults. The extent to which PS ester fatty acid composition affects intestinal micelle formation and cholesterol absorption in humans requires further study.
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Affiliation(s)
- Timothy P Carr
- Departments of Nutrition and Health Sciences, University of Nebraska, Lincoln, NE 68583, USA.
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35
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Windler E, Zyriax BC, Kuipers F, Linseisen J, Boeing H. Association of plasma phytosterol concentrations with incident coronary heart disease. Atherosclerosis 2009; 203:284-90. [DOI: 10.1016/j.atherosclerosis.2008.06.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 06/13/2008] [Accepted: 06/13/2008] [Indexed: 02/04/2023]
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36
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Llop JM, Virgili N, Moreno-Villares JM, García-Peris P, Serrano T, Forga M, Solanich J, Pita AM. Phytosterolemia in parenteral nutrition patients: Implications for liver disease development. Nutrition 2008; 24:1145-52. [DOI: 10.1016/j.nut.2008.06.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 06/09/2008] [Accepted: 06/17/2008] [Indexed: 11/29/2022]
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Baseline plasma plant sterol concentrations do not predict changes in serum lipids, C-reactive protein (CRP) and plasma plant sterols following intake of a plant sterol-enriched food. Eur J Clin Nutr 2007; 63:543-51. [PMID: 18073779 DOI: 10.1038/sj.ejcn.1602969] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Plant sterol (PS) consumption lowers serum cholesterol levels, while modestly increasing plasma PS concentrations. Plasma PS concentrations may reflect sterol absorption, thus individuals with high plasma plant sterol (HPS) concentrations may show greater changes in circulating cholesterol and PS than individuals with low plasma plant sterol (LPS) concentrations. The objective of this study was to examine whether HPS and LPS concentrations are related to subsequent changes in plasma PS, serum lipid and C-reactive protein (CRP) concentrations, following dietary PS intake in otherwise healthy hypercholesterolemic men. SUBJECTS/METHODS This single-blinded, randomized, diet-controlled study consisted of two 4-week phases, separated by a 4-week washout, where a diet with a placebo or the 2.0 g per day PS-enriched spread was consumed during the phases. RESULTS At baseline, men with HPS possessed higher (P<0.01) mean serum cholesterol concentration, while those with LPS had higher (P<0.05) body mass index. Following PS intake, plasma sum of campesterol plus sitosterol concentrations were elevated from 34.6+/-4.2 to 46.2+/-3.3 micromol l(-1) (mean+/-SE) and 16.5+/-0.9 to 20.8+/-1.2 micromol l(-1) after PS intake in men with HPS and LPS, respectively. Changes in plasma PS concentrations, however, were not different between individuals with either HPS or LPS baseline concentrations. Total cholesterol and low-density lipoprotein cholesterol levels were decreased (P<0.0001) by 6.3 and 7.8%, respectively, with PS consumption for all individuals. Changes in lipid parameters were not different between individuals with HPS or LPS baseline concentrations. No changes in CRP were apparent subsequent to PS intervention. CONCLUSIONS Baseline plasma PS concentrations are not associated or predictive of changes in serum cholesterol or plasma PS concentrations after PS intervention. Thus, individuals with HPS show similar increases in PS concentrations as individuals with LPS following PS supplementation. Plasma PS remained in the range of previously reported concentrations.
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Clifton PM, Mano M, Duchateau GSMJE, van der Knaap HCM, Trautwein EA. Dose-response effects of different plant sterol sources in fat spreads on serum lipids and C-reactive protein and on the kinetic behavior of serum plant sterols. Eur J Clin Nutr 2007; 62:968-77. [PMID: 17538539 DOI: 10.1038/sj.ejcn.1602814] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To test the dose-response effect on low-density lipoprotein cholesterol (LDL-c) of plant sterols (PS) from different sources in a low-fat spread. METHODS Dose responses of soybean oil (BO), tall oil (TO) and a mix of tall oil and rapeseed oil (TO/RP) as fatty acid esters were tested in a parallel design in free-living subjects recruited from the general community who had elevated cholesterol concentrations. Subjects received either control for 6 weeks or 1.6 g PS per day for 3 weeks, then 3.0 g/day for 3 weeks. RESULTS LDL-c was lowered significantly by consumption of 1.6 g/day of PS (-10.4%, range -7.3 to -11.4%). Increasing the dose to 3.0 g/day modestly reduced LDL-c concentrations further to -14.7%. TO, containing 78% sitosterol, produced an increase in serum sitosterol of 6.5 nmol/ml, while BO, containing only 27% campesterol, produced an increase in serum campesterol of 9.5 nmol/ml in 6 weeks. After PS withdrawal, serum sterols declined by 50% within 2 weeks. CONCLUSION Different PS sources were equally effective in lowering serum LDL-c concentrations. The decrease in absolute concentrations of LDL-c was dependent on the baseline concentrations.
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Affiliation(s)
- P M Clifton
- CSIRO Human Nutrition, Adelaide, South Australia, Australia.
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Abstract
Phytochemicals have been proposed to offer protection against a variety of chronic ailments including cardiovascular diseases, obesity, diabetes, and cancer. As for cancer protection, it has been estimated that diets rich in phytochemicals can significantly reduce cancer risk by as much as 20%. Phytosterols are specific phytochemicals that resemble cholesterol in structure but are found exclusively in plants. Phytosterols are absorbed from the diet in small but significant amounts. Epidemiological data suggest that the phytosterol content of the diet is associated with a reduction in common cancers including cancers of the colon, breast, and prostate. The means by which dietary phytosterols may be achieving these effects is becoming clearer from molecular studies with tumorigenic research models. Phytosterols affect host systems potentially enabling more robust antitumor responses, including the boosting of immune recognition of cancer, influencing hormonal dependent growth of endocrine tumors, and altering sterol biosynthesis. In addition, phytosterols have effects that directly inhibit tumor growth, including the slowing of cell cycle progression, the induction of apoptosis, and the inhibition of tumor metastasis. This review summarizes the current state of knowledge regarding the anticancer effects of phytosterols.
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Affiliation(s)
- Peter G Bradford
- Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14214-3000, USA.
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Polagruto JA, Wang-Polagruto JF, Braun MM, Lee L, Kwik-Uribe C, Keen CL. Cocoa flavanol-enriched snack bars containing phytosterols effectively lower total and low-density lipoprotein cholesterol levels. ACTA ACUST UNITED AC 2006; 106:1804-13. [PMID: 17081832 DOI: 10.1016/j.jada.2006.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dietary intervention studies incorporating phytosterol-enriched margarine spreads have reported significant decreases in total and low-density lipoprotein (LDL) cholesterol in populations with both normal lipid levels and those with hypercholesterolemia. There is emerging support for more diverse and lower-fat phytosterol-enriched matrixes. Controversy exists, however, over whether phytosterol-enriched foods affect serum fat-soluble vitamins. OBJECTIVE We investigated whether a flavanol-rich cocoa snack food containing phytosterols would decrease total and LDL cholesterol levels in subjects with hypercholesterolemia and significantly affect serum fat-soluble vitamins and carotenoids. DESIGN A randomized, double-blind parallel arm study design was used. Subjects were randomized to one of two dietary treatments: a cocoa flavanol-enriched snack bar containing 1.5 g phytosterol (n=32), or a control product containing no phytosterols (n=35). Subjects consumed two servings per day. RESULTS Consumption of the phytosterol-enriched snack bars but not control bars for 6 weeks was associated with significant reductions in plasma total (4.7%; P<0.01) and LDL cholesterol (6%; P<0.01), and the ratio of total to high-density lipoprotein cholesterol (7.4%; P<0.001). There were no changes in high-density lipoprotein cholesterol, triglycerides, or lipid-adjusted lycopene, beta-cryptoxanthin, lutein/zeaxanthin, alpha-carotene levels, or levels of serum vitamins A or E. A significant reduction in lipid-adjusted serum beta-carotene was observed in the phytosterol but not the no-phytosterol-added group (P<0.05). CONCLUSIONS This study supports the use of a novel phytosterol-enriched snack bar to effectively reduce plasma total and LDL cholesterol levels in a population with hypercholesterolemia. The data suggest that the incorporation of this snack food into a balanced diet represents a practical dietary strategy in the management of serum cholesterol levels.
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Chan YM, Varady KA, Lin Y, Trautwein E, Mensink RP, Plat J, Jones PJH. Plasma Concentrations of Plant Sterols: Physiology and Relationship with Coronary Heart Disease. Nutr Rev 2006; 64:385-402. [PMID: 17002235 DOI: 10.1111/j.1753-4887.2006.tb00224.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recently, it has been questioned whether elevated levels of circulating plant sterols increase the risk of coronary heart disease (CHD). To date, no definitive conclusions regarding such a relationship have been reached, nor have there been any studies summarizing the factors that contribute to the observed elevations in plant sterol concentrations in plasma. Thus, the purpose of this review is to systematically compare the plant sterol levels of subjects from the general population and to describe factors that contribute to the variations observed. The question of whether elevated plasma concentrations of plant sterols are associated with an increased risk of CHD was also assessed. Results indicate that the key factors accounting for variations in circulating plant sterol concentrations include: apolipoprotein E phenotypes, ATP-binding cassette transporter polymorphisms, use of statin drugs, presence of metabolic syndrome, dietary intake of plant sterols, gender, and analytical techniques used in the measurement of plant sterols in the plasma. An analysis of the studies examining the relationship between circulating levels of plant sterols and CHD risk in non-sitosterolemic populations revealed no clear associations. Furthermore, it was shown that the above-mentioned factors play an important role in determining the levels of plant sterols in plasma. Since these factors may act as potential confounders, they must be controlled for before more solid conclusions can be reached.
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Affiliation(s)
- Yen-Ming Chan
- School of Dietetics and Human Nutrition, McGill University, 21,111 Lakeshore Road, Ste. Anne de Bellevue, Québec, Canada H9X 3V9
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Jakulj L, Vissers MN, Rodenburg J, Wiegman A, Trip MD, Kastelein JJP. Plant stanols do not restore endothelial function in pre-pubertal children with familial hypercholesterolemia despite reduction of low-density lipoprotein cholesterol levels. J Pediatr 2006; 148:495-500. [PMID: 16647412 DOI: 10.1016/j.jpeds.2005.11.023] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2005] [Revised: 10/06/2005] [Accepted: 11/04/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To examine the effect of plant stanols on lipids and endothelial function in pre-pubertal children with familial hypercholesterolemia (FH). STUDY DESIGN Children with FH (n=42), aged 7-12 years, were enrolled in a double-blind crossover trial, in which they consumed 500 mL of a low-fat yogurt enriched with 2.0 g of plant stanols and 500 mL of a low-fat placebo yogurt for 4 weeks, separated by a 6-week washout period. Lipid profiles and endothelial function were assessed after both consumption periods. Endothelial function was measured as flow-mediated dilation (FMD) of the brachial artery. RESULTS This daily intake of 2.0 g of stanols significantly decreased the levels of total cholesterol (TC) by 7.5% and low-density lipoprotein cholesterol (LDL-C) by 9.2% as compared with placebo. High-density lipoprotein cholesterol and triglyceride levels remained unaltered. The reduction of LDL-C levels did not improve FMD, which was 10.5%+/-5.1% after plant stanol consumption and 10.6%+/-5.0% after placebo consumption, respectively (P=.852). CONCLUSION This study demonstrates that plant stanols reduce LDL-C levels in children with FH without improving endothelial function.
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Affiliation(s)
- Lily Jakulj
- Department of Vascular Medicine, and Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
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Rudkowska I, Roynette CE, Nakhasi DK, Jones PJH. Phytosterols mixed with medium-chain triglycerides and high-oleic canola oil decrease plasma lipids in overweight men. Metabolism 2006; 55:391-5. [PMID: 16483884 DOI: 10.1016/j.metabol.2005.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 09/24/2005] [Indexed: 11/29/2022]
Abstract
Phytosterols (PSs) have been recently added to various mediums. Nevertheless, matrices with functional properties, such as medium-chain triglycerides (MCTs), should be precisely examined for supplementary advantages. The objective of this study was to identify the existence of combined biological actions of a functional oil enriched in PSs within MCTs and high-oleic canola (HOC), relative to a control (olive oil), in overweight, hyperlipidemic men using a rigorously controlled dietary intervention. Twenty-three overweight, hyperlipidemic men consumed both types of oil in a randomized, crossover trial for 6 weeks each. Fasted plasma samples were collected on the first and last 2 days of each study period. Body weight decreased -1.22 +/- 0.35 kg (P = .0019) and -1.68 +/- 0.47 kg (P = .0016) after the 6-week study period in the olive oil and functional oil groups, respectively. The end points for total cholesterol and low-density lipoprotein cholesterol (LDL-C) in the functional oil group (P = .0006) were lower than in the olive oil group (P = .0002). Total cholesterol values decreased from comparable baseline to end point of 4.71 +/- 0.16 mmol/L (P < .0001) in the functional oil phase and 5.14 +/- 0.19 mmol/L (P = .0001) in the olive oil phase (P = .0592). In addition, LDL-C demonstrated a similar drop, to an end point of 3.12 +/- 0.16 mmol/L (P < .0001) and 3.54 +/- 0.18 mmol/L (P = .0002), for the functional oil and olive oil groups, respectively, with significant changes (P = .0221). High-density lipoprotein cholesterol levels did not change in either treatment. Triacylglycerol end points decreased in functional oil and olive oil groups (P = .0195 and .0105, respectively) to the same extent from baseline. Results indicate that PSs mixed within an MCT- and HOC-rich matrix lower plasma LDL-C, without significantly changing the high-density lipoprotein cholesterol concentrations, in hyperlipidemic, overweight men, and may therefore decrease the risk of cardiovascular events.
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Affiliation(s)
- Iwona Rudkowska
- School of Dietetics and Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal, Québec, Canada H9X 3V9
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Moruisi KG, Oosthuizen W, Opperman AM. Phytosterols/Stanols Lower Cholesterol Concentrations in Familial Hypercholesterolemic Subjects: A Systematic Review with Meta-Analysis. J Am Coll Nutr 2006; 25:41-8. [PMID: 16522931 DOI: 10.1080/07315724.2006.10719513] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To-date, reviews regarding the cholesterol lowering capacity of phytosterols/stanols have focused on normo- and hypercholesterolemic (HC) subjects. Familial hypercholestrolemia (FH) is characterized by very high low-density lipoprotein cholesterol (LDL-C) concentrations and is considered a world public health problem due to the high incidence of premature coronary heart disease (CHD) in these patients. OBJECTIVE To conduct a systematic review that investigates the efficacy of phytosterols/stanols in lowering total cholesterol (TC) and LDL-C concentrations in FH subjects. DESIGN Randomized controlled intervention trials with the primary objective to investigate the effects of phytosterols/stanols on lipid concentrations in FH subjects were identified through selected international journal databases and reference lists of relevant publications. Two researchers extracted data from each identified trial and only trials of sufficient quality (e.g. controlled, randomized, double-blind, good compliance, sufficient statistical power) were included in the review. The main outcome measures were differences between treatment and control groups for LDL-C, TC, high-density lipoprotein cholesterol (HDL-C) and triacylglycerol (TG). RESULTS Six out of 13 studies were of sufficient quality. Two were excluded from the meta-analysis because the sterols were administered in the granulate form at very high dosages (12 g/day and 24 g/day) compared to the other studies that used fat spreads as vehicle with dosages ranging from 1.6-2.8 g/day. The subjects were heterozygous, aged 2-69 years with baseline TC and LDL-C concentrations of +/-7 mmol/L and +/-5.4 mmol/L, respectively. The duration of the studies ranged from 4 weeks to 3 months. Fat spreads enriched with 2.3 +/- 0.5 g phytosterols/stanols per day significantly reduced TC from 7 to 11% with a mean decrease of 0.65 mmol/L [95% CI -0.88, -0.42 mmol/L], p < 0.00001 and LDL-C from 10-15% with a mean decrease of 0.64 mmol/L [95% CI -0.86, -0.43 mmol/L], p < 0.00001 in 6.5 +/- 1.9 weeks compared to control treatment, without any adverse effects. TG and HDL-C concentrations were not affected. CONCLUSION Phytosterols/stanols may offer an effective adjunct to the cholesterol lowering treatment strategy of FH patients.
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Affiliation(s)
- Kgomotso G Moruisi
- School of Physiology, Nutrition and Consumer Science, North-West University, Private Bag X6001 (Internal box 594), Potchefstroom, 2520, South Africa
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Patch CS, Tapsell LC, Williams PG, Gordon M. Plant sterols as dietary adjuvants in the reduction of cardiovascular risk: theory and evidence. Vasc Health Risk Manag 2006; 2:157-62. [PMID: 17319460 PMCID: PMC1993991 DOI: 10.2147/vhrm.2006.2.2.157] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Plant sterol-enriched foods are an effective dietary adjuvant in reducing cardiovascular risk by lowering total cholesterol and low density lipoprotein-cholesterol (LDL-C) in serum by up to approximately 15%. The mechanism of action of plant sterols is different from those of 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) and thus their effect is additive. Combining plant sterols with other dietary components known to reduce cholesterol in a portfolio approach has proven to be most effective for reduction of hypercholesterolemia and provide an alternative treatment option for clinicians. Plant sterol-enriched foods provides clinicians with a relatively cheap, safe, and effective way to help patients manage their cardiovascular risk.
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Affiliation(s)
- Craig S Patch
- National Centre of Excellence in Functional Foods, Northfields Avenue, University of Wollongong, New South Wales, Australia.
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Domeño C, Ruiz B, Nerín C. Determination of sterols in biological samples by SPME with on-fiber derivatization and GC/FID. Anal Bioanal Chem 2005; 381:1576-83. [PMID: 15827725 DOI: 10.1007/s00216-005-3056-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Revised: 12/13/2004] [Accepted: 01/03/2005] [Indexed: 10/25/2022]
Abstract
A new procedure for the determination of sterols in serum samples is proposed. The system consists of coating a Solid Phase Microextraction (SPME) microfiber in headspace mode with the derivatizing agent N,O-bis(trimethylsilyl)trifluoracetamide (BSTFA) and then applying this coated fiber to the simultaneous extraction and derivatization of three precursors in the cholesterol biosynthesis pathway (desmosterol, lathosterol and lanosterol) and two phytosterols (sitosterol and sitostanol) in serum samples. Optimization of the analytical procedure via the application of an experimental design, a study of matrix effects, and an analysis of serum pool samples are all described and discussed.
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Affiliation(s)
- Celia Domeño
- Department of Analytical Chemistry, Centro Politécnico Superior (CPS), University of Zaragoza, María de Luna 3, 50018 Zaragoza, Spain
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Sullivan DR. The clinical and nutritional implications of lipid-lowering drugs that act in the gastrointestinal tract. Curr Opin Lipidol 2005; 16:39-45. [PMID: 15650562 DOI: 10.1097/00041433-200502000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW A new class of cholesterol-lowering therapy that reduces intestinal sterol absorption has recently been introduced. This increases the number of classes of lipid-lowering agents that directly affect gastrointestinal function and raises questions concerning the overall effect of these agents on absorption and nutritional status. RECENT FINDINGS A recent assessment notes a paucity of information concerning the factors that affect the bioavailability and intestinal absorption of lipophilic nutrients. By contrast, the specificity of the mechanisms of action of new drugs acting on the gastrointestinal tract may circumvent some of the detrimental effects on nutrient and drug bioavailability that have been noted with older forms of treatment. SUMMARY The clinical imperative for aggressive control of lipid and metabolic risk factors makes widespread use, alone or in combination, of lipid-lowering agents that affect the gastrointestinal tract seem increasingly likely. Whilst the opportunity for therapeutic synergy is attractive, care will be required to avoid interference with intestinal absorptive function.
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Affiliation(s)
- David R Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
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