Continuous Dose-Response Relationship of the LDL-Cholesterol-Lowering Effect of Phytosterol Intake

• Published in: The Journal of nutrition Vol. 139; no. 2; pp. 271 - 284
• Main Authors: Demonty, Isabelle, Ras, Rouyanne T, Knaap, Henk C.M. van der, Duchateau, Guus S.M.J.E, Meijer, Linsie, Zock, Peter L, Geleijnse, Johanna M, Trautwein, Elke A
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.02.2009
• Subjects: administration & dosage; Adult; adults; beverages; Biological and medical sciences; blood; blood lipids; Cholesterol, LDL; Cholesterol, LDL - blood; diet; dosage; dose response; Dose-Response Relationship, Drug; equations; Feeding. Feeding behavior; foods; Fundamental and applied biological sciences. Psychology; Humans; literature reviews; low density lipoprotein; mathematical models; meta-analysis; pharmacology; phytostanols; phytosterols; Phytosterols - administration & dosage; Phytosterols - pharmacology; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Lipids; Cholesterol LDL; Nutrition; Hypocholesterolemic agent; Continuous; Phytosterol
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.3945/jn.108.095125

Phytosterols (plant sterols and stanols) are well known for their LDL-cholesterol (LDL-C)-lowering effect. A meta-analysis of randomized controlled trials in adults was performed to establish a continuous dose-response relationship that would allow predicting the LDL-C-lowering efficacy of different phytosterol doses. Eighty-four trials including 141 trial arms were included. A nonlinear equation comprising 2 parameters (the maximal LDL-C lowering and an incremental dose step) was used to describe the dose-response curve. The overall pooled absolute (mmol/L) and relative (%) LDL-C-lowering effects of phytosterols were also assessed with a random effects model. The pooled LDL-C reduction was 0.34 mmol/L (95% CI: -0.36, -0.31) or 8.8% (95% CI: -9.4, -8.3) for a mean daily dose of 2.15 g phytosterols. The impacts of subject baseline characteristics, food formats, type of phytosterols, and study quality on the continuous dose-response curve were determined by regression or subgroup analyses. Higher baseline LDL-C concentrations resulted in greater absolute LDL-C reductions. No significant differences were found between dose-response curves established for plant sterols vs. stanols, fat-based vs. non fat-based food formats and dairy vs. nondairy foods. A larger effect was observed with solid foods than with liquid foods only at high phytosterol doses (>2 g/d). There was a strong tendency (P = 0.054) towards a slightly lower efficacy of single vs. multiple daily intakes of phytosterols. In conclusion, the dose-dependent LDL-C-lowering efficacy of phytosterols incorporated in various food formats was confirmed and equations of the continuous relationship were established to predict the effect of a given phytosterol dose. Further investigations are warranted to investigate the impact of solid vs. liquid food formats and frequency of intake on phytosterol efficacy.