Abstract
We investigated the changes of cholesterol and non-cholesterol sterol metabolism during plant stanol ester margarine feeding in 153 hypercholesterolemic subjects. Rapeseed oil (canola oil) margarine without (n = 51) and with (n = 102) stanol (2 or 3 g/day) ester was used for 1 year. Serum sterols were analyzed with gas–liquid chromatography. The latter showed a small increase in sitostanol peak during stanol ester margarine eating. Cholestanol, campesterol, and sitosterol proportions to cholesterol were significantly reduced by 5–39% (P < 0.05 or less for all) by stanol esters; the higher their baseline proportions the higher were their reductions. The precursor sterol proportions were significantly increased by 10–46%, and their high baseline levels predicted low reduction of serum cholesterol. The decrease of the scheduled stanol dose from 3 to 2 g/day after 6-month feeding increased serum cholesterol by 5% (P < 0.001) and serum plant sterol proportions by 8–13% (P < 0.001), but had no consistent effect on precursor sterols. In twelve subjects, the 12-month level of LDL cholesterol exceeded that of baseline; the non-cholesterol sterol proportions suggested that stimulated synthesis with relatively weak absorption inhibition contributed to the non-responsiveness of these subjects. In conclusion, plant stanol ester feeding lowers serum cholesterol in about 88% of subjects, decreases the non-cholesterol sterols that reflect cholesterol absorption, increases the sterols that reflect cholesterol synthesis, but also slightly increases serum plant stanols. Low synthesis and high absorption efficiency of cholesterol results in the greatest benefit from stanol ester consumption.—Gylling, H., P. Puska, E. Vartiainen, and T. A. Miettinen. Serum sterols during stanol ester feeding in a mildly hypercholesterolemic population. J. Lipid Res. 1999. 40: 593–600.
Highlights
We investigated the changes of cholesterol and non-cholesterol sterol metabolism during plant stanol ester margarine feeding in 153 hypercholesterolemic subjects
Similar observations were found in human experiments showing that in familial hypercholesterolemia serum cholesterol was dramatically reduced by sitostanol, and that this reduction was associated with enhanced fecal elimination of cholesterol due to absorption inhibition [12, 13]
We investigated the changes in serum non-cholesterol sterols of this mildly hypercholesterolemic population, cholesterol changes reported previously [25], to determine 1) what are the cholesterol lowering mechanisms; 2) what are the mechanisms in those subjects in whom serum cholesterol is not reduced; 3) how non-cholesterol sterols are related to each other and to serum cholesterol; and 4) are stanols unabsorbable
Summary
We investigated the changes of cholesterol and non-cholesterol sterol metabolism during plant stanol ester margarine feeding in 153 hypercholesterolemic subjects. This procedure increases fat solubility of sitostanol improving its consumption, because stanol ester could be solubilized in nutritional fats, for instance, in mayonnaise and margarines, general nutritients in many western countries In clinical studies, these fat preparations significantly reduced serum total and LDL cholesterol through cholesterol malabsorption [15,16,17,18,19,20,21,22,23,24]. In an 1-year study in a mildly hypercholesterolemic population, sitostanol ester margarine feeding significantly reduced serum total (Ϫ10%) and LDL (Ϫ15%) cholesterol with no changes in HDL cholesterol or triglyceride levels [25]. We investigated the changes in serum non-cholesterol sterols of this mildly hypercholesterolemic population, cholesterol changes reported previously [25], to determine 1) what are the cholesterol lowering mechanisms; 2) what are the mechanisms in those subjects in whom serum cholesterol is not reduced; 3) how non-cholesterol sterols are related to each other and to serum cholesterol; and 4) are stanols unabsorbable
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