Solubilization of phytosterols in diacylglycerol versus triacylglycerol improves the serum cholesterol-lowering effect

Effects of phytosterol supplementation on lipid profiles in patients with hypercholesterolemia: a systematic review and meta-analysis of randomized controlled trials

Phytosterols (PSs) have been reported to improve blood lipids in patients with hypercholesterolemia for many years. However, meta-analyses of the effects of phytosterols on lipid profiles are limited and incomplete. A systematic search of randomized controlled trials (RCTs) published in PubMed, Embase, Cochrane Library, and Web of Science from inception to March 2022 was conducted according to the 2020 preferred reporting items of the guidelines for systematic reviews and meta-analysis (PRISMA) statement. These included studies of people with hypercholesterolemia, comparing foods or preparations containing PSs with controls. Mean differences with 95% confidence intervals were used to estimate continuous outcomes for individual studies. The results showed that in patients with hypercholesterolemia, taking a diet containing a certain dose of plant sterol significantly reduced total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) (TC: Weight Mean Difference (WMD) [95% CI] = -0.37 [-0.41, -0.34], p < 0.001; LDL-C: WMD [95% CI] = -0.34 [-0.37, -0.30], p < 0.001). In contrast, PSs had no effect on high density lipoprotein cholesterol (HDL-C) or triglycerides (TGs) (HDL-C: WMD [95% CI] = 0.00 [-0.01, 0.02], p = 0.742; TG: WMD [95% CI] = -0.01 [-0.04, 0.01], p = 0.233). Also, a significant effect of supplemental dose on LDL-C levels was observed in a nonlinear dose-response analysis (p-nonlinearity = 0.024). Our findings suggest that dietary phytosterols can help reduce TC and LDL-C concentrations in hypercholesterolemia patients without affecting HDL-C and TG concentrations. And the effect may be affected by the food substrate, dose, esterification, intervention cycle and region. The dose of phytosterol is an important factor affecting the level of LDL-C.

Effect of the Addition of Buckwheat Sprouts Modified with the Addition of Saccharomyces cerevisiae var. boulardii to an Atherogenic Diet on the Metabolism of Sterols, Stanols and Fatty Acids in Rats

The aim of the study was to evaluate the effect of the addition of Fagopyrum esculentum Moench buckwheat sprouts modified with the addition of Saccharomyces cerevisiae var. boulardii to an atherogenic diet on the metabolism of sterols and fatty acids in rats. It was noticed in the study that the group fed with modified sprouts (HFDPRS) had a greater amount of sterols by 75.2%, compared to the group fed on an atherogenic diet (HFD). The content of cholesterol in the liver and feces was lower in the HFDPRS group than the HFD group. In the serum of the HFDPRS group, a more significant amount of the following acids was observed: C18:2 (increase by 13.5%), C20:4 (increase by 15.1%), and C22:6 (increase by 13.1%), compared to the HFDCS group. Regarding the biochemical parameters, it was noted that the group fed the diet with the addition of probiotic-rich sprouts diet had lower non-HDL, LDL-C and CRP ratios compared to the group fed the high-fat diet. The obtained results indicate that adding modified buckwheat sprouts to the diet by adding the probiotic strain of the yeast may have a significant impact on the metabolism of the indicated components in the organism.

Property of Phytosterols and Development of Its Containing Mayonnaise-Type Dressing

Phytosterols are functional ingredients with known efficacy and safety. Phytosterols are found as free sterols or as their esters with fatty acids. Although phytosterol esters are soluble in oil and have been used in many commercial foods, it has been difficult to similarly use free phytosterols since they are insoluble in water and practically insoluble in oil. We have developed mayonnaise-type dressing materials using free phytosterols since people who are conscious about cholesterol intake are likely to be conscious about oil. In this review article, we summarized pieces of evidence for the development of phytosterol-containing mayonnaise-type dressing materials.

Irvingia gabonensis Seed Extract: An Effective Attenuator of Doxorubicin-Mediated Cardiotoxicity in Wistar Rats

Cardiotoxicity as an off-target effect of doxorubicin therapy is a major limiting factor for its clinical use as a choice cytotoxic agent. Seeds of Irvingia gabonensis have been reported to possess both nutritional and medicinal values which include antidiabetic, weight losing, antihyperlipidemic, and antioxidative effects. Protective effects of Irvingia gabonensis ethanol seed extract (IGESE) was investigated in doxorubicin (DOX)-mediated cardiotoxicity induced with single intraperitoneal injection of 15 mg/kg of DOX following the oral pretreatments of Wistar rats with 100-400 mg/kg/day of IGESE for 10 days, using serum cardiac enzyme markers (cardiac troponin I (cTI) and lactate dehydrogenase (LDH)), cardiac tissue oxidative stress markers (catalase (CAT), malonyldialdehyde (MDA), superoxide dismutase (SOD), glutathione-S-transferase (GST), glutathione peroxidase (GSH-Px), and reduced glutathione (GSH)), and cardiac histopathology endpoints. In addition, both qualitative and quantitative analyses to determine IGESE's secondary metabolites profile and its in vitro antioxidant activities were also conducted. Results revealed that serum cTnI and LDH were significantly elevated by the DOX treatment. Similarly, activities of tissue SOD, CAT, GST, and GSH levels were profoundly reduced, while GPx activity and MDA levels were profoundly increased by DOX treatment. These biochemical changes were associated with microthrombi formation in the DOX-treated cardiac tissues on histological examination. However, oral pretreatments with 100-400 mg/kg/day of IGESE dissolved in 5% DMSO in distilled water significantly attenuated increases in the serum cTnI and LDH, prevented significant alterations in the serum lipid profile and the tissue activities and levels of oxidative stress markers while improving cardiovascular disease risk indices and DOX-induced histopathological lesions. The in vitro antioxidant studies showed IGESE to have good antioxidant profile and contained 56 major secondary metabolites prominent among which are γ-sitosterol, Phytol, neophytadiene, stigmasterol, vitamin E, hexadecanoic acid and its ethyl ester, Phytyl palmitate, campesterol, lupeol, and squalene. Overall, both the in vitro and in vivo findings indicate that IGESE may be a promising prophylactic cardioprotective agent against DOX-induced cardiotoxicity, at least in part mediated via IGESE's antioxidant and free radical scavenging and antithrombotic mechanisms.

Effects of Urtica dioica hydro-alcoholic extract on blood serum glucose and lipid profiles of female Wistar rats with long-term estrogen deficiency

In this study, the effects of Urtica dioica hydro-alcoholic extract were investigated on the blood glucose and lipid profiles of female ovariectomized and non-ovariectomized rats. In total, 32 adult female rats were divided into four groups (eight each) including control and ovariectomy groups as well as non-ovariectomy and ovariectomy groups treated with 200 mg kg^-1 of Urtica dioica extract orally in the last five weeks of the study starting from the week 56^th. The duration of the study was 60 weeks. Glucose, serum lipid profiles and pancreatic pathological alterations were determined in these groups at the end of experiment. Serum glucose, triglyceride (TG), very-low-density lipoprotein (VLDL), and TG/high-density lipoprotein (HDL) ratio indicated a significant increase in the healthy female rats under treatment with Urtica dioica extract compared to others. The TG, cholesterol, HDL, low-density lipoprotein (LDL) and VLDL showed a significant increase in menopaused rats compared to others. The interaction of consuming Urtica dioica extract and ovariectomy caused significant decreases in glucose, TG, VLDL, HDL/LDL ratio and TG/HDL ratio. Consumption of Urtica dioica extract by non-menopaused rats damaged the beta cells in Langerhans islets. Results of the present study revealed that the consumption of Urtica dioica extract is not beneficial and has diabetogenic effects in female non-ovariectomized rats compared to ovariectomized ones.

Effects of Phytosterol Supplementation on Serum Levels of Lipid Profiles, Liver Enzymes, Inflammatory Markers, Adiponectin, and Leptin in Patients Affected by Nonalcoholic Fatty Liver Disease: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial

OBJECTIVE

Considering the high prevalence of nonalcoholic fatty liver disease and based on the evidence about the role of dietary cholesterol in liver inflammation, and also with regard to the effect of phytosterols on the metabolism of cholesterol, we aimed at exploring the therapeutic potential of phytosterol supplementation against nonalcoholic fatty liver disease.

METHOD

Thirty-eight patients with nonalcoholic fatty liver disease were randomly divided into two groups: The phytosterol group (n = 19) received a 1.6-g phytosterol supplement daily and the control group (n = 19) received 1.6 g starch daily as placebo for an 8-week period. Blood samples of all patients were taken at baseline (week 0) and at the end of the study (week 8) for measurement of lipid profiles, liver enzymes, inflammatory markers, adiponectin, and leptin.

RESULTS

Phytosterol supplementation significantly improved the levels of low-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, and tumor necrosis factor alpha compared to the placebo group. On the other hand, there were no significant differences between the two groups in total cholesterol, triglycerides, high-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol, gamma-glutamyl transferase, interleukin 6, high-sensitivity C-reactive protein, adiponectin, and leptin.

CONCLUSIONS

The present study suggested that daily consumption of 1.6 g phytosterols efficiently lowers low-density lipoprotein cholesterol, aspartate aminotransferase, alanine aminotransferase, and tumor necrosis factor alpha in patients with nonalcoholic fatty liver disease.

The food matrix and sterol characteristics affect the plasma cholesterol lowering of phytosterol/phytostanol

Foods with added phytosterols/phytostanols (PS) are recommended to lower LDL cholesterol (LDL-c) concentrations. Manufacturers have incorporated PS into a variety of common foods. Understanding the cholesterol-lowering impact of the food matrix and the PS characteristics would maximize their success and increase the benefit to consumers. This review systematically examines whether the PS characteristics and the fatty acid composition of foods with added PS affects serum LDL-c. A total of 33 studies published between the years 1998 and 2011 inclusive of 66 individual primary variables (strata) were evaluated. The functional food matrices included margarine, mayonnaise, yogurt, milk, cheese, meat, grain, juice, and chocolate. Consistently, ≥10% reductions in LDL-c were reported when the characteristics of the food matrix included poly- and monounsaturated fatty acids known to lower LDL-c. Also, >10% mean reductions in LDL-c were reported when β-sitostanol and campestanol as well as stanol esters were used. These characteristics allow both low-fat and high-fat foods to successfully incorporate PS and significantly lower LDL-c.

Investigating the effectiveness of different tea types from various thyme kinds (Origanum onites, Thymbra spicata and Satureja cuneifolia) on anemia and anticholesterolemic activity

In a study on villagers settled on the outskirts of the Taurus Mountains and whose source of living is thyme, it was revealed that the villagers excessively consumed thyme by adding it to their tea and many of their foods; high incidences of anemia was found among these villagers. In this study, 42 male adult Wistar albino rats weighing 200–250 g were used. The rats were divided to six equal groups as follows: control, cholesterol (Chol), 80 mg/kg Origanum onites Labiatae (OOL), 80 mg/kg Thymbra spicata Labiatae (TSL), 80 mg/kg Satureja cuneifolia Labiatae (SCL), and 160 mg/kg TSL, and each group consisted of seven rats. The control group was fed with normal pellet feed. The Chol group and all the other groups, except for the control group, were fed with 2% cholesterol-containing pellet feed. Physiological serum of 4 ml was given to the control and Chol group, wheile 80 mg/kg of thymes tea was given to the OOL group, TSL group, and SCL group, and 160 mg/kg of thymes tea was given to the TSL group by means of a gavage for 30 days. In the blood samples, the hematologic parameters and the biochemical parameters of serum glucose, blood urea nitrogen, creatinine, total protein, albumin, iron (I), total iron-binding capacity, aminotransferase aspartate, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, triglyceride, and oxidized LDL levels were examined. The kidney and liver tissues were examined histopathologically. The results of the study showed that different types of thymes had an antihypercholesterolemic effect. In addition to the anemic effect detected in group TSL and the mild granular degeneration found in the liver of 80 mg/kg SCL group, distinct granular degeneration was observed in 160 mg/kg TSL group.

Substitution of TAG oil with diacylglycerol oil in food items improves the predicted 10 years cardiovascular risk score in healthy, overweight subjects

Dietary fat is normally in TAG form, but diacylglycerol (DAG) is a natural component of edible oils. Studies have shown that consumption of DAG results in metabolic characteristics that are distinct from those of TAG, which may be beneficial in preventing and managing obesity. The objective of the present study was to investigate if food items in which part of the TAG oil is replaced with DAG oil combined with high α-linolenic acid (ALA) content would influence metabolic markers. A 12-week double-blinded randomised controlled parallel-design study was conducted. The participants (n 23) were healthy, overweight men and women, aged 37–67 years, BMI 27–35 kg/m², with waist circumference >94 cm (men) and >88 cm (women). The two groups received 20 g margarine, 11 g mayonnaise and 12 g oil per d, containing either high ALA and sn-1,3-DAG or high ALA and TAG. Substitution of TAG oil with DAG oil in food items for 12 weeks led to an improvement of the predicted 10 years cardiovascular risk score in overweight subjects by non-significantly improving markers of health such as total body fat percentage, trunk fat mass, alanine aminotransferase, systolic blood pressure, γ-glutamyl transferase, alkaline phosphatase and total fat-free mass. This may suggest that replacing TAG oil with DAG oil in healthy, overweight individuals may have beneficial metabolic effects.

Diacylglycerol: Efficacy and Mechanism of Action of an Anti-Obesity Agent

Obesity is at the forefront of global health issues and directly contributes to many chronic illnesses. Several dietary components show promise in the treatment of obesity, one of which is oil rich in diacylglycerols (DAGs). Present objectives are to examine scientific knowledge concerning DAG to assess evidence supporting the effects on substrate oxidation rates, body weight and fat mass, and blood lipids, and to assess safety, as well as elucidate potential mechanisms of action. DAG can be synthesized by an enzymatic process to produce mainly 1,3-isoform DAG. This 1,3-DAG oil is believed to have the ability to increase beta-oxidation, to enhance body weight loss, to suppress body fat accumulation, and to lower serum triacylglycerol levels postprandially. While certain animal and human studies indicate that consumption of 1,3-DAG has positive physiological effects, others report no effect. The mechanisms of action of DAG are suggested to decrease the resynthesis of chylomicrons as well as shunting them directly to the liver through the portal vein, where they are oxidized. This increased fat oxidation may influence control of food intake by increasing satiety. Further study into the precise mechanism is required to understand its effects. Safety studies show no risks in consuming a diet rich in DAG oil. Overall, consumption of oils with higher amounts of DAG, specifically 1,3-DAG, may be useful in the battle against obesity.

Postprandial lipid-related metabolites are altered in dogs fed dietary diacylglycerol and low glycemic index starch during weight loss

In this study, we investigated a combination of a low glycemic index starch (LGIS) and diacylglycerol (DAG) on lipid, lipoprotein (LP) metabolism, and weight management. Obese, intact female adult Beagle dogs were assigned to 1 of 4 starch/oil combination diets [LGIS/DAG (LD); LGIS/triacylglycerol (TAG); high glycemic index starch (HGIS)/DAG; and HGIS/TAG (HT)] and fed for 9 wk (n = 6/group) using an incomplete 4 × 4 Latin square design. Each dog was fed 1 of 2 opposite starch/oil combination diets (e.g. LD and HT). At wk 1 and 8, postprandial blood was collected for plasma triacylglycerol (TG), β-hydroxybutyrate (BHB), total cholesterol (TC), and LP analyses. During the same week, dogs were overnight feed-deprived and post-heparin blood was collected for LP lipase and hepatic lipase activity determinations. At wk 1, 4, and 8, blood was drawn from overnight feed-deprived dogs for plasma TG, BHB, TC, LP, leptin, and adiponectin measurements. Feces were collected at wk 3 for digestibility calculations. The LGIS diets resulted in lower carbohydrate, protein, total tract dry matter digestibilities, and metabolizable energy compared with the HGIS diet groups (P < 0.05). Thus, the LGIS groups lost more body weight (P = 0.001), which was positively correlated with plasma leptin concentrations (r(2) = 0.427; P < 0.001). Moreover, the LGIS diet lowered TC concentrations in combination with DAG. The DAG diet groups decreased postprandial TG and increased BHB concentrations (P < 0.05). Starch/oil types did not alter lipase activities or adiponectin concentrations. In conclusion, the LGIS diet demonstrated potential as a weight management tool in dogs by decreasing postprandial TG and increasing BHB in combination with DAG.

Cholesterol-reducer, antioxidant and liver protective effects of Thymbra spicata L. var. spicata

ETHNOPHARMACOLOGICAL RELEVANCE

Thymbra spicata is a member of the Lamiaceae family; leaves of this plant have recently gained much popularity as a remedy to combat hypercholesterolaemia.

AIM OF THE STUDY

To evaluate the antihypercholesterolaemic, antioxidant and anti-steatohepatitic activities of the diethyl ether (DEE), ethyl acetate (EtOAc) and remaining aqueous (RA) extracts from Thymbra spicata var. spicata in mice.

MATERIALS AND METHODS

In this study, diethyl ether, ethyl acetate and remaining aqueous extracts of Thymbra spicata L. var. spicata P.H.Davis (Lamiaceae) were evaluated for the effects on the plasma total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) and glucose; blood malondialdehyde (MDA) and reduced glutathione (GSH); erythrocyte superoxide dismutase (SOD) and catalase activity (CAT) in mice fed with high-fat diet (HFD).

RESULTS

The HFD induced an increase in plasma TC, TG, LDL, MDA concentrations compared to control group. However, administration of DEE with HFD reduced TC, LDL, TG and MDA concentrations, while increased HDL concentration, as well as GSH, SOD and CAT activities compared to HFD. The other extract from the plant was RA, which also showed a similar activity profile with DEE except CAT. On the other hand, administration of EtOAc extract with HFD decreased plasma TC, TG and MDA, while GSH concentration was increased. Histopathologically, best liver conditions were observed in DEE and lesser in RA extracts. Based on the results obtained in this investigation it is suggested that the DEE and partially RA extracts of Thymbra spicata var. spicata displayed significant antihypercholesterolaemic, antioxidant and anti-steatohepatitic activities. HPLC analysis of the DEE extract of Thymbra spicata var. spicata revealed the presence of carvacrol (44.13%).

CONCLUSION

The observed cholesterol-reducer, antioxidant and liver protective effects of the DEE and partially of RA extracts of Thymbra spicata which contain mainly carvacrol indicates that these extracts possess some potential medicinal value and explain their ethnomedical use.

Phytosterols dissolved in diacylglycerol oil reinforce the cholesterol-lowering effect of low-dose pravastatin treatment

BACKGROUND AND AIMS

Dietary therapy using phytosterols can reinforce statin treatment; however the value of a low-dose combination of those agents remains to be investigated. Plant sterols (PS), dissolved in diacylglycerol (DAG) oil, (PS/DAG) can be effective at a relatively low dose. The objective of the present study was to examine the effect of PS/DAG oil on blood cholesterol concentrations in hypercholesterolemic outpatients on low-dose pravastatin (10 mg/day).

METHODS AND RESULTS

The patients (n=61) were randomly assigned to one of three groups, who consumed TAG (control), DAG or PS/DAG oil. The average intake of PS from the PS/DAG oil during the test period was significantly higher than that for TAG and DAG oils (502 vs. 49 and 38 mg/day, P<0.05). Significant cholesterol-lowering effects from the baseline were observed in the case of the PS/DAG oil treatment alone. Changes in low-density lipoprotein (LDL) cholesterol were inversely correlated with baseline serum campesterol concentrations (r=-0.560, P<0.05), but not baseline LDL cholesterol concentrations. In addition, serum apolipoprotein B concentrations were reduced to a greater extent in subjects with high versus low levels of baseline campesterol (-13.2 mg/dL vs. -3.1 mg/dL, P<0.05). Furthermore, there was a mild, but significant reduction in serum lipoprotein (a) concentration from the baseline (-5.9 mg/dL), which was correlated with the reduction in serum apolipoprotein B concentration (r=0.596, P<0.05).

CONCLUSION

A low-dose combination of PS/DAG oil and pravastatin may be a useful strategy for further ameliorating blood cholesterol and lipoprotein (a) concentrations for hypercholesterolemic patients with a low response to pravastatin.

Olive oil containing olive oil fatty acid esters of plant sterols and dietary diacylglycerol reduces low-density lipoprotein cholesterol and decreases the tendency for peroxidation in hypercholesterolaemic subjects

Plant sterols (PS) and MUFA are well-documented cholesterol lowering agents. We aimed to determine the effect of PS esterified to olive oil fatty acids (PS-OO) on blood lipid profile and lipid peroxidation in hypercholesterolaemic subjects. Twenty-one moderately overweight, hypercholesterolaemic subjects consumed three consecutive treatment diets, each lasting 28 d and separated by 4-week washout periods, using a randomized crossover design. Diets contained 30 % energy as fat, 70 % of which was provided by olive oil (OO), and differed only in the treatment oils: OO, PS esterified to sunflower oil fatty acids (PS-SO), and PS-OO. Both PS-SO and PS-OO treatments provided 1·7 g PS /d. PS-OO and PS-SO consumption resulted in a decrease (P = 0·0483) in LDL-cholesterol (LDL-C) concentrations compared with the OO diet. Although total cholesterol and apo B-100 levels were not significantly affected, PS-SO and, to some extent, PS-OO reduced the total:HDL-cholesterol (HDL-C) ratio (P = 0·0142) and the apo B-100:apo A-I ratio (P = 0·0168) compared with the OO diet. There were no differences across diets in lipoprotein(a) (Lp(a)) and lipid peroxidation levels. However, following consumption of OO and PS-SO, Lp(a) concentrations increased (P = 0·0050 and 0·0421, respectively), while PS-OO treatment did not affect Lp(a) levels. Furthermore, there was a decrease (P = 0·0097) in lipid peroxidation levels with PS-OO treatment during the supplementation phase. Our results suggest that supplementing an OO-rich diet with PS-OO favourably alters the plasma lipid profile and may decrease the susceptibility of LDL-C to lipid peroxidation in hypercholesterolaemic subjects.

Respective hydrolysis and esterification of esterified and free plant stanols occur rapidly in human intestine after their duodenal infusion in triacyl- or diacylglycerol

Esterification of dietary phytosterols and glycerols may affect intestinal absorption of cholesterol and non-cholesterol sterols. We infused plant stanol esters in triacylglycerol (TAG) (F1) and diacylglycerol (DG) (F2) oils, and free plant stanols in F1 and F2 (F3) to the duodenum of healthy human subjects and sampled the contents from the proximal jejunum (PJ). Free and ester sterols were analysed from the infusates, and intestinal contents before and after ultracentrifuge separation of oil, micelle and sediment phases. During the 60-cm intestinal passage, over 40% of plant stanol esters were hydrolysed (P < 0.05) but around 30% of the infused free plant stanols (P < 0.05) and up to 40% of cholesterol (P < 0.05) were esterified in PJ after infusions. TAG in F1 favoured accumulation of plant stanol esters in the oil phase of the PJ aspirates as compared with respective values of F2 and F3 (P < 0.05 for both). About one third of free plant stanols of F3 had been esterified (P < 0.05) and 17% precipitated mainly in free form in the PJ aspirates (P < 0.05 compared with F1 and F2). In conclusion, DG- and TAG-oils had no profound superiority over each other as intestinal carriers regarding hydrolysis/esterification of administered plant stanol esters and cholesterol and their partition in oil, micellar and sediment phases in the PJ. The unesterified plant stanols experienced partial esterification and sedimentation during their intestinal passage, which might influence their biochemical properties in that segment of the gut where cholesterol is absorbed.

Functional foods for the prevention and treatment of cardiovascular diseases: cholesterol and beyond

Cardiovascular disease (CVD) is a major cause of death and disability in many developed countries. The purpose of this literature review is to establish a recommendation for the intake of functional food ingredients in a healthy diet--such as plant sterols (PSs) in low-fat and functional matrices, fatty acid composition and other nutrients of tree nuts and flavonoids in dark chocolate--for the prevention and treatment of CVD. These three specific functional foods are explored in this review, since there is a higher potential for their increased consumption by the population to prevent CVD. First, PS have been added to various nontraditional matrices, such as low-fat products and functional oils, which have shown cholesterol-lowering effects in most clinical trials. Secondly, a growing number of clinical studies indicate that the beneficial effect of tree nuts may not only be due to their fatty acid composition but to other key nutrients, which may provide supplementary health benefits, such as endothelial cell function, as well as decreasing total cholesterol and low-density lipoprotein cholesterol (LDL-C). Lastly, flavonoids in dark chocolate may protect LDL-C particles from undergoing oxidative modification. However, some gaps in our knowledge need to be filled before firm recommendations can be made for habitual dark chocolate consumption. Overall, these functional foods should be considered as an addition to current lipid-lowering recommendations for improving CVD risk.

Antihypercholesterolaemic and antioxidant activity assessment of some plants used as remedy in Turkish folk medicine

Ethanolic and aqueous extracts from five plant species used in Turkish traditional medicine were evaluated for in vivo hypercholesterolaemic and antioxidant activities: Agrostemma githago L., Potentilla reptans L., Thymbra spicata var. spicata L., Urtica dioica L. and Viscum album var. album L. We assayed the effects of the administration of plant extracts on serum total cholesterol, triglyceride, HDL-C, LDL-C, glucose, AST and ALT concentrations in mice fed with cholesterol-rich diet. In addition, plasma TAA, MDA and NO(x) levels in the same animals were assayed. All the aqueous plant extracts did not affect the serum cholesterol concentration. However, the ethanolic extracts of Agrostemma githago, Thymbra spicata and Viscum album decreased the serum cholesterol concentration in the mice fed with high-cholesterol diet without inducing any gastric damage. The ethanolic extracts of Thymbra spicata, Viscum album, Potentilla reptans and Urtica dioica and the aqueous extract of Agrostemma githago increased the serum HDL concentration, whereas the ethanolic extracts of Agrostemma githago, Thymbra spicata, Viscum album and Urtica dioica decreased the serum LDL-C concentration. Thymbra spicata and Viscum album were observed to decrease the serum triglyceride concentration. Among the plant extracts studied, the ethanolic extracts of Thymbra spicata significantly decreased the MDA level in mice. The ethanolic extract of Potentilla reptans increased in NO(x). None of these plants showed statistically prominent activity on plasma TAA. Results of the present study indicated that the ethanolic extracts of Agrostemma githago, Thymbra spicata and Viscum album showed potent hypocholesterolaemic activity in the mice fed with a diet containing high-cholesterol.

Dose-dependent cholesterol-lowering effect of a mayonnaise-type product with a main component of diacylglycerol-containing plant sterol esters

OBJECTIVE

The objective of this study was to investigate the effective dose of plant sterol ester (PSE)-enriched diacylglycerol (DAG) oil for healthy subjects with mild hypercholesterolemia.

METHODS

A randomized, placebo-controlled, double-blind, parallel study was performed in patients with mild hypercholesterolemia; 0.0, 0.3, 0.4, and 0.5 g of PSE was dissolved in 15 g of a DAG-containing mayonnaise-type product; and 15 g/d of the product was administered 4 wk.

RESULTS

Total serum cholesterol levels were significantly decreased as a result of the ingestion of at least 0.4 g/d of PSE, and serum low-density lipoprotein cholesterol levels were significantly decreased by the ingestion of at least 0.3 g/d of PSE.

CONCLUSIONS

Daily ingestion of 15 g of DAG plus mayonnaise containing at least 0.4 g/d of PSE for 4 wk may significantly decrease cholesterol.

Dietary fats and oils: Technologies for improving cardiovascular health

The role of dietary lipids in the etiology of coronary heart disease (CHD) continues to evolve as we gain a better understanding of the metabolic effects of individual fatty acids and their impact on surrogate markers of risk. A recent meta-analysis of 60 human studies suggests that for each 1% energy replacement of carbohydrates in the diet with saturated fat or trans fat, serum low-density lipoprotein cholesterol concentrations increase by 0.032 (1.23 mg/dL) and 0.04 mmol/L (1.54 mg/dL), respectively. Current dietary recommendations to keep saturated fat and trans fat intake as low as possible, and to increase the intake of cis mono-unsaturated and polyunsaturated fatty acids, as well as growing recognition of these recommendations by consumers and food regulatory agencies in the United States, have been major driving forces for the edible oil industry and food manufacturers to develop alternative fats and oils with nutritionally improved fatty acid compositions. As solutions for use of trans fatty acids are being sought, oilseeds with modified fatty acid compositions are being viewed as a means to provide such solutions. Additionally, oilseeds with modified fatty acid composition, such as enhanced content of long-chain omega-3 fatty acids or conjugated linoleic acid, have been developed as a way to increase delivery of these fatty acids directly into the food supply or indirectly as use for feed ingredients for livestock. New processing technologies are being utilized around the world to create dietary fats and oils with specific physiologic functions relevant to risk factors for cardiovascular disease.

Cultivar and year-to-year variation of phytosterol content in rye (Secale cereale L.)

Intake of phytosterols (and -stanols) has been shown to decrease the level of low-density lipoprotein cholesterol and thus protect against development of cardiovascular diseases. Therefore, studies on the cultivar and year-to-year variation in phytosterol content in rye grains have been performed. The phytosterol content and composition of different rye cultivars, grown under identical conditions on the same field in three consecutive years, were analyzed. Both cultivar and year-to-year variation in sterol content were statistically significant (p < 0.0001). The total sterol content varied from 1007 +/- 21 mg/kg in the highest yielding cultivar, Tsulpan 3, to 761 +/- 10 mg/kg in the lowest yielding cultivar (Amando in the 1999 harvest). Because the meteorological conditions varied substantially between the different years, it was possible to deduce the impact of varying weather conditions on phytosterol content in the different cultivars. The studied cultivars had all the lowest phytosterol contents in the dry and warm harvest season of 1999. Although there were statistically significant cultivar and year-to-year variations in the sterol composition (p < 0.0001), these were only between 2 and 4% of the total sterol content.

Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels

Foods with plant stanol or sterol esters lower serum cholesterol levels. We summarize the deliberations of 32 experts on the efficacy and safety of sterols and stanols. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%; higher intakes added little. Efficacy is similar for sterols and stanols, but the food form may substantially affect LDL reduction. Effects are additive with diet or drug interventions: eating foods low in saturated fat and cholesterol and high in stanols or sterols can reduce LDL by 20%; adding sterols or stanols to statin medication is more effective than doubling the statin dose. A meta-analysis of 10 to 15 trials per vitamin showed that plasma levels of vitamins A and D are not affected by stanols or sterols. Alpha carotene, lycopene, and vitamin E levels remained stable relative to their carrier molecule, LDL. Beta carotene levels declined, but adverse health outcomes were not expected. Sterol-enriched foods increased plasma sterol levels, and workshop participants discussed whether this would increase risk, in view of the marked increase of atherosclerosis in patients with homozygous phytosterolemia. This risk is believed to be largely hypothetical, and any increase due to the small increase in plasma plant sterols may be more than offset by the decrease in plasma LDL. There are insufficient data to suggest that plant stanols or sterols either prevent or promote colon carcinogenesis. Safety of sterols and stanols is being monitored by follow-up of samples from the general population; however, the power of such studies to pick up infrequent increases in common diseases, if any exist, is limited. A trial with clinical outcomes probably would not answer remaining questions about infrequent adverse effects. Trials with surrogate end points such as intima-media thickness might corroborate the expected efficacy in reducing atherosclerosis. However, present evidence is sufficient to promote use of sterols and stanols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease.

Effect of phytosterols in dietary diacylglycerol on atherosclerosis in cholesterol-fed rabbits

OBJECTIVE

The present study investigated the effects of phytosterols (PS) in combination with diacylglycerol (DAG) versus PS in combination with triacylglycerol (TAG) on serum lipids and atherosclerosis in cholesterol-fed rabbits.

METHODS

Cholesterol-fed (0.3%) New Zealand white rabbits were treated with a control diet, a 0.3% PS and 7% TAG diet, or a 0.3% PS and 7% DAG diet for 14 wk.

RESULTS

Serum total cholesterol level in the PS/DAG group was statistically lower than that in the control and PS/TAG groups, whereas serum high-density lipoprotein cholesterol and triacylglycerol levels were not statistically different between these two groups. The ratio of the atherosclerotic lesion area and the mean thickness of the intima in the aortas of the PS/DAG group were statistically lower than those of the control group, whereas there was no statistical difference between the PS/TAG and control groups. In particular, the ratio of the lesion area in the abdominal aorta and the mean thickness of the intima in the thoracic and total aortas of the PS/DAG group were statistically lower than those of the PS/TAG group. The ratio of the atherosclerotic lesion area and the mean thickness of the intima in the aortas correlated positively with total cholesterol exposure level.

CONCLUSIONS

These findings suggested that PS in combination with DAG as opposed to TAG prevents the development of atherosclerosis via a decrease in total cholesterol exposure level and might be useful as a dietary oil for the prevention of atherosclerosis.

Metabolic effects of plant sterols and stanols (Review)

High serum LDL cholesterol concentration is a major risk factor for cardiovascular complications. This risk can be lowered by diet. In this respect foods containing plant sterol or stanol esters can be useful for mildly- and hypercholesteraemic subjects. Plant sterols and stanols, which are structurally related to cholesterol, decrease the incorporation of dietary and biliary cholesterol into micelles. This lowers cholesterol absorption. Furthermore, these components increase ABC-transporter expression, which may also contribute to the decreased cholesterol absorption. Consequently, cholesterol synthesis and LDL receptor activity increase, which ultimately leads to decreased serum LDL cholesterol concentrations. Animal studies have further shown that these dietary components may also lower atherosclerotic lesion development. Plant sterols and stanols also lower plasma lipid-standardized concentrations of the hydrocarbon carotenoids, but not those of the oxygenated cartenoids and tocopherols. Also, vitamin A and D concentrations are not affected. Although absorption of plant sterols and stanols (0.02-3.5%) is low compared to cholesterol (35-70%), small amounts are found in the circulation and may influence other physiological functions. However, there is no consistent evidence that plant sterols or stanols can change the risk of colon or prostate cancer, or immune status. In conclusion, plant sterols and stanols effectively reduce serum LDL cholesterol and atherosclerotic risk. In addition potential effects of plant sterols and stanols on other metabolic processes remain to be elucidated.

Phytosterols and human lipid metabolism: efficacy, safety, and novel foods

Plant sterols have been known for several decades to cause reductions in plasma cholesterol concentrations. These plant materials have been granted a conditional health claim in the United States regarding their effects in the prevention of cardiovascular disease and are being sold in functional foods in several countries in Europe as well as in the United States and Australia. It is generally suggested that daily consumption of approximately 2 g of plant sterols can lower cholesterol concentrations as part of a dietary prevention strategy. However, phytosterols have been added and tested for their cholesterol-lowering effects mainly in spreads. Consumption of these high-fat foods seemingly flies in the face of current recommendations for the promotion of heart health, which suggest lowering total fat and energy intake to maintain weight. Hence, new food formulations are being evaluated using phytosterols incorporated into low-fat and reduced-fat food items. The purpose of this review is to examine the cholesterol-lowering efficacy of plant sterols, focusing on novel food applications, their mechanism of action, and safety. These novel food formulations include new solubilization processes that lead to improved uses for plant sterols, as well as new foods into which phytosterols have been incorporated, such as breads, cereals, and beef. Such new foods and formulations should pave the way for greater use of phytosterols in heart health promotion, increasing the longer-term potential for the creation of innovative functional foods containing plant sterols and their derivatives.

Diacylglycerol on lipid metabolism

PURPOSE OF REVIEW

Diacylglycerol is an intermediate product of triacylglycerol hydrolysis and comprises up to 10% of glycerides in plant-derived edible fats and oils. Recent developments in oil chemistry have led to the availability of a novel diacylglycerol oil for clinical studies. Recent research has shown that the oil containing 70% of unusual 1,3- species has metabolic characteristics distinct from those of triacylglycerol of similar fatty acid composition. This review summarizes recent research in humans and experimental animals into the metabolic effects and possible mechanisms of action of this oil.

RECENT FINDINGS

Consumption of the oil affects lipid metabolism including lowering of plasma triacylglcerol, decreases postprandial lipemia and reduces body fat mass, compared with triacylglcerol. As the fatty acids of the two oils are similar, the metabolic differences reside in their structural differences.

SUMMARY

It is still uncertain whether longer term consumption of the diacylglycerol oil will lead to persistent and consistent reductions in plasma triacylglycerol and body fat. However future studies may demonstrate a role in managing aspects of the metabolic syndrome.

Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and health-promoting uses

Phytosterols (plant sterols) are triterpenes that are important structural components of plant membranes, and free phytosterols serve to stabilize phospholipid bilayers in plant cell membranes just as cholesterol does in animal cell membranes. Most phytosterols contain 28 or 29 carbons and one or two carbon-carbon double bonds, typically one in the sterol nucleus and sometimes a second in the alkyl side chain. Phytostanols are a fully-saturated subgroup of phytosterols (contain no double bonds). Phytostanols occur in trace levels in many plant species and they occur in high levels in tissues of only in a few cereal species. Phytosterols can be converted to phytostanols by chemical hydrogenation. More than 200 different types of phytosterols have been reported in plant species. In addition to the free form, phytosterols occur as four types of "conjugates," in which the 3beta-OH group is esterified to a fatty acid or a hydroxycinnamic acid, or glycosylated with a hexose (usually glucose) or a 6-fatty-acyl hexose. The most popular methods for phytosterol analysis involve hydrolysis of the esters (and sometimes the glycosides) and capillary GLC of the total phytosterols, either in the free form or as TMS or acetylated derivatives. Several alternative methods have been reported for analysis of free phytosterols and intact phytosteryl conjugates. Phytosterols and phytostanols have received much attention in the last five years because of their cholesterol-lowering properties. Early phytosterol-enriched products contained free phytosterols and relatively large dosages were required to significantly lower serum cholesterol. In the last several years two spreads, one containing phytostanyl fatty-acid esters and the other phytosteryl fatty-acid esters, have been commercialized and were shown to significantly lower serum cholesterol at dosages of 1-3 g per day. The popularity of these products has caused the medical and biochemical community to focus much attention on phytosterols and consequently research activity on phytosterols has increased dramatically.

Flaxseed improves lipid profile without altering biomarkers of bone metabolism in postmenopausal women

The risk of cardiovascular disease and osteoporosis drastically increases at the onset of menopause. Phytoestrogens have been suggested to inhibit bone loss and protect the cardiovascular system, in part by improving lipid profiles. The purpose of the present study was to examine the effects of flaxseed, a rich source of the phytoestrogens called lignans, on lipid metabolism and biomarkers of bone turnover in postmenopausal women. Postmenopausal women who were not on hormone replacement therapy were assigned to one of two treatment groups in a double-blind randomized study. Women were asked to consume 40 g of either ground flaxseed or wheat-based comparative control regimen daily for 3 months. In addition, all subjects received 1,000 mg calcium and 400 IU vitamin D daily. Flaxseed supplementation lowered (P < 0.05) both serum total cholesterol and non-high-density lipoprotein cholesterol by 6%, whereas the comparative control regimen had no such effect. Flaxseed regimen reduced serum levels of both low-density- and high-density-lipoprotein cholesterol by 4.7% and triglyceride by 12.8%, albeit not statistically significant. Serum apolipoprotein A-1 and apolipoprotein B concentrations were significantly (P < 0.005) reduced by 6 and 7.5%, respectively, by the flaxseed regimen. Markers of bone formation and resorption were not affected by either of the treatments. The findings of this study indicate that flaxseed supplementation improves lipid profiles but has no effect on biomarkers of bone metabolism in postmenopausal women.