Zhang Yihua, Zhang Qian, Wang Xiumei, Jia Yatian, Niu Qingmei, Ding Shuo, Li Wenjing
School of Nursing, Shanxi University of Chinese Medicine, Yuci, China.
Department of Nursing, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Front Pharmacol. 2025 Jul 2;16:1619922. doi: 10.3389/fphar.2025.1619922. eCollection 2025.
As naturally occurring compounds in plant-based foods, phytosterols have attracted attention for their lipid-modulating potential and proposed role as adjunctive therapies in managing hyperlipidemia. Nevertheless, conflicting evidence persists regarding their dual impact on dyslipidemia and subclinical inflammation.
This systematic review aimed to assess the impact of phytosterol-rich foods on lipid metabolism and inflammatory responses in hyperlipidemic populations.
A thorough literature search was performed across nine databases (including China National Knowledge Infrastructure Wanfang Data, VIP, SinoMed, PubMed, Cochrane Library, Embase, Scopus, Web of Science) from their inception up to 15 February 2025. Studies included were randomized controlled trials evaluating phytosterol interventions in adults with hyperlipidemia. The quality of the included studies was evaluated using the Cochrane Randomized Trial Risk Bias Tool, and Data analysis was performed using RevMan 5.4.
This study included 14 randomized controlled trials with a total of 1,088 participants. The pooled results demonstrated statistically significant reductions in total cholesterol (TC) levels (mean difference (MD) = -0.65, 95% CI -0.83 to -0.47, < 0.00001) and low-density lipoprotein cholesterol (LDL-C) levels (MD = -0.52, 95% CI -0.66 to -0.38, < 0.00001), along with a modest increase in high-density lipoprotein cholesterol (HDL-C) levels (MD = 0.08, 95% CI 0.05 to 0.10, < 0.00001). No significant change was observed for C-reactive protein (CRP) levels (MD = -0.00, 95% CI -0.01 to 0.00, = 0.32). Although a borderline significant reduction in triglycerides (TG) levels was noted (MD = -0.24, 95% CI -0.47 to -0.01, = 0.04), this finding displayed considerable heterogeneity.
Phytosterol intervention demonstrates significant efficacy in modulating atherogenic lipid profiles, such as TC and LDL-C, while also elevating HDL-C levels in individuals with hyperlipidemia. Yet, it fails to demonstrate anti-inflammatory activity as measured by CRP levels. The observed marginal TG-lowering effect should be interpreted with caution given substantial interstudy heterogeneity. Therefore, larger, metabolomics-inclusive studies are required for definitive conclusions and clinical guidance.
https://www.crd.york.ac.uk/PROSPERO/#loginpage, identifier CRD420251002645.
作为植物性食物中的天然化合物，植物甾醇因其调节脂质的潜力以及在管理高脂血症中作为辅助疗法的潜在作用而受到关注。然而，关于它们对血脂异常和亚临床炎症的双重影响，证据仍然相互矛盾。
本系统评价旨在评估富含植物甾醇的食物对高脂血症人群脂质代谢和炎症反应的影响。
从九个数据库（包括中国知网、万方数据、维普、中国生物医学文献数据库、PubMed、Cochrane图书馆、Embase、Scopus、Web of Science）建库起至2025年2月15日进行了全面的文献检索。纳入的研究为评估植物甾醇对成人高脂血症干预效果的随机对照试验。使用Cochrane随机试验偏倚风险工具评估纳入研究的质量，并使用RevMan 5.4进行数据分析。
本研究纳入了14项随机对照试验，共1088名参与者。汇总结果显示，总胆固醇（TC）水平有统计学意义的降低（平均差（MD）=-0.65，95%置信区间-0.83至-0.47，P<0.00001），低密度脂蛋白胆固醇（LDL-C）水平降低（MD=-0.52，95%置信区间-0.66至-0.38，P<0.00001），同时高密度脂蛋白胆固醇（HDL-C）水平有适度升高（MD=0.08，95%置信区间0.05至0.10，P<0.00001）。C反应蛋白（CRP）水平未观察到显著变化（MD=-0.00，95%置信区间-0.01至0.00，P=0.32）。尽管甘油三酯（TG）水平有临界显著降低（MD=-0.24，95%置信区间-0.47至-0.01，P=0.04），但这一结果显示出相当大的异质性。
植物甾醇干预在调节致动脉粥样硬化脂质谱（如TC和LDL-C）方面显示出显著疗效，同时也能提高高脂血症患者的HDL-C水平。然而，以CRP水平衡量，它未能显示出抗炎活性。鉴于研究间存在较大异质性，对观察到的TG降低的边际效应应谨慎解释。因此，需要更大规模、纳入代谢组学的研究来得出明确结论并提供临床指导。
https://www.crd.york.ac.uk/PROSPERO/#loginpage，标识符CRD420251002645。
