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
