Phytosterol supplementation in the treatment of dyslipidemia in children and adolescents: a systematic review

Abstract

Objective: To carry out a systematic review on the effects of phytosterol supplementation on the treatment of dyslipidemia in children and adolescents. Data sources: Review in the SciELO, Lilacs, Bireme, PubMed and Web of Science databases, with no time limit. Descriptors: phytosterols or plant sterols and dyslipidemias, hypercholesterolemia, cholesterol, children, adolescent, in English and Portuguese. The articles included were published in Portuguese, English or Spanish and evaluated the effect of phytosterol supplementation in pediatric patients with dyslipidemia. Documents that involved adults or animals, review papers, case studies and abstracts were excluded. Two authors performed independent extraction of articles. Of 113 abstracts, 19 were read in full and 12 were used in this manuscript. Data synthesis: Phytosterol supplementation to reduce cholesterol levels has been shown to be effective in reducing LDL-cholesterol levels by approximately 10%, with reductions above 10% in LDL-cholesterol levels observed after 8 to 12 weeks of intervention. Studies have not shown significant changes in HDL-cholesterol and triglyceride levels. Based on the absence of adverse effects, its use seems to be safe and of good tolerance in children and adolescents. Conclusions: Phytosterol supplementation seems to be of great therapeutic aid for the treatment of hypercholesterolemia in children and adolescents. Further studies assessing the long-term effect of phytosterol supplementation are necessary.

Effect of phytosterols in the treatment of hypercholesterolemia in adults – systematic review with meta-analysis / Efeitos dos fitoesteróis no tratamento da hipercolesterolemia em adultos – revisão sistemática com metanálise

“…Like Demonty et al 34 and Mantovani 35 , in this systematic review, it was possible to verify the generation of a continuous and physiologically important dose-response, for the reduction of LDL-c through phytosterols. The variety of forms of presentation of foods supplemented with phytosterols, from fat-based foods or hypolipids, allows an update on their hypocholesterolemic effect.…”

Cholesterol-Lowering Bioactive Foods and Nutraceuticals in Pediatrics: Clinical Evidence of Efficacy and Safety

“…Margarine containing 1.6 g/day plant sterols or plant stanol ester reduced TC (−9%) and LDL-C (−12%) in children with FH after for 5-6 weeks [66,68], while in the STRIP study, 6-year-olds with mild hypercholesterolemia significantly decreased TC and LDL-C, respectively, by −5.4% and −7.5% [60]. Then, plant sterol supplementation could safely reduce LDL-C by roughly 10% and without significantly affecting other lipoprotein levels [73]. Remarkably, the Apo E4 or E3 genotypes were not reported to influence the biochemical effects of sterol addiction in children [65].…”

Plant Sterols and Stanols for Pediatric Patients with Increased Cardiovascular Risk

“…Reaching a therapeutic concentration of plant sterols and stanols only through food is very difficult, given their poor intestinal absorption and their relatively low concentration in food items [14]. Therefore, the lipid-lowering effect of plant sterols and stanols can be better reached through the intake of food enriched with 1.5 to 3 g of plant sterols or stanols per day [77]. International guidelines for hypercholesterolemia suggest the use of plant sterols and stanols for adult and pediatric patients aged more than six years [4,10,47], though evidence of plant sterols and stanols lipid-lowering effect in pediatric patients is not as robust as in adults.…”