Impact of quality of dietary fat on serum cholesterol and coronary heart disease: focus on plant sterols and other non-glyceride components

Abstract

Elevated serum low density lipoprotein (LDL) cholesterol is a strong risk factor for coronary heart disease; dietary as well as therapeutic regimens target reduction of serum LDL cholesterol to decrease the morbidity and mortality of coronary heart disease. The fatty acid composition of dietary fat has a marked impact on serum LDL cholesterol and other risk factors of diet-related chronic diseases (metabolic syndrome, diabetes and coronary heart disease). Besides fatty acids, which constitute > 95% of their content, fats in foods contain other fat-soluble chemicals collectively called non-glyceride components. Sterols are a major part of the non-glyceride components of fats in plant foods and get concentrated in vegetable oils. Current evidence suggests that properly solubilized plant sterols or stanols incorporated in ester or free form in various food formulations effectively restrict the absorption of both dietary and biliary cholesterol causing 10%-14% reduction in serum LDL cholesterol in normal, hyperlipidaemic and diabetic subjects. The carotenoid-lowering effect of foods enriched with plant sterols can be corrected by increasing the intake of foods rich in carotenoids. The use of foods enriched with plant sterols as a part of a heart-healthy diet is recommended only after consulting a clinician. Recent studies strongly suggest that even smaller amounts of sterols available from natural plant foods and vegetable oils are important dietary components for lowering serum LDL cholesterol. Furthermore, some of the other non-glyceride components of food fats have one or more of the following functions-vitamin activity, serum LDL cholesterol-lowering and antioxidant activity. Since the hypocholesterolaemic and antioxidant effects ofa combination of the non-glyceride components may be more than their individual effects, increasing dietary plant sterols and non-glyceride components from natural plant foods and vegetable oils could provide an additional dietary means for prevention/correction of dyslipidaemia and increasing the antioxidant potential of human diets. The food-based dietary guidelines recommended to ensure an optimal fat quality in the diet of Indians provide high levels of natural plant sterols and other health-promoting non-glyceride components in addition to adequate absolute levels of individual fatty acids and their optimal balance. National policies to promote these dietary guidelines may contribute to the prevention of coronary heart disease and other diet-related chronic diseases.