Plant sterols and stanols that lower low-density lipoprotein cholesterol
https://doi.org/10.21626/vestnik/2022-2/10
Abstract
Objective: analyze and evaluate scientific literature data on the need for the use of plant sterols and stanols for the treatment of hypercholesterolemia in order to reduce the risk of coronary heart disease. Materials and methods. The article summarizes the information of scientific publications in the journals of search systems PubMed, Scopus, Google Scholar, as well as library databases (eLibrary). Results. Phytosterols (phytosterols), phytostanols, are lipid-like compounds found in foods of plant origin. Their structure is similar to cholesterol and therefore they successfully compete with it for absorption in the intestine, thus reducing the flow of cholesterol into the bloodstream. As a result of this therapy for hypercholesterolemia, the risk of coronary heart disease is reduced. The factors influencing the efficacy of sterols/stanols and ways to improve therapy with their use are discussed in the review. The effect of stanols on the immune system is also presented. Conclusion. Food products enriched with sterols and stanols (yoghurt, kefir, milk, spreads, etc.) are promising tools in the complex of non-medicinal measures to reduce LDL cholesterol levels, an established risk factor for CHD, and their introduction into the diet will contribute to the prevention of CHD among the Russian population.
About the Author
Victoria V. Fedotova
Pyatigorsk Medical and Pharmaceutical Institute - a branch of Volgograd State Medical University (PMPhI - a branch of the VolgSMU)
Russian Federation
Russian Federation
References
1. MacKay D.S., Gebauer S.K., Eck P.K., Baer D.J., Jones P.J. Lathosterol-to-cholesterol ratio in serum predicts cholesterol-lowering response to plant sterol consumption in a dual-center, randomized, single-blind placebo-controlled trial. Am J Clin Nutr. 2015;101(3):432-439. DOI: 10.3945/ajcn.114.095356
2. Lugasi A. Foods fortified with phytosterins: their role in decreasing serum cholesterol level, their European Community authorization and requirements for placing them on the market. Orv Hetil. 2009;150(11): 483-496. DOI: 10.1556/OH.2009.28572 (in Hun.)
3. Ras R.T., Fuchs D., Koppenol W.P., Garczarek U., Greyling A., Keicher C., Verhoeven C., Bouzamondo H. et al. The effect of a low-fat spread with added plant sterols on vascular function markers: results of the Investigating Vascular Function Effects of Plant Sterols (INVEST) study. Am J Clin Nutr. 2015;101(4):733-741. DOI: 10.3945/ajcn.114.102053
4. Jones P.J.H., Shamloo M., MacKay D.S., Rideout T.C., Myrie S.B., Plat J., Roullet J.B., Baer D.J. et al. Progress and perspectives in plant sterol and plant stanol research. Nutr Rev. 2018;76(10):725-746. DOI: 10.1093/nutrit/nuy032
5. Demonty I., Ras R.T., van der Knaap H.C., Duchateau G.S., Meijer L., Zock P.L., Geleijnse J.M., Trautwein E.A. Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake. J Nutr. 2009;139(2):271-284. DOI: 10.3945/jn.108.095125
6. Katan M.B., Grundy S.M., Jones P., Law M., Miettinen T., Paoletti R, Stresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. 2003 ;78(8):965-78. DOI: 10.4065/78.8.965
7. Sarkkinen E., Lyyra M., Nieminen S., Kuusisto P., Wester I. Cereal-Based Snack Bar with Added Plant Stanol Ester (Benecol®) Consumed between Meals Lowers Serum Total and LDL Cholesterol Effectively in Mildly to Moderately Hypercholesterolemic Subjects. Cholesterol. 2018;2018:1463628. DOI: 10.1155/2018/1463628
8. Blom W.A.M., Koppenol W.P., Hiemstra H., Stojakovic T., Scharnagl H., Trautwein E.A. A low-fat spread with added plant sterols and fish omega-3 fatty acids lowers serum triglyceride and LDL-cholesterol concentrations in individuals with modest hypercholesterolaemia and hypertriglyceridaemia. Eur J Nutr. 2019;58(4):1615-1624. DOI: 10.1007/s00394-018-1706-1
9. Cheung C.L., Ho D.K., Sing C.W., Tsoi M.F., Cheng V.K., Lee G.K., Ho Y.N., Cheung B.M. Randomized controlled trial of the effect of phytosterols-enriched low-fat milk on lipid profile in Chinese. Sci Rep. 2017;7:41084. DOI: 10.1038/srep41084
10. Chau Y.P., Cheng Y.C., Sing C.W., Tsoi M.F., Cheng V.K., Lee G.K., Cheung C.L., Cheung B.M.Y. The lipid-lowering effect of once-daily soya drink fortified with phytosterols in normocholesterolaemic Chinese: a double-blind randomized controlled trial. Eur J Nutr. 2020;59(6):2739-2746. DOI: 10.1007/s00394-019-02119-w
11. Jew S., Antoine J., Bourlioux P., Milner J., Tapsell L.C., Yang Y., Jones, P.J.H. Nutrient essentiality revisited. Journal of Functional foods. 2015;14(20):3-209
12. Hansel B., Carrié A., Brun-Druc N., Leclert G., Chantepie S., Coiffard A.S., Kahn J.F,. Chapman M.J. et al. Premature atherosclerosis is not systematic in phytosterolemic patients: severe hypercholesterolemia as a confounding factor in five subjects. Atherosclerosis. 2014;234(1):162-168. DOI: 10.1016/j.atherosclerosis.2014.02.030
13. Federal State Statistics Service (in Russ.). URL: https://www.gks.ru
14. Khuchieva M.A., Perova N.V., Akhmedzhanov N.M. Plant sterols and stanols as dietary factors that reduce hypercholesterolemia by inhibiting intestinal absorption of cholesterol. Cardiovascular therapy and prevention. 2011;10(6):124-132 (in Russ.). DOI: 10.15829/1728-8800-2011-6-124-132. EDN: OCCFZL
15. Safaryan A.S., Kamyshova T.V., Nebieridze D.V., Sargsyan V.D. The role of plant stanols in the primary prevention of hypercholesterolemia in patients with arterial hypertension. Cardiovascular therapy and prevention. 2019;18(3);5-10 (in Russ.). DOI: 10.15829/1728-8800-2019-3-5-10. EDN: JZSRMR
16. Perova N.V. Non-pharmaceutical hypercholesterolemia management by plant stanol-enriched product consumption. Cardiovascular therapy and prevention. 2006;5(5):64-69 (in Russ.). EDN: ISVXZJ
17. Register of products that have passed state registration (in Russ.). URL: http://fp.crc.ru
18. Moreau R.A.Composition of Plant Sterols and Stanols in Supplemented Food Products. J AOAC Int. 2015;98(3):685-690. DOI: 10.5740/jaoacint.SGEMoreau
19. Moreau R.A., Whitaker B.D., Hicks K.B. Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and health-promoting uses. Prog Lipid Res. 2002;41(6):457-500. DOI: 10.1016/s0163-7827(02)00006-1
20. Ras R.T., Geleijnse J.M., Trautwein E.A. LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr. 2014;112(2):214-219. DOI: 10.1017/S0007114514000750
21. Jones P.J., Demonty I., Chan Y.M., Herzog Y., Pelled D. Fish-oil esters of plant sterols differ from vegetable-oil sterol esters in triglycerides lowering, carotenoid bioavailability and impact on plasminogen activator inhibitor-1 (PAI-1) concentrations in hypercholesterolemic subjects. Lipids Health Dis. 2007;6:28. DOI: 10.1186/1476-511X-6-28
22. Carr T.P., Krogstrand K.L., Schlegel V.L., Fernandez M.L. Stearate-enriched plant sterol esters lower serum LDL cholesterol concentration in normo- and hypercholesterolemic adults. J Nutr. 2009;139(8):1445-1450. DOI: 10.3945/jn.109.106328
23. Doornbos A.M., Meynen E.M., Duchateau G.S., van der Knaap H.C., Trautwein E.A.Intake occasion affects the serum cholesterol lowering of a plant sterol-enriched single-dose yoghurt drink in mildly hypercholesterolaemic subjects. Eur J Clin Nutr. 2006;60(3):325-333. DOI: 10.1038/sj.ejcn.1602318
24. Kriengsinyos W., Wangtong A., Komindr S. Serum cholesterol reduction efficacy of biscuits with added plant stanol ester. Cholesterol. 2015;2015:353164. DOI: 10.1155/2015/353164
25. Ras R.T., Koppenol W.P., Garczarek U., Otten-Hofman A., Fuchs D., Wagner F., Trautwein E.A. Increases in plasma plant sterols stabilize within four weeks of plant sterol intake and are independent of cholesterol metabolism. Nutr Metab Cardiova DOI: 10.1016/j.numecd.2015.11.007
26. Brüll F., De Smet E., Mensink R.P., Vreugdenhil A., Kerksiek A., Lütjohann D., Wesseling G., Plat J. Dietary plant stanol ester consumption improves immune function in asthma patients: results of a randomized, double-blind clinical trial. Am J Clin Nutr. 2016;103(2):444-453. DOI: 10.3945/ajcn.115.117531
27. Trautwein E.A., Koppenol W.P., de Jong A., Hiemstra H., Vermeer M.A., Noakes M., Luscombe-Marsh N.D. Plant sterols lower LDL-cholesterol and triglycerides in dyslipidemic individuals with or at risk of developing type 2 diabetes; a randomized, double-blind, placebo-controlled study. Nutr Diabetes. 2018;8(1):30. DOI: 10.1038/s41387-018-0039-8
28. Shaghaghi M.A., Harding S.V., Jones P.J.H. Water dispersible plant sterol formulation shows improved effect on lipid profile compared to plant sterol esters. J Funct Foods. 2014;6:280-289
29. Maki K.C., Lawless A.L., Reeves M.S., Kelley K.M., Dicklin M.R., Jenks B.H., Shneyvas E., Brooks J.R. Lipid effects of a dietary supplement softgel capsule containing plant sterols/stanols in primary hypercholesterolemia. Nutrition. 2013;29(1):96-100. DOI: 10.1016/j.nut.2012.05.002
30. Sialvera T.E., Pounis G.D., Koutelidakis A.E., Richter D.J., Yfanti G., Kapsokefalou M., Goumas G., Chiotinis N. et al. Phytosterols supplementation decreases plasma small and dense LDL levels in metabolic syndrome patients on a westernized type diet. Nutr Metab Cardiovasc Dis. 2012;22(10):843-848. DOI: 10.1016/j.numecd.2010.12.004
31. Gylling H., Halonen J., Lindholm H., Konttinen J., Simonen P., Nissinen M.J., Savolainen A., Talvi A. et al. The effects of plant stanol ester consumption on arterial stiffness and endothelial function in adults: a randomised controlled clinical trial. BMC Cardiovasc Disord. 2013;13:50. DOI: 10.1186/1471-2261-13-50
32. Ras R.T., Fuchs D., Koppenol W.P., Schalkwijk C.G., Otten-Hofman A., Garczarek U., Greyling A., Wagner F. et al. Effect of a plant sterol-enriched spread on biomarkers of endothelial dysfunction and low-grade inflammation in hypercholesterolaemic subjects. J Nutr Sci. 2016;5:e44. DOI: 10.1017/jns.2016.40
33. Ho X.L., Loke W.M. Dietary Plant Sterols Supplementation Increases In Vivo Nitrite and Nitrate Production in Healthy Adults: A Randomized, Controlled Study. J Food Sci. 2017;82(7):1750-1756. DOI: 10.1111/1750-3841.13752
34. Rideout T.C., Harding S.V., Mackay D., Abumweis S.S., Jones P.J. High basal fractional cholesterol synthesis is associated with nonresponse of plasma LDL cholesterol to plant sterol therapy. Am J Clin Nutr. 2010;92(1):41-46. DOI: 10.3945/ajcn.2009.29073
35. Rideout T.C., Harding S.V., Mackay D.S. Metabolic and genetic factors modulating subject specific LDL-C responses to plant sterol therapy. Can J Physiol Pharmacol. 2012;90(5):509-514. DOI: 10.1139/y2012-060
36. Weingärtner O., Bogeski I., Kummerow C., Schirmer S.H., Husche C., Vanmierlo T., Wagenpfeil G., Hoth M. et al. Plant sterol ester diet supplementation increases serum plant sterols and markers of cholesterol synthesis, but has no effect on total cholesterol levels. J Steroid Biochem Mol Biol. 2017;169:219-225. DOI: 10.1016/j.jsbmb.2016.07.016
37. MacKay D.S., Eck P.K., Gebauer S.K., Baer D.J., Jones P.J. CYP7A1-rs3808607 and APOE isoform associate with LDL cholesterol lowering after plant sterol consumption in a randomized clinical trial. Am J Clin Nutr. 2015;102(4):951-957. DOI: 10.3945/ajcn.115.109231
38. Nissinen M.J., Gylling H., Miettinen T.A. Responses of surrogate markers of cholesterol absorption and synthesis to changes in cholesterol metabolism during various amounts of fat and cholesterol feeding among healthy men. Br J Nutr. 2008;99(2):370-378. DOI: 10.1017/S0007114507811998
Review
For citations:
Fedotova V.V. Plant sterols and stanols that lower low-density lipoprotein cholesterol. Humans and their health. 2022;25(2):97-104. (In Russ.) https://doi.org/10.21626/vestnik/2022-2/10
Views:
898
Email this article 