title: Low intestinal cholesterol absorption is associated with a reduced efficacy of phytosterol esters as hypolipemic agents in patients with metabolic syndrome.
abstract: OBJECTIVE
  Phytosterols (PS) lower LDLc, but their effect on metabolic syndrome (MetS) remains unknown. We evaluated whether low-fat milk enriched with PS improves cardiovascular risk factors in these patients.
  
  
  METHODS
  A randomised parallel trial employing 24 moderate-hypercholesterolaemic MetS patients and consisting of two 3-month intervention phases. After a 3-month healthy diet, patients were divided into two intervention groups: diet (n = 10) and diet + PS (n = 14) (2 g/day). A control group of 24 moderate-hypercholesterolaemic patients without MetS (matched in age and BMI) underwent the same procedure.
  
  
  RESULTS
  Neither dietary intervention nor enrichment of PS induced any improvement in the serum lipoprotein profile of MetS patients. By contrast, in the non-MetS population, a healthy diet effectively reduced TC, LDLc, non-HDLc and Apo B-100, with further decreases in TC (6.9%), LDLc (10.5%), non-HDLc (10.3%), Apo B-100 (6.2%) and Apo B-100/ApoA-I ratio (11.6%) being observed when PS were administered. No differences in LDL diameter, hsCRP or homocysteine were detected in any of the groups after consuming PS. This supplementation produced a significant increase in PS levels only in the non-MetS population.
  
  
  CONCLUSIONS
  PS therapy appears to be of little value to MetS patients, likely due to its reduced intestinal cholesterol absorption. The efficacy of PS as hypocholesterolaemic agents is thus limited.
authors.affiliation: Service of Endocrinology, University Hospital Dr. Peset, Av. Gaspar Aguilar 90, 46017, Valencia, Spain. hernandez_antmij@gva.es
authors.forename: Antonio
authors.initials: A
authors.lastname: Hernández-Mijares
authors.forename: Celia
authors.initials: C
authors.lastname: Bañuls
authors.forename: Ana
authors.initials: A
authors.lastname: Jover
authors.forename: Eva
authors.initials: E
authors.lastname: Solá
authors.forename: Lorena
authors.initials: L
authors.lastname: Bellod
authors.forename: Maria L
authors.initials: ML
authors.lastname: Martínez-Triguero
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Lagarda
authors.forename: Víctor M
authors.initials: VM
authors.lastname: Víctor
authors.forename: Milagros
authors.initials: M
authors.lastname: Rocha
mesh_terms: D000328:Adult; D000924:Anticholesteremic Agents / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002784:Cholesterol / Q000031:analogs & derivatives / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use; D002791:Cholesterol, Dietary / Q000378:metabolism; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000178:diet therapy* / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use*; D007408:Intestinal Absorption; D008074:Lipoproteins / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000178:diet therapy* / Q000378:metabolism / Q000503:physiopathology; D008875:Middle Aged; D010840:Phytosterols / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D012855:Sitosterols / Q000097:blood / Q000378:metabolism / Q000627:therapeutic use; D013030:Spain / Q000453:epidemiology
chemical_list: D000924:Anticholesteremic Agents; D002791:Cholesterol, Dietary; D000960:Hypolipidemic Agents; D008074:Lipoproteins; D010840:Phytosterols; D012855:Sitosterols; C030104:lipoprotein cholesterol; C021273:campesterol; C025473:gamma-sitosterol; D002784:Cholesterol