Serum sterol responses to increasing plant sterol intake from natural foods in the Mediterranean diet
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Phytosterols in natural foods are thought to inhibit cholesterol absorption. The Mediterranean diet is rich in phytosterol-containing plant foods.
Aim of the study
To assess whether increasing phytosterol intake from natural foods was associated with a cholesterol-lowering effect in a substudy of a randomized trial of nutritional intervention with Mediterranean diets for primary cardiovascular prevention (PREDIMED study).
One hundred and six high cardiovascular risk subjects assigned to two Mediterranean diets supplemented with virgin olive oil (VOO) or nuts, which are phytosterol-rich foods, or advice on a low-fat diet. Outcomes were 1-year changes in nutrient intake and serum levels of lipids and non-cholesterol sterols.
Average phytosterol intake increased by 76, 158 and 15 mg/day in participants assigned VOO, nuts and low-fat diets, respectively. Compared to participants in the low-fat diet group, changes in outcome variables were observed only in those in the Mediterranean diet with nuts group, with increases in intake of fibre, polyunsaturated fatty acids and phytosterols (P < 0.020, all) and significant (P < 0.05) reductions of LDL-cholesterol (0.27 mmol/l or 8.3%) and the LDL/HDL-cholesterol ratio (0.29 mmol/l or 11.5%). Variations in saturated fat, cholesterol or fibre intake were unrelated to LDL-cholesterol changes. In the whole group, changes in serum sitosterol-to-cholesterol, which reflect those of dietary phytosterol intake and absorption, correlated inversely to LDL-cholesterol changes (r = −0.256; P = 0.008). In multivariate analyses, baseline LDL-cholesterol, increases in serum sitosterol ratios and statin use were independently associated with LDL-cholesterol reductions.
Small amounts of phytosterols in natural foods appear to be bioactive in cholesterol lowering.
KeywordsPhytosterols Mediterranean diet Nuts Olive oil Cholesterol
- 1.Andersson SW, Skinner J, Ellegård L, Welch AA, Bingham S, Mulligan A, Andersson H, Khaw KT (2004) Intake of dietary plant sterols is inversely related to serum cholesterol concentration in men and women in the EPIC Norfolk population: a cross-sectional study. Eur J Clin Nutr 58:1378–1385CrossRefGoogle Scholar
- 2.Brown L, Rosner B, Willett WW, Sacks FM (1999) Cholesterol lowering effects of dietary fibre: a meta-analysis. Am J Clin Nutr 69:30–42Google Scholar
- 4.Clarke R, Frost C, Collins R, Appleby P, Peto R (1997) Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ 314:112–117Google Scholar
- 7.Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas MI, Fiol M, Gomez-Gracia E, Lopez-Sabater MC, Vinyoles E, Aros F, Conde M, Lahoz C, Lapetra J, Saez G, Ros E (2006) Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med 145:1–11Google Scholar
- 8.Ferro-Luzzi A, Strazzullo P, Scaccini C, Siani A, Sette S, Mariani MA, Mastranzo P, Dougherty RM, Iacono JM, Mancini M (1984) Changing the Mediterranean diet: effects on blood lipids. Am J Clin Nutr 40:1027–1037Google Scholar
- 11.Jenkins DJA, Kendall CWC, Marchie A, Faulkner DA, Wong JMW, de Souza R, Emam A, Parker TL, Vidgen E, Trautwein EA, Lapsley KG, Josse RG, Leiter LA, Singer W, Connelly PW (2005) Direct comparison of a dietary portfolio of cholesterol-lowering foods with a statin in hypercholesterolemic participants. Am J Clin Nutr 81:380–387Google Scholar
- 13.Keys A (1980) Seven countries. A multivariate analysis of death and coronary heart disease. Harvard University Press, CambridgeGoogle Scholar
- 14.Klingberg S, Ellegard L, Johansson I, Hallmans G, Weinehall L, Andersson H, Winkvist A (2008) Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden. Am J Clin Nutr 87:993–1001Google Scholar
- 16.Lerman RH, Minich DM, Darland G, Lamb JJ, Schiltz B, Babish JG, Bland JS, Tripp ML (2008) Enhancement of a modified Mediterranean-style, low glycemic load diet with specific phytochemicals improves cardiometabolic risk factors in subjects with metabolic syndrome and hypercholesterolemia in a randomized trial. Nutr Metab (Lond) 5:29CrossRefGoogle Scholar
- 19.Mena MP, Sacanella E, Vazquez-Agell M, Morales M, Fitó M, Escoda R, Serrano-Martínez M, Salas-Salvadó J, Benages N, Casas R, Lamuela-Raventós RM, Masanes F, Ros E, Estruch R (2009) Inhibition of circulating immune cell activation: a molecular antiinflammatory effect of the Mediterranean diet. Am J Clin Nutr 89:248–256CrossRefGoogle Scholar
- 20.Menotti A, Keys A, Kromhout D, Nissinen A, Blackburn H, Fidanza F, Giampaoli S, Karvonen MJ, Pekkanen J, Punsar S (1990) Twenty-five year mortality from coronary heart disease and its prediction in five cohorts of middle-age men in Finland, the Netherlands and Italy. Prev Med 19:270–278CrossRefGoogle Scholar
- 22.Miettinen TA, Tilvis RS, Kesäniemi YA (1990) Serum plant sterols and cholesterol precursors reflect cholesterol absorption and synthesis in volunteers of a randomly selected male population. Am J Epidemiol 131:20–31Google Scholar
- 24.Muti P, Awad AB, Schünemann H, Fink CS, Hovey K, Freudenheim JL, Wu YW, Bellati C, Pala V, Berrino F (2003) A plant food-based diet modifies the serum β-sitosterol concentration in hyperandrogenic postmenopausal women. J Nutr 133:4252–4255Google Scholar
- 26.Ostlund RE Jr, Racette SB, Okeke A, Stenson WF (2002) Phytosterols that are naturally present in commercial corn oil significantly reduce cholesterol absorption in humans. Am J Clin Nutr 75:1000–1004Google Scholar
- 27.Ostlund RE Jr, Racette SB, Stenson WF (2003) Inhibition of cholesterol absorption by phytosterol-replete wheat germ compared with phytosterol-depleted wheat germ. Am J Clin Nutr 77:1385–1389Google Scholar
- 31.Tammi A, Ronnemaa T, Valsta L, Seppanen R, Rask-Nissila L, Miettinen TA, Gylling H, Viikari J, Anttolainen M, Simell O (2001) Dietary plant sterols alter the serum plant sterol concentration but not the cholesterol precursor sterol concentrations in young children (the STRIP Study). J Nutr 131:1942–1945Google Scholar
- 33.Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353:1547–1557CrossRefGoogle Scholar
- 35.Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61:1402S–1406SGoogle Scholar