Plant stanol ester spreads as components of a balanced diet for pregnant and breast-feeding women: evaluation of clinical safety

Abstract

Clinical safety of consuming plant stanol ester spreads during pregnancy and lactation, the impact on maternal and infant serum and breast-milk cholesterol and the ratios (mmol/mmol of cholesterol) of synthesis and absorption markers were evaluated. Pregnant women (n 21) were randomised to control and dietary intervention groups, the intervention including advice to follow a balanced diet and to consume spreads enriched with plant stanol esters. Participants were followed during and after pregnancy and their infants up to 1 year of age. A mean 1·1 (SD 0·4) g consumption of plant stanols during pregnancy and 1·4 (SD 0·9) g 1 month post-partum increased sitostanol and the markers for cholesterol synthesis, lathosterol, lathosterol/campesterol and lathosterol/sitosterol, and reduced a marker for cholesterol absorption, campesterol, in maternal serum. In breast milk, desmosterol was lower in the intervention group, while no differences were detected between the groups in infants' serum. Plant stanol ester spread consumption had no impact on the length of gestation, infants' growth or serum b-carotene concentration at 1 and 6 months of age, but the cholesterol-adjusted serum b-carotene concentration was lowered at 1 month in the intervention group. Plant stanol ester spread consumption appeared safe in the clinical setting, except for potential lowering of infants' serum b-carotene concentration, and was reflected in the markers of cholesterol synthesis and absorption in mothers' serum, encouraging further studies in larger settings. Plant stanol esters: Pregnancy: Breast milkPrevention is better than cure, particularly in CVD, which represents globally a leading public-health problem. These diseases are growing in magnitude and manifesting themselves at an ever earlier age. A central underlying dietary determinant is the intake of cholesterol and SFA (1,2) . The association between hypercholesterolaemia in women during pregnancy and the early onset of atherosclerotic lesions in their children (3) underscores the need for early preventive measures. Furthermore, hypercholesterolaemia has been associated with pregnancyinduced hypertension (4) , thus compromising maternal health. Total serum cholesterol rises up to 60 % and the TAG concentration up to 150 % with progressing pregnancy (5 -7) . This is explained by hormonal changes as the concentrations of oestrogen and insulin increase (8) and the enzymal activity of lipid-regulating lipoprotein lipase decreases (9) , securing a constant intake of energy for the fetus (10)

Sterol Composition in Infant Formulas and Estimated Intake

“…Regarding the content of plant sterols, the 13 IFs had quantities markedly higher (Table 4) than human milk, as reported Laitinen et al 36 (0.108 mg/100 mL) and Benoit et al 3 (0.16 μg/mg cholesterol). This could be because the IFs were formulated with a combination of vegetable oils (coconut, soy, canola, high oleic safflower, high oleic sunflower, and palm oleic oils), in order to more closely simulate the fatty acid profile of HM.…”

Infantile Cases of Sitosterolaemia with Novel Mutations in the ABCG5 Gene: Extreme Hypercholesterolaemia is Exacerbated by Breastfeeding

“…Accordingly, the transcription of hepatic LDLR is assumed to be inhibited, resulting in an increase in circulatory cholesterol. Breast milk contains around 100 mg/dl of sitosterol, which is independent of plant sterol intake (Laitinen et al 2009). Thus, the infantile consumption of sitosterol is estimated at around 1,000 mg/ day if an infant ingests 1,000 ml of breast milk per day; this amount of sitosterol intake is close to that of an adult but greater in terms of proportion with body weight.…”

Elevated serum squalene and cholesterol synthesis markers in pregnant obese women with gestational diabetes mellitus

“…Serum noncholesterol sterols in pregnancy have been examined previously in only two studies. The fi rst compared normal and cholestatic pregnancy just before delivery and 6 weeks postpartum ( 18 ), and the latter the effect of consuming plant stanol ester margarine on sterols in normal pregnancy in the fi rst and third trimester and 1 month postpartum ( 19 ). To our knowledge, no studies exist that explore squalene and noncholesterol sterols in subjects with GDM, nor is there data available about potential associations of maternal noncholesterol sterols with neonatal birth weight.…”