DLM: Stanols/Sterols (2001)

Citation:

Lichtenstein AH, Deckelbaum RJ. Stanol/Sterol ester-containing foods and blood cholesterol levels. Circulation. 2001;103:1177-1179.

Worksheet created prior to Spring 2004 using earlier ADA research analysis template.
 
Study Design:
Consensus Statement
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:
Inclusion Criteria:
Exclusion Criteria:
Description of Study Protocol:
Since Stanol/Sterol esters do not occur in nature in foods commonly eaten, all studies to evaluate these have been clinical trials and the majority have been RCT.
Data Collection Summary:
Description of Actual Data Sample:
Summary of Results:
Benefits of Stanol/Sterol Ester containing fats: 1. Sitostanol ester (3.4 g/d) in canola oil-based margarine decreases LDL cholesterol ~10% in modestly hyperhcolesterolemic subjects and in individuals with apo E4 alleles (previously reported to have the highest efficiency of cholesterol absorption). 2. Maximal efficacy with respect to total and LDL cholesterol lowering is achieved at ~2 g/d and that there is little effect on HDL cholesterol or trigylcerides. 3. Consumption of sterol esters is efficacious in both normolipidemic and dyslipidemic individuals including those being treated with HMG-CoA reductase inhibitors or other lipid lowering medications. 4. Daily ingestion of 1.8 to 3 g of stanol esters/d in hypercholesterolemic children resulted in decreased LDL cholesterol similar to that of adults (9% to 20%). Possible adverse effects of consuming stanol ester foods: 1. Decrease plasma a and b carotenes, a -tocopherol, and/or lycopene especially in children and pregnant women. Stanol/Sterol Ester—containing fats should be reserved for adults requiring lowering of total and LDL cholesterol because of Hypercholesterolemia or 2° Prevention after an atherosclerotic event. More long-term studies are needed before these products can be recommended for the general population to prevent CHD or for children with hypercholesterolemia because of the possible side effects related to malabsorption of fat soluble vitamins.
Author Conclusion:
No details of the studies were given in this review. This was strictly a narrative review. Data from RCT are available to demonstrate the efficacy of stanol/sterol ester containing foods in decreased total and LDL cholesterol.
Funding Source:
Not-for-profit
0
Foundation associated with industry:
Reviewer Comments:
Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? ???
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? ???
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? ???
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? No
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? ???
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? ???
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? ???
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? ???
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? ???
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? ???
  10. Was bias due to the review's funding or sponsorship unlikely? ???