Effects of plant sterol esters in skimmed milk and vegetable-fat-enriched milk on serum lipids and non-cholesterol sterols in hypercholesterolaemic subjects: a randomised, placebo-controlled, crossover study.
Plant sterol (PS)-supplemented foods are recommended to help in lowering serum LDL-cholesterol (LDL-C). Few studies have examined the efficacy of PS-enriched skimmed milk (SM) or semi-SM enriched with vegetable fat (PS-VFM). There is also insufficient information on factors predictive of LDL-C responses to PS. We examined the effects of PS-SM (0·1 % dairy fat) and PS-VFM (0·1 % dairy fat plus 1·5 % vegetable fat) on serum lipids and non-cholesterol sterols in hypercholesterolaemic individuals. In a placebo-controlled, crossover study, forty-three subjects with LDL-C>1300 mg/l were randomly assigned to three 4-week treatment periods: control SM, PS-SM and PS-VFM, with 500 ml milk with or without 3·4 g PS esters (2 g free PS). Serum concentrations of lipids and non-cholesterol sterols were measured. Compared to control, LDL-C decreased by 8·0 and 7·4 % (P < 0·015, both) in the PS-SM and PS-VFM periods, respectively. Serum lathosterol:cholesterol (C) ratios increased by 11-25 %, while sitosterol:C and campesterol:C ratios increased by 70-120 % with both the PS-fortified milk. Adjusted LDL-C reductions were variably enhanced in participants with basal low serum lathosterol/C or conversely high sitosterol/C and campesterol/C. Subjects with post-treatment serum PS:C ratios above the median showed mean LDL-C changes of - 5·9 to - 10·4 %, compared with 1·7 to - 2·9 % below the median. In conclusion, consumption of 2 g/d of PS as PS-SM and PS-VFM lowered LDL-C in hypercholesterolaemic subjects to a similar extent. Basal and post-treatment changes in markers of cholesterol metabolism indicating low cholesterol synthesis and high cholesterol absorption predicted improved LDL-C responses to PS.
Lipid Clinic, Service of Endocrinology and Nutrition, Institut d'Investigations Biomediques August Pi Sunyer, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
Patricia
P
Casas-Agustench
Mercè
M
Serra
Ana
A
Pérez-Heras
Montserrat
M
Cofán
Xavier
X
Pintó
Elke A
EA
Trautwein
Emilio
E
Ros
D000328:Adult; D000818:Animals; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood*; D018592:Cross-Over Studies; D004041:Dietary Fats / Q000494:pharmacology / Q000627:therapeutic use; D019587:Dietary Supplements; D004952:Esters / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D005527:Food, Fortified; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged; D008892:Milk; D010840:Phytosterols / Q000494:pharmacology / Q000627:therapeutic use*; D008517:Phytotherapy; D010936:Plant Extracts / Q000494:pharmacology / Q000627:therapeutic use; D010938:Plant Oils / Q000494:pharmacology / Q000627:therapeutic use*; D013261:Sterols / Q000097:blood*
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D004041:Dietary Fats; D004952:Esters; D010840:Phytosterols; D010936:Plant Extracts; D010938:Plant Oils; D013261:Sterols