Patti Sterols Final

5/28/2018 Patti Sterols Final

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Plant Sterols and Stanols in the

Management of Blood Cholesterol Levels

HNS 716 Nutrition Aspect of Disease

Phatcharee Lueyot and Maryna Lisai


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Hypothesis

Plant sterols and stanols lower intestinal

cholesterol absorption therefore lowering

blood cholesterol levels


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History

Since the 1950s dietary plant sterols and stanols have been

studied and showed to lower LDL-cholesterol levels

1952: Effects of soybean sterols in the diet on plasma and liver

cholesterol in chicks

1953: Absorption of cholesterol-4-C 14 in rats fed mixed soybean

sterols and sitosterol

1954: Lowering of Serum Cholesterol by the Administration of a

Plant Sterol

References;J. Nutrition 47: 57, 1952/Bio. &Med.83:498,1953/ Circulation, Volume X, August, 1954

J Lipid Res.1988;29:1589-91/ J Nutr Sci Vitaminol (Tokyo)1989;361-9

Based on their structural similarity to cholesterol- physicalInterference micellization in intestinal lumen


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Cholesterol absorption


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Structure of Cholesterol, Sterol and Stanol

4-desmethylsterols


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Effects of sterols and stanols on micellar composition


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Cholesterol-Lowering Effects

Compete with cholesterolin micellization

Regulation cholesterolsynthesis

Plan sterols

Increase bile acidsynthesis

Plant sterols and stanols

++

Cholesterol-

loweringEffect

Plant stanol-

Suppress bile acid

synthesis

Reference:Nutr Metab Cardiovas Dis (2004) 14:133-142


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FoodsThe typical daily intake of plant sterols and plant stanols is about 150-350 mg/d. However, in order to

get just 0.8 g/d (min effective dose) of plant sterols from these natural sources, you would need to

consume 22 oranges, 44 apples or 50 carrots.

Eur J Clin Nutr. 2008 Jun;62(6):695-703

Sources


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Supplements

Phytosterol supplements marketed as beta-sitosterol

are available without a prescription in the U.S.

Doses 60-130 mg/day

How to get an effective dose?

F.H. Mattson is a brilliant man who suggested esterification process of

plant sterols in 1972 to make them soluble in dietary fat.

Foods Enriched with Plant Sterols

and Plant Stanols

Just one tablespoon of Benecolspread

contains 0.850 g plant stanol esters.

Eur J Nutr 40 : 6673 (2001)


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Summarized data from 10 randomized trials where sterols

and stanols were solubilized in fat-containing food

Effective dose

It has been demonstrated that 2-3 g/d of plant sterols and stanols can

reduce total and LDL-cholesterol levels by 10-20%

Mayo Clin Proc. 2003;78:965-978


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Effect of frequency intake

- Most of the trials, the total daily intake of plant sterols and stanols was

divided into 2 or 3 portions over the day

- However, 3 studies showed that 2-3 g of plant stanols taken at lunchproduced the same LDL-lowering effects as 2-3 g divided over 3 meals.

# What the exact mechanism of action?

Responses of Subgroups

British Journal of Nutrition (2009), 101, 17971804 J Clin Endocrinol Metab. 2008 Nov;93(11):4200-9

0 5 10 15

Reduction in LDL (%)

pregnant women patients with diabetes children


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Main study 150 patients with mild hypercholesterolaemia (TC=200-250 mg/dl). Age 553 ,

BMI27 kg/m.

Study design: Prospective, randomized, placebo-controlled study.

Patients were randomly assigned to 1 of the following 3 groups:

1. Plant stanol ester spread (2 g/day) group (n=50)

2. Placebo group (n=50)

3. Mediterranean diet group (n=50)

The intervention period 16 weeks.

Placebo

Mediterraneandiet

Plant stanols

Nutrition, Metabolism & Cardiovascular Diseases (2009) xx, 1-9


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Side effects

Fat-soluble Vitamins (vitamins A, D, E and K)

-The effects on fat-soluble vitamin status have beenstudied in clinical trials.

- The majority of studies found no changes in plasma

vitamin A, E, D concentrations.

- There is little evidence that plant sterol or stanolconsumption adversely affects vitamin K status.

Carotenoids

- Dietary carotenoids are fat-soluble phytochemicals that circulate in

lipoproteins.

- A number of studies have observed about 10% reductions in plasma

carotenoids (alpha-carotene, beta-carotene).

- It was suggested that increasing the intake of carotenoid-rich vegetables and

fruits can compensate plasma carotenoid levels.


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Drugs interaction- It has been observed that No Drug Interaction.

- Patients who are takingstatinsand need additional

cholesterol lowering, it is more effective to add sterols

and stanols to their diets than to increase statin doses.

Atherosclerosis

- Using plant sterol (not plant stanol) enriched productselevates serum

plant sterol concentrations in humans.

- One of the concerns is the potential atherogenic effect of circulatingsitosterols and campsterols.

- High levels of sitosterols associated with very rare genetic disorder called

phytosterolemia. Patients with phytosterolemia has a high rate of

atherosclerosis. In addition, several epidemiological studies support this

assumption .


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Pre-SREBPSREBP2

Micelle

Cholesterol synthesis

Reference: ASEB J. 16 12481253 2002

chymlomicron LDL


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Pre-SREBP

Mixed micelle

Effects

OfSterols

And

Stanols

Cholesterol synthesis

ABCA1

Reference. Lipid Res. 2005. 46: 24682476.

SREBP2

chymlomicron LDL


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Conclusion

Recommendation: 2-3 g/day for

hypercholesterolemic people

Food enriched sterols and stanols (esterified)

Lower 10-20% LDL-Cholesterol, no effects on TG

and HDL Lower total cholesterol; preferable for the long-

term management of hypercholesterolemia

No side effect

Safety

Gene regulation of phytosterols is still unclear


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Opinions

Recommend plant stanols for hypercholesterolemicpeople (A-level evidence) ; healthy people should

manage their cholesterol level through balance diet

Regulation in genomic level is partially unclear**

Could reduce the risk for CHD up to 20%, thus,

there is a theoretical possibility. More future

research on CHDs

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