DLM: Plant Stanols and Sterols (2010)
(2010) In adults, are there any adverse effects when consuming plant stanols and sterols?
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 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.
Evidence Summary: Are there any adverse effects when consuming plant stanols and sterols?
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
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- Christiansen LI, Lahteenmaki PLA, Mannelin MR, Seppanen-Laakso TE, Hiltunen RVK, Yliruusi JK. Cholesterol-lowering effect of spreads enriched with microcrystalline plant sterols in hypercholesterolemic subjects. Eur J Nutrition 2001 Apr; 40 (2): 66-73.
- Colgan HA, Floyd S, Noone EJ, Gibney MJ, Roche HM. Increased intake of fruit and vegetables and a low-fat diet, with and without low-fat plant sterol-enriched spread consumption: effects on plasma lipoprotein and carotenoid metabolism. J Hum Nutr Diet. 2004 Dec; 17(6): 561-569.
- Davidson MH, Maki KC, Umporowicz DM, Ingram KA, Dicklin MR, Schaefer E, Lane RW, McNamara JR, Ribaya-Mercado JD, Perrone G, Robins SJ, Franke WC. Safety and tolerability of esterified phytosterols administered in reduced-fat spread and salad dressing to healthy men and women. J Am Coll Nutr. 2001 Aug; 20(4): 307-319.
- De Jong A, Plat J, Bast A, Godschalk RW, Basu S, Mensink RP. Effects of plant sterol and stanol ester consumption on lipid metabolism, antioxidant status and markers of oxidative stress, endothelial function and low-grade inflammation in patients on current statin treatment. Eur J Clin Nutr. 2008 Feb; 62(2): 263-273. Epub 2007 May 9.
- Fassbender K, Lütjohann D, Dik MG, Bremmer M, König J, Walter S, Liu Y, Letièmbre M, von Bergmann K, Jonker C.Moderately elevated plant sterol levels are associated with reduced cardiovascular risk: The LASA study. Atherosclerosis. 2008 Jan; 196 (1): 283-288.
- Gylling H, Hallikainen M, Raitakari OT, Laakso M, Vartiainen E, Salo P, Korpelainen V, Sundvall J, Miettinen TA. Long-term consumption of plant stanol and sterol esters, vascular function and genetic regulation. Br J Nutr. 2009 Jun; 101 (11): 1,688-1,695.
- Helske S, Miettinen T, Gylling H, Mäyränpää M, Lommi J, Turto H, Werkkala K, Kupari M, Kovanen PT. Accumulation of cholesterol precursors and plant sterols in human stenotic aortic valves. J Lipid Res. 2008 Jul; 49 (7): 1,511-1,518.
- Hendriks HFJ, Brink EJ, Meijer GW, Princen HMG, Ntanios FY. Safety of long-term consumption of plant sterol esters-enriched spread. Eur J Clin Nutr. 2003 May; 57(5): 681-692.
- Homma Y, Ikeda I, Ishikawa T, Tateno M, Sugano M, Nakamura H. Decrease in plasma low-density lipoprotein cholesterol, apolipoprotein B, cholesteryl ester transfer protein, and oxidized low-density lipoprotein by plant stanol ester-containing spread: A randomized, placebo-controlled trial. Nutrition. 2003 Apr; 19 (4): 369-374.
- Korpela R, Tuomilehto J, Högström P, Seppo L, Piironen V, Salo-Väänänen P, Toivo J, Lamberg-Allardt C, Kärkkäinen M, Outila T, Sundvall J, Vilkkilä S, Tikkanen MJ. Safety aspects and cholesterol-lowering efficacy of low-fat dairy products containing plant sterols. Eur J Clin Nutr. 2006 May; 60 (5): 633-642.
- Lea LJ, Hepburn PA. Safety evaluation of phytosterol-esters. Part 9: Results of a European post-launch monitoring programme. Food Chem Toxicol. 2006 Aug;44 (8):1,213-1,222.
- Maki KC, Davidson MH, Umporowicz DM, Schaefer EJ, Dicklin MR, Ingram KA, Chen S, McNamara JR, Gebhart BW, Ribaya-Mercado JD, Perrone G, Robins SJ, Franke WC. Lipid reponses to plant-sterol-enriched reduced-fat spreads incorporated into a National Cholesterol Education Program Step I diet. Am J Clin Nutr 2001 Jul; 74 (1): 33-43.
- Mensink RP, Ebbing S, Lindhout M, Plat J, van Heugten MMA. Effects of plant stanol esters supplied in low-fat yoghurt on serum lipids and lipoproteins, non-cholesterol sterols and fat soluble antioxidant concentrations. Atherosclerosis 2002 Jan; 160(1):205-213.
- Nestel P, Cehun M, Pomeroy S, Abbey M, Weldon G. Cholesterol-lowering effects of plant sterol esters and non-esterified stanols in margarine, butter and low-fat foods. European Journal of Clinical Nutrition. 2001 Dec; 55 (12): 1,084-1,090.
- Noakes M, Clifton P, Ntanios F, Shrapnel W, Record I, McInerney J. An increase in dietary carotenoids when consuming plant sterols or stanols is effective in maintaining plasma carotenoid concentrations. Am J Clin Nutr 2002; 75: 79-86.
- Ntanios FY, Homma Y, Ushiro S. A spread enriched with plant sterol-esters lowers blood cholesterol and lipoproteins without affecting vitamins A and E in normal and hypercholesterolemic Japanese men and women. J Nutr. 2002; 132 (12): 3,650-3,655.
- O'Neill FH, Sanders TA, Thompson GR. Comparison of efficacy of plant stanol ester and sterol ester: Short-term and longer-term studies. Am J Cardiol. 2005 Jul 4; 96 (1A): 29D-36D.
- Quilez J, Rafecas M, Brufau G, Garcia-Lorda P, Megias I, Bullo M, Ruiz JA, Salas-Salvado J. Bakery products enriched with phytosterol esters, a-tocopherol and ß-carotene decrease plasma LDL-cholesterol and maintain plasma ß-carotene concentrations in normocholesterolemic men and women. J Nutr 2003 Oct; 133(10):3103-3109.
- Raitakari OT, Salo P, Gylling H, Miettinen TA Plant stanol ester consumption and arterial elasticity and endothelial function. Br J Nutr. 2008; 100: 603-608.
- Rajaratnam RA, Gylling H, Miettinen TA. Independent association of serum squalene and noncholesterol sterols with coronary artery disease in postmenopausal women. J Am Coll Cardiol. 2000 Apr; 35(5): 1,185-1,191.
- Schiepers OJ, de Groot RH, van Boxtel MP, Jolles J, de Jong A, Lütjohann D, Plat J, Mensink RP. Consuming functional foods enriched with plant sterol or stanol esters for 85 weeks does not affect neurocognitive functioning or mood in hypercholesterolemic individuals. J Nutr. 2009 Jul; 139 (7): 1,368-1,373.
- Silbernagel G, Fauler G, Renner W, Landl EM, Hoffmann MM, Winkelmann BR, Boehm BO, März W. The relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease. J Lipid Res. 2009 Feb; 50 (2): 334-341.
- Tuomilehto J, Tikkanen MJ, Högström P, Keinänen-Kiukaanniemi S, Piironen V, Toivo J, Salonen JT, Nyyssönen K, Stenman UH, Alfthan H, Karppanen H. Safety assessment of common foods enriched with natural non-esterified plant sterols. Eur J Clin Nutr. 2009 May; 63 (5): 684-691.
- Volpe R, Niittynen L, Korpela R, Sirtori C, Bucci A, Fraone N, Pazzucconi F. Effects of yoghurt enriched with plant sterols on serum lipids in patients with moderate hypercholesterolaemia. British Journal of Nutrition 2001 Aug; 86(2):233-239.
- Weingärtner O, Lütjohann D, Ji S, Weisshoff N, List F, Sudhop T, von Bergmann K, Gertz K, König J, Schäfers HJ, Endres M, Böhm M, Laufs U. Vascular effects of diet supplementation with plant sterols. J Am Coll Cardiol. 2008 Apr 22; 51 (16): 1,553-1,561.
- Wilund KR, Yu L, Xu F, Vega GL, Grundy SM, Cohen JC, Hobbs HH. No association between plasma levels of plant sterols and atherosclerosis in mice and men. Arterioscler Thromb Vasc Biol. 2004 Dec; 24 (12): 2,326-2,332.
- Windler E, Zyriax BC, Kuipers F, Linseisen J, Boeing H. Association of plasma phytosterol concentrations with incident coronary heart disease Data from the CORA study, a case-control study of coronary artery disease in women. Atherosclerosis. 2009 Mar; 203(1): 284-290.
Search Plan and Results: DLM: Plant Stanols/Sterols and Adverse Effects 2010