Effectiveness of customary use of phytosterol/-stanol enriched margarines on blood cholesterol lowering

Wolfs, Marion; Jong, Nynke de; Ocké, Marga C.; Verhagen, Hans

doi:10.1016/j.fct.2006.05.006

Cited by 47 publications

(35 citation statements)

References 31 publications

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“…Indeed, the proportion of phytosterol/-stanol-enriched margarine users of 5% was relatively high. For example, in the Doetinchem cohort study (Wolfs et al, 2006), which served as the control group for this community intervention study only 2% of the subjects used phytosterol/-stanol-enriched margarine in the same study period. According to the Dutch National Food Consumption Survey that was held in 2003 also a usage rate of 2% was found, but these subjects were from a different age category (19-30 years) (Hulshof et al, 2003;de Jong et al, 2005).…”

Section: Discussionmentioning

confidence: 99%

Exposure and effectiveness of phytosterol/-stanol-enriched margarines

et al. 2007

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Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines. Objective: To study the use and effectiveness of phytosterol/-stanol-enriched margarine. Design, setting and subjects: The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs. Results: Mean (7s.d.) daily intake of phytosterol-enriched margarine (n ¼ 99) and phytostanol-enriched margarine (n ¼ 16) was 1479 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users À2.0471.50 mmol/l (À29%), in cholesterol-lowering drug users À1.0971.17 mmol/l (À17%), in the enriched margarine users À0.2470.75 mmol/l (À4%) and in non-users þ 0.1070.72 mmol/l ( þ 2%)(Po0.05). Conclusion: Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.

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Section: Discussionmentioning

confidence: 99%

Exposure and effectiveness of phytosterol/-stanol-enriched margarines

et al. 2007

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“…Post-marketing surveillance studies are required to assess the long-term safety of the combination therapies and the safety in specific risk groups; clinical trials do often not attain adequate power for evaluating rare events and interactions. Moreover, the effectiveness of the combination therapies under customary conditions should be addressed as adherence to drugs is known to be suboptimal (133,134) and recommended doses of FF and DS might not be consumed (45,46,135) .…”

Section: Discussionmentioning

confidence: 99%

“…De Jong et al (45) and Wolfs et al (46) also investigated the cholesterol-lowering effects of plant sterol-and stanolenriched margarine (no differentiation between plant sterols and stanols) between statin users and non-statin users in a post-marketing surveillance setting over 5 years. These authors suggest that plant sterols and stanols have an additive (35) DB, PC, R 3 HC on pravastatin therapy $ 1 year (n 14)…”

Section: Mechanism Of Supporting Statin Therapymentioning

confidence: 99%

Support of drug therapy using functional foods and dietary supplements: focus on statin therapy

et al. 2010

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Functional foods and dietary supplements might have a role in supporting drug therapy. These products may (1) have an additive effect to the effect that a drug has in reducing risk factors associated with certain conditions, (2) contribute to improve risk factors associated with the condition, other than the risk factor that the drug is dealing with, or (3) reduce drug-associated side effects, for example, by restoring depleted compounds or by reducing the necessary dose of the drug. Possible advantages compared with a multidrug therapy are lower drug costs, fewer side effects and increased adherence. In the present review we have focused on the support of statin therapy using functional foods or dietary supplements containing plant sterols and/or stanols, soluble dietary fibre, n-3 PUFA or coenzyme Q 10 . We conclude that there is substantial evidence that adding plant sterols and/or stanols to statin therapy further reduces total and LDL-cholesterol by roughly 6 and 10 %, respectively. Adding n-3 PUFA to statin therapy leads to a significant reduction in plasma TAG of at least 15 %. Data are insufficient and not conclusive to recommend the use of soluble fibre or coenzyme Q 10 in patients on statin therapy and more randomised controlled trials towards these combinations are warranted. Aside from the possible beneficial effects from functional foods or dietary supplements on drug therapy, it is important to examine possible (negative) effects from the combination in the long term, for example, in post-marketing surveillance studies. Moreover, it is important to monitor whether the functional foods and dietary supplements are taken in the recommended amounts to induce significant effects. Combination therapy: Dyslipidaemia: Statins: Functional foodsThe world market for functional foods (FF) and dietary supplements (DS) is expanding rapidly. In 2010 FF are expected to represent 5 % of the total global food market (1) and the market for DS is estimated at more than $60 billion worldwide (2) . In general, the target population of FF or DS is healthy individuals with slightly elevated risk factors or some physical discomfort. However, due to the fast growing market of FF or DS and the accompanying strong advertising and marketing, also patients on medication may be stimulated to use FF or DS. This may have several consequences for the quality of drug treatment as stated by de Jong et al. with the example of the combined intake of plant sterols and/or stanols and statins (3) . Whereas they addressed the additive effect of plant sterols and/or stanols on reducing LDL-cholesterol values in patients on statin treatment, their main focus was the possible negative aspects of the combination, such as unfavourable effects on patient adherence with drug treatment and increasing the potential for food-drug interactions.In the present review we will focus on the possible beneficial effects that FF or DS may have on drug therapy. Because of the large number of subjects treated suboptimally with statins (hydroxymethylglutaryl Co...

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“…the continuous use of the recommended daily amount of 2 g phytosterols or -stanols. Actual adherence is, however, known to be less than optimal (Luoto et al, 2004;Wolfs et al, 2006). People do stop the use of phytosterols/-stanols and consume less than the recommended intake amount.…”

Section: Real-life (Rl)mentioning

confidence: 99%