LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies
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Phytosterols (PS, comprising plant sterols and plant stanols) have been proven to lower LDL-cholesterol concentrations. The dose–response relationship for this effect has been evaluated in several meta-analyses by calculating averages for different dose ranges or by applying continuous dose–response functions. Both approaches have advantages and disadvantages. So far, the calculation of averages for different dose ranges has not been done for plant sterols and stanols separately. The objective of the present meta-analysis was to investigate the combined and separate effects of plant sterols and stanols when classified into different dose ranges. Studies were searched and selected based on predefined criteria. Relevant data were extracted. Average LDL-cholesterol effects were calculated when studies were categorised by dose, according to random-effects models while using the variance as weighing factor. This was done for plant sterols and stanols combined and separately. In total, 124 studies (201 strata) were included. Plant sterols and stanols were administered in 129 and fifty-nine strata, respectively; the remaining used a mix of both. The average PS dose was 2·1 (range 0·2–9·0) g/d. PS intakes of 0·6–3·3 g/d were found to gradually reduce LDL-cholesterol concentrations by, on average, 6–12 %. When plant sterols and stanols were analysed separately, clear and comparable dose–response relationships were observed. Studies carried out with PS doses exceeding 4 g/d were not pooled, as these were scarce and scattered across a wide range of doses. In conclusion, the LDL-cholesterol-lowering effect of both plant sterols and stanols continues to increase up to intakes of approximately 3 g/d to an average effect of 12 %.
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The expected reductions of the intended combination of a Portfolio dietary pattern and NCEP Step II diet of ~27% (32% in efficacy and 15% in effectiveness trials) are similar to those seen with starting doses of low intensity statins (18 to 28%) or 10 mg of ezetimibe (15-20%).
“The expected reductions of the intended combination of a Portfolio dietary pattern and NCEP Step II diet of ~27% (32% in efficacy and 15% in effectiveness trials) are similar to those seen with the starting doses of low intensity statins (18 to 28%) 67 or 10 mg of ezetimibe (15-20%).69”
From Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials (2018) · cites this paper as [67]
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Experimental — accuracy not yet measuredPlant sterols and stanols' LDL cholesterol-lowering effect continues to increase up to intakes of approximately 3 g/day, with an average LDL-C reduction of 12%.
“their LDL cholesterol-lowering effect continues to increase up to intakes of approximately 3 g/day with an average LDL-C reduction of 12% [12].”
From Nutraceuticals in the Management of Dyslipidemia: Which, When, and for Whom? Could Nutraceuticals Help Low-Risk Individuals with Non-optimal Lipid Levels? (2021) · cites this paper as [12]
Plant sterols and stanols are safe.
“A large meta-analysis of 124 studies (201 strata) concluded that the PS are safe and that their LDL cholesterol-lowering effect continues to increase up to intakes of approximately 3 g/day with an average LDL-C reduction of 12% [12].”
From Nutraceuticals in the Management of Dyslipidemia: Which, When, and for Whom? Could Nutraceuticals Help Low-Risk Individuals with Non-optimal Lipid Levels? (2021) · cites this paper as [12]
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Self-citation
- Authors
- Ras, R. T., Geleijnse, J. M., & Trautwein, E. A.
- Affiliations
- Unilever Research and Development Vlaardingen (NL)
- Wageningen University & Research (NL)
- Corresponding author
- Ras, Rouyanne T.
- Venue
- British Journal of Nutrition
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-04-30
- Volume
- 112
- Issue
- 2
- Pages
- 214-219
- ISSN
- 0007-1145 (ISSN-L)
- 1475-2662
- PMC
- PMC4071994
- OpenAlex
- W2145483967
- Cited by
- 379
- References
- 31
- Citations by year
- 2026: 22 · 2025: 17 · 2024: 20 · 2023: 36 · 2022: 31 · 2021: 42 · 2020: 43 · 2019: 41 · 2018: 34 · 2017: 32 · 2016: 31 · 2015: 26 · 2014: 2
- FWCI
- 5.72
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- British Journal Of Nutrition (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Natural Products and Biological Research
- Keywords
- phytosterols, plant stanols, LDL cholesterol, dose-response relationship, cholesterol-lowering effect, dietary supplementation, hypercholesterolemia, dose range
- MeSH terms
- Adult, Anticholesteremic Agents, Humans, Hypercholesterolemia, Cholesterol, LDL, Phytosterols, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Dietary Supplements, Functional Food
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