The effect of phytosterol supplementation on lipid profile: A critical umbrella review of interventional meta‐analyses

Abstract

Despite multiple investigations assessing the impact of phytosterol supplementation on serum lipid levels, there is still a great deal of debate regarding the benefits of this intervention in the management of dyslipidemia. Therefore, we aimed at clarifying this dilemma by conducting the present umbrella review of interventional meta‐analyses. Scopus, PubMed, Web of Science, and EMBASE were used to search for pertinent publications on the effect of phytosterol supplementation on the lipid profile in humans up to June 2023. To compute the overall effect size (ES) and confidence intervals (CI), the random‐effects model was used. The I2 statistic and Cochrane's Q‐test were applied to estimate the heterogeneity among the studies. Seventeen meta‐analyses with 23 study arms were included in the umbrella meta‐analysis. Data pooled from the 23 eligible arms revealed that phytosterol supplementation reduces low‐density lipoprotein cholesterol (LDL‐C) (ES = −11.47 mg/dL; 95% CI: −12.76, −10.17, p < 0.001), total cholesterol (TC) (ES = −13.02 mg/dL; 95% CI: −15.68, −10.37, p < 0.001), and triglyceride (TG) (ES = −3.77 mg/dL; 95% CI: −6.04, −1.51, p = 0.001). Subgroup analyses showed that phytosterol administration with dosage ≥2 g/day and duration over 8 weeks and in hypercholesterolemic subjects was more likely to decrease LDL‐C, TC, and TG. Phytosterol administration did not significantly modify HDL‐C (ES = 0.18 mg/dL; 95% CI: −0.13, −0.51, p = 258) levels when compared to controls. The present umbrella meta‐analysis confirms that phytosterol administration significantly reduces LDL‐C, TC, and TG, with a greater effect with doses of ≥2 g/day and treatment duration >8 weeks, suggesting its possible application as a complementary therapy for cardiovascular risk reduction. Further studies are needed to determine the efficacy of phytosterols in patients with specific health conditions, as well as to ascertain the adverse effects, the maximum tolerable dose, and the maximum recommended duration of phytosterol administration.

Can Daily Dietary Choices Have a Cardioprotective Effect? Food Compounds in the Prevention and Treatment of Cardiometabolic Diseases

“…However, it is noteworthy that despite studies indicating a mild cholesterol-lowering effect in patients supplementing plant sterols with diet, their elimination from daily consumption is associated with an increase in LDL-C [ 13 ]. Furthermore, the maximum safe daily dose of plant sterols has not been determined, and researchers suggest the need to identify possible adverse effects and establish the duration for which they can be used [ 19 ].…”

Association between Serum Phytosterols and Lipid Levels in a Population-Based Study

“…Despite the lack of evidence of clinical benefits in preventing CVD [ 6 ], PSs are accepted as a reliable means to help correct hypercholesterolemia and fight atherosclerosis [ 7 ]. An umbrella review of international meta-analyses reported that the administration of 2 g/day of PS decreased total cholesterol, LDL-cholesterol and triglycerides [ 8 ], and a large randomized controlled trial showed that the administration of a ready-to-drink dietary supplement with 2.5 g of PS decreased total cholesterol, LDL-cholesterol and apo B100 in a group of patients with polygenic hypercholesterolemia [ 9 ]. While most studies have focused on the administration of PS in large doses, little is known about the capacity of dietary PS to influence the blood lipid profile.…”