Plant Sterol Intake Research Articles

Association of dietary intake of polyphenols, lignans, and phytosterols with immune-stimulating microbiota and COVID-19 risk in a group of Polish men and women.

Devastating consequences of COVID-19 disease enhanced the role of promoting prevention-focused practices. Among targeted efforts, diet is regarded as one of the potential factors which can affect immune function and optimal nutrition is postulated as the method of augmentation of people's viral resistance. As epidemiological evidence is scarce, the present study aimed to explore the association between dietary intake of total polyphenols, lignans and plant sterols and the abundance of immunomodulatory gut microbiota such as Enterococcus spp. and Escherichia coli and the risk of developing COVID-19 disease. Demographic data, dietary habits, physical activity as well as the composition of body and gut microbiota were analyzed in a sample of 95 young healthy individuals. Dietary polyphenol, lignan and plant sterol intakes have been retrieved based on the amount of food consumed by the participants, the phytochemical content was assessed in laboratory analysis and using available databases. For all investigated polyphenols and phytosterols, except campesterol, every unit increase in the tertile of intake category was associated with a decrease in the odds of contracting COVID-19. The risk reduction ranged from several dozen percent to 70 %, depending on the individual plant-based chemical, and after controlling for basic covariates it was statistically significant for secoisolariciresinol (OR = 0.28, 95% CI: 0.11-0.61), total phytosterols (OR = 0.47, 95% CI: 0.22-0.95) and for stigmasterols (OR = 0.34, 95% CI: 0.14-0.72). We found an inverse association between increased β-sitosterol intake and phytosterols in total and the occurrence of Escherichia coli in stool samples outside reference values, with 72% (OR = 0.28, 95% CI: 0.08-0.86) and 66% (OR = 0.34, 95% CI: 0.10-1.08) reduced odds of abnormal level of bacteria for the highest compared with the lowest tertile of phytochemical consumption. Additionally, there was a trend of more frequent presence of Enterococcus spp. at relevant level in people with a higher intake of lariciresinol. The beneficial effects of polyphenols and phytosterols should be emphasized and these plant-based compounds should be regarded in the context of their utility as antiviral agents preventing influenza-type infections.

Abstract P521: Association Between Dietary Phytosterols and Risk of Cardiovascular Disease Mortality in US Adults: Findings From the Third National Health and Nutrition Examination Survey (NHANES III), 1988-1994

Introduction: Phytosterols (plant sterols) are naturally occurring components of plant food sources, including vegetable oils, nuts, cereals and legumes. Their chemical structure impedes intestinal cholesterol absorption and regular consumption has been related to lower serum low-density cholesterol (LDL-C), a causal risk factor for cardiovascular disease (CVD). The association between dietary plant sterol intake and CVD has yet to be determined. Objective: We aimed to examine the association of phytosterol consumption in the diet with cardiovascular mortality in US adults the National Health & Nutrition Examination Survey III (NHANES III), 1988-1994. Methods: We conducted a prospective cohort analysis on National Health and Nutrition Examination Survey (NHANES, 1988-1994 [III]), linked with the National Death Index mortality data (2015) to associate dietary phytosterol intake from 24h dietary recall data with CVD mortality. We included 13,004 adults aged ≥20 years who were non-pregnant, free of CVD at baseline and completed ≥1 24h dietary recall with plausible caloric intake data. We excluded individuals with death occurring within 1 year of baseline. We created a database quantifying the phytosterol content of foods in the 24h dietary recall data and estimated usual intake by quintiles using the NCI method. We determined the risk function by regression calibration and estimated CVD mortality risk between the 10 th (Q1) and 90 th (Q5) percentiles of usual intake. Data was adjusted for sex, age, smoking status and ethnicity. Results: Over a mean±SD follow-up period of 21.2±5.1y, 949 CVD deaths occurred in a population with a mean±SD age of 44.2±14.3y, BMI 26.7±4.7 kg/m 2 and mean dietary plant sterol usual intake of 272.3 mg/day. The top sources of dietary phytosterols were from potatoes 23%), wheat and other grains (21%) and beans, legumes and nuts (13%). Mean usual intake plant intake in the 10 th (Q1) and 90 th (Q5) percentiles of the population was 150.1 and 414.0 mg/day. The estimated relative risk for CVD mortality between Q1 (ref) and Q5 was 0.972 (p<0.05). Conclusions: Preliminary analyses suggest a CVD death risk reduction of 2.8% in the highest versus lowest intakes of dietary plant sterols in the US population. We plan to expand the multivariable model to include the Healthy Eating Index (diet quality) and assess stratification by healthful and unhealthful sources of phytosterols and linear and non-linear dose response analyses to determine the robustness of the association. OSF Registration: osf.io/da4sg Funding: Amgen Scholars Program, Canadian Institutes of Health Research (CIHR), Banting and Best Diabetes Centre (BBDC), Toronto 3D Knowledge Synthesis and Clinical Trials foundation

Dietary Plant Sterols and Phytosterol-Enriched Margarines and Their Relationship with Cardiovascular Disease among Polish Men and Women: The WOBASZ II Cross-Sectional Study.

Dietary cholesterol has been suggested to increase the risk of cardiovascular disease (CVD). Phytosterols, present in food or phytosterol-enriched products, can reduce cholesterol available for absorption. The present study aimed to investigate the association between habitual intake of total and individual plant sterols (β-sitosterol, campesterol, and stigmasterol) or a diet combined with phytosterol-enriched products and CVD in a cross-section of Polish adults, participants of the Multicenter National Health Survey II (WOBASZ II). Among men (n = 2554), median intakes of plant sterols in terciles ranged between 183–456 mg/d and among women (n = 3136), 146–350 mg/d in terciles. The intake of phytosterols, when consumed with food containing phytosterols, including margarine, ranged between 184–459 mg/d for men and 147–352 mg/d for women. Among both men and women, beta-sitosterol intake predominated. Plant sterol intake was lower among both men and women with CVD (p = 0.016) compared to those without CVD. Diet quality, as measured by the Healthy Diet Index (HDI), was significantly higher in the third tercile of plant sterol intake for both men and women and the entire study group (p < 0.0001). This study suggests that habitual dietary intake of plant sterols may be associated with a lower chance of developing CVD, particularly in men.

Imbalance of Long-Chain Omega 3 Polyunsaturated Fatty Acids and Sterols in the Diet of Healthy Young People

ObjectivesThe present research was aimed at studying the content of lipid components with high biological activity in the diet of healthy young people, which regulate the risk of developing cardiovascular pathology. The purpose of this series of studies was the prevention of actual metabolic disorders as a result of changing the stereotypes choice food sources of the essential lipid components. MethodsThis study analyzed the diets of a representative group of students of the I.M.Sechenov First Moscow State Medical University: 77 men and 237 women aged 17–27. The 24 hour recall method was used three times and nutrient content was further assessed using a standard database. ResultsThe average energy value was 1788 ± 428.6 kcal for men and 1618 ± 605 kcal for women. The percentage of energy from total fat was higher than the recommended one (more than 30% of fat calories from the total energy value of the diet): by 75% (84.2 ± 23.3 g) and 95.3% (70.5 ± 23.2 g) in men and women respectively. Of greatest interest was the analysis of the amount and ratio of essential polyunsaturated fatty acids (PUFAs) of the omega 6 and omega 3 groups, as well as sterols. While the ratio of linoleic acid/α-linolenic acid was the same (9/1) in both men and women, a significant difference was shown in their amount: linoleic acid/α-linolenic acid in men was estimated at 12 g/1.4 g and 9.7 g/1.2 g in women. The amount of essential fatty acids was 6.1% and 0.7% of the total calorie content of the diet. Consumption of long-chain omega 3 PUFAs was extremely low: 80.5 ± 53.5 mg and 209.4 ± 139.5 mg of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), respectively, in the men group; 79.2 ± 68.05 mg and 229.7 ± 180.2 mg in the women group. The intake of cholesterol and plant sterols, as well as their ratio, turned out to be suboptimal both in men 1.40/1 (455 ± 204.8 mg/357 ± 163.9 mg) and in women 1.38/1 (372.3 ± 168.3 mg/295.8 ± 150.8 mg). ConclusionsThe results showed a significant imbalance of PUFAs and sterols in the students’ diet. To optimize the fatty acid composition of the diet, on the one hand, it is necessary to reduce the proportion of total fat, and also include sources of long-chain omega 3 PUFAs (EPA and DHA) in the diet 2–3 times a week, primarily through oily (but not salty) marine fish, on the other hand, consume low-fat foods containing plant sterols such as cereals products and vegetables daily. Funding SourcesNo funding.

Relationship between phytosterol intake and cardiovascular disease in the adult Polish population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Plant sterols are compounds with multiple biological functions, mainly cholesterol-reducing. Although phytosterols lower LDL-cholesterol, their relationship to cardiovascular risk is unclear. Purpose To assess dietary total phytosterol, β-sitosterol, campesterol and stigmasterol and to determine the relationship between total plant sterols and the chance of cardiovascular disease (CVD) in the adult Polish population. Methods Within the frame of the National Multicenter Health Survey (WOBASZ II), a random sample of the whole Polish population aged 20 years and above was screened during the years 2013-2014. Dietary habits and an interview of a history of CVD were assessed in 2554 men and 3136 women. The international food databases were used to develop a database on plant sterols in the products consumed in Poland. Plant sterols were calculated from the amount of food consumed by the participants combined with the phytosterol content of the food. The subjects were divided according to the tertiles of total phytosterol intake – 1st tertile (mean [mg/day]); 153 (men 174; women 141); 2nd tertile – 257 (293; 233 respectively), and 3rd tertile 439 (496; 383). The logistic regression method was used to calculate the odds ratio (OR) of the occurrence of CVD in phytosterol tertiles after adjustment for age, BMI and consumption of lipid-lowering drugs, fiber, and alcohol. Results The average total plant sterol intake [mg/day] was significantly lower in subjects with CVD than in subjects without CVD (men 299 vs 326, p= 0.0016 and women 238 vs 256, p= 0.0016); β-sitosterol (186 vs 201, p= 0.0062 and 149 vs 160 p= 0.0016 respectively), campesterol (63.2 vs 70.6; p=0.0044 and 46.8 vs 51.9 p= 0.0015) and stigmasterol (24.2 vs 26.9; p=0.0017; 20.7 vs 23.1 p=0.0023). In the whole group there was a significantly lower OR=0.695 (0.528-0.916) of developing CVD in the third tertile compared to the first. In men, the odds ratios of CVD were significantly lower in the second tertile OR=0.637 (95%CI 0.445-0.911) and in the third tertile OR=0.581 (95%CI 0.372-0.907) compared to the first tertile. In women, the trends were similar, although no significant differences were shown – in the second tertile OR = 0.927 (95% CI 0.695-1.237) and in the third tertile OR=0.843 (95%CI 0.600-1.184). In addition, there was a better overall quality of nutrition in people in the third tertile of phytosterol intake compared to the first tertile. Conclusion The content of phytosterols in the diet may determine the chance of developing CVD, especially in men.

Novel encapsulation approaches for phytosterols and their importance in food products: A review

AbstractPhytosterols are naturally occurring plant cell membranes, which have received greater attention in food industries due to their potential health benefits especially lowering low‐density lipoprotein (LDL) cholesterol levels within the human body. However, the application of phytosterols in various foods (aqueous‐based) is challenging due to their low water solubility and poor stability resulting in poor bioavailability/bioaccessibility. The encapsulation technique is considered as an alternative approach to protect phytosterols from various factors, thus improving their bioavailability and stability. This review aims in presenting a detailed study on techniques and technologies currently employed to encapsulate phytosterols. Based on recent studies, mostly used techniques are spray drying, freeze drying, spray chilling, emulsification, liposome entrapment, extrusion, electro‐spinning, and electro‐spraying. Various processing factors affecting phytosterol stability in fortified food have been outlined as well.Practical ApplicationsPhytosterols are plant‐based bioactive compounds that have been commonly linked to having anti‐diabetic, anti‐inflammatory properties and cholesterol‐lowering effects. Consumption of processed and ready‐to‐eat foods lowers the intake of plant sterols in the human diet. Additionally, their availability in plant‐based foods is also limited. Phytosterol fortified foods are now available to fulfill the phytosterol requirement in our diet. The consumption of phytosterol enriched foods or supplements can be an alternative option to lower cholesterol levels in the human body. However, phytosterols are insoluble in water which results in poor bioavailability and stability. Furthermore, the incorporation of phytosterols in food products is difficult due to the probability of oxidation at higher processing temperatures and storage. Hence, encapsulation is an alternative approach to enhance phytosterols' stability and bioavailability.

Assessment of Plant Sterols in the Diet of Adult Polish Population with the Use of a Newly Developed Database.

Plant sterols are compounds with multiple biological functions, mainly cholesterol-reducing. There are no comprehensive databases on plant sterols, which makes it difficult to estimate their intake in the Polish population. This work attempted to use international food databases, additionally supplemented by scientific data from the literature, to create a database of plant sterols, which would cover various kinds of foods and dishes consumed in Poland. The aim was to assess the size and sources of dietary plant sterols in the adult population of Poland. The literature search was conducted using PubMed, Web of Science, Scopus, and Google Scholar to identify possible sources of published food composition data for plant sterols. The study group consisted of 5690 participants of the WOBASZ II survey. We identified 361 dietary sources of plant sterols based on the consumption of foods and dishes reported by participants. Cereals and fats provided 61% of the total plant sterols, and together with vegetables and fruits, this totaled 80%. The median intake of plant sterols in the Polish population was 255.96 mg/day, and for men and women 291.76 and 230.61 mg/day, respectively. Canola oil provided the most plant sterols at 16.92%, followed by white bread at 16.65% and soft margarine at 8.33%. The study found that plant sterol intake in Poland is comparable to other populations, and women’s diets are more dense in plant sterols. Due to the lack of literature sources on plant sterol content in some foods, future studies should expand and complete the databases on plant sterol content in foods.

Dietary intake of plant sterols in cardiovascular diseases: a population-based study of Polish adults

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Cardiology, Warsaw, Poland Introduction. Cardiovascular diseases (CVD) are a major cause of premature mortality and disability in developed countries. Among various risk factors, disorders of lipid metabolism are prevalent. Scientific evidence shows that plant sterols have a positive effect on dyslipidemia. The primary mechanism of hypolipemic effect of plant sterols is inhibition of cholesterol absorption in the small intestine, and this effect depends on the dose. Purpose. The aim of the study was to determine the intake of plant sterols, which was never studied in the Polish population. Methods. In total, 5690 participants of the population-based cross-sectional Polish National Multicenter Health Examination Survey WOBASZ II (2013-2014), aged 20+, were evaluated in the study (1). Nutritional data were collected using a single 24-hour dietary recall method. A dietary plant sterol database was compiled from available experimental data including total and individual plant sterols such as β-sitosterol, campesterol and stigmasterol. Plant sterol intakes were calculated taking into account plant sterol contents in individual food products and the volume of food consumption. Statistical calculations were performed using Statistical Analysis System (SAS), version 9.4 (SAS Institute Inc., Cary, NC, USA). Results. The dietary plant sterol intake (DPSI) for the general population, 283 mg/day, was dependent on the age and gender. The intake of sterols among people over 65 years of age (264 mg/day in men and 208 mg/day in women) was lower than in younger age groups (20-44 years) of participants (343 mg/day in men and 259 mg/day in women). The main dietary plant sterol for both genders was β-sitosterol (∼62% of intake), followed by campesterol (∼21%) and stigmasterol (∼9%). Overall, men and women with cardiovascular disease had significantly lower DPSI (p &amp;gt; 0.002) than men and women without cardiovascular disease, 298.6 and 237.8 vs. 326.1 and 255.9 mg/d, respectively, and men but not women with diabetes had significantly (p &amp;gt; 0.04) lower DPSI than men without diabetes, 301.7 vs. 323.3, respectively. Conclusions. In the view of current recommendations to lower cholesterol, this research confirms findings for other populations, that the dietary intake of plant sterols in the Polish population is insufficient to beneficially modulate lipid metabolism, especially in CVD and diabetic patients.

Effects of Plant Sterols Intake on Systematic and Tissue Specific Lipid Metabolism in C57BL/6J Mice

Abstract Objectives To investigate the effects of plant sterols intake on systematic and tissue specific lipid metabolism in C57BL/6J mice. Methods Male C57BL/6J mice were randomly divided into control diet group (CS) and plant sterol group (PS, 2% plant sterols). After 28 weeks of continuous feeding, the serum of the mice were collected for biochemical and mass spectrometry tests. Serum levels of total cholesterol (TC), triglyceride (TG) and free sterols were determined. The livers and lungs were collected for free sterol quantification and RNA-seq analysis. Results Compared with the CS group, 2% plant sterols intake significantly reduced the levels of TC in the serum of mice (P &amp;lt; 0.05), with the TG level unchanged. The quantitative results of free sterols showed that the concentration of campesterol were increased, and the cholestanol levels were decreased significantly in the serum and liver of the PS group mice. The results of RNA-seq analysis were used to further evaluate its impact on the lipid metabolism related gene expression profile in the livers and lungs. The results showed that HMGCR, SQLE, HMGCS1, SREBF1, and other genes related to cholesterol synthesis in the PS group were significantly up-regulated in the liver, but not in the lung; Among the first 20 targeting pathways related to the action of plant sterols, the liver differentially expressed genes were enriched in lipid metabolism (steroid biosynthesis, terpenoid skeleton biosynthesis, peroxisome, bile acid secretion, PPAR, MAPK, fatty acid metabolism.), inflammation related (Cell adhesion molecules, leukocyte trans-endothelial migration) and amino acid metabolism (glutathione, valine, leucine and isoleucine metabolism). The differential genes in lung tissue are enriched in lipid metabolism (acetone metabolism, fatty acid metabolism, insulin resistance, terpenoid skeleton biosynthesis, iron death, PPAR), cell function (internal Swallowing, aging) and vascular smooth muscle contraction etc. Conclusions Differentially expressed gene networks reflect the multi-dimensional regulation of plant sterols on tissue specific lipid metabolism, which lays a good foundation for further revealing its mechanism. Funding Sources Yihaikerry Nutrition and Food Safety Foundation, Chinese Nutrition Society; Project of Technology Innovation and Application, Chongqing, China

Cross-Sectional Study of Plant Sterols Intake as a Basis for Designing Appropriate Plant Sterol-Enriched Food in Indonesia.

Coronary heart disease (CHD) is one of the leading causes of mortality in many low-income and middle-income countries, including Indonesia, with elevated blood cholesterol level being one of significant risk factors for this condition. The problem should be addressed by combining healthy lifestyle and diet, where functional foods having a cholesterol-lowering activity could play a significant role. A group of compounds that had been proven to show cholesterol-lowering ability are plant sterols. To develop more suitable functional foods that could substantially contribute to hypercholesterolemia prevention in Indonesian population, up-to-date data about plant sterols dietary intake are required, and were not available until this research was done. This study aimed to estimate daily plant sterols intake and to determine the consumption pattern of foods containing plant sterols in rural and urban area of Bogor, West Java, Indonesia. The research was conducted with a cross-sectional design, with 200 respondents. The study revealed that the level of plant sterols intake in Bogor reached on average 229.76 mg/day and was not significantly different between urban and rural area. Cereals, vegetables, and fruit products were the main food sources of plant sterols in both areas. In addition, a list of several surveyed food items possible to be enriched with plant sterols was developed within the study. These results provide baseline data to develop functional foods fortified with plant sterols suitable for the Indonesian needs and taste. However, further studies are needed to confirm efficacy and safety of introducing such phytosterol-enriched products into a habitual diet, especially considering possible long-term side effects of plant sterol treatment.

On the new (2021) Norms of physiological requirements in energy and nutrients of various groups of the population of the Russian Federation

The article presents the main provisions of the new "Norms of physiological requirements in energy and nutrients for various groups of the population of the Russian Federation" developed and approved in accordance with the established procedure, accumulating the latest fundamental knowledge and world and domestic experience, that determine the values of physiological requirements in nutrients and energy sources, adequate levels of consumption of micronutrients and biologically active substances with an established physiological effect. In the Norms the conceptual apparatus has been expanded and updated, several terms and definitions to them (nutriome, intestinal microbiome, trans-isomers of fatty acids, critical nutrients, edible salt, glycemic index of food products, etc.) have been introduced. Changes have been made to the age periodization of the child and adult population of the Russian Federation, as well as adjustments in the differentiation of the population by the level of physical activity (4 groups for men and women). Taking into account these data, the recommendations on the proportion of macronutrients in the calorie content of the daily diet have been adjusted. The levels of physiological requirements in energy and nutrients have been clarified, depending on the physical activity of the population, including vitamins and mineral substances for both men and women, including period of pregnancy and lactation, as well as for children of different ages. For the first time, recommendations are included to reduce the intake of critical nutrients for health (dietary salt, added sugars, trans-isomeric fatty acids), based on data from modern meta-analyzes on the negative health effects of their excessive intake. Recommendations on the consumption of ω-3 and ω-6 polyunsaturated fatty acids by children and adults, including pregnant and lactating women, have been significantly expanded; adequate dietary intake of plant sterols have been introduced for the first time; while adequate dietary intake of certain phenolic compounds (phenolic acids, flavonoids, polymeric phenolic compounds and stilbenes) were specified. For the first time, the Norms include recommended levels of water (drinks) consumption to maintain the body's water balance under optimal environmental conditions for adult men and women at different levels of physical activity, for children, as well as pregnant and lactating women. For the first time in world practice, a complex of qualitative and quantitative indicators of the reference intestinal microbiome is presented, including modern taxonomic and functional characteristics that give an conception of microbiota phenotype in adults with a normal body mass index.

Cardiovascular Disease Prevention: The Earlier the Better? A Review of Plant Sterol Metabolism and Implications of Childhood Supplementation

Atherosclerosis is the underlying cause of major cardiovascular events. The development of atherosclerotic plaques begins early in life, indicating that dietary interventions in childhood might be more effective at preventing cardiovascular disease (CVD) than treating established CVD in adulthood. Although plant sterols are considered safe and consistently effective in lowering plasma cholesterol, the health effects of early-life supplementation are unclear. Studies suggest there is an age-dependent effect on plant sterol metabolism: at a younger age, plant sterol absorption might be increased, while esterification and elimination might be decreased. Worryingly, the introduction of low-cholesterol diets in childhood may unintentionally favor a higher intake of plant sterols. Although CVD prevention should start as early as possible, more studies are needed to better elucidate the long-term effects of plant sterol accumulation and its implication on child development.

Combining Plant Sterols With Walking Lowers Postprandial Triacylglycerol More Than Walking Only in Chinese Men With Elevated Body Mass Index.

This study examined if plant sterols and walking reduce postprandial triacylglycerol (TAG) concentrations in Chinese men with elevated body mass index (≥ 23.5kg/m2). Fifteen Chinese men (mean [SD]: age = 25 [3] years and body mass index = 26.2 [1.5]kg/m2] completed four 10-day trials in random order with a 7- to 10-day washout between trials: (a)daily consumption of a control margarine while sedentary (C-S), (b)daily consumption of margarine containing 2g/day of plant sterols while sedentary (PS-S), (c)daily consumption of a control margarine with 30-min daily walking (C-W), and (d)daily consumption of margarine containing 2g/day of plant sterols with 30-min daily walking (PS-W). On Day 11 of each trial, postprandial TAG was measured after a high-fat milkshake. The 5-hr total area under the TAG curve was 22%, 25%, and 12% lower on PS-W (mean [SD]: 8.9 [4.3] mmol·5hr/L) than C-S (11.4 [4.5]mmol·5hr/L; p = .005; d = 0.56), PS-S (11.9 [4.9] mmol·5hr/L; p = .004; d = 0.67), and C-W (10.1 [4.4]mmol·5hr/L; p = .044; d = 0.27) trials, respectively. Similarly, 5-hr incremental area for PS-W (4.5 [2.7]mmol·5hr/L) was 31%, 32%, and 18% lower than C-S (6.6 [3.3]mmol·5hr/L; p = .005; d = 0.62), PS-S (6.6 [3.4]mmol·5hr/L; p = .004; d = 0.64), and C-W (5.5 [2.8]mmol·5hr/L; p = .032; d = 0.29). Ten days of daily plant sterol intake combined with walking presents an intervention strategy to lower postprandial TAG in Chinese men with elevated body mass index.

Association Between Consumption Of Phytosterols And Markers Of Subclinical Atherosclerosis In The Elsa Brasil Population

Background and Aims: The efficacy of plant sterol supplementation, and usual intake of plant sterols, to obtain significant levels of LDL-c reduction, is well documented; however, little is known about the usual consumption of phytosterols on maintenance of serum levels of LDL-c and the presence of subclinical atherosclerosis.

P3.25: INTESTINAL CHOLESTEROL ABSORPTION IS PRESERVED AFTER ISOLATED INTESTINAL TRANSPLANTATION DESPITE INCREASED CHOLESTEROL SYNTHESIS

Introduction. We aimed to investigate cholesterol metabolism in relation to nutritional status and serum lipids after isolated intestinal transplantation (ITX). Methods. Seven patients who had undergone isolated ITX including ascending colon at median age of 17.3 (range, 5.9–52) years due to intestinal failure caused by chronic intestinal pseudo obstruction (n=5) and total intestinal aganglionosis (n=2) were included median 3.5 (IQR, 2.9–7.4) years after ITX. Blood samples were analyzed for fat-soluble vitamins (A, E, D-25-OH), prealbumin, and cholesterol (total, LDL, HDL) and triglyceride levels. In six patients and 14 heathy age- and gender-matched controls, cholesterol metabolism was assessed with serum non-cholesterol sterols. The ratios to cholesterol (102 x µmol/mmol of cholesterol) of the serum cholesterol precursors (cholestenol, desmosterol and lathosterol) reflect cholesterol synthesis, while those of plant sterols (campesterol, sitosterol, and avenasterol) and cholestanol reflect cholesterol absorption efficiency. Lathosterol/cholestanol ratio reflects the balance between cholesterol absorption and synthesis and campesterol/cholestanol ratio reflects the plant sterol intake. Results. Patients were on tacrolimus-based maintenance immunosuppression without current signs of acute or chronic transplant rejection. All patients had weaned off PN median 39 days (IQR 21–215) after ITX and had a median body mass-index of 18.2 (IQR, 16.6–19.1) kg/m2. The levels of fat-soluble vitamins and prealbumin were mostly in normal range while plasma HDL cholesterol was low and triglyceride levels were increased in most patients (Table 1). Cholesterol precursor levels were significantly increased while plant sterols and cholestanol were not significantly different between patients and controls (Table 2). Increased lathosterol/cholestanol-ratio suggest that cholesterol synthesis markedly predominated absorption in patients’ whole body cholesterol homeostasis while the campesterol/cholestanol ratio suggest that the plant sterol intake was decreased in patients compared to controls (Table 2). Conclusion. Following isolated ITX, intestinal cholesterol absorption efficiency is preserved, while cholesterol synthesis increases likely to compensate malabsorption of bile acids. Satisfactory nutritional status, normal fat-soluble vitamin levels and preserved cholesterol absorption suggest that the compensatory increase was sufficient to maintain adequate lipid absorption.

A Newly Integrated Model for Intestinal Cholesterol Absorption and Efflux Reappraises How Plant Sterol Intake Reduces Circulating Cholesterol Levels.

Cholesterol homeostasis is maintained through a balance of de novo synthesis, intestinal absorption, and excretion from the gut. The small intestine contributes to cholesterol homeostasis by absorbing and excreting it, the latter of which is referred to as trans-intestinal cholesterol efflux (TICE). Because the excretion efficiency of endogenous cholesterol is inversely associated with the development of atherosclerosis, TICE provides an attractive therapeutic target. Thus, elucidation of the mechanism is warranted. We have shown that intestinal cholesterol absorption and TICE are inversely correlated in intestinal perfusion experiments in mice. In this review, we summarized 28 paired data sets for absorption efficiency and fecal neutral sterol excretion, a surrogate marker of TICE, obtained from 13 available publications in a figure, demonstrating the inverse correlation were nearly consistent with the assumption. We then offer a bidirectional flux model that accommodates absorption and TICE occurring in the same segment. In this model, the brush border membrane (BBM) of intestinal epithelial cells stands as the dividing ridge for cholesterol fluxes, making the opposite fluxes competitive and being coordinated by shared BBM-localized transporters, ATP-binding cassette G5/G8 and Niemann-Pick C1-like 1. Furthermore, the idea is applied to address how excess plant sterol/stanol (PS) intake reduces circulating cholesterol level, because the mechanism is still unclear. We propose that unabsorbable PS repeatedly shuttles between the BBM and lumen and promotes concomitant cholesterol efflux. Additionally, PSs, which are chemically analogous to cholesterol, may disturb the trafficking machineries that transport cholesterol to the cell interior.

Is Plant Sterols a Good Strategy to Lower Cholesterol?

Cardiovascular disease (CVD) has emerged as the leading cause of dealth worldwide today. Lowering circulating total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) is one of the most effective approaches of CVD prevention. Dietary guidelines and health organizations approved using plant sterols (PS) as the alternative to conventional method in attenuating circulating TC and LDL-C levels and risk of CVD. However, current findings apprear to be controversial on the efficacy of PS. Giving the rise of the field "Nutrigenetics", single nucleotide polymorphisms (SNPs) such as CYP7A1-rs3808607 have been identified that strongly associate with cholesterol metabolism in response to PS intake, towards causing inter-individual variations. This review article aims to discuss the efficacy of dietary PS in managing cholesterol levels based on findings from recent studies. The scope includes reviewing evidence on supporting the efficacy, the metabolic claims, inter-individual variations as well as sitosterolemia associated with PS intake.

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

BackgroundManaging cardiovascular disease (CVD) risk factors, e.g., dyslipidemia in type-2 diabetes mellitus (T2DM) is critically important as CVD is the most common cause of death in T2DM patients. This study aimed to investigate the effect of plant sterols (PS) on lowering both elevated low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG).MethodsIn a double-blind, randomized, placebo-controlled, parallel study, 161 individuals at increased risk of and with established T2DM, consumed low-fat spreads without or with added PS (2 g/d) for 6 weeks after a 2-week run-in period. Increased risk of developing T2DM was defined by the Australian T2DM Risk Assessment Tool (AUSDRISK). Fasting serum/plasma total cholesterol (TC), LDL-C, TG, high-density lipoprotein cholesterol (HDL-C), glucose and insulin were measured at baseline and after 6 weeks. Effects on acute and chronic postprandial blood lipids, glucose and insulin were measured over 4-h in 39 individuals with T2DM following a mixed meal challenge without and with added 2 g/d PS at week 6. The study was registered at clinicaltrials.gov (NCT02288585).ResultsHundred fifty-one individuals completed the study and 138 (57% men, 43% women; 44 with and 94 at risk of T2DM) were included in per protocol analysis. Baseline LDL-C and TG were 3.8 ± 1.0 and 2.5 ± 0.8 mmol/l, respectively. PS intake significantly lowered fasting LDL-C (−4.6%, 95%CI −1.2; −8.0; p = 0.009), TC (−4.2%, 95%CI −1.2; −7.1; p = 0.006) and TG (−8.3%, 95% −1.1, −15.0; p = 0.024) with no significant changes in HDL-C, glucose or insulin. Postprandial lipid (TG, TC, LDL-C, HDL-C, remnant cholesterol), glucose and insulin responses did not differ.ConclusionsIn individuals at risk of and with established T2DM and with elevated TG and LDL-C, 2 g/d of PS results in dual LDL-C plus TG lowering. Postprandial lipid or glycemic responses did not differ between PS and control treatment.

Variations in dietary intake and plasma concentrations of plant sterols across plant-based diets among North American adults.

Phytosterols are bioactive compounds in plants with similar cholesterol-lowering properties as vegetarian diets. However, information on phytosterol intake and plasma plant sterols among vegetarians is sparse. We examined dietary intake and plasma concentration of plant sterols and cholesterol across five dietary patterns in the Adventist Health Study-2 Calibration Sub-study (n = 861, 66% females, average age 61 years). To measure intake and plasma concentrations of these compounds, we used 24-h dietary recalls and gas-liquid chromatography-flame ionization detection, respectively. Mean (SD) total phytosterol and cholesterol intake were 363 (176) mg/day and 131 (111) mg/day; plasma β-sitosterol, campesterol, and cholesterol were 3.3 (1.7) μg/mL, 4.2 (2.3) μg/mL, and 1.9 (0.4) mg/mL, respectively. Total phytosterol intake was lowest among non-vegetarians (263 mg/day) and highest among vegans (428 mg/day) (p < 0.0001). Cholesterol intake was lowest among vegans (15.2 mg/day) and highest among non-vegetarians (124.6 mg/day) (p < 0.0001). Plasma plant sterols and cholesterol did not differ by diet. Cholesterol-adjusted plasma β-sitosterol and campesterol were significantly higher in Blacks than Whites, though no ethnic differences were observed in dietary intake of these plant sterols. Dietary intake but not plasma concentration of plant sterols and cholesterol varies across distinct plant-based diets.

Aloe sterol supplementation improves skin elasticity in Japanese men with sunlight-exposed skin: a 12-week double-blind, randomized controlled trial.

Background/objectiveRecently, it was confirmed that the daily oral intake of plant sterols of Aloe vera gel (Aloe sterol) significantly increases the skin barrier function, moisture, and elasticity in photoprotected skin. This study aimed to investigate whether Aloe sterol intake affected skin conditions following sunlight exposure in Japanese men.MethodsWe performed a 12-week, randomized, double-blind, placebo-controlled study to evaluate the effects of oral Aloe sterol supplementation on skin conditions in 48 apparently healthy men (age range: 30–59 years; average: 45 years). The subjects were instructed to expose the measurement position of the arms to the sunlight outdoors every day for 12 weeks. The skin parameters were measured at 0 (baseline), 4, 8, and 12 weeks.ResultsDepending on the time for the revelation of the sunlight, the b* value and melanin index increased and the skin moisture decreased. After taking an Aloe sterol tablet daily for 12 weeks, the skin elasticity index (R2, R5, and R7) levels were significantly higher than the baseline value. There were no differences between the groups in these skin elasticity values. In the subgroup analysis of subjects aged <46 years, the change in the R5 and R7 was significantly higher in the Aloe group than in the placebo group at 8 weeks (P=0.0412 and P=0.0410, respectively). There was a difference in the quantity of sun exposure between each subject, and an additional clinical study that standardizes the amount of ultraviolet rays is warranted. No Aloe sterol intake-dependent harmful phenomenon was observed during the intake period.ConclusionAloe sterol ingestion increased skin elasticity in the photodamaged skin of men aged <46 years.