Beneficios de la alimentación | 23 ENE 07

Metabolismo de fitoesteroles y colesterol

Los fitosteroles reducen en forma eficaz el colesterol LDL cuando se los administra como suplementos, y las cantidades más pequeñas en los alimentos naturales también parecen ser importantes.
INDICE:  1. Desarrollo | 2. Continuación | 3. Bibliografía

Bibliografía y lecturas recomendadas

Los artículos de interés particular, publicados dentro del período anual de revisión se han marcado como:
*    de interés especial
**  de interés sobresaliente

1** Katan MB, Grundy SM, Jones P, et al. , and Stresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003; 78:965–978. The transcript of a comprehensive international conference on phytosterol supplements held in 2001, with many references.
2* Ostlund RE Jr. Phytosterols in human nutrition. Ann Rev Nutr 2002; 22:533– 549. The structure and mechanisms responsible for phytosterol effects on cholesterol metabolism are considered, with references.
3** Ostlund RE Jr, Racette SB, Stenson WR. Effects of trace components of dietary fat on cholesterol metabolism: phytosterols, oxysterols and squalene. Nutr Rev 2002; 60:349–359. This review encompasses both early and recent literature on the dietary effects of food oils on cholesterol metabolism. The case is made that phytosterols and other trace components of unsupplemented natural oils may affect serum cholesterol levels independent of the fatty acid composition.
4* St-Onge MP, Jones PJ. Phytosterols and human lipid metabolism: efficacy safety and novel foods. Lipids 2003; 38:367–375. The use of new phytosterol formulations that add less fat to the diet and can be used in breads, cereals and beef, are discussed.
5* Moreau RA, Whitaker BD, Hicks KB. Phytosterols, phytostanols, and their conjugates in foods: structural diversity, quantitative analysis, and healthpromoting uses. Prog Lipid Res 2002; 41:457–500. An excellent review of phytosterol chemistry, structure and analytical methodology.
6 de Jong A, Plat J, Mensink RP. Metabolic effects of plant sterols and stanols [Review]. J Nutr Biochem 2003; 14:362–369.
7 Lichtenstein AH. Plant sterols and blood lipid levels. Curr Opin Clin Nutr Metab Care 2002; 5:147–152.
8 Vanstone CA, Raeini-Sarjaz M, Parsons WE, Jones PJ. Unesterified plant sterols and stanols lower LDL-cholesterol concentrations equivalently in hypercholesterolemic persons. Am J Clin Nutr 2002; 76:1272–1278.
9** Mensink RP, Ebbing S, Lindhout M, et al. Effects of plant stanol esters supplied in low-fat yoghurt on serum lipids and lipoproteins, non-cholesterol sterols and fat soluble antioxidant concentrations. Atherosclerosis 2002; 160:205–213. This study reported that stanol esters added to low-fat yoghurt reduced LDL by 13.7%.
10 Matvienko OA, Lewis DS, Swanson M, et al. A single daily dose of soybean phytosterols in ground beef decreases serum total cholesterol and LDL cholesterol in young, mildly hypercholesterolemic men. Am J Clin Nutr 2002; 76:57–64.
11* Gremaud G, Dalan E, Piguet C, et al. Effects of non-esterified stanols in a liquid emulsion on cholesterol absorption and synthesis in hypercholesterolemic men. Eur J Nutr 2002; 41:54–60. In this study, the consumption of 3 g a day of lecithin-emulsified stanols for 3 days reduced cholesterol absorption by 40%.
12* Spilburg CA, Goldberg AC, McGill JB, et al. Fat-free foods supplemented with soy stanol-lecithin powder reduce cholesterol absorption and LDL cholesterol. J Am Diet Assoc 2003; 103:577–581. In this study, supplementation with 1.9 g a day lecithin-emulsified soy stanols in lemonade reduced LDL-cholesterol by 14% and cholesterol absorption by 32%. Lecithin-emulsified stanols added to egg whites and cooked into a pudding lowered cholesterol absorption 38% in single-meal tests.
13* Jones PJ, Vanstone CA, Raieni-Sarjaz M, St-Onge MP. Phytosterols in lowand non-fat beverages as part of a controlled diet fail to lower plasma lipid levels. J Lipid Res 2003; 44:1713–1719. In this study, feeding 1.8 g a day phytosterols added either directly to a beverage or dispersed in a small amount of oil and then added to the beverage had no effect on LDL-cholesterol levels.
14** Ostlund RE Jr, Racette SB, Okeke A, Stenson WF. Phytosterols that are naturally present in commercial corn oil significantly reduce cholesterol absorption in humans. Am J Clin Nutr 2002; 75:1000–1004. Cholesterol absorption was measured in single meal tests containing corn oil preparations. Sterol-free purified corn oil increased cholesterol absorption 38% compared with commercial corn oil and phytosterol-reconstituted purified corn oil containing approximately 300 mg phytosterols.
15** Ostlund RE Jr, Racette SB, Stenson WF. Inhibition of cholesterol absorption by phytosterol-replete wheat germ compared with phytosterol-depleted wheat germ. Am J Clin Nutr 2003; 77:1385–1389. Cholesterol absorption was measured in wheat germ muffin test meals. The use of phytosterol-free wheat germ increased cholesterol absorption by 43% compared with normal and extracted/reconstituted muffins containing 328 mg phytosterols.
16 Sudhop T, Gottwald BM, von Bergmann K. Serum plant sterols as a potential risk factor for coronary heart disease. Metabolism 2002; 51:1519–1521.
17* Ostlund RE Jr, McGill JB, Zeng C-M, et al. Gastrointestinal absorption and plasma kinetics of soy D5-phytosterols and phytostanols in humans. Am J Physiol Endocrinol Metab 2002; 282:E911–E916. The absorption of deuterated phytosterols was measured by mass spectrometry and was found to be much lower than in previous work using radioactive counting.
18 Ketomaki AM, Gylling H, Antikainen M, et al. Red cell and plasma plant sterols are related during consumption of plant stanol and sterol ester spreads in children with hypercholesterolemia. J Pediatr 2003; 142:524–531.
19 Plat J, Mensink RP. Relationship of genetic variation in genes encoding apolipoprotein A-IV, scavenger receptor B1, HMG-CoA reductase, CETP and apolipoprotein E with cholesterol metabolism and the response to plant stanol ester consumption. Eur J Clin Invest 2002; 32:242–250.
20** Gylling H, Miettinen TA. Baseline intestinal absorption and synthesis of cholesterol regulate its response to hypolipidaemic treatments in coronary patients. Atherosclerosis 2002; 160:477–481. Statin-treated individuals with high baseline cholesterol absorption responded with LDL lowering to the addition of stanol esters, but those with low baseline absorption did not.
21* Mussner M, Parhofer KG, von Bergmann K, et al. Effects of phytosterol esterenriched margarine on plasma lipoproteins in mild to moderate hypercholesterolemia are related to basal cholesterol and fat intake. Metabolism 2002; 51:189–194. In this study, the best responders to plant sterol esters were those with high
dietary cholesterol, energy intake, total and saturated fat intake, and high or average baseline cholesterol absorption.
22 Gylling H, Miettinen RA. Inheritance of cholesterol metabolism of probands with high or low cholesterol absorption. J Lipid Res 2002; 43:1472–1476.
23 Gylling H, Miettinen TA. LDL cholesterol lowering by bile acid malabsorption during inhibited synthesis and absorption of cholesterol in hypercholesterolemic coronary subjects. Nutr Metab Cardiovasc Dis 2002; 12:19–23.
24* Nissinen M, Gylling H, Vuoristo M, Miettinen TA. Micellar distribution of cholesterol and phytosterols after duodenal plant stanol ester infusion. Am J Physiol 2002; 282:G1009–G1015. Triple-lumen human intubation studies directly show that the micellar cholesterol concentration in the small bowel lumen is reduced by stanol esters.
25** Igel M, Giesa U, Lutjohann D, von Bergmann K. Comparison of the intestinal uptake of cholesterol, plant sterols, and stanols in mice. J Lipid Res 2003; 44:533–538. The absorption of a mixture of cholesterol and phytosterols in mice shows the rapid accumulation of all sterols in the mucosa and a surprisingly large absorption of D5-sterols into the plasma followed by rapid re-excretion into the bile. Rejection of phytosterols appears to occur both in the intestine and in the liver over 240 min.
26** Plat J, Mensink RP. Increased intestinal ABCA1 expression contributes to the decrease in cholesterol absorption after plant stanol consumption. FASEB J 2002; 16:1248–1253. In this study, CaCO-2 cells, a model for enterocytes, showed large increases in ABCA1 mRNA expression after 6 h treatment with micellar sitostanol.
27 Plat J, Brzezinka H, Lutjohann D, et al. Oxidized plant sterols in human serum and lipid infusions as measured by combined gas-liquid chromatography– mass spectrometry. J Lipid Res 2001; 42:2030–2038.
28* Plat J, Mensink RP. Effects of plant stanol esters on LDL receptor protein expression and on LDL receptor and HMG-CoA reductase mRNA expression in mononuclear blood cells of healthy men and women. FASEB J 2002; 16:258–260. In this study, LDL receptor protein and mRNA were increased in stanol-treated subjects.
29** Yu L, Hammer RE, Li-Hawkins J, et al. Disruption of Abcg5 and Abcg8 in mice reveals their crucial role in biliary cholesterol secretion. Proc Natl Acad Sci U S A 2002; 99:16237–16242. In this study, knockout of both ABCG5 and ABCG8 genes resulted in increased fractional intestinal absorption of phytosterols and reduced biliary cholesterol secretion.
30* Yu L, Li-Hawkins J, Hammer RE, et al. Overexpression of ABCG5 and ABCG8 promotes biliary cholesterol secretion and reduces fractional absorption of dietary cholesterol. J Clin Invest 2002; 110:671–680. This study reported that the overexpression of ABCG5 and ABCG8 increases biliary cholesterol secretion and reduces plasma levels of phytosterols.
31 Sudhop T, Sahin Y, Lindenthal B, et al. Comparison of the hepatic clearances of campesterol, sitosterol, and cholesterol in healthy subjects suggests that efflux transporters controlling intestinal sterol absorption also regulate biliary secretion. Gut 2002; 51:860–863



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