Primary hyperlipidemias in children: effect of plant sterol supplementation on plasma lipids and markers of cholesterol synthesis and absorption

Abstract

Plant sterols lower serum cholesterol concentration. Available data have confirmed the lipid-lowering efficacy in adults, while there is a relative dearth of data in children and almost exclusively restricted to subjects with familial hypercholesterolemia (FH). Aim of the present study was to evaluate the efficacy, tolerability and safety of plant sterol supplementation in children with different forms of primary hyperlipidemias. The effect of plant sterol consumption on plasma lipids was evaluated in 32 children with heterozygous FH, 13 children with Familial Combined Hyperlipidemia (FCH) and 13 children with Undefined Hypercholesterolemia (UH) in a 12-week open-label intervention study using plant sterol-enriched yoghurt. Plasma lipids and apolipoproteins were measured by routine methods. Markers of cholesterol synthesis (lathosterol) and absorption (campesterol and sitosterol) were measured by GC-MS. Tolerability and adherence to recommended regimen was very high. A significant reduction was observed in LDL-cholesterol in the three groups (10.7, 14.2 and 16.0% in FH, FCH and UH, respectively). Lathosterol concentrations were unchanged, reflecting a lack of increased synthesis of cholesterol. Of the two absorption markers, only sitosterol showed a slight but significant increase. Daily consumption of plant sterol dairy products favorably changes lipid profile by reducing LDL-cholesterol. To our knowledge, this is the first report of the use of plant sterols-enriched foods in treating children with primary hyperlipidemia such as FCH and UH, likely to be the most frequent form also in the young age in the western populations.

Nutraceuticals and dyslipidaemia: Beyond the common therapeutics

“…As many studies (Casas-Agustench et al, 2012;Demonty et al, 2006;Garaiova et al, 2013;Gonç alves et al, 2006;Guardamagna et al, 2011;Maki et al, 2012;Pá rraga et al, 2011;Weingä rtner et al, 2009;Zhao et al, 2011) have already indicated, plant sterols are able to actively influence lipid profile. The mean LDL-cholesterol reduction after consumption of plant sterol-supplemented foods ranges from 5.9% to 10.4% (Casas-Agustench et al, 2012).…”

“…Many studies have evaluated the potential role of nutraceuticals in the prevention of dyslipidaemia both in animal models (Alshatwi et al, 2011;Chen et al, 2008;Dvir et al, 2009;Huang & Lin, 2012a, 2012b and in humans (Becker et al, 2009;CasasAgustench et al, 2012;Demonty et al, 2006;Dulin et al, 2006;Garaiova et al, 2013;Gonç alves et al, 2006;Guardamagna et al, 2011;Izzo et al, 2010;Maki et al, 2012;Marazzi et al, 2011;Pá rraga et al, 2011;Qin et al, 2009;Rayman et al, 2011;Sirtori et al, 2009;Tomé -Carneiro et al, 2012;Weingä rtner, Bö hm, & Laufs, 2009;Wofford et al, 2012;Wong et al, 2010;Zhao et al, 2011).…”

“…A good idea on the feasible application of nutraceuticals comes from Guardamagna et al (2011). They attempted to explore the influence of plant sterols on hypercholesterolaemia in children suffering from primary hyperlipidaemia.…”

Regulation of Intestinal Cholesterol Absorption: A Disease Perspective

“…Similarly, this trend in impairment was found in Zucker diabetic rats [101] and in type 2 diabetic subjects [71]. Plant sterols and stanols have been effectively shown to lower plasma cholesterol levels in familial hypercholesterolemia patients through ABCG5/G8 transporters [102]. Use of these sterols and stanols as cholesterollowering agents and as biomarkers of cardiovascular disease have been reviewed [103] [104].…”

Diagnóstico y tratamiento de las dislipidemias en niños y adolescentes: Recomendaciones de la Rama de Nutrición de la Sociedad Chilena de Pediatría

“…Suplementos: Los fitoesteroles o fitoestanoles son esteroles de origen vegetal (maíz, soya, maravilla, canola, nueces y cereales) que ayudan a reducir el c-ldl sin efectos adversos en niños 17,30,31 . actúan en el intestino mediante 3 mecanismos: inhiben la absorción del colesterol dietario y biliar, la re-esterificación de los ácidos grasos y estimulan la actividad y expresión del transportador que secreta el colesterol desde los enterocitos hacia el lumen.…”