Progress and perspectives in plant sterol and plant stanol research

doi:10.1093/nutrit/nuy032

Review

. 2018 Oct 1;76(10):725-746.

doi: 10.1093/nutrit/nuy032.

Progress and perspectives in plant sterol and plant stanol research

Peter J H Jones^{1

2}, Maryam Shamloo^{2

3}, Dylan S MacKay³, Todd C Rideout⁴, Semone B Myrie^{1

2}, Jogchum Plat⁵, Jean-Baptiste Roullet⁶, David J Baer⁷, Kara L Calkins⁸, Harry R Davis⁹, P Barton Duell¹⁰, Henry Ginsberg¹¹, Helena Gylling¹², David Jenkins¹³, Dieter Lütjohann¹⁴, Mohammad Moghadasian², Robert A Moreau¹⁵, David Mymin¹⁶, Richard E Ostlund Jr¹⁷, Rouyanne T Ras¹⁸, Javier Ochoa Reparaz¹⁹, Elke A Trautwein¹⁸, Stephen Turley²⁰, Tim Vanmierlo²¹, Oliver Weingärtner²²

Affiliations

¹ Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
³ George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Department of Exercise and Nutrition Sciences, University of Buffalo, Buffalo, New York, USA.
⁵ Department of Human Biology, Maastricht University, Maastricht, the Netherlands.
⁶ Division of Metabolism, Child Development and Rehabilitation Center-Portland, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
⁷ US Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Beltsville, Maryland, USA.
⁸ Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; and the UCLA Mattel's Children's Hospital, Los Angeles, California, USA.
⁹ CVPath Institute, Inc, Gaithersburg, Maryland, USA.
¹⁰ Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA.
¹² University of Helsinki and the Helsinki University Central Hospital, Helsinki, Finland.
¹³ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; and the Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁴ Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany.
¹⁵ Eastern Regional Research Center, US Department of Agriculture, Agricultural Research Service, Wyndmoor, Pennsylvania, USA.
¹⁶ Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ Division of Endocrinology, Metabolism and Lipid Research, Washington University, St Louis, USA.
¹⁸ Unilever Research & Development Vlaardingen, Vlaardingen, the Netherlands.
¹⁹ Department of Biology, Eastern Washington University, Cheney, Washington, USA.
²⁰ UT Southwestern Medical Center, Dallas, Texas, USA.
²¹ Department of Immunology and Biochemistry, Biomedical Research Institute, Hasselt University, Hasselt, Belgium.
²² Klinik für Innere Medizin I, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany; Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany.

PMID: 30101294
PMCID: PMC6130982
DOI: 10.1093/nutrit/nuy032

Review

Progress and perspectives in plant sterol and plant stanol research

Peter J H Jones et al. Nutr Rev. 2018.

. 2018 Oct 1;76(10):725-746.

doi: 10.1093/nutrit/nuy032.

Authors

Affiliations

¹ Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada.
² Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
³ George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada.
⁴ Department of Exercise and Nutrition Sciences, University of Buffalo, Buffalo, New York, USA.
⁵ Department of Human Biology, Maastricht University, Maastricht, the Netherlands.
⁶ Division of Metabolism, Child Development and Rehabilitation Center-Portland, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA.
⁷ US Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Beltsville, Maryland, USA.
⁸ Department of Pediatrics, Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA; and the UCLA Mattel's Children's Hospital, Los Angeles, California, USA.
⁹ CVPath Institute, Inc, Gaithersburg, Maryland, USA.
¹⁰ Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA.
¹² University of Helsinki and the Helsinki University Central Hospital, Helsinki, Finland.
¹³ Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; and the Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.
¹⁴ Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany.
¹⁵ Eastern Regional Research Center, US Department of Agriculture, Agricultural Research Service, Wyndmoor, Pennsylvania, USA.
¹⁶ Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁷ Division of Endocrinology, Metabolism and Lipid Research, Washington University, St Louis, USA.
¹⁸ Unilever Research & Development Vlaardingen, Vlaardingen, the Netherlands.
¹⁹ Department of Biology, Eastern Washington University, Cheney, Washington, USA.
²⁰ UT Southwestern Medical Center, Dallas, Texas, USA.
²¹ Department of Immunology and Biochemistry, Biomedical Research Institute, Hasselt University, Hasselt, Belgium.
²² Klinik für Innere Medizin I, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany; Abteilung für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Oldenburg, Germany.

PMID: 30101294
PMCID: PMC6130982
DOI: 10.1093/nutrit/nuy032

Abstract

Current evidence indicates that foods with added plant sterols or stanols can lower serum levels of low-density lipoprotein cholesterol. This review summarizes the recent findings and deliberations of 31 experts in the field who participated in a scientific meeting in Winnipeg, Canada, on the health effects of plant sterols and stanols. Participants discussed issues including, but not limited to, the health benefits of plant sterols and stanols beyond cholesterol lowering, the role of plant sterols and stanols as adjuncts to diet and drugs, and the challenges involved in measuring plant sterols and stanols in biological samples. Variations in interindividual responses to plant sterols and stanols, as well as the personalization of lipid-lowering therapies, were addressed. Finally, the clinical aspects and treatment of sitosterolemia were reviewed. Although plant sterols and stanols continue to offer an efficacious and convenient dietary approach to cholesterol management, long-term clinical trials investigating the endpoints of cardiovascular disease are still lacking.

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Figures

**Figure 1**
**Percent change in low-density lipoprotein cholesterol (LDL-C) from baseline in response to consumption of a low-fat soy beverage enriched with plant sterols (plant sterol intake, 1.95 g/d).**

**Figure 2**
Proposed surrogate measure of cholesterol metabolism that could overcome issues related to the use of ratios of markers of surrogate synthesis to markers of absorption.

**Figure 3**
**Correlations between changes in serum low-density lipoprotein cholesterol (LDL-C) and plasma plant sterols and changes in flow-mediated dilation (used** **with permission from Ras et al** ¹⁶⁴ ). *Abbreviations*: FMD, flow-mediated dilation; pp, percentage points

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References

1. Plat J, Mackay D, Baumgartner S, et al. Progress and prospective of plant sterol and plant stanol research: report of the Maastricht meeting. Atherosclerosis. 2012;225:521–533. - PubMed
1. Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev. 2017;75:731–767. - PubMed
1. Malina DM, Fonseca FA, Barbosa SA, et al. Additive effects of plant sterols supplementation in addition to different lipid-lowering regimens. J Clin Lipidol. 2015;9:542–552. - PubMed
1. Ward N, Sahebkar A, Banach M, et al. Recent perspectives on the role of nutraceuticals as cholesterol-lowering agents. Curr Opin Lipidol. 2017;28:495–501. - PubMed
1. Rysz J, Franczyk B, Olszewski R, et al. The use of plant sterols and stanols as lipid-lowering agents in cardiovascular disease. Curr Pharm Des. 2017;23:2488–2495. - PubMed

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[1] Plat J, Mackay D, Baumgartner S, et al. Progress and prospective of plant sterol and plant stanol research: report of the Maastricht meeting. Atherosclerosis. 2012;225:521–533. - PubMed

[2] Plat J, Mackay D, Baumgartner S, et al. Progress and prospective of plant sterol and plant stanol research: report of the Maastricht meeting. Atherosclerosis. 2012;225:521–533. - PubMed

[3] Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev. 2017;75:731–767. - PubMed

[4] Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev. 2017;75:731–767. - PubMed

[5] Malina DM, Fonseca FA, Barbosa SA, et al. Additive effects of plant sterols supplementation in addition to different lipid-lowering regimens. J Clin Lipidol. 2015;9:542–552. - PubMed

[6] Malina DM, Fonseca FA, Barbosa SA, et al. Additive effects of plant sterols supplementation in addition to different lipid-lowering regimens. J Clin Lipidol. 2015;9:542–552. - PubMed

[7] Ward N, Sahebkar A, Banach M, et al. Recent perspectives on the role of nutraceuticals as cholesterol-lowering agents. Curr Opin Lipidol. 2017;28:495–501. - PubMed

[8] Ward N, Sahebkar A, Banach M, et al. Recent perspectives on the role of nutraceuticals as cholesterol-lowering agents. Curr Opin Lipidol. 2017;28:495–501. - PubMed

[9] Rysz J, Franczyk B, Olszewski R, et al. The use of plant sterols and stanols as lipid-lowering agents in cardiovascular disease. Curr Pharm Des. 2017;23:2488–2495. - PubMed

[10] Rysz J, Franczyk B, Olszewski R, et al. The use of plant sterols and stanols as lipid-lowering agents in cardiovascular disease. Curr Pharm Des. 2017;23:2488–2495. - PubMed

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Progress and perspectives in plant sterol and plant stanol research

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Progress and perspectives in plant sterol and plant stanol research

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