Phytosterols, Phytostanols, and Lipoprotein Metabolism.
Level 5 - mechanism / opinion, no new human data
Narrative review without systematic search or meta-analysis
PubMed 26393644 · doi:10.3390/nu7095374
What was done
The authors reviewed published literature on the lipid-lowering efficacy and metabolic mechanisms of plant sterols and stanols consumed via foods or dietary supplements. The review evaluated effects on serum lipid panels (LDL-C, HDL-C, triglycerides, lipoprotein(a)), PCSK9 concentrations, intestinal absorption/synthesis dynamics, and fasting versus postprandial lipoprotein kinetics.
What was found
Phytosterols and phytostanols at a dose of 2 g/day lowered LDL cholesterol by 8% to 10%, an effect observed regardless of age, sex, ethnicity, body weight, background diet, or concurrent statin use. No changes were observed for HDL cholesterol, lipoprotein(a), or PCSK9. In individuals with metabolic syndrome and moderate hypertriglyceridemia, phytostanols lowered serum triglycerides by 27%, lowered non-HDL cholesterol, and reduced large and medium VLDL particle concentrations. Kinetic evaluations demonstrated reduced LDL apolipoprotein B-100 transport rates and lower small dense LDL cholesterol concentrations without altering overall LDL particle size.
Why it matters
This paper consolidates evidence that displacing cholesterol from mixed intestinal micelles via phytosterols and phytostanols provides a consistent, non-pharmacologic method to diminish circulating atherogenic lipoproteins.
Limits
As a narrative review, the report lacks a systematic search protocol, risk-of-bias assessment, and pooled meta-analytic effect estimates. The abstract notes that lipoprotein kinetic studies and detailed postprandial evaluations (including apolipoprotein B-48) remain scarce, and clinical cardiovascular outcome data were not evaluated.
Cited by
- supports High intake of plant sterols (phytosterols) reduces total cholesterol absorption by outcompeting cholesterol at enterocytes in the gut.