Functional foods with added plant sterols for treatment of hypercholesterolaemia and prevention of ischaemic heart disease

Background. A spread with added plant sterols, Pro-activ, is marketed in South Africa as an adjunct to low-fat diets for lowering of total and low-density lipoprotein (LDL) cholesterol concentrations and to decrease risk of ischaemic heart disease (IHD). Objectives. The need for this functional food in South Africa, its efficacy, safety and target market, are evaluated in this review. Results. The high, and probably increasing incidence of hypercholesterolaemia and cardiovascular disease in South Africa motivates the need for appropriate functional foods. There is convincing evidence in the literature that an average daily intake of about 2 g plant sterols in about 20 g of spread significantly lowers total and LDL cholesterol concentrations by approximately 10 - 15%, without influencing high-density lipoprotein (HDL) cholesterol and triglyceride concentrations. There is some concern about the effects on absorption of lipid-soluble vitamins and pro-vitamins, but safety tests lasting for up to 3 years found no serious adverse effects. Conclusions. The target market for this spread should be nonpregnant, non-lactating adults with hypercholesterolaemia and/or increased risk of IHD. If it is considered for use in hypercholesterolaemic children, fat-soluble vitamin status should be monitored. It is recommended that post-marketing surveillance should be established to determine long-term effects and safety

Patterns of medical management of overactive bladder (OAB) and benign prostatic hyperplasia (BPH) in the United States

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142147/1/nau23276.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142147/2/nau23276_am.pd

Reduction in Cholesterol Absorption Is Enhanced by Stearate-Enriched Plant Sterol Esters in Hamsters

Consumption of plant sterol esters reduces plasma LDL cholesterol concentration by inhibiting intestinal cholesterol absorption. Commercially available plant sterol esters are prepared by esterifying free sterols to fatty acids from edible plant oils such as canola, soybean, and sunflower. To determine the influence of the fatty acid moiety on cholesterol metabolism, plant sterol esters were made with fatty acids from soybean oil (SO), beef tallow (BT), or purified stearic acid (SA) and fed to male hamsters for 4 wk. A control group fed no plant sterol esters was also included. Hamsters fed BT and SA had significantly lower cholesterol absorption and decreased concentrations of plasma non-HDL cholesterol and liver esterified cholesterol, and significantly greater fecal sterol excretion than SO and control hamsters. Cholesterol absorption was lowest in hamsters fed SA (7.5%), whereas it was 72.9% in control hamsters. Cholesterol absorption was correlated with fecal sterol excretion (r = –0.72, P \u3c 0.001), liver cholesterol concentration (r = 0.88, P \u3c 0.001), and plasma non-HDL cholesterol concentration (r = 0.85, P \u3c 0.001). A multiple regression model that included each sterol ester type vs. cholesterol absorption indicated that intake of steryl stearate was the only dietary component that contributed significantly to the model (R2 = –0.75, P \u3c 0.001). Therefore, our results demonstrate that BT and SA are more effective than SO in reducing cholesterol absorption, liver cholesterol, and plasma non-HDL cholesterol concentration, suggesting that cardioprotective benefits can be achieved by consuming stearate-enriched plant sterol esters

Vitamin A status of 20- to 59-year-old adults living in Seoul and the metropolitan area, Korea

Dietary intakes and plasma concentrations of retinol and carotenoids were estimated in assessing the vitamin A status of Korean adults living in Seoul and the metropolitan area. Three consecutive 24-h food recalls were collected from 106 healthy subjects (33 males and 73 females) aged 20-59 years. Fasting blood samples of the subjects were obtained and plasma retinol and carotenoids were analyzed. The daily vitamin A intakes (mean ± SD) were 887.77 ± 401.35 µg retinol equivalents or 531.84 ± 226.42 µg retinol activity equivalents. There were no significant differences in vitamin A intakes among age groups. The retinol intake of subjects was 175.92 ± 129.87 µg/day. The retinol intake of the subjects in their 50's was significantly lower than those in their 20's and 30's (P < 0.05). Provitamin A carotenoid intakes were 3,828.37 ± 2,196.29 µg/day β-carotene, 472.57 ± 316.68 µg/day α-carotene, and 412.83 ± 306.46 µg/day β-cryptoxanthin. Approximately 17% of the subjects consumed vitamin A less than the Korean Estimated Average Requirements for vitamin A. The plasma retinol concentration was 1.22 ± 0.34 µmol/L. There was no significant difference in plasma retinol concentrations among age groups. However, the concentrations of β-carotene, lycopene, and lutein of subjects in their 50's were significantly higher than those of in their 20's. Only one subject had a plasma retinol concentration < 0.70 µmol/L indicating marginal vitamin A status. Plasma retinol concentration in 30% of the subjects was 0.70- < 1.05 µmol/L, which is interpreted as the concentration possibly responsive to greater intake of vitamin A. In conclusion, dietary intakes and status of vitamin A were generally adequate in Korean adults examined in this study

coreNASH: Multi-stakeholder Consensus on Core Outcomes for Decision Making About Nonalcoholic Steatohepatitis Treatment

The increasing prevalence and burden of nonalcoholic steatohepatitis (NASH) has spurred the development of new treatments and a need to consider outcomes used for NASH treatment decision making. Development of a NASH core outcome set (COS) can help prioritize outcomes of highest importance by incorporating the perspectives from a variety of decision makers. coreNASH was an initiative to develop a COS for NASH using a modified Delphi consensus process with a multi-stakeholder voting panel. A candidate outcome list was created based on a literature review and key informant interviews. The candidate outcome list was then condensed and prioritized through three rounds of online voting and through discussion at an in-person meeting. Outcomes were retained or eliminated based on predetermined consensus criteria, which included special weighting of patients’ opinions in the first two voting rounds. The coreNASH Delphi panel included 53 participants (7 patients, 10 clinicians and researchers, 7 health technology assessors, 22 industry representatives, 2 regulators, and 5 payers) who considered outcomes for two NASH-related COS: one for NASH without cirrhosis (F2-F3) and one for NASH with cirrhosis (F4). The initial candidate outcome list for both disease stages included 86 outcomes. The panel agreed on including two core outcomes for NASH without cirrhosis and nine core outcomes for NASH with cirrhosis in the COS. Conclusion: A consensus-based COS has been developed that can be used across the life cycle of NASH treatments. Outcomes included can contribute to decision making for regulatory, market access, and on-market decision making. Including the coreNASH COS in clinical development programs will facilitate improved comparisons and help decision makers assess the value of new products

Cholesterol lowering efficacy of plant sterols : mechanisms of action

Phytosterols occur naturally in the non-saponifiable material of plant oils. Sitostanol, the saturated derivative of beta-sitosterol, is found in negligible concentrations in plant sources and, hence, is almost absent from typical Western diets. Tall oil extracts, on the other hand, contain about 20% (w/w) sitostanol. Phytosterols have been shown to lower plasma total cholesterol levels in animals and humans while sitostanol exhibited stronger reducing effects. Several studies have suggested that phytosterols lower plasma total cholesterol levels by either inhibiting cholesterol absorption or altering the activities of enzymes critical in cholesterol metabolism and excretion. However, results obtained demonstrate inconsistency regarding the effects of phytosterols on cholesterol absorption rates and cholesterogenesis. In addition, few studies have determined quantitatively the changes in the rate of cholesterol absorption and biosynthesis. Hence, the objective of this thesis was to investigate further the impact of different sources of phytosterols on plasma lipid profiles and to develop a new methodology for simultaneous measurement of percent cholesterol absorption and cholesterol synthesis rates in animals and humans. The stable isotopes, 13C-, 18 O-cholesterol, and deuterium oxide were utilized for the dual isotope plasma ratio and deuterium uptake methodologies. Results from the series of animal experiments conducted demonstrate (i) a gender effect of phytosterols in modulating plasma lipid profile in hamsters, (ii) that sitostanol was more potent in lowering plasma and hepatic lipid concentrations than beta-sitosterol in hamsters and rabbits and (iii) that this lowering effect was due to a reduction in fractional cholesterol absorption and an increase in cholesterol excretion rates. Concomitantly, an up-regulation in cholesterogenesis was observed in hamsters. Furthermore, in humans tall oil phytosterols lowered total cholesterol levels in hypercholesterol

Safety of long-term consumption of plant sterol esters-enriched spread

Objective: To evaluate both efficacy and safety in humans of long-term consumption of spreads containing plant sterol esters. Design: Randomized double-blind placebo-controlled parallel trial. Subjects: Hundred and eighty-five healthy volunteers (35-64y). Intervention: Volunteers daily consumed 20g spread enriched with 1.6g plant sterols as fatty acid esters or a control spread for 1 y. They continued their habitual diet and lifestyle. Outcome measures included efficacy markers such as total and LDL-cholesterol, a large range of safety parameters, and reporting of adverse events. Results: Consumption of the plant sterol ester-enriched spread consistently lowered total and LDL cholesterol during the 1 y period on average by 4 and 6%, respectively (0.01 0.05). However, carotenoid concentrations changed over time. Plant sterols intake reduced lipid adjusted α- and β-carotene-concentrations by only 15-25% after 1 y, relative to control. Lipid-adjusted fat-soluble vitamin concentrations remained unchanged. Plant sterol concentrations in serum were increased from 2.76 to 5.31 (μmol/mmol total cholesterol) for campesterol (P < 0.0001) and from 1.86 to 2.47 (μmol/mmol total cholesterol) for β-sitosterol (P < 0.0001). The increase in total plant sterol concentration in red blood cells (5.29-9.62 μg/g) did not affect red blood cell deformability. Hormone levels in males (free and total testosterone) and females (luteinizing hormone, follicle stimulating hormone, β-estradiol and progesterone) as well as all clinical chemical and hematological parameters measured were unaffected. Adverse events reported were not different between subjects consuming control spread and subjects consuming plant sterol esters-enriched spread. Conclusion: Consumption of a plant sterol esters-enriched spread is an effective way to consistently lower blood cholesterol concentrations and is safe to use over a long period of time