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Presents information on a study which determined the efficacy on plasma cholesterol-lowering of plant sterol esters or non-esterified stanols eaten within low-fat foods and margarine. Experimental design; Lipid changes with plant sterol ester or non-esterified stanol-containing foods; Lipid changes with sterol ester in fifty percent butter fat spread.

Summary. Background: The cholesterol absorption inhibiting properties of plant sterols in milks are unknown. The milk fat globule membrane components may enhance the absorption of cholesterol and could make plant sterols less efficient in this complex matrix. Aim of the study: To evaluate in hypercholesterolemic men the cholesterol absorption inhibiting properties of verified properly solubilized, non-esterified plant sterols in partly vegetable oil containing milks. Methods: The plant sterols in milk were determined to be properly solubilized, and to have effective in vitro functionality. Sixteen hypercholesterolemic adult men (initial total cholesterol 5.8–8.6 mM) then consumed milk containing sterols (1.8 g of non-esterified pure plant sterols/d) and control milk, alternatively, during two 6-day periods in a double blind cross over design. During the trial, cholesterol absorption was evaluated from the ratio of plasma isotopic enrichment of [26, 26, 26, 27, 27, 27–[sup 2] H[sub 6] ]cholesterol from oral intake (35.6 ± 0.2 μmol, ± SEM) over enrichment of [23, 24, 25, 26, 27–[sup 13] C[sub 5] ]cholesterol from intravenous injection (77.9 ± 0.5 μmol). Results: Plant sterols in low fat milks contained very few crystals > 11 μm in the presence and absence of bile salts and lysophospholipids, and inhibited cholesterol uptake in Caco-2 cell. This assured that the sterols were properly solubilized prior to the clinical trial. In the clinical study, compliance of volunteers was excellent. After tracer injections (72 h), the plasma [[sup 2] H] and [[sup 13] C] isotopic enrichments changed from 0.024 ± 0.001 and 0.072 ± 0.003 MPE (control) to 0.015 ± 0.001 and 0.074 ± 0.002 MPE during sterol treatment, respectively. Cholesterol absorption was reduced from 70.1 ± 4.2 % with control to 41.1 ± 4.0 % with milks containing plant sterol (P < 0.001). Conclusions: These results demonstrate that... [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To measure the relative effects of each of four phytosterol ester-enriched low-fat foods (bread, breakfast cereal, milk and yoghurt) on serum lipids, plasma phytosterols and carotenoids. DESIGN:: Three research centres undertook a randomised, incomplete crossover, single-blind study consisting of four treatment periods of 3 weeks each, one of which was a control period. Each sterol-enriched test food provided 1.6?g/day of phytosterols as sterol esters. SETTING:: General Community. SUBJECTS:: In all 58, free-living men and women with mean age (s.d.) 54 (8)?y, moderately elevated plasma total cholesterol 6.2 (0.7)?mmol/l and body mass index 26.2 (3.0)?kg/m2. MAIN OUTCOME MEASURES:: Serum lipids, plasma phytosterols and carotenoids. RESULTS:: Serum total and LDL cholesterol levels were significantly lowered by consumption of phytosterol-enriched foods: milk (8.7 and 15.9%) and yoghurt (5.6 and 8.6%). Serum LDL cholesterol levels fell significantly by 6.5% with bread and 5.4% with cereal. They were both significantly less efficacious than sterol-enriched milk (P<0.001). Plasma sitosterol increased by 17-23% and campesterol by 48-52% with phytosterol-enriched milk and bread. Lipid-adjusted ß-carotene was lowered by 5-10% by sterols in bread and milk, respectively. CONCLUSIONS:: This is the first study to demonstrate that cholesterol-lowering effects of plant sterol esters may differ according to the food matrix. Plant sterols in low-fat milk was almost three times more effective than in bread and cereal. Despite phytosterol-enriched cereal products resulting in lower serum cholesterol reductions compared to sterol-enriched milk, the detection of similar changes in plasma phytosterols demonstrated that such products still delivered and released phytosterols to the gut.European Journal of Clinical Nutrition (2004) 58, 503-509. doi:10.1038/sj.ejcn.1601837 [ABSTRACT FROM AUTHOR]

Background/Objectives: To assess safety during a diet based on low-fat foods enriched with nonesterified wood-derived plant sterols and mineral nutrients related to serum phytosterol, sex hormone and fat-soluble vitamin metabolism.Subjects/Methods: Seventy-one study participants (52 women, 19 men) with mild-to-moderate hypercholesterolemia completed the double-blind, placebo-controlled feeding trial lasting for 15 weeks. The subjects were randomly allocated to the sterol group receiving food items enriched with mineral nutrients as well as with a total of 1.25, 2.5 and 5.0 g per day of plant sterols during the first, second and third 5-week periods, respectively, or to the placebo group receiving similar food items without plant sterols. This outpatient clinical trial with free-living subjects was carried out at two hospital clinics.Results: Two significant findings were observed. Serum sitosterol concentrations increased from 2.84 to 5.35 mg l−1 (P<0.004 vs placebo) but those of serum total plant sterols did not because of compensatory changes in other phytosterols. The highest plant sterol levels did not exceed 0.6% of total serum sterols. Serum α-tocopherol concentrations decreased in the sterol group by 10% (P<0.0002), but the between-group difference disappeared after adjusting for the change in the carrier (LDL cholesterol).Conclusions: Fifteen-week consumption of natural nonesterified plant sterol-enriched food does not cause any serious adverse effects during such a period. However, serum α-tocopherol levels were somewhat reduced in the sterol group suggesting that long-term effects of plant sterols on serum fat-soluble vitamin concentrations should be further explored, especially in relation to very low-fat diets.European Journal of Clinical Nutrition (2009) 63, 684–691; doi:10.1038/ejcn.2008.11; published online 13 February 2008 [ABSTRACT FROM AUTHOR]

Objectives:This paper describes the dietary intake of total fat, saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) and cholesterol of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) in 27 centres across 10 countries.Methods:Between 1995 and 2000, a stratified random sample of 36 034 participants (age range 35–74 years) completed a standardized 24-h dietary recall, assessed by means of the computer software EPIC-SOFT. Lipid intake data were calculated using a standardized nutrient database.Results:On average, the contribution of fat to total energy intake was 34% of energy intake (%en) in women and 36%en in men for most EPIC centres, except for the British, Dutch and most Italian cohorts. Total fat (>40%en) and MUFA intakes (21%en, mainly from olive oil) were highest in Greece. Except for the Greek, Spanish and Italian centres, the average MUFA intake ranged between 10 and 13%en, with a high proportion derived from animal sources. SFA intake in women and men was lowest in the Greek, Spanish, Italian and UK cohorts with an average of 13%en (down to 9%en), and highest in the Swedish centres (16%en). The mean PUFA intake was in the range of 4–8%en, being highest in the UK health-conscious cohort. The average cholesterol intake across EPIC varied from 140 to 384 mg/d in women and 215–583 mg/d in men.Conclusions:The presented data show differences and similarities in lipid intake across the European EPIC cohorts and also show differences in food sources of dietary lipids. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to investigate whether a plant sterol mixture would reduce serum cholesterol when added to low fat dairy products in subjects with hypercholesterolaemia, and to examine the effects of the mixture on the serum plant sterol and fat-soluble vitamin levels.Design:A parallel, double-blind study.Setting:The study was performed in three different locations in Finland.Subjects:In total, 164 mildly or moderately hypercholesterolaemic subjects participated in the study.Methods:The subjects were randomly divided into two groups: a plant sterol group and a control group. The subjects consumed the products for 6 weeks after a 3-week run-in period. The targeted plant sterol intake was 2 g/day in the sterol group.Results:During the treatment period, there was a 6.5% reduction in serum total cholesterol in the sterol group while no change was observed in the control group (P<0.0005). Serum low-density lipoprotein (LDL) cholesterol was reduced by 10.4% in the sterol group and by 0.6% in the control group (P<0.00005). There was no change during the trial in serum high-density lipoprotein (HDL) cholesterol or triacylglycerol concentrations. The HDL/LDL cholesterol ratio increased by 16.1% in the sterol group and by 4.3% in the control group (P=0.0001). Serum plant sterol levels increased significantly (P=0.0001) in the sterol group. None of the fat-soluble vitamin levels decreased significantly when changes in serum total cholesterol were taken into account. The hypocholesterolaemic effect of sterol administration was not influenced by apolipoprotein E phenotype.Conclusions:Yoghurt, low-fat hard cheese and low-fat fresh cheese enriched with a plant sterol mixture reduced serum cholesterol in hypercholesterolaemic subjects and no adverse effects were noted in the dietary control of hypercholesterolaemia.European Journal of Clinical Nutrition (2006) 60, 633–642. doi:10.1038/sj.ejcn.1602362; published online 11 January 2006 [ABSTRACT FROM AUTHOR]

Objective:To determine the impact of intake occasion (with or without a meal), and product fat level on the cholesterol-lowering efficacy of a plant sterol (PS)-enriched (3 g/day) single-dose yoghurt drink.Design:Double-blind, randomized, placebo-controlled, parallel study with a 4 weeks run-in and 4 weeks intervention period.Setting:Subjects recruited from the general community.Subjects:A total of 184 moderate hypercholesterolaemic subjects (81 men and 103 women) (age 57±2 years) completed the study.Interventions:The study product was a 100-g single-dose yoghurt drink with or without added PS in the form of PS esters. The subjects were randomly assigned to one of five 4-week treatments: (i) drink A (0.1% dairy fat, 2.2% total fat) with a meal, (ii) drink A without a meal, (iii) drink B (1.5% dairy fat, 3.3% total fat) with a meal, (iv) drink B without a meal and (v) placebo drink with a meal.Results:LDL-cholesterol (LDL-C) was significantly lowered when the single-dose drink was taken with a meal independent of its fat content (drink A: −9.5% (P<0.001, 95% CI: −13.8 to −5.2); drink B: −9.3% (P<0.001, 95% CI: −13.7 to −4.9)) as compared to placebo. When consumed without a meal, LDL-C was also significantly decreased (drink A: −5.1% (P<0.05, 95% CI: −9.4 to −0.8); drink B: −6.9% (P<0.01, 95% CI: −11.3 to −2.5) as compared to placebo, however the effect was significantly smaller as compared to the intake with a meal.Conclusion:These results indicate that a PS-ester-enriched single-dose yoghurt drink effectively reduces LDL-C irrespective of the fat content of the product. A substantially larger decrease in serum cholesterol concentration was achieved when the single-dose drink was consumed with a meal emphasizing the importance of the intake occasion for optimal cholesterol-lowering efficacy.Sponsorship:Unilever Research and Development, Vlaardingen, The Netherlands.European Journal of Clinical Nutrition (2006) 60, 325–333. doi:10.1038/sj.ejcn.1602318; published online 19 October 2005 [ABSTRACT FROM AUTHOR]

Comprehensive very-low-calorie diet (VLCD) programs are the preferred treatment for selected obese individuals. They combine energy intakes of 400-800 kcal/day with medical monitoring and intensive lifestyle education. Typical VLCD patients have median body mass indexes of 36 kg/m² and have median ages of 40 years. About 70% are female. Commonly associated medical problems include hypertension in 50%, hyper-lipidemia in 41%, and diabetes mellitus or glucose intolerance in 14%. Typical weight loss with VLCD is around 21 kg in 16 wk. Reductions of 8-13% in blood pressure, 5-15% in serum total cholesterol, 5-207% in low-density lipoprotein-cholesterol, 15-50% in triglycerides, and decreases in blood glucose and glycohemoglobin in diabetic individuals accompany weight loss. VLCD-associated side effects can be managed medically without discontinuing treatment. Lifestyle education promotes long-term weight maintenance of approximately 56% 2 yr after VLCD treatment. Weight losses using comprehensive VLCDs allow moderately to morbidly obese persons to achieve greater benefits than other nonsurgical treatments and should be considered before opting for surgical treatment. [ABSTRACT FROM AUTHOR]

To complement traditional dietary surveys, which are costly and of limited scale, researchers have resorted to digital data to infer the impact of eating habits on people's health. However, online studies are limited in resolution: they are carried out at country or regional level and do not capture precisely the composition of the food consumed. We study the association between food consumption (derived from the loyalty cards of the main grocery retailer in London) and health outcomes (derived from publicly-available medical prescription records of all general practitioners in the city). The scale and granularity of our analysis is unprecedented: we analyze 1.6B food item purchases and 1.1B medical prescriptions for the entire city of London over the course of one year. By studying food consumption down to the level of nutrients, we show that nutrient diversity and amount of calories are the two strongest predictors of the prevalence of three diseases related to what is called the "metabolic syndrome": hypertension, high cholesterol, and diabetes. This syndrome is a cluster of symptoms generally associated with obesity, is common across the rich world, and affects one in four adults in the UK. Our linear regression models achieve an R 2 of 0.6 when estimating the prevalence of diabetes in nearly 1000 census areas in London, and a classifier can identify (un)healthy areas with up to 91% accuracy. Interestingly, healthy areas are not necessarily well-off (income matters less than what one would expect) and have distinctive features: they tend to systematically eat less carbohydrates and sugar, diversify nutrients, and avoid large quantities. More generally, our study shows that analytics of digital records of grocery purchases can be used as a cheap and scalable tool for health surveillance and, upon these records, different stakeholders from governments to insurance companies to food companies could implement effective prevention strategies. [ABSTRACT FROM AUTHOR]