The effects of phytosterol and phytostanol supplementation on the lipid profile in postmenopausal women: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Various studies have proven that phytosterols and phytostanols (PS) are lipidlowering agents. These compounds play a role in regulating high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) metabolism. Although various drugs are available and are currently used to treat dyslipidemia, the management of lipid abnormalities during the postmenopausal period remains a challenge. Thus, scientists are trying to develop new strategies to reduce serum lipids concentrations using natural products.However, the impact of PS administration on serum lipids in postmenopausal women remains unclear. Hence, the purpose of this study was to assess the effect of PS supplementation on the lipid profile in postmenopausal women based on a systematic review of the literature and a meta-analysis of randomized controlled trials.PubMed/Medline, Scopus, Embase, and Web of Science were searched to identify suitable papers published until January 18, 2022. We combined the effect sizes with the DerSimonian and Laird method using a random effects model. PS supplementation resulted in a significant decrease in TC (weighted mean difference [WMD]: À16.73 mg/dl) and LDL-C (WMD: À10.06 mg/dl) levels. No effect of PS supplementation on TG (WMD: À1.14 mg/dl) or HDL-C (WMD: À0.29 mg/dl) concentrations was detected. In the stratified analysis, there was a notable reduction in TC and LDL-C levels when the PS dose was ≥2 g/day (TC: À22.22 mg/dl and LDL-C: À10.14 mg/dl) and when PS were administered to participants with a body mass index ≥25 kg/m 2 (TC: À20.22 mg/dl and LDL-C: À14.85 mg/dl). PS administration can decrease TC and LDL-C, particularly if the dose of administration is ≥2 g/day and if the participants are overweight or obese. Further high-quality studies are needed to firmly establish the clinical efficacy of PS usage in postmenopausal females.

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

“…Similar results have been reported by a review, which suggested that administering 2 g/day of phytosterol would result in an efficient reduction of the TC concentrations (Katan et al, 2003), a clinical trial, which demonstrated that increasing phytosterol to 3 g/day has a higher efficacy in reducing TC levels (Mensink et al, 2002), and another randomized, double‐blind, parallel study conducted in hypercholesterolemic subjects, revealed that higher phytosterol doses increase its lipid‐lowering effects (Gylling et al, 2010). Our analysis also revealed that a greater reduction in TC concentrations was achieved by a treatment duration of >8 weeks, which is consistent with a meta‐analysis, which reported a greater reduction in TC concentrations when the phytosterol administration lasted 8 or more weeks (Xia et al, 2022). In contrast, another study reported that phytosterol efficiently reduced TC when given for more than 3 weeks, with no greater benefit when the duration was extended beyond 3 weeks (Hansel et al, 2007).…”

“…After screening the titles and abstracts of the 412 remaining papers, 380 publications did not fulfill inclusion criteria and were excluded. Ultimately, 17 meta‐analyses with 23 study arms with a total of 52,958 participants were included in this umbrella meta‐analysis (Abumweis et al, 2008; Amir Shaghaghi et al, 2013; Baker et al, 2009; Demonty et al, 2009; Ferguson et al, 2016; Fontané et al, 2023; Gao et al, 2023; Han et al, 2016; Moruisi et al, 2006; Musa‐Veloso et al, 2011; Ras et al, 2013; Ras et al, 2014; Scholle et al, 2009; Seppo et al, 2007; Wu et al, 2009; Xia et al, 2022; Ying et al, 2019). Included meta‐analyses were published between 2006 and 2023, with a number of included primary studies in each meta‐analysis ranging from 4 to 141.…”

“…Our critical umbrella review also revealed that phytosterol intervention did not significantly increase HDL‐C levels, which is consistent with a meta‐analysis reporting that phytosterol supplementation significantly reduced TG levels but did not have any effects on HDL‐C concentrations (Ying et al, 2019). Additionally, a meta‐analysis conducted in postmenopausal women also reported an association between phytosterol intake and a reduction in LDL‐C and TC levels, but without a significant impact on TG (Xia et al, 2022). However, a meta‐analysis conducted in type two diabetic patients reported that phytosterols improved TC, LDL‐C, and HDL‐C, without a beneficial effect on TG (Baker et al, 2009), and the Spanish EPIC cohort study reported a significant increase in HDL‐C and a decrease in the ratio of cholesterol/HDL with phytosterol administration (Escurriol et al, 2010).…”

“…Satorra et al (2023) reported that 1.7% of the trials included in their meta‐analysis presented a high risk of bias and they excluded seven trials, which were not published in English or Spanish. Xia et al (2022) reported that no available information on random sequence generation was found in four trials included in their meta‐analysis and no adequate information in allocation concealment in three trials.…”

Legume Consumption and Risk of All-Cause and Cause-Specific Mortality: A Systematic Review and Dose–Response Meta-Analysis of Prospective Studies

“…The potential mechanisms underlying the inverse association between legume consumption and stroke mortality may include the following. A high concentration of phytosterols is found in legumes, and meta-analyses of randomized controlled trials have shown that they significantly reduce total cholesterol, LDL cholesterol, atherogenic apolipoprotein levels, and free fatty acids [ 86 , 87 ]. These compounds might also reduce the risk of atherosclerosis [ 88 ].…”