Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-30T19:59:54.742Z Has data issue: false hasContentIssue false
  • English
  • Français

Consumption of tall oil-derived phytosterols in a chocolate matrix significantly decreases plasma total and low-density lipoprotein-cholesterol levels

Published online by Cambridge University Press:  09 March 2007

Jacqueline de Graaf ,
Pernette R. W. de Sauvage Nolting ,
Marjel van Dam ,
Elizabeth M. Belsey ,
John J. P. Kastelein ,
P. Haydn Pritchard  and
Anton F. H. Stalenhoef
Jacqueline de Graaf*
Affiliation:
Department of General Internal Medicine, University Medical Centre Nijmegen, Nijmegen, The Netherlands
Pernette R. W. de Sauvage Nolting
Affiliation:
Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
Marjel van Dam
Affiliation:
Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
Elizabeth M. Belsey
Affiliation:
Department of Statistics, Division of Infectious Diseases, Northwestern University, Chicago IL, USA
John J. P. Kastelein
Affiliation:
Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands
P. Haydn Pritchard
Affiliation:
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
Anton F. H. Stalenhoef
Affiliation:
Department of General Internal Medicine, University Medical Centre Nijmegen, Nijmegen, The Netherlands
*
*Corresponding author: Dr J. de Graaf, fax +31 24 35 417 34, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

In a randomized, double-blind, placebo-controlled trial we evaluated the effect of dietary chocolates enriched with a wood-based phytosterol–phytostanol mixture, containing 18% (w/w) sitostanol, compared with placebo dietary chocolates in seventy subjects with primary hypercholesterolaemia (total cholesterol levels below 8 mmol/l). For 4 weeks, participants consumed three servings of the phytosterol-enriched chocolate/d that provided 1·8 g unesterified phytosterols/d or a placebo chocolate in conjunction with a low-fat, low-cholesterol diet. Plasma total and LDL-cholesterol levels were statistically significantly reduced by 6·4% (−0·44 mmol/l) and 10·3% (−0·49 mmol/l), respectively, after 4 weeks of phytosterol-enriched-chocolate treatment. Plasma HDL-cholesterol and triacylglycerol levels were not affected. Consumption of phytosterol-enriched chocolates significantly increased plasma lathosterol concentration (+20·7%), reflecting an increased endogenous cholesterol synthesis in response to phytosterol-induced decreased intestinal cholesterol absorption. Furthermore, the chocolates enriched with phytosterols significantly increased both plasma sitosterol (+95·8%) and campesterol (+64·1%) levels, compared with the placebo chocolate group. However, the absolute values of plasma sitosterol and campesterol remained within the normal range, that is, below 10 mg/l. The chocolates with phytosterols were palatable and induced no clinical or biochemical side effects. These findings indicate that dietary chocolate enriched with tall oil-derived phytosterols (1·8 g/d) is effective in lowering blood total and LDL-cholesterol levels in subjects with mild hypercholesterolaemia and thus may be helpful in reducing the risk of CHD in these individuals.

Keywords

PhytosterolsLipidsChocolate
Type
Research Article
Information
British Journal of Nutrition , Volume 88 , Issue 5 , November 2002 , pp. 479 - 488
Copyright
Copyright © The Nutrition Society 2002

References

Blair, SN, Capuzzi, DM, Gottlieb, SO, Nguyen, T, Morgan, JM & Cater, NB (2000) Incremental reduction of serum total cholesterol and low-density lipoprotein cholesterol with the addition of plant stanol ester-containing spread to statin therapy. American Journal of Cardiology 86, 46–52.CrossRefGoogle ScholarPubMed
Cater, NB (1999) Historical and scientific basis for the development of plant stanol ester foods as cholesterol lowering agents. European Heart Journal 1, S36–S44.Google Scholar
de Graaf, J & Stalenhoef, AFH (2000) The use of margarine with added phytosterols as functional food. Nederlands Tijdschrift voor Geneeskunde 144, 918–921.Google Scholar
Denke, MA (1995) Lack of efficacy of low-dose stiostanol therapy as an adjunct to a cholesterol-lowering diet in men with moderate hypercholesterolemia. American Journal of Clinical Nutrition 61, 392–396.CrossRefGoogle ScholarPubMed
Diplock, AT, Agget, PJ, Ashwell, M, Bornet, F, Fern, EB & Roberfroid, MB (1999) Scientific concepts of functional foods in Europe: consensus document. British Journal of Nutrition 91, S1–S27.Google Scholar
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the 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). Journal of the American Medical Association 285, 2486–2497.CrossRefGoogle Scholar
Gluck, CJ, Speirs, J, Tracy, T, Streicher, P, Illig, E & VanderGrift, J (1991) Relationships of serum plant sterols (phytosterols) and cholesterol in 595 hypercholesterolemic subjects, and familial aggregation of phytosterols, cholesterol, and premature coronary heart disease in hypercholesterolemic probands and their first-degree relatives. Metabolism 40, 842–848.CrossRefGoogle Scholar
Gylling, H & Miettinen, TA (1994) Serum cholesterol and lipoprotein metabolism in hypercholesterolemic NIDDM patients before and during sitostanol ester margarine treatment. Diabetologia 37, 773–780.CrossRefGoogle ScholarPubMed
Gylling, H & Miettinen, TA (1996) Effects of inhibiting cholesterol absorption and synthesis on cholesterol and lipoprotein metabolism in hypercholesterolemic non-insulin-dependent diabetic men. Journal of Lipid Research 37, 1776–1785.CrossRefGoogle ScholarPubMed
Gylling, H, Radhakrishnan, R & Miettinen, TA (1997) Reduction of serum cholesterol in postmenopausal women with previous myocardial infarction and cholesterol malabsorption induced by dietary sitostanol ester margarine. Women and dietary sitostanol. Circulation 96, 4226–4231.CrossRefGoogle ScholarPubMed
Gylling, H, Siimes, MA & Miettinen, TA (1995) Sitostanol ester margarine in dietary treatment of children with familial hypercholesterolemia. Journal of Lipid Research 36, 1807–1812.CrossRefGoogle ScholarPubMed
Hallikainen, MA, Sarkkinen, ES, Gylling, H, Erkkila, AT & Uusitupa, MIJ (2000) Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolemic subjects on a low-fat diet. European Journal of Clinical Nutrition 54, 715–725.CrossRefGoogle ScholarPubMed
Hallikainen, MA, Sarkkinen, ES & Uusitupa, MIJ (2000) Plant stanol esters affect serum cholesterol concentrations of hypercholesterolemic men and women in a dose-dependent manner. Journal of Nutrition 130, 767–776.CrossRefGoogle ScholarPubMed
Hallikainen, MA & Uusitupa, MIJ (1999) Effects of 2 low-fat stanol ester-containing margarines on serum cholesterol concentrations as part of a low-fat diet in hypercholesterolemic subjects. American Journal of Clinical Nutrition 69, 403–410.CrossRefGoogle ScholarPubMed
Heinemann, T, Axtmann, G & von Bergmann, K (1993) Comparison of intestinal absorption of cholesterol with different plant sterols in man. European Journal of Clinical Investigation 23, 827–831.CrossRefGoogle ScholarPubMed
Hodis, HN, Crawford, DW & Sevanian, A (1991) Cholesterol feeding increases plasma and aortic tissue cholesterol oxide levels in parallel: further evidence for the role of cholesterol oxidation in atherosclerosis. Atherosclerosis 89, 117–126.CrossRefGoogle ScholarPubMed
Jones, PJ, Howell, T, MacDougall, DE, Feng, JY & Parsons, W (1998) Short-term administration of tall oil phytosterols improves plasma lipid profiles in subjects with different cholesterol levels. Metabolism 47, 751–756.CrossRefGoogle ScholarPubMed
Jones, PJ, Ntanios, FY, Raeini-Sarjaz, M & Vanstone, CA (1999) Cholesterol-lowering efficacy of a sitostanol-containing phytosterol mixture with a prudent diet in hyperlipidemic men. American Journal of Clinical Nutrition 69, 1144–1150.CrossRefGoogle ScholarPubMed
Jones, PJ, Raeini-Sarjaz, M, Ntanios, FY, Vanstone, CA, Feng, JY & Parsons, WE (2000) Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. Journal of Lipid Research 41, 697–705.CrossRefGoogle ScholarPubMed
Kempen, HJM, Glatz, JFC, Gevers Leuven, JA, van der Voort, HA & Katan, MB (1988) Serum lathosterol concentration is an indicator of whole-body cholesterol synthesis in humans. Journal of Lipid Research 29, 1149–1155.CrossRefGoogle ScholarPubMed
Koopman, BJ, van der Molen, JC, Wolters, BG & van der Pas, JB (1987) Determination of some hydroxycholesterols in human serum samples. Journal of Chromatology 416, 1–13.CrossRefGoogle ScholarPubMed
Law, M (2000) Plant sterol and stanol margarines and health. British Medical Journal 320, 861–864.CrossRefGoogle ScholarPubMed
Law, MR, Wald, N & Thompson, SG (1994) By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischemic heart disease? British Medical Journal 308, 367–373.CrossRefGoogle Scholar
Lee, M, Lu, K & Patel, SB (2001) Genetic basis of sitosterolemia. Current Opinion in Lipidology 12, 141–149.CrossRefGoogle ScholarPubMed
Lees, AM, Mok, HY, Lees, RS, McCluskey, MA & Grundy, SM (1977) Plant sterols as cholesterol-lowering agents: clinical trials in patients with hypercholesterolemia and studies of sterol balance. Atherosclerosis 28, 325–338.CrossRefGoogle ScholarPubMed
Lutjohann, D & von Bergmann, K (1997) Phytosterolaemia: diagnosis, chracterization and therapeutical approaches. Annals of Medicine 29, 181–184.CrossRefGoogle Scholar
Mattson, FH, Grundy, SM & Crouse, JR (1982) Optimizing the effect of plant sterols on cholesterol absorption in man. American Journal of Clinical Nutrition 35, 697–700.CrossRefGoogle ScholarPubMed
Miettinen, TA & Gylling, H (1999) Regulation of cholesterol metabolism by dietary plant sterols. Current Opinion in Lipidology 10, 9–14.CrossRefGoogle ScholarPubMed
Miettinen, TA, Puska, P, Gylling, H, Vanhanen, H & Vartiainen, E (1995) Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. New England Journal of Medicine 333, 1308–1312.CrossRefGoogle Scholar
Miettinen, TA, Tilvis, RS & Kesaniemi, YA (1990) Serum plant sterols and cholesterol precursors reflect cholesterol absorption and synthesis in volunteers of a randomly selected male population. American Journal of Epidemiology 131, 20–31.CrossRefGoogle ScholarPubMed
Moghadasian, MH & Frohlich, JJ (1999) Effects of dietary phytosterols on cholesterol metabolism and atherosclerosis: clinical and experimental evidence. American Journal of Medicine 107, 588–594.CrossRefGoogle ScholarPubMed
National Cholesterol Education Program (NCEP) (2001) Executive summary of the 3rd report of the NCEP expert panel on detection, evaluation and treatment of high blood cholesterol in adults (adult treatment panel III). Journal of American Medical Association 285, 2486–2497.CrossRefGoogle Scholar
Normen, L, Dutta, P, Lia, A & Andersson, H (2000) Soy sterol esters and b-sitostanol ester as inhibitors of cholesterol absorption in human small bowel. American Journal of Clinical Nutrition 71, 908–913.CrossRefGoogle ScholarPubMed
Plat, J & Mensink, RP (2000) Vegetable oil based versus wood based stanol ester mixtures: effects on serum lipids and hemostatic factors in non-hypercholesterolemic subjects. Atherosclerosis 148, 101–112.CrossRefGoogle ScholarPubMed
Plat, J & Mensink, RP (2001) Effect of plant sterols and stanols on lipid metabolism and cardiovascular risk. Nutrition Metabolism and Cardiovascular Diseases 11, 31–40.Google ScholarPubMed
Scandinavian Simvastatin Survival Study Group (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344, 1301–1307.Google Scholar
Shephard, J, Cobbe, SM, Ford, I, Isles, CG, Lorimar, AR, Macfarlane, W, McKillop, JH & Packard, CJfor the West of Scotland Coronary (1995) Prevention Study Group Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. New England Journal of Medicine 333, 1301–1307.CrossRefGoogle Scholar
Stalenhoef, AFH, Hectors, M & Demacker, PNM (2001) Effect of plant sterol-enriched margarine on plasma lipids and sterols in subjects heterozygous for phytosterolaemia. Journal of Internal Medicine 249, 163–166.CrossRefGoogle ScholarPubMed
Tammi, A, Ronnemaa, T, Gylling, H, Rask-Nissila, L, Viikari, J, Tuominen, J, Pulkki, K & Simell, O (2000) Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Special Turku Coronary Risk Factors Intervention Project. Journal of Pediatrics 136, 503–510.CrossRefGoogle ScholarPubMed
Westrate, JA & Meijer, GW (1998) Plant-sterol-enriched margarines and reduction of plasma total and LDL-cholesterol concentrations in normocholesterolemic and mildly hypercholesterolemic subjects. European Journal of Clinical Investigation 52, 334–343.Google Scholar