LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies

Abstract

Phytosterols (PS, comprising plant sterols and plant stanols) have been proven to lower LDL-cholesterol concentrations. The dose–response relationship for this effect has been evaluated in several meta-analyses by calculating averages for different dose ranges or by applying continuous dose–response functions. Both approaches have advantages and disadvantages. So far, the calculation of averages for different dose ranges has not been done for plant sterols and stanols separately. The objective of the present meta-analysis was to investigate the combined and separate effects of plant sterols and stanols when classified into different dose ranges. Studies were searched and selected based on predefined criteria. Relevant data were extracted. Average LDL-cholesterol effects were calculated when studies were categorised by dose, according to random-effects models while using the variance as weighing factor. This was done for plant sterols and stanols combined and separately. In total, 124 studies (201 strata) were included. Plant sterols and stanols were administered in 129 and fifty-nine strata, respectively; the remaining used a mix of both. The average PS dose was 2·1 (range 0·2–9·0) g/d. PS intakes of 0·6–3·3 g/d were found to gradually reduce LDL-cholesterol concentrations by, on average, 6–12 %. When plant sterols and stanols were analysed separately, clear and comparable dose–response relationships were observed. Studies carried out with PS doses exceeding 4 g/d were not pooled, as these were scarce and scattered across a wide range of doses. In conclusion, the LDL-cholesterol-lowering effect of both plant sterols and stanols continues to increase up to intakes of approximately 3 g/d to an average effect of 12 %.

Saturated Fatty Acids and Cardiovascular Disease: Replacements for Saturated Fat to Reduce Cardiovascular Risk

“…Higher magnesium intakes are associated with lower risk of CVD [117], as are greater potassium intakes (relative to lower sodium intakes [118]). Polyphenols and phytosterols are also known to benefit the cardiovascular system [119][120][121]. In addition, the different amino acid profiles of plant and animal proteins may also contribute to the differing vascular effects.…”

Immune Modulation of Aloe vera: Acemannan and Gut Microbiota Modulator

“…Studies carried out with PS doses exceeding 4g/d were not pooled, as these were scare and scattered across a wide range of doses. In conclusion, the LDL-cholesterol-lowering effect of both plant sterols and stanols continues to increase up to intakes of approximately 3 g/d to an average effect of 12% [48] .…”

Utilidad de los esteroles vegetales en el tratamiento de la hipercolesterolemia

“…Un metaanálisis evidencia que el consumo de 2,1 y de 3,3 gramos al día logra respectivamente una reducción en las concentraciones de c-LDL del 8,4% y el 12,4%, y que existe una relación gradual y directa entre la cantidad de esteroles vegetales ingeridos y la disminución de la colesterolemia (10). Los resultados de los diferentes estudios han sido considerados en un documento de consenso sobre la utilidad de los esteroles para el manejo de la dislipemia y la prevención de la enfermedad cardiovascular, donde se afirma que el consumo de 2 gramos diarios de esteroles vegetales produce una inhibición de la absorción intestinal de colesterol y reduce las concentración de c-LDL entre un 8 y un 10% (11).…”