• Increase Font Size
  • Decrease Font Size
  • View as PDF

  • Assessment
    How might the consumption of carotenoid-rich fruits or vegetables alter plasma carotenoid levels when also consuming sterols?
    • Conclusion

      Preliminary research suggests that consuming one extra carotenoid rich fruit or vegetable per day has been shown to maintain plasma carotenoid levels when also consuming sterol-enriched spreads.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
  • Intervention
    (2005) What effect does the intake of plant sterols and stanols have on total cholesterol and LDL cholesterol?
    • Conclusion

      Plant sterols and stanols are potent hypocholesterolemic agents and a daily consumption of 2 - 3 g (through margarine, lowfat yogurt, orange juice, breads, and cereals) lowers TC concentrations in a dose dependent manner by 4 – 11% and LDL cholesterol concentrations by 7 – 15% without changing HDL cholesterol or triacylglycerol concentrations.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What effect does EPA/DHA taken as a fish oil supplement have on triglycerides in hypertriglyceridemic patients who are taking cholesterol lowering medication (statins)?
    • Conclusion

      The triglyceride lowering benefit of EPA/DHA fish oil with HMG-Co A reductase inhibitors (statins) was reported in three studies of varied patient populations. Studies provided 1.68-3.2g EPA/DHA daily for 5-48 weeks in patients receiving statin therapy with diet and lifestyle changes. This resulted in a 0-35% reduction in triglycerides vs. baseline values. Two of the studies found a 32-35% reduction and one study found no reduction in triglycerides. In these three studies there appears to be no dose response. No dietary adherence data were reported.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2005) How are the effects of stanols and sterols on cholesterol levels altered when eaten as part of a cholesterol lowering diet?
    • Conclusion

      The total cholesterol and LDL cholesterol lowering effects of stanols and sterols are evident even when sterols and stanols are consumed as part of a cholesterol lowering diet.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2006) How do sterols and stanols compare in terms of their efficacy in lowering cholesterol?
    • Conclusion

      The cholesterol loweing effects are similarly caused by sterols and stanols. Sterols lowered TC by 6-11% and LDL-C by 7-15%. Stanols lowered TC by 4-10% and LDL-C by 7-14%. Although the reduction in TC and LDL-C are similar, two high-quality randomized controlled trials in hypercholesterolemic adults report slightly greater though non-significant effects with consumption of stanols compared to sterols.

       

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2005) How do esterified and nonesterified forms of stanols and sterols compare in terms of their cholesterol lowering ability?
    • Conclusion

      Nonesterified and esterified forms of sterols and stanols are equally effective. Consumption of 2-3 g of nonesterified sterols and stanols reduce TC by 4-11% and LDL-C by 8-15% and esterified sterols and stanols reduce TC by 6-10% and LDL-C by 7-15%.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2005) Can plant stanols further reduce LDL cholesterol and total cholesterol even for people receiving statin therapy?
    • Conclusion

      For patients receiving statin therapy, plant stanols further reduce LDL cholesterol and total cholesterol.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2005) Can statin dose be reduced through the use of stanols and sterols?
    • Conclusion

      Data regarding whether the dose of statins can be reduced by the use of stanols and sterols are needed.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    (2010) In adults, are there any adverse effects when consuming plant stanols and sterols?
    • Conclusion

      Consumption of plant stanols and sterols was not associated with adverse effects that were investigated in a total of 28 studies. Seventeen randomized controlled trials (RCTs) demonstrated effective serum cholesterol-lowering benefits without any reported adverse effects, including no significant effect on fat soluble vitamin status. Very limited data suggest otherwise. Two other RCTs reported lowering of carotenoid levels. Although three of six observational studies report a possible association between plasma or tissue sterol levels and increased risk of coronary heart disease (CHD), the short-term RCTs do not indicate negative effects on vascular function. 

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.