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2015 ; 7
(9
): 7965-77
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Phytosterols, Phytostanols, and Lipoprotein Metabolism
#MMPMID26393644
Gylling H
; Simonen P
Nutrients
2015[Sep]; 7
(9
): 7965-77
PMID26393644
show ga
The efficacy of phytosterols and phytostanols added to foods and food supplements
to obtain significant non-pharmacologic serum and low density lipoprotein (LDL)
cholesterol reduction is well documented. Irrespective of age, gender, ethnic
background, body weight, background diet, or the cause of hypercholesterolemia
and, even added to statin treatment, phytosterols and phytostanols at 2 g/day
significantly lower LDL cholesterol concentration by 8%-10%. They do not affect
the concentrations of high density lipoprotein cholesterol, lipoprotein (a) or
serum proprotein convertase subtilisin/kexin type 9. In some studies,
phytosterols and phytostanols have modestly reduced serum triglyceride levels
especially in subjects with slightly increased baseline concentrations.
Phytosterols and phytostanols lower LDL cholesterol by displacing cholesterol
from mixed micelles in the small intestine so that cholesterol absorption is
partially inhibited. Cholesterol absorption and synthesis have been carefully
evaluated during phytosterol and phytostanol supplementation. However, only a few
lipoprotein kinetic studies have been performed, and they revealed that LDL
apoprotein B-100 transport rate was reduced. LDL particle size was unchanged, but
small dense LDL cholesterol concentration was reduced. In subjects with metabolic
syndrome and moderate hypertriglyceridemia, phytostanols reduced not only non-
high density lipoprotein (HDL) cholesterol concentration but also serum
triglycerides by 27%, and reduced the large and medium size very low density
lipoprotein particle concentrations. In the few postprandial studies, the
postprandial lipoproteins were reduced, but detailed studies with apoprotein B-48
are lacking. In conclusion, more kinetic studies are required to obtain a more
complete understanding of the fasting and postprandial lipoprotein metabolism
caused by phytosterols and phytostanols. It seems obvious, however, that the most
atherogenic lipoprotein particles will be diminished.
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