Foods fortified with sterols and stanols
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Foods Fortified with Sterols and Stanols: Cholesterol-Lowering Efficacy and Safety
Introduction to Plant Sterols and Stanols
Plant sterols and stanols (PS) are natural compounds found in small amounts in many fruits, vegetables, nuts, seeds, cereals, legumes, and vegetable oils. They are structurally similar to cholesterol and can help reduce cholesterol levels by blocking its absorption in the intestines . This article explores the efficacy and safety of foods fortified with plant sterols and stanols, focusing on their role in managing hypercholesterolemia.
Cholesterol-Lowering Effects of Sterol and Stanol Fortified Foods
Efficacy in Various Food Formats
Research has consistently shown that foods fortified with plant sterols and stanols effectively lower LDL cholesterol levels. A meta-analysis of over 100 clinical trials demonstrated that consuming 2-3 grams per day of these compounds can reduce LDL cholesterol by 9-12% . This effect is observed across various food formats, including spreads, yogurts, and low-fat foods .
Comparison with Supplements
Interestingly, the cholesterol-lowering efficacy of plant sterols and stanols is similar whether they are consumed in food or supplement form. A systematic review found that both food-based and supplement-based sterols and stanols reduced LDL cholesterol by approximately 12 mg/dL. This suggests that individuals can choose the format that best fits their lifestyle without compromising efficacy.
Safety and Nutritional Considerations
Impact on Plasma Carotenoids and Vitamins
One concern with the consumption of plant sterols and stanols is their potential to lower plasma carotenoid levels, which are important antioxidants. However, studies have shown that this effect can be mitigated by increasing the intake of carotenoid-rich fruits and vegetables. For instance, consuming an additional serving of high-carotenoid vegetables or fruits daily can maintain plasma carotenoid concentrations while still achieving significant LDL cholesterol reductions. Moreover, the levels of vitamins A, D, and E remain stable with sterol and stanol consumption.
Long-Term Safety
Long-term studies have confirmed the safety of plant sterols and stanols. An 85-week study found no adverse effects on neurocognitive functioning or mood in individuals consuming sterol or stanol-enriched margarines. Additionally, the slight increase in plasma plant sterol levels observed with sterol-enriched foods is not expected to pose significant health risks, especially when considering the overall reduction in LDL cholesterol.
Clinical Applications
Use in Hypercholesterolemia Management
Plant sterols and stanols are recommended as part of a dietary strategy to manage hypercholesterolemia. They can be used as adjuncts to a healthy diet, in combination with statins, or as part of treatment for metabolic syndrome and diabetes . For children with hypercholesterolemia who are not yet candidates for statin therapy, plant sterols and stanols offer a safe and effective alternative.
Endorsements by Health Organizations
The consistent scientific evidence supporting the cholesterol-lowering efficacy and safety of plant sterols and stanols has led several national and international health organizations to endorse their use. These endorsements highlight the importance of incorporating sterol and stanol-fortified foods into dietary guidelines for cardiovascular health .
Conclusion
Foods fortified with plant sterols and stanols are effective and safe options for lowering LDL cholesterol levels. They offer a versatile approach to managing hypercholesterolemia, with benefits observed across various food formats and supplement forms. By incorporating these functional foods into a balanced diet, individuals can achieve significant cholesterol reductions without compromising nutritional status or long-term health.
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