Abstract
The LDL-cholesterol (LDL-C) lowering effect of plant sterols/stanols (PSS) is summarized in several meta-analyses showing a dose-response relationship with intakes of 1.5 to 3 g/day lowering LDL-C by 7.5% to 12%. This review summarizes evidence for the impact of various factors potentially influencing the LDL-C-lowering efficacy of PSS. PSS are efficacious in all food formats and in food supplements. Some factors related to food format, e.g., solid vs. liquid foods, seem to impact efficacy, while there is no difference between free PSS and esters. Compared to multiple daily intakes, once-a-day intake of PSS, especially in the morning with light breakfast, leads to a sub-optimal LDL-C lowering. However, intake frequency seems influenced by intake occasion, i.e., with or without a meal, and time of day. Meal intake is a critical factor for an optimal LDL-C lowering efficacy of PSS. While age has no impact, gender is suggested to influence the LDL-C lowering effect of PSS with greater reductions reported for men than women; but overall evidence is inconclusive and larger studies show no gender by treatment interaction. In conclusion, PSS are efficacious in all foods and food supplements; for optimal efficacy they should be consumed with a (main) meal and twice daily.
Highlights
Plant sterols (PSter) and stanols (PStan), known as phytosterols, are cholesterol-like compounds that occur naturally in plant-based foods
While age has no impact, gender is suggested to influence the LDL-C lowering effect of plant sterols/stanols (PSS) with greater reductions reported for men than women; but overall evidence is inconclusive and larger studies show no gender by treatment interaction
Numerous clinical studies have shown that the intake of PSS lowers LDL-C concentrations by
Summary
Plant sterols (PSter) and stanols (PStan), known as phytosterols (here collectively being abbreviated as PSS), are cholesterol-like compounds that occur naturally in plant-based foods. To food format or matrix effects and intake-related factors, other more metabolically-related influences are thought to affect the cholesterol-lowering efficacy of PSS such as age, gender, health vs disease status and being classified as ‘cholesterol absorber’ or ‘cholesterol synthesizer’ based on cholesterol absorption or synthesis efficiency. A tendency for a higher efficacy of solid/edible foods, i.e., predominantly fat-based products like spreads and margarines vs liquid/drinkable food formats such as milk and juices, was found in two meta-analyses [5,7]. Whether the type of carrier fat used in the formulation of PSS-added foods could impact the LDL-C lowering effect was studied in a recent meta-analysis [16]. Publication bias (lack of studies) could be another confounder since only studies that reported details of the fat carrier used in the food formulations were included in this meta-analysis
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