Regulation of cholesterol metabolism by dietary plant sterols

Renewal has occurred in the use of plant sterols for the treatment of hyper cholesterolemias. A novel development was to convert plant sterols to corre sponding stanols and esterify them to fat soluble form. In contrast to the crystalline plant sterols or stanols, plant stanol esters can be easily con sumed during normal food intake in soluble form in different fat-containing food constituents when they have a potent cholesterol-lowering effect, sho wn in normo- and hypercholesterolemic men and women without or with coronar y heart disease, children and diabetes. Cholesterol lowering is approximate ly 10% for total and 15% for LDL cholesterol, with the respective values fo r stanol ester margarine (2-3 g/day stanols) being 15% and 20%. Stanol este rs reduce cholesterol absorption efficiency by up to 65%, increase choleste rol elimination in feces as cholesterol itself, usually not as bile acids, and stimulate cholesterol synthesis. Serum beta-carotene level is lowered, but no fat malabsorption or lowering of serum fat soluble vitamins have bee n observed. In contrast to plant sterols, stanols and their esters are mini mally absorbed and they reduce serum plant sterol concentrations, also prev enting statin-induced increase of plant sterols. Stanol ester margarine has been included in dietary treatment of hypercholesterolemia followed by the addition of drug treatment in resistant cases. Curr Opin Lipidol 10:9-14. (C) 1999 Lippincott Williams & Wilkins.