title: Continuous dose-response relationship of the LDL-cholesterol-lowering effect of phytosterol intake.
abstract: Phytosterols (plant sterols and stanols) are well known for their LDL-cholesterol (LDL-C)-lowering effect. A meta-analysis of randomized controlled trials in adults was performed to establish a continuous dose-response relationship that would allow predicting the LDL-C-lowering efficacy of different phytosterol doses. Eighty-four trials including 141 trial arms were included. A nonlinear equation comprising 2 parameters (the maximal LDL-C lowering and an incremental dose step) was used to describe the dose-response curve. The overall pooled absolute (mmol/L) and relative (%) LDL-C-lowering effects of phytosterols were also assessed with a random effects model. The pooled LDL-C reduction was 0.34 mmol/L (95% CI: -0.36, -0.31) or 8.8% (95% CI: -9.4, -8.3) for a mean daily dose of 2.15 g phytosterols. The impacts of subject baseline characteristics, food formats, type of phytosterols, and study quality on the continuous dose-response curve were determined by regression or subgroup analyses. Higher baseline LDL-C concentrations resulted in greater absolute LDL-C reductions. No significant differences were found between dose-response curves established for plant sterols vs. stanols, fat-based vs. non fat-based food formats and dairy vs. nondairy foods. A larger effect was observed with solid foods than with liquid foods only at high phytosterol doses (>2 g/d). There was a strong tendency (P = 0.054) towards a slightly lower efficacy of single vs. multiple daily intakes of phytosterols. In conclusion, the dose-dependent LDL-C-lowering efficacy of phytosterols incorporated in various food formats was confirmed and equations of the continuous relationship were established to predict the effect of a given phytosterol dose. Further investigations are warranted to investigate the impact of solid vs. liquid food formats and frequency of intake on phytosterol efficacy.
authors.affiliation: Unilever R&D, 3130 AC Vlaardingen, The Netherlands. isabelle.demonty@unilever.com
authors.forename: Isabelle
authors.initials: I
authors.lastname: Demonty
authors.forename: Rouyanne T
authors.initials: RT
authors.lastname: Ras
authors.forename: Henk C M
authors.initials: HC
authors.lastname: van der Knaap
authors.forename: Guus S M J E
authors.initials: GS
authors.lastname: Duchateau
authors.forename: Linsie
authors.initials: L
authors.lastname: Meijer
authors.forename: Peter L
authors.initials: PL
authors.lastname: Zock
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.forename: Elke A
authors.initials: EA
authors.lastname: Trautwein
mesh_terms: D000328:Adult; D008078:Cholesterol, LDL / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D010840:Phytosterols / Q000008:administration & dosage* / Q000494:pharmacology
chemical_list: D008078:Cholesterol, LDL; D010840:Phytosterols