Review Shows Phytosterols Cut "Bad" Cholesterol
Lee Swanson Research Update
February 2009
Phytosterol-enriched foods are efficacious for reducing levels of LDL (bad) cholesterol, according to a new review of previous studies. Referring to the phytosterols, researchers found no difference in efficacy between stanols and sterols, or delivery in fat or non-fat foods.
By reviewing 84 trials, researchers report that science supports the incorporation of phytosterols in various food formats. The findings are published in the Journal of Nutrition.
"For the recommended intake of two grams per day, the expected LDL-lowering effect of phytosterols is 29%," wrote the authors, led by Isabelle Demonty. "A reduction in LDL cholesterol of about 10% would reduce the incidence of coronary heart disease (CHD) by about 10% to 20%.
"Although no direct evidence is available yet for the ability of phytosterols to lower CHD incidence, the well-documented cholesterol-lowering effect of phytosterols is the basis for recommendations to include phytosterols into strategies to lower LDL cholesterol concentrations," they added.
The researchers identified 165 trials but narrowed the list to 84 after applying stricter inclusion criteria. The review evaluated the impact of different characteristics such as phytosterol type (plant sterols or stanols) and the impact of food format (fat-based or non-fat-based, dairy or non-dairy, and liquid or solid food formats) on the dose response.
Demonty and her co-workers report that, overall, an average intake of 2.15 grams of phytosterols per day was linked to a reduction in LDL cholesterol levels of 0.34 mmol/L, equivalent to a 8.8% drop.
While there were no significant differences between sterols or stanols, or fat-based or non-fat-based, and dairy or non-dairy food formats, the researchers did observe a larger effect for solid foods, compared to liquid foods at phytosterol doses over two grams per day.
Furthermore, a "strong tendency" was observed for higher efficacy of multiple daily intakes, compared to a single daily intake of phytosterols.
"The key outcome of this review and meta-analysis is the generation of a physiologically relevant, continuous dose-response relationship for the LDL cholesterol-lowering effect of phytosterols," wrote the researchers. "By including not only fat-based foods consumed multiple times per day but also low-fat or fat-free foods and food formats intended for once-a-day use, this approach provides an updated estimation of the LDL cholesterol-lowering efficacy of phytosterols in the variety of available food formats."
Journal of Nutrition 139(2):271-284, 2009
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