The objective of this study was to measure the effects on serum lipids and plasma phytosterols of 6.6 g/day phytosterols from three foods (bread, breakfast cereal, and spread) consumed for 12 weeks compared with a diet that was not enriched with phytosterols. Thirty-five subjects undertook a nonrandomized, single-blind study consisting of a 2 week baseline period, 6 weeks on high-phytosterol intake, 6 weeks on high-phytosterol intake plus increased fruit and vegetable intake, and a final 2 week washout period. Serum total cholesterol decreased by 8.3% from 6.59 to 6.04 mmol/l, and LDL cholesterol decreased by 12.6% from 4.44 to 3.88 mmol/l. Plasma phytosterol levels increased by 45% (sitosterol) and 105% (campesterol). Cholesterol-adjusted plasma ␣ -and  -carotene levels decreased by 19-23%, lutein by 14%, and lycopene by 11%. Levels of ␣ -carotene and lutein increased with extra fruit and vegetables. Only lycopene failed to increase during the washout phase. There were no significant changes in biochemical parameters. Serum LDL cholesterol lowering with 6.6 g/day ingested phytosterols was in the range seen with 1.6-3.2 g/day phytosterols. Lowering of plasma carotenoids was greater than that seen with lower phytosterol intake and was partially reversed by increased fruit and vegetable intake. There are extensive data confirming the effectiveness of esterified phytosterols in margarines, with LDL cholesterol lowering of 10-15% with a dose of 1.6-2.4 g/day sterol (1-6). There are few published data (7, 8) on the short-term use of higher amounts of plant sterols (8.6-9 g/day) in margarines, and there is some evidence that carotenoid lowering is greater on a high dose of phytosterol without enhancement of cholesterol lowering (7). It is not known if increased fruit and vegetables can restore the plasma level of carotenoids after a higher intake of phytosterols, although they can achieve this with a more usual intake of phytosterols (4). The aim of this study was to examine the effect of 6.6 g/day phytosterols in bread, breakfast cereals, and margarine over a 12 week period, to examine the role of extra fruit and vegetables in ameliorating the decrease in carotenoid concentration, and to examine the changes in carotenoid concentrations after cessation of phytosterol ingestion.
METHODS
SubjectsThirty-five mildly hypercholesterolemic men and women were recruited and entered the study. The study was conducted at two clinical research centers: the Commonwealth Scientific and Industrial Research Organization (CSIRO) Division of Health Sciences and Nutrition in Adelaide and the Baker Medical Research Institute in Melbourne. Subjects were screened on the basis of the following inclusion criteria: age, 20-75 years; body mass index (BMI), Ͻ 31; total serum cholesterol, Ͼ 5.0 mmol/l and Ͻ 7.5 mmol/l; and serum triglycerides, Ͻ 4.5 mmol/l. No lipid-lowering medication was permitted, nor was medication likely to affect lipid metabolism. Subjects were not diabetic, had normal thyroid status, and had no metabolic disorde...