Plant Stanol and Sterol Esters in the Control of Blood Cholesterol Levels: Mechanism and Safety Aspects

doi:10.1016/j.amjcard.2005.03.015

The American Journal of Cardiology

Volume 96, Issue 1, Supplement, 4 July 2005, Pages 15-22

https://doi.org/10.1016/j.amjcard.2005.03.015 Get rights and content

Incorporation of plant stanol esters into margarine is among the first examples of a functional food with proven low-density lipoprotein (LDL) cholesterol-lowering effectiveness. Recently, there have been many studies on the effects of plant stanols/sterols on cholesterol metabolism. It has been found that the serum LDL cholesterol-lowering effect of plant stanols/sterols originates from reduced intestinal cholesterol absorption, a process in which changes in micellar composition are thought to play a major role. However, recent findings suggest that there is an additional process in which plant stanols/sterols actively influence cellular cholesterol metabolism within intestinal enterocytes. Furthermore, in response to the reduced supply of exogenous cholesterol, receptor-mediated lipoprotein cholesterol uptake is probably enhanced, as shown by increased LDL receptor expression. At recommended intakes of about 2 to 2.5 g/day, products enriched with plant stanol/sterol esters lower plasma LDL cholesterol levels by 10% to 14% without any reported side effects. Thus, plant stanols/sterols can be considered to be effective and safe cholesterol-lowering functional food ingredients.

Section snippets

Plant Stanol Esters Reduce Intestinal Cholesterol Absorption

Many studies have been performed recently on the effects of plant stanols/sterols on cholesterol metabolism. These show that plant stanol esters reduce intestinal cholesterol absorption⁴ and, subsequently, LDL cholesterol.4, 5 But what is the mechanism underlying these effects? Plant stanols are structurally related to cholesterol and are incorporated into mixed micelles in the intestinal tract.

For many years it has been assumed that because plant stanols are more hydrophobic than cholesterol,

Effects of Plant Stanol Esters on Cholesterol Metabolism

As outlined above, plant stanol esters decrease intestinal cholesterol absorption. A lower flux of intestinal-derived cholesterol secreted as chylomicrons into the body triggers cells to restore cellular cholesterol homeostasis by other mechanisms. For example, cells may increase endogenous cholesterol synthesis or receptor-mediated uptake of circulating lipoproteins, such as intermediate-density lipoproteins (IDLs) and LDLs. Circulating LDL particles are taken up by the LDL receptor, which is

Safety Aspects

Extensive safety evaluation studies have been conducted for plant stanols/sterols. Studies with several animal and cell models did not reveal any adverse effects.21, 22, 23, 24, 25, 26 Supplementation of an atherogenic diet with plant stanol/sterols appeared to lower plaque formation in transgenic mice.27, 28, 29 Thus, plant stanols/sterols can be considered effective and safe cholesterol-lowering functional food ingredients. Also, margarines enriched with plant stanol ester have been available

Conclusion

At recommended intakes of about 2 to 2.5 g/day, products enriched with plant stanol/sterol esters lower plasma LDL cholesterol levels by 10% to 14% without any reported side effects. The serum LDL cholesterol-lowering effect originates from reduced intestinal cholesterol absorption, a process in which plant stanols/sterols actively influence cellular cholesterol metabolism within intestinal enterocytes. Additionally, in response to the reduced supply of exogenous cholesterol, receptor-mediated

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Plant Stanol and Sterol Esters in the Control of Blood Cholesterol Levels: Mechanism and Safety Aspects

Section snippets

Plant Stanol Esters Reduce Intestinal Cholesterol Absorption

Effects of Plant Stanol Esters on Cholesterol Metabolism

Safety Aspects

Conclusion

Lancet

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Lipid Res

J Lipid Res

Cell

J Lipid Res

Am J Cardiol

J Lipid Res

Food Chem Toxicol

Food Chem Toxicol

Regul Toxicol Pharmacol

Atherosclerosis

Metabolism

Am J Clin Nutr

J Lipid Res

J Lab Clin Med

Metabolism

Metabolism

Atherosclerosis

J Lipid Res

J Nutr