title: Cocoa flavanol-enriched snack bars containing phytosterols effectively lower total and low-density lipoprotein cholesterol levels.
abstract: BACKGROUND
  Dietary intervention studies incorporating phytosterol-enriched margarine spreads have reported significant decreases in total and low-density lipoprotein (LDL) cholesterol in populations with both normal lipid levels and those with hypercholesterolemia. There is emerging support for more diverse and lower-fat phytosterol-enriched matrixes. Controversy exists, however, over whether phytosterol-enriched foods affect serum fat-soluble vitamins.
  
  
  OBJECTIVE
  We investigated whether a flavanol-rich cocoa snack food containing phytosterols would decrease total and LDL cholesterol levels in subjects with hypercholesterolemia and significantly affect serum fat-soluble vitamins and carotenoids.
  
  
  METHODS
  A randomized, double-blind parallel arm study design was used. Subjects were randomized to one of two dietary treatments: a cocoa flavanol-enriched snack bar containing 1.5 g phytosterol (n=32), or a control product containing no phytosterols (n=35). Subjects consumed two servings per day.
  
  
  RESULTS
  Consumption of the phytosterol-enriched snack bars but not control bars for 6 weeks was associated with significant reductions in plasma total (4.7%; P<0.01) and LDL cholesterol (6%; P<0.01), and the ratio of total to high-density lipoprotein cholesterol (7.4%; P<0.001). There were no changes in high-density lipoprotein cholesterol, triglycerides, or lipid-adjusted lycopene, beta-cryptoxanthin, lutein/zeaxanthin, alpha-carotene levels, or levels of serum vitamins A or E. A significant reduction in lipid-adjusted serum beta-carotene was observed in the phytosterol but not the no-phytosterol-added group (P<0.05).
  
  
  CONCLUSIONS
  This study supports the use of a novel phytosterol-enriched snack bar to effectively reduce plasma total and LDL cholesterol levels in a population with hypercholesterolemia. The data suggest that the incorporation of this snack food into a balanced diet represents a practical dietary strategy in the management of serum cholesterol levels.
authors.affiliation: Department of Nutrition, University of California, Davis, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Polagruto
authors.forename: Janice F
authors.initials: JF
authors.lastname: Wang-Polagruto
authors.forename: Marlia M
authors.initials: MM
authors.lastname: Braun
authors.forename: Luke
authors.initials: L
authors.lastname: Lee
authors.forename: Catherine
authors.initials: C
authors.lastname: Kwik-Uribe
authors.forename: Carl L
authors.initials: CL
authors.lastname: Keen
mesh_terms: D002099:Cacao / Q000737:chemistry*; D002338:Carotenoids / Q000097:blood; D002392:Catechin / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D044948:Flavonols / Q000494:pharmacology / Q000627:therapeutic use*; D005527:Food, Fortified; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*; D014280:Triglycerides / Q000097:blood; D014801:Vitamin A / Q000097:blood; D014810:Vitamin E / Q000097:blood
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D044948:Flavonols; D010840:Phytosterols; D014280:Triglycerides; D014801:Vitamin A; D014810:Vitamin E; D002338:Carotenoids; D002392:Catechin; D002784:Cholesterol