Nigon F, Serfaty-Lacrosnière C, Beucler I, Chauvois D, Neveu C, Giral P, Chapman M J, Bruckert E
Institut National de la Santé et de la Recherche Médicale U551, Hôpital de la Pitié, Paris, France.
Clin Chem Lab Med. 2001 Jul;39(7):634-40. doi: 10.1515/CCLM.2001.103.
Phytosterols, found in fat-soluble fractions of plants, chemically resemble cholesterol and inhibit cholesterol absorption in the small intestine. Phytosterol consumption in human subjects reduces plasma total and low density lipoprotein-cholesterol (LDL-C) levels. The primary aim of this study was to determine the efficacy of a low-fat spread enriched with plant sterols in reducing total and LDL-C concentrations in primary hypercholesterolemia. The secondary objective was to evaluate whether patients receiving a lipid-lowering drug (fibrate) might differ in their response to plant sterols. The study was a randomized, double-blind, placebo-controlled two-period cross-over trial with two treatments and three periods. Both treatment periods lasted 2 months, with a washout period (2 months) between them. Spread enriched with plant sterols was compared to non-enriched control spread. Fortified fat spread provided 1.6 g/day of plant sterols derived from edible vegetable oils and fatty acids from sunflower seed oil. The plant sterol content consisted of sitosterol esters (50%), campesterol esters (25%), stigmasterol esters (20%) and 10% of other esters. Data in 53 hypercholesterolemic patients (31 females and 22 males) who completed the study were as follows: patients were 58+/-12 years of age with mean body mass index 23.5+/-2.8 kg/m2 (mean+/-SD). No adverse side-effects of the diet were reported. Plasma total cholesterol and LDL-C concentrations were significantly reduced by 6.4% and 8.8%, respectively, after using the spread enriched in plant sterols, as compared to controls (0.0% and 1.3%, respectively). No effect on high density lipoprotein-cholesterol (HDL-C) and lipoprotein(a) concentrations was detected. When subjects were divided in two subgroups according to fibrate treatment, supplementation with phytosterols decreased plasma cholesterol and LDL-C by 8.5% and 11.1%, respectively in the subgroup of patients treated with fibrates. In the group of patients who did not receive fibrates, consumption of plant sterol margarine reduced plasma cholesterol and LDL-C by 5.5% and 7.7%, respectively. Spread enriched with plant sterol esters significantly lowers blood total and LDL-C levels without affecting HDL-C concentrations, in a hypercholesterolemic population following a strict low cholesterol diet (NCEP step1). In addition, a combination of fibrate treatment and plant sterol ester-supplemented spread offers a safe and effective measure to significantly decrease abnormally high cholesterol levels. We conclude that phytosterol-enriched spread is a useful adjunctive therapy for hypercholesterolemic patients.
植物甾醇存在于植物的脂溶性部分，其化学结构与胆固醇相似，可抑制小肠对胆固醇的吸收。人体摄入植物甾醇可降低血浆总胆固醇和低密度脂蛋白胆固醇（LDL-C）水平。本研究的主要目的是确定富含植物甾醇的低脂涂抹酱对降低原发性高胆固醇血症患者总胆固醇和LDL-C浓度的疗效。次要目的是评估接受降脂药物（贝特类）治疗的患者对植物甾醇的反应是否存在差异。该研究是一项随机、双盲、安慰剂对照的两阶段交叉试验，有两种治疗方法和三个阶段。两个治疗阶段均持续2个月，中间有一个洗脱期（2个月）。将富含植物甾醇的涂抹酱与未强化的对照涂抹酱进行比较。强化脂肪涂抹酱每天提供1.6克源自食用植物油的植物甾醇以及来自葵花籽油的脂肪酸。植物甾醇含量包括50%的谷甾醇酯、25%的菜油甾醇酯、20%的豆甾醇酯和10%的其他酯。完成研究的53名高胆固醇血症患者（31名女性和22名男性）的数据如下：患者年龄为58±12岁，平均体重指数为23.5±2.8kg/m²（平均值±标准差）。未报告饮食的不良副作用。与对照组（分别为0.0%和1.3%）相比，使用富含植物甾醇的涂抹酱后，血浆总胆固醇和LDL-C浓度分别显著降低了6.4%和8.8%。未检测到对高密度脂蛋白胆固醇（HDL-C）和脂蛋白（a）浓度有影响。当根据贝特类治疗将受试者分为两个亚组时 在接受贝特类治疗的患者亚组中，补充植物甾醇使血浆胆固醇和LDL-C分别降低了8.5%和11.1%。在未接受贝特类治疗的患者组中，食用植物甾醇人造黄油使血浆胆固醇和LDL-C分别降低了5.5%和7.7%。在遵循严格低胆固醇饮食（NCEP第一步）的高胆固醇血症人群中富含植物甾醇酯的涂抹酱可显著降低血液总胆固醇和LDL-C水平，而不影响HDL-C浓度。此外，贝特类治疗与补充植物甾醇酯的涂抹酱联合使用是一种安全有效的措施，可显著降低异常高的胆固醇水平。我们得出结论，富含植物甾醇的涂抹酱是高胆固醇血症患者有用的辅助治疗方法。
