Continuous Dose-Response Response Relationship of the LDL-Cholesterol-Lowering Effect of Phytosterol Intake 1,2

I. Demonty, R.T. Ras, H.C.M. van der Knaap, G.S.M.J.E. Duchateau, L. Meijer, P.L. Zock, J.M. Geleijnse, E.A. Trautwein

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357 Citations (Scopus)

Abstract

Phytosterols (plant sterols and stanols) are well known for their LDL-cholesterol (LDL-C)¿lowering effect. A meta-analysis of randomized controlled trials in adults was performed to establish a continuous dose-response relationship that would allow predicting the LDL-C¿lowering efficacy of different phytosterol doses. Eighty-four trials including 141 trial arms were included. A nonlinear equation comprising 2 parameters (the maximal LDL-C lowering and an incremental dose step) was used to describe the dose-response curve. The overall pooled absolute (mmol/L) and relative (%) LDL-C¿lowering effects of phytosterols were also assessed with a random effects model. The pooled LDL-C reduction was 0.34 mmol/L (95% CI: ¿0.36, ¿0.31) or 8.8% (95% CI: ¿9.4, ¿8.3) for a mean daily dose of 2.15 g phytosterols. The impacts of subject baseline characteristics, food formats, type of phytosterols, and study quality on the continuous dose-response curve were determined by regression or subgroup analyses. Higher baseline LDL-C concentrations resulted in greater absolute LDL-C reductions. No significant differences were found between dose-response curves established for plant sterols vs. stanols, fat-based vs. nonfat-based food formats and dairy vs. nondairy foods. A larger effect was observed with solid foods than with liquid foods only at high phytosterol doses (>2 g/d). There was a strong tendency (P = 0.054) towards a slightly lower efficacy of single vs. multiple daily intakes of phytosterols. In conclusion, the dose-dependent LDL-C¿lowering efficacy of phytosterols incorporated in various food formats was confirmed and equations of the continuous relationship were established to predict the effect of a given phytosterol dose. Further investigations are warranted to investigate the impact of solid vs. liquid food formats and frequency of intake on phytosterol efficacy.
Original languageEnglish
Pages (from-to)271-284
JournalThe Journal of Nutrition
Volume139
Issue number2
DOIs
Publication statusPublished - 2009

Keywords

  • mildly hypercholesterolemic subjects
  • density-lipoprotein-cholesterol
  • plant stanol esters
  • randomized controlled-trial
  • sterol-enriched spread
  • plasma-lipid levels
  • low-fat diet
  • soluble antioxidant concentrations
  • to-moderate hypercholesterolemia
  • serum

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