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Title: Progress and perspectives in plant sterol and plant stanol research

item JONES, PETER - University Of Manitoba
item SHAMLOO, MARYAM - University Of Manitoba
item MACKAY, DYLAN - University Of Manitoba
item RIDEOUT, TODD - University Of Manitoba
item MYRIE, SEMONE - University Of Manitoba
item PLAT, JOGCHUM - Maastricht University
item ROULLET, JEAN-BAPTISTE - Oregon Health & Science University
item Baer, David
item CALKINS, KARA - University Of California
item DUELL, BARTON - Oregon Health & Science University
item GINSBERG, HENRY - Columbia University - New York
item GYLLING, HELENA - University Of Helsinki
item JENKINS, DAVID - University Of Toronto
item MOGHADASIAN, MOHAMMAD - University Of Manitoba
item Moreau, Robert
item MYMIN, DAVID - University Of Manitoba
item OSTLUND, RICHARD - Washington University
item RAS, ROUYANNE - Unilever
item REPARAZ, JAVIER - Eastern Washington University
item TRAUTWEIN, ELKE - Unilever
item TURLEY, STEPHEN - University Of Texas Southwestern Medical Center
item VANMIERLO, TIM - University Of Hasselt
item WEINGÄRTNER, OLIVER - Carl von Ossietzky University Of Oldenburg

Submitted to: Nutrition Reviews
Publication Type: Review Article
Publication Acceptance Date: 3/5/2018
Publication Date: 8/7/2018
Citation: Jones, P.J., Shamloo, M., Mackay, D.S., Rideout, T.C., Myrie, S., Plat, J., Roullet, J., Baer, D.J., Calkins, K., Davis, H. Duell, B., Ginsberg, H., Gylling, H., Jenkins, D., Lütjohann, D., Moghadasian, M., Moreau, R.A., Mymin, D., Ostlund, R., Ras, R., Reparaz, J., Trautwein, E., Turley, S., Vanmierlo, T., Weingärtner, O. 2018. Progress and perspectives in plant sterol and plant stanol research. Nutrition Reviews. 76:725-745.

Interpretive Summary:

Technical Abstract: A meeting of experts in the field of plant sterols and stanols was convened September 30 - October 2, 2016, in Winnipeg, Manitoba, to enable discussion of developments and controversies in this active area of functional food science. The purpose of the present report is to provide a comprehensive overview of past and recent developments in the basic biology of plant sterols and stanols, largely in the context of their value as therapeutic agents for dyslipidemia management in the general population. It also presents guidance for the clinical management of rare disorders resulting from mutations in sterol metabolism at various levels that lead to the retention in the circulation and tissues of cholesterol, plant sterols and stanols, as well as other types of non-cholesterol sterols. Particularly novel in the area of plant sterol/stanol physiology is the recognition that even low levels of intake of plant sterols or stanols can influence cholesterol absorption efficiency and circulatory pools in both adults and infants. Also, the reciprocity between cholesterol synthesis and absorption and how that ratio impacts the efficacy of plant sterol/stanol action in LDL cholesterol lowering is being increasingly recognized. How polymorphisms within genes coding for enzymes active in lipid pathways affect the LDL-C lowering action are now better understood. Advantages of combining plant sterols/stanols with other dietary elements such as fiber, soy protein and nuts have been recognized. Overall importance of LDL cholesterol lowering in cardiovascular disease risk has been further established from combined drug trials. In best approaches to clinical management of sitosterolemia, ezetimibe continues to prevail as the drug of choice. The disparity in degree of severity of this disorder across patients was emphasized, as well as the importance of proper screening using both levels of circulatory plant sterols as well as confirmation of the specific mutation as diagnostic criteria. It is considered important to rely on these tools for correct identification of patients with sitosterolemia so as not to confuse them with familial hypertriglyceridemia. In summary, plant sterols and stanols continue to offer an efficacious and convenient dietary approach to cholesterol management and serve as an important natural health product as well as functional food ingredient. Their clinical benefit through long-term studies addressing cardiovascular disease endpoints has however not been established.