Pflanzliche Sterole als Nahrungsmitteladditiva zur Prävention kardiovaskulärer Erkrankungen

Zusammenfassung

Sterol-angereichtere Nahrungsmittel „Functional Foods” werden zur Senkung des Cholesterinspiegels von vielen Menschen konsumiert. Ein Wirksamkeitsbeleg von Phytosterolen im Hinblick auf kardiovaskuläre Ereignisse liegt nicht vor. Das Krankheitsbild der Sitosterolämie, epidemiologische Daten und neue experimentelle Ergebnisse ergeben Hinweise, dass pflanzliche Sterole negative kardiovaskuläre Effekte induzieren könnten. Vor einer generellen Empfehlung dieser Produkte sind daher weitere Daten zur Wirksamkeit und Sicherheit erforderlich.

Summary

„Functional foods” supplemented with plant sterols are advertised and added to regular meals to reduce serum cholesterol concentrations. The effects of increased phytosterol levels on cardiovascular diseases, however, are not known. Findings in patients with sitosterolemia, data from epidemiological studies, and experimental data from animal studies suggest that plant sterols may potentially exert negative cardiovascular effects. Additional studies investigating relevant clinical endpoints are needed before a diet supplemented with plant sterols can be recommended in the prevention of cardiovascular diseases.

pflanzliche Sterole - Prävention - Ernährung - kardiovaskuläres Risiko - Nahrungsergänzungsstoffe

plant sterols - prevention - nutrition - cardiovascular risk - functional food

Literatur

• 1 Anttolainen M, Luoto R, Uutela A. et al . Characteristics of users and nonusers of plant sterol ester margarine in Finland: an approach to study functional food.  J Am Diet Assoc. 2001;  101 1365-1368
• 2 Arzneimittelkommission der deutschen Ärzteschaft .Newsletter 2004 - 2045. vom 15.01.2004
• 3 Assmann G, Cullen P, Erby J. et al . Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: results of a nested case-control analysis of the Prospective Cardiovascular Munster (PROCAM) study.  Nutr Metab Cardiovasc Dis. 2006;  16 13-21
• 4 Bhattacharyya A K, Connor W E. Beta-sitosterolemia and xanthomatosis. A newly described lipid storage disease in two sisters.  J Clin Invest. 1974;  53 1033-1043
• 5 Brendsel J, Green S J. Regarding the potential perils of phytosterols.  Atherosclerosis. 2007;  192 (1) 227-229
• 6 Dietz R, Rauch B. Leitlinie zur Diagnose und Behandlung der chronischen koronaren Herzerkrankung der Deutschen Gesellschaft für Kardiologie.  Z Kardiol. 2003;  92 501-521
• 7 Glueck C J, Speirs J, Tracy T. et al . Relationships of plasma plant sterols (phytosterols) and cholesterol in 595 hypercholesterolemic subjects, and familial aggregation of phytosterols, cholesterol, and premature coronary heart disease in hyperphytosterolemic probands and their first-degree relatives.  Metabolism. 1991;  40 842-848
• 8 Gohlke H, Kübler W, Mathes P. Positionspapier zur Primärprävention kardiovaskulärer Erkrankungen.  Z Kardiol. 2003;  92 522-524
• 9 Hallikainen M A, Sarkkinen E S, Uusitupa M I. Comparison of the effects of plant sterol ester and plant stanol ester-enriched margarines in lowering serum cholesterol concentrations in hypercholesterolaemic subjects on a low-fat diet.  Eur J Clin Nutr. 2000;  54 715-725
• 10 Hendriks H F, Weststrate J A, van Vliet T. et al . Spreads enriched with three different levels of vegetable oil sterols and the degree of cholesterol lowering in normocholesterolaemic and mildly hypercholesterolaemic subjects.  Eur J Clin Nutr. 1999;  53 319-327
• 11 Katan M B, Grundy S M. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels.  Mayo Clin Proc. 2003;  78 965-978
• 12 Lees R S, Lees A M. Effects of sitosterol on plasma lipid and lipoprotein concentration.  Lipoprotein Metab. 1976;  8 119-130
• 13 Miettinen T A, Puska P, Gylling H. et al . Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population.  N Eng J Med. 1995;  333 1308-1312
• 14 Miettinen T A, Standberg T E, Gylling H. Noncholesterol sterols and cholesterol lowering by long-term simvastatin treatment in coronary patients: relation to basal serum cholestanol.  Arterioscler Thromb Vasc Biol. 2000;  20 1340-1346
• 15 National Cholesterol Education Program Expert Panel. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).  JAMA. 2001;  285 (19) 2486-2497
• 16 Patel M D, Thompson P D. Phytosterols and vascular disease.  Athero-sclerosis. 2006;  186 (1) 12-19
• 17 Plat J, Brzezinka H, Lütjohann D. et al . Oxidized plant sterols in human serum and lipid infusions as measured by combined gas-liquid chromatography-mass spectrometry.  J Lipid Res. 2001;  42 2030-2038
• 18 Peterson D W. Effect of soybean sterols in the diet on plasma and liver cholesterol in chicks.  Proc Soc Exp Biol Med. 1951;  78 143-147
• 19 Rajaratnam R A, Gylling H, Miettinen T A. Independent association of plasma sequalene and noncholesterol sterols with coronary artery disease in postmenopausal women.  J Am Coll Cardiol. 2000;  35 1185-1191
• 20 Salen G, Starc T, Sisk C M. et al . Intestinal cholesterol absorption inhibitor ezetimibe added to cholestyramine for sitosterolemia and xanthomatosis.  Gasteroenterology. 2006;  130 1853-1857
• 21 Salo P, Wester I. Low-fat formulations of plant stanols and sterols.  Am J Cardiol. 2005;  96 51D-54D
• 22 Sudhop T, Bergmann K von. Sitosterolemia - a rare disease. Are elevated plant sterols an additional risk factor?.  Z Kardiol. 2004;  93 921-928
• 23 Sudhop T, Gottwald B M, Bergmann K von. Plasma plant sterols as a potential risk factor for coronary heart disease.  Metabolism. 2002;  51 1519-1521
• 24 Sutherland W HF, Williams M JA, Nye E R. et al . Associations of plasma noncholesterol sterol levels with severity of coronary heart disease.  Nutr Metab Cardiovasc Dis. 1998;  8 386-391
• 25 Tierry J, Ceglarek U, Fiedler G M. et al . Elevated campesterol serum levels - a significant predictor of incident myocardial infarction: results of the population-based MONICA/KORA follow-up study 1994 - 2005.  Circulation suppl. 2006;  144 4099 A
• 26 USA Food and Drug Administration .Summary of all GRAS notices. Center for Food Safety and Applied Nutrition. Office of Food Additive Safety. http://www.cfsan.fda.gov/∼rdb/. 2003
• 27 Vanhanen H T, Blomqvist S, Ehnholm C. et al . Serum cholesterol, cholesterol precursors, and plant sterols in hypercholesterolemic subjects with different apoE phenotypes during dietary sitostanol ester treatment.  J Lipid Res. 1993;  34 1535-1544
• 28 Weingärtner O, Lütjohann D, Ji S. et al . Vascular effects of a diet supplementation with plant sterols.  J Am Coll Cardiol. 2008;  51 1553-1561
• 29 Weststrate J A, Meijer G W. Plant sterol-enriched margarines and reduction of plasma total- and LDL-cholesterol concentrations in normocholesterolaemic and mildly hypercholesterolaemic subjects.  Eur J Clin Nutr. 1998;  52 334-343