Effect of a diet based on low-fat foods enriched with nonesterified plant sterols and mineral nutrients on serum cholesterol


      Plant sterols have been incorporated into nutritional fats to achieve cholesterol lowering, but studies using enrichment of low-fat foods with plant sterols have not been reported. Our study was aimed at determining the effect of dietary intake of low-fat foods containing natural nonesterified plant sterols together with recommended doses of calcium, magnesium, and potassium on serum cholesterol and low-density lipoprotein (LDL) cholesterol-lowering in persons with mild to moderate hypercholesterolemia. This was a randomized, double-blind, placebo-controlled feeding trial lasting 15 weeks and performed in 2 university hospital centers. Seventy-eight subjects aged 25 to 75 years with serum cholesterol concentrations varying between 6 mmol/L (232 mg/dl) and 8 mmol/L (310 mg/dl) were randomly allocated to active treatment consisting of intake of bread, meat products, and jam enriched with 1.25 to 5.0 g/day of plant sterols and the slightly elevated concentrations of mineral nutrients, or the corresponding placebo food items. Serum lipid, high-density lipoprotein cholesterol and calculated LDL cholesterol concentrations were determined. Seventy-one persons completed the trial. Reduction in serum total cholesterol was 8% in the active treatment group and 3% in the placebo group (p = 0.0071) and that of LDL cholesterol was 13% in the active treatment group and 5% in the placebo group (p = 0.0070). In conclusion, natural nonesterified plant sterols contained in low-fat food items and ingested in moderate doses reduced serum total and LDL cholesterol concentrations to the same extent as reported previously for esterified plant sterol derivatives added to nutritional fats. The presence of mineral nutrients in doses recommended for blood pressure-lowering did not interfere with the cholesterol-lowering efficacy of the sterols, providing a promising approach to dietary prevention of cardiovascular diseases.
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        • Vaskonen T.J
        • Mervaala E
        • Sumuvuori V
        • Seppänen-Laakso T
        • Karppanen H
        Calcium and magnesium enhance the cholesterol-lowering effect of plant sterols in obese Zucker rats.
        Nutr Metab Cardiovasc Dis. 2001; 11: 158-167
        • Krauss R.M
        • Eckel R.H
        • Howard B
        • Appel L.J
        • Daniels S.R
        • Deckelbaum R.J
        • Erdman Jr, J.W
        • Kris-Etherton P
        • Goldberg T.J
        • Kotchen T.H
        AHA dietary guidelines. Revision 2000.
        Circulation. 2000; 102: 2296-2311
        • Sugiuchi H
        • Uji Y
        • Okabe H
        • Irie T
        • Uekama K
        • Kayahara N
        • Miyauchi K
        Measurement of high-density lipoprotein cholesterol in serum with polyethylene glycol-modified enzymes and sulfated alpha-cyclodextrin.
        Clin Chem. 1995; 41: 717-723
        • Friedewald W.T
        • Levy R.I
        • Fredrickson D.S
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Havel R.J
        • Eder H.A
        • Bragdon J.H
        The distribution and chemical composition of ultracentrifugally separated lipoproteins in human serum.
        J Clin Invest. 1955; 34: 1345-1353
        • Vahouny G.V
        • Kritchevsky D
        Plant and marine sterols and cholesterol metabolism.
        in: Nutritional Pharmacology. Alan R. Liss, New York, NY1981
        • Yacowitz H
        • Fleischman A.I
        • Bierenbaum M.L
        Effects of oral calcium upon serum lipids in man.
        Br Med J. 1965; 1: 1352-1354
        • Criqui M
        • Colombo B.A
        Epidemiologic aspects of lipid abnormalities.
        Am J Med. 1998; 105: 48S-57S
        • Miettinen T.A
        • Puska P
        • Gylling H
        • Vanhanen H
        • Vartiainen E
        Reduction of serum cholesterol with sitostanol ester margarine in a mildly hypercholesterolemic population.
        N Engl J Med. 1995; 333: 1308-1312
        • Weststrate J.A
        • Meijer G.W
        Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects.
        Eur J Clin Nutr. 1998; 52: 334-343
        • Gylling H
        • Puska P
        • Vartiainen E
        • Miettinen T.A
        Serum sterols during stanol ester feeding in a mildly hypercholesterolemic population.
        J Lipid Res. 1999; 40: 593-600
        • Hendriks H.F.J
        • Weststrate J.A
        • van Vliet T
        • Meijer G.W
        Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects.
        Eur J Clin Nutr. 1999; 53: 319-327
        • Moghadasian M.H
        • Frohlich J.J
        Effects of dietary phytosterols on cholesterol metabolism and atherosclerosis.
        Am J Med. 1999; 107: 588-594
        • Pollak O.J
        Reduction of blood cholesterol in man.
        Circulation. 1953; 7: 702-706
        • Pollak O.J
        Effect of plant serols on serum lipids and atherosclerosis.
        Pharmacol Ther. 1985; 31: 177-208
      1. Cater, N.B.; Grundy, S.M. Lowering serum cholesterol with plant sterols and stanols: a special report. Postgraduate Med 1998:6-14.

        • Lees A.M
        • Mok H.Y.I
        • Lees R.S
        • McCluskey M.A
        • Grundy S.M
        Plant sterols as cholesterol-lowering agents.
        Atherosclerosis. 1977; 28: 325-338
        • Denke M.A
        Lack of efficacy of low-dose sitostanol therapy as an adjunct to a cholesterol-lowering diet in men with moderate hypercholesterolemia.
        Am J Clin Nutr. 1995; 61: 392-396