title: Effects of phytosterols on markers of inflammation: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Regular intake of phytosterols (PS) is proven to dose-dependently lower LDL-cholesterol (LDL-C). Whether PS consumption can also impact low-grade inflammation is unclear. Considering the low feasibility of outcomes studies involving PS consumption, investigation of surrogate markers of atherosclerosis represents a valuable approach. This study assessed the anti-inflammatory effect of PS consumption, according to inflammatory biomarkers, mainly C-reactive protein (CRP).
  
  
  RESULTS
  A systematic search of Medline, Cab Abstracts, and Food Science & Technology Abstracts was conducted through January 2015. Our study selection included randomized controlled trials (RCT), involving intake of PS-enriched foods as active treatment, and measurement of plasma inflammatory biomarkers. Random-effects meta-analyses were performed using average baseline and end-of-intervention concentrations and control-adjusted absolute changes in CRP and blood lipids. There were 20 eligible RCTs including a total of 1308 subjects. The absolute change of plasma CRP levels with PS consumption was -0.10 mg/L (95%CI -0.26; 0.05), a non-significant change, and heterogeneity had borderline significance (I(2) = 29.1; p-value = 0.073). The absolute reduction of LDL-C was -14.3 mg/dL (95%CI -17.3; -11.3). Meta-regression analyses showed that both the dose and duration of PS intake significantly influenced the absolute changes in plasma CRP (β = -0.35, p = 0.0255 and β = -0.03, p = 0.0209, respectively).
  
  
  CONCLUSIONS
  In this meta-analysis, regular intake of PS-enriched foods did not significantly change CRP, whilst LDL-C concentrations were significantly reduced. Further studies with higher PS doses may provide more definite conclusions on a potential anti-inflammatory effect of PS intake.
authors.affiliation: Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Viviane Z
authors.initials: VZ
authors.lastname: Rocha
authors.affiliation: Unilever Research and Development Vlaardingen, Vlaardingen, The Netherlands.
authors.forename: Rouyanne T
authors.initials: RT
authors.lastname: Ras
authors.affiliation: Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Gagliardi
authors.affiliation: Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Mangili
authors.affiliation: Unilever Research and Development Vlaardingen, Vlaardingen, The Netherlands.
authors.forename: Elke A
authors.initials: EA
authors.lastname: Trautwein
authors.affiliation: Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil. Electronic address: raul.santos@incor.usp.br.
authors.forename: Raul D
authors.initials: RD
authors.lastname: Santos
mesh_terms: D000893:Anti-Inflammatory Agents / Q000737:chemistry; D015415:Biomarkers / Q000378:metabolism*; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008055:Lipids / Q000097:blood; D010840:Phytosterols / Q000737:chemistry*; D010944:Plants / Q000737:chemistry; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D014280:Triglycerides / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D008055:Lipids; D010840:Phytosterols; D014280:Triglycerides; D002784:Cholesterol
keywords: Atherosclerosis; C-reactive protein; Cholesterol; Inflammation; Phytosterols; Plant sterols; Stanols