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

Objective: To investigate cholesterol-lowering effects of stanol ester (STAEST) and sterol ester (STEEST)enriched margarines as part of a low-fat diet. Design: According to a Latin square model randomized double-blind repeated measures design with three test margarines and three periods. Setting: Outpatient clinical trial with free-living subjects. Subjects: Thirty-four hypercholesterolaemic subjects completed the study. Interventions: Subjects consumed three rapeseed oil-based test margarines (STAEST, STEEST and control (no added stanols or sterols)) as part of a low-fat diet each for 4 weeks. Results: Mean daily intake of total plant sterols plus stanols was 2.01-2.04g during the two test margarine periods. In reference to control, serum total cholesterol was reduced by 9.2 and 7.3% with the STAEST and STEEST margarine, respectively (P < 0.001 for both). The respective reductions for low-density lipoprotein (LDL) cholesterol were 12.7 and 10.4% (P < 0.001). The cholesterol-lowering effects of the rest margarines did not differ significantly. The presence of apolipoprotein E4 allele had a significant effect on LDL cholesterol response during the STAEST margarine only. Serum sitosterol and campesterol increased by 0.83 and 2.77 mg/l with the STEEST (P < 0.001), respectively and decreased by 1.18 and 2.60 mg/l with the STAEST margarine (P < 0.001). Increases of serum sitostanol and campestanol were 0.11 and 0.19 mg/l with the STAEST margarine (P < 0.001), repsectively. No significant changes were found in serum fat-soluble vitamin and carotenoid concentrations when related to serum total cholesterol. Conclusions: STAEST and STEEST margarines reduced significantly and equally serum total and LDL cholesterol concentrations as part of a low-fat diet.