Cardiovascular Disease Prevention: The Earlier the Better? A Review of Plant Sterol Metabolism and Implications of Childhood Supplementation

Abstract

Atherosclerosis is the underlying cause of major cardiovascular events. The development of atherosclerotic plaques begins early in life, indicating that dietary interventions in childhood might be more effective at preventing cardiovascular disease (CVD) than treating established CVD in adulthood. Although plant sterols are considered safe and consistently effective in lowering plasma cholesterol, the health effects of early-life supplementation are unclear. Studies suggest there is an age-dependent effect on plant sterol metabolism: at a younger age, plant sterol absorption might be increased, while esterification and elimination might be decreased. Worryingly, the introduction of low-cholesterol diets in childhood may unintentionally favor a higher intake of plant sterols. Although CVD prevention should start as early as possible, more studies are needed to better elucidate the long-term effects of plant sterol accumulation and its implication on child development.

Biological and pharmacological effects and nutritional impact of phytosterols: A comprehensive review

“…PSs, are not synthesized endogenously in the human body. So, the diet, especially foods of plant origin, are their main sources (Ling & Jones, 1995; Scolaro et al, 2020). Dietary sources of PSs include vegetable oils, mainly corn, sunflower, soybean, and olive oils, respectively, cereals such as wheat germ and wheat bran, margarines, breads, nuts (mainly almonds), spreads, and vegetables such as cauliflower, which supply 50%–80% of the dietary intake of PSs, and fruits such as oranges and passion fruit (Scolaro et al, 2020).…”

“…So, the diet, especially foods of plant origin, are their main sources (Ling & Jones, 1995; Scolaro et al, 2020). Dietary sources of PSs include vegetable oils, mainly corn, sunflower, soybean, and olive oils, respectively, cereals such as wheat germ and wheat bran, margarines, breads, nuts (mainly almonds), spreads, and vegetables such as cauliflower, which supply 50%–80% of the dietary intake of PSs, and fruits such as oranges and passion fruit (Scolaro et al, 2020). A regular Western diet provides an average of 300 mg phytosterols per day, while this could be up to 50% higher with a vegetarian diet, which contains approximately 300–500 mg of PSs per day (Ojewole et al, 2006; Scolaro et al, 2020).…”

Oilseed crop sunflower (Helianthus annuus) as a source of food: Nutritional and health benefits

“…The major mechanisms by which phytosterol found in sunflower lower the LDL‐cholesterol levels usually occur through the reduction (30%–50%) in the rate of cholesterol absorption in the intestine (Scolaro, de Andrade, & Castro, 2020). The reduction in the cholesterol levels may be achieved by some mechanisms through competition with cholesterol by the solubilization in mixed micelles in the intestinal lumen, thus cause a reduction in the absorbable cholesterol (Blanco‐Vaca, Cedó, & Julve, 2019).…”

Sacha Inchi Seed (Plukenetia volubilis L.) Oil: Terpenoids

“…The β-sitosterol, followed by stigmasterol or campesterol and other minor sterols (triterpenes) such as fucosterol, and Δ5-avenasterol are the most representative in vegetable oils. In addition, 50% to 80% of the plant sterols intake comes from oils, spreads, butters, breads, cereals, grains, pastes, and vegetables [55]. On the other hand, other triterpenoids such as cycloartenol, 24-Methylene cycloartenol, and lanosterol were detected in commercial Sacha inchi oil, the contents ranged from 0.10 to 47.44%, 2.59 to 24.15%, 0.80 to 11.79%, respectively.…”