The effect of plant stanol- and sterol-enriched foods on lipid metabolism, serum lipids and coronary heart disease

Ann Clin Biochem 2005;42:254-263
© 2005 Association for Clinical Biochemistry

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Helena Gylling and
Tatu A Miettinen

Department of Clinical Nutrition, University of Kuopio and Kuopio University Hospital, Kuopio, Finland;
Department of Medicine, Division of Internal Medicine, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland

Phytosterols are plant sterols, mainly campesterol and sitosterol, and their respective stanols (5-saturated derivatives), whichchemically resemble cholesterol. They are present in a normaldiet and are absorbed proportionally to cholesterol, but toa much lesser extent, such that less than 0.1% of serum sterolsare plant sterols. Phytosterols inhibit intestinal cholesterolabsorption, and fat-soluble plant stanol esters were introducedas a functional food for lowering serum cholesterol in the early1990s; plant sterol esters entered the market at the end ofthe 1990s. Inhibition of the intestinal absorption of cholesterolstimulates cholesterol synthesis, a factor which limits serumcholesterol lowering to about 10% with phytosterols. Enrichmentof the diet with plant stanol esters reduces absorption andserum concentrations of both cholesterol and plant sterols,whereas enrichment of the diet with plant sterol esters, especiallyin combination with statins, lowers serum cholesterol but increasesserum plant sterol levels. Recent studies have suggested thathigh-serum plant sterol levels may be associated with increasedcoincidence of coronary heart disease.

Estimates of coronary heart disease reduction by 20-25% withplant sterols/stanols is based mainly on short-term studies.Long-term cholesterol lowering, needed for the prevention ofcoronary heart disease, may be successful with plant stanolesters, which lower serum cholesterol in both genders over atleast a year.

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