Lipid responses to plant-sterol-enriched reduced-fat spreads incorporated into a National Cholesterol Education Program Step I diet

Background: Plant sterol esters reduce cholesterol absorption and lower cir culating blood cholesterol concentrations when incorporated into the habitu al diet. Objective: This randomized, double-blind, 3-group parallel, controlled stud y evaluated the influence of esterified plant sterols on serum lipid concen trations in adults with mild-to-moderate primary hypercholesterolemia. Design: Subjects incorporated a conventional 50%-fat spread into a National Cholesterol Education Program Step I diet for a 4-wk lead-in period, follo wed by a 5-wk intervention period of the diet plus either a control reduced -fat spread (40% fat; n = 92) or a reduced-fat spread enriched with plant s terol esters to achieve intakes of 1.1 g/d (n = 92; low-sterol group) or 2. 2 g/d (n = 40; high-sterol group). Results: Subjects in the low- and high-sterol groups who consumed greater t han or equal to 80% of the scheduled servings (per-protocol analyses) had t otal cholesterol values that were 5.2% and 6.6% lower, LDL-cholesterol valu es that were 7.6% and 8.1% lower, apolipoprotein B values that were 6.2% an d 8.4% lower, and ratios of total to HDL cholesterol that were 5.9% and 8.1 % lower, respectively, than values for the control group (P < 0.001 for all ). Additionally, triacylglycerol concentrations decreased by 10.4% in the h igh-sterol group. Serum concentrations of fat-soluble vitamins and caroteno ids were generally within reference ranges at baseline and postintervention . Serum plant sterol concentrations increased from baseline (0.48% of total sterol by wt) to 0.64% and 0.71% by wt for the low- and high-sterol groups , respectively (P < 0.05 compared with control). Conclusion: A reduced-fat spread containing plant sterol esters incorporate d into a low-fat diet is a beneficial adjunct in the dietary management of hypercholeslerolemia.