European Journal of Nutrition

, Volume 44, Issue 4, pp 214–222 | Cite as

Plant sterol ester–enriched milk and yoghurt effectively reduce serum cholesterol in modestly hypercholesterolemic subjects

  • Manny Noakes
  • P. M. Clifton
  • A. M. E. Doornbos
  • E. A. Trautwein
ORIGINAL CONTRIBUTION

Summary

Background

The cholesterol–lowering efficacy of plant sterol esters (PSteE) or stanol esters (PStaE) in regular– and low–fat spreads has been consistently demonstrated, while their effectiveness in a low–fat, aqueous food carrier such as milk and yoghurt is less well established.

Aim of the study

Two studies were carried out to assess the cholesterol–lowering effect of PSteE–enriched low-fat milk and PSteE– and PStaE–enriched low–fat yoghurt in modestly hypercholesterolemic subjects (total cholesterol between 5–7.5 mmol/l).

Methods

Study one was a single blind crossover design with 4 phases of 3–week interventions. Subjects consumed 300ml/d of placebo or PSteE–milk (2.0 g plant sterols/d) alone or combined with 25 g/d of placebo or PSteE–spread. Study two was a fully randomised, double blind crossover design with 3 phases of 3–week interventions. Subjects consumed 2 portions (150 g tubs each) of placebo, PSteE–yoghurt (1.8 g plant sterols/d) or PStaE–yoghurt (1.7 g plant stanols/d). In study one 39 subjects (21 men and 18 women) and in study two 40 subjects (17 men and 23 women) completed the dietary intervention.

Results

In study one, PSteE–milk and PSteE–spread were equally efficacious in lowering total and LDL–cholesterol as compared to placebo by 6–8% and 8–10%, respectively. No significant additional cholesterol–lowering was observed with the combination of PSteE–milk and PSteE–spread (4 g plant sterols/d). PSteE–enriched milk and the combination of PSteE–enriched milk plus spread both lowered lipid–adjusted serum β–carotene concentrations by 10–14% (P < 0.02),while the PSteE–rich spread alone did not significantly alter serum β–carotene levels. In study two, the PSteE– and PStaE–enriched yoghurts reduced LDL–cholesterol significantly compared to placebo by 0.27 ± 0.05 mmol/l (6%) and 0.23 ± 0.05 mmol/l (5 %), respectively. In both studies, there was no effect on HDL–cholesterol and triacylglycerol concentrations.

Conclusion

Plant sterols in the form of their esters when provided in lowfat milk and yoghurt are effective in lowering total and LDL–cholesterol.

Key words

modestly hypercholesterolemic subjects milk yoghurt plant sterols low–fat foods 

Abbreviations

BMI

body mass index

PSteE

plant sterol esters

PStaE

plant stanol esters

TC

total cholesterol

LDL

low density lipoprotein

HDL

high density lipoprotein

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References

  1. 1.
    Miettinen TA, Puska P, Gylling H, Vanhanen H, Vartiainen E (1995) Reduction of Serum Cholesterol with Sitostanol- Ester Margarine in a Mildly Hypercholesterolemic Population. N Engl J Med 333:1308–1312CrossRefPubMedGoogle Scholar
  2. 2.
    Hallikainen MA, Sarkkinen ES, Uusitupa MI (2000) Plant Stanol Esters Affect Serum Cholesterol Concentrations of Hypercholesterolemic Men and Women in a Dose-Dependent Manner. J Nutr 130:767–776PubMedGoogle Scholar
  3. 3.
    Ling WH, Jones PJ (1995) Dietary Phytosterols: A Review of Metabolism, Benefits and Side Effects. Life Sci 57:195–206CrossRefPubMedGoogle Scholar
  4. 4.
    Miettinen TA, Gylling H (1999) Regulation of Cholesterol Metabolism by Dietary Plant Sterols. Curr Opin Lipidol 10:9–14CrossRefPubMedGoogle Scholar
  5. 5.
    Weststrate JA, Meijer GW (1998) Plant Sterol-Enriched Margarines and Reduction of Plasma Total and LDL Cholesterol Concentrations in Normocholesterolaemic and Mildly Hypercholesterolaemic Subjects. Eur J Clin Nutr 52:334–343PubMedGoogle Scholar
  6. 6.
    Hendriks HF,Weststrate JA, van Vliet T, Meijer GW (1999) Spreads Enriched with Three Different Levels ofVegetable Oil Sterols and the Degree of Cholesterol Lowering in Normocholesterolaemic and Mildly Hypercholesterolaemic Subjects. Eur J Clin Nutr 53:319–327CrossRefPubMedGoogle Scholar
  7. 7.
    Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R; Stresa Workshop Participants (2003) Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 78:965–978PubMedGoogle Scholar
  8. 8.
    Law MR (2000) Plant sterol and stanol margarines and health. Br Med J 320:861–864Google Scholar
  9. 9.
    Tikkanen MJ, Hogstrom P, Tuomilehto J,Keinanen-Kiukaanniemi S, Sundvall J, Karppanen H (2001) Effect of a diet based on low-fat foods enriched with nonesterified plant sterols and mineral nutrients on serum cholesterol. Am J Cardiol 88:1157–1162PubMedGoogle Scholar
  10. 10.
    Volpe R, Niittynen L, Korpela R, Sirtori C, Bucci A, Fraone N, Pazzucconi F (2001) Effects of yoghurt enriched with plant sterols on serum lipids in patients with moderate hypercholesterolaemia. Br J Nutr 86:233–239PubMedGoogle Scholar
  11. 11.
    Mensink RP, Ebbing S, Lindhout M, Plat J, van Heugten MM (2002) Effects of plant stanol esters supplied in low-fat yoghurt on serum lipids and lipoproteins, non-cholesterol sterols and fat soluble antioxidant concentrations. Atherosclerosis 160:205–213CrossRefPubMedGoogle Scholar
  12. 12.
    Nestel P, Cehun M, Pomeroy S, Abbey M, Weldon G (2001) Cholesterol lowering effects of plant sterol esters and non-esterified stanols in margarine, butter and low fat foods. Eur J Clin Nutr 55:1084–1090CrossRefPubMedGoogle Scholar
  13. 13.
    Matvienko OA, Lewis DS, Swanson M, Arndt B, Rainwater DL, Stewart J,Alekel DL (2002) A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL-cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 76:57–64PubMedGoogle Scholar
  14. 14.
    Scientific Committee on Food. Opinion of the Scientific Committee on Food on a report on Post Launch Monitoring of “ yellow fat spreads with added phytosterol esters” (expressed on 26 September 2002),SCF/CS/NF/21 ADD 2 Final, 4 October 2002Google Scholar
  15. 15.
    Australian Bureau of Statistics. National Survey: Foods eaten, Australia, 1995 (4804.0) Australian Government Publishing Service, Canberra, 1998Google Scholar
  16. 16.
    Robert Koch-Institut. Beiträge zur Gesundheitsberichterstattung des Bundes, Berlin 2002 (in German)Google Scholar
  17. 17.
    National Diet & Nutrition Survey: Adults aged 19 to 64, Volume 2, 2003 http://www.foodstandards.gov.uk/multimedia/ pdfs/ndnsv2. pdfGoogle Scholar
  18. 18.
    US Department of Health and Human Services. Third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation,and treatment of high blood cholesterol in adults (Adult Treatment Panel III) NIH publication No. 01–3670, May 2001Google Scholar
  19. 19.
    Voedingscentrum. Resultaten van de Voedselconsumptiepeiling 1997–1998, Den Haag, 1998 (in Dutch)Google Scholar
  20. 20.
    Jones PJ, Vanstone CA, Raeini-Sarjaz M, St-Onge MP (2003) Phytosterols in lowand nonfat beverages as part of a controlled diet fail to lower plasma lipid levels. J Lipid Res 44:1713–1719CrossRefPubMedGoogle Scholar
  21. 21.
    Moreau R, Whitaker B, Hicks K (2002) Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and healthpromoting uses. Prog Lipid Res 41:457–500CrossRefPubMedGoogle Scholar
  22. 22.
    Hodge A, Patterson AJ, Brown WJ, Ireland P, Giles G (2000) The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation. Aust N Z J Public Health 24:576–583PubMedGoogle Scholar
  23. 23.
    Allain CC, Poon LS, Chan CS, Richmond W, Fu PC (1974) Enzymatic Determination of Total Serum Cholesterol. Clin Chem 20:470–475PubMedGoogle Scholar
  24. 24.
    Fossati P, Prencipe L (1982) Serum Triacylglycerols Determined Colorimetrically with an Enzyme that Produces Hydrogen Peroxide. Clin Chem 28:2077–2080PubMedGoogle Scholar
  25. 25.
    Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of The Concentration of Low-Density Lipoprotein Cholesterol in Plasma, without use of the Preparative Ultracentrifuge. Clin Chem 18:499–502PubMedGoogle Scholar
  26. 26.
    Yang CS, Lee MJ (1987) Methodology of Plasma Retinol, Tocopherol and Carotenoid Assays in Cancer Prevention Studies. J Nutrition Growth and Cancer 4:19–27Google Scholar
  27. 27.
    Khachik F Beecher GR, Goli MB, Lusby WR, Smith JC Jr (1992) Separation and Identification of Carotenoids and their Oxidation Products in the Extracts of Human Plasma. Analytical Chemistry 64:2111–2122CrossRefPubMedGoogle Scholar
  28. 28.
    Beer MU, Pritchard PH, Olesen M, Black R (2001) Free phytosterols from tall oil delivered in low fat food matrix successfully lowers plasma cholesterol Ann Nutr Metab 45:99Google Scholar
  29. 29.
    Trautwein EA, Duchateau GSMJE, Lin YG, Mel’nikov SM, Molhuizen HOF, Ntanios FY (2003) Proposed mechanisms of cholesterol-lowering action of plant sterols Eur J Lipid Sci Tech 105:171–185CrossRefGoogle Scholar
  30. 30.
    Hallikainen MA, Sarkkinen ES, Uusitupa MI (1999) Effects of low-fat stanol ester enriched margarines on concentrations of serum carotenoids in subjects with elevated serum cholesterol concentrations. Eur J Clin Nutr 53:966–969CrossRefPubMedGoogle Scholar
  31. 31.
    Pouteau EB, Monnard IE, Piguet- Welsch C, Groux MJ, Sagalowicz L, Berger A (2003) Non-esterified plant sterols solubilized in low fat milks inhibit cholesterol absorption–a stable isotope double-blind crossover study. Eur J Nutr 42:154–164PubMedGoogle Scholar
  32. 32.
    Plat J, van Onselen EN, van Heugten MM, Mensink RP (2000) Effects on Serum Lipids,Lipoproteins and Fat Soluble Antioxidant Concentrations of Consumption Frequency ofMargarines and Shortenings Enriched with Plant Stanol Esters. Eur J Clin Nutr 54:671–677CrossRefPubMedGoogle Scholar
  33. 33.
    Noakes M, Clifton P, Ntanios F, Shrapnel W, Record I, McInerney J (2002) An Increase in Dietary Carotenoids when Consuming Plant Sterols or Stanols is Effective in Maintaining Plasma Carotenoid Concentrations. Am J Clin Nutr 75:79–86PubMedGoogle Scholar
  34. 34.
    Ayesh R, Weststrate JA, Drewitt PN, Hepburn PA (1999) Safety Evaluation of Phytosterol Esters. Part 5. Faecal Short-Chain Fatty Acid and Microflora Content, Faecal Bacterial Enzyme Activity and Serum Female Sex Hormones in Healthy Normolipidaemic Volunteers Consuming a Controlled Diet either with or without a Phytosterol Ester-Enriched Margarine Food. Chem Toxicol 37:1127–1138CrossRefGoogle Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • Manny Noakes
    • 1
    • 2
  • P. M. Clifton
    • 1
  • A. M. E. Doornbos
    • 3
  • E. A. Trautwein
    • 3
  1. 1.CSIRO Health Sciences and Nutrition AdelaideAustralia
  2. 2.Adelaide, BC SA 5000Australia
  3. 3.Unilever Health InstituteUnilever Research & DevelopmentVlaardingenThe Netherlands

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