Efecto reductor del colesterol de una margarina comercial en adultos con hipercolesterolemia: revisión de la literatura científica.
DOI:
https://doi.org/10.14306/renhyd.17.1.5Palabras clave:
colesterol, esteroles vegetales, fitoesteroles, margarina, declaraciones de saludResumen
Introducción: la hipercolesterolemia es un problema creciente, responsable de una quinta parte de los episodios coronarios en España. Se considera que los Esteroles Vegetales (EV) podrían desempeñar un importante papel en su tratamiento.
Objetivo: Se revisa el papel de una gama de alimentos funcionales con EV añadidos (incluyendo los estudios específicos de la marca Flora pro•activ) en adultos que padecen hipercolesterolemia.
Métodos: se ha realizado una revisión de la literatura en la base de datos PubMed para localizar estudios en humanos que hayan evaluado el papel de Flora pro•activ o de alimentos enriquecidos en EV con una composición similar. Se ha consultado, asimismo, la base de datos de la Autoridad Europea de Seguridad Alimentaria (EFSA).
Resultados: Flora pro•activ ha demostrado en estudios científicos rigurosos disminuir el colesterol en adultos que padecen hipercolesterolemia. Bastaría con dos raciones diarias de Flora pro•activ (1,5 g de EV) para observar este efecto. La disminución del colesterol mediante Flora pro•activ (2 raciones/día) oscilará, tal y como señala la EFSA, entre el 7 y el 10%. Este efecto se observará tras 2-3 semanas. Su composición le permite realizar declaraciones de salud con respecto a la disminución del colesterol en el marco de la Unión Europea. La eficacia hipocolesterolemiante de alimentos enriquecidos con EV distintos a margarinas, mayonesas, aderezos para ensaladas y productos lácteos está poco investigada. Salvo en pocas excepciones, la utilización de alimentos enriquecidos con EV es segura.
Conclusiones: las actuales evidencias científicas justifican la promoción de la utilización de EV para disminuir el colesterol LDL en adultos que presentan hipercolesterolemia.
Citas
European Food Safety Authority (EFSA) . Scientific substantiation of a health claim related to plant sterols and lower/reduced blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal 2008;781:1-12.
European Food Safety Authority (EFSA) . Scientific substantiation of a health claim related to a low fat fermented milk product (Danacol®) enriched with plant sterols/stanols and lowering/reducing blood cholesterol and reduced risk of (coronary) heart disease pursuant to Article 14 of Regulation (EC) No 1924/2006. The EFSA Journal 2009;1177:1-12.
European Food Safety Authority (EFSA) . Plant sterols/plant stanols related health claims. EFSA Journal 2010;8(10):1813.
Russolillo G, Baladia E, Moñino M, Colomer M, García M, Basulto J, et al. Incorporación del dietista-nutricionista en el Sistema Nacional de Salud (SNS): Declaración de Postura de la Asociación Española de Dietistas-Nutricionistas (AEDN). Act Diet 2009;13(2):62-9.
Royo-Bordonada MÁ., , Lobos-Bejarano JM., , Millán Núñez-Cortés J., , Villar-Álvarez F, Brotons-Cuixart C, Camafort-Babkowski M, et al. Dislipidemias: un reto pendiente en prevención cardiovascular. Documento de consenso CEIPC/SEA. Med Clin (Barc) 2011 Jun;137(1):30.
Devaraj S, Jialal I. The role of dietary supplementation with plant sterols and stanols in the prevention of cardiovascular disease. Nutr Rev 2006;64(7 Pt 1):348-54. PubMed PMID: 16910223.
National Library of Medicine. . MeSH. Medical Subject Headings [portal web]. Plant Sterols. 2012. En línea: Http://www.ncbi.nlm.nih.gov/mesh?term=plant%20sterols [Consulta: 1 de febrero de 2013]. .
Talati R, Sobieraj DM, Makanji SS, Phung OJ, Coleman CI. The comparative efficacy of plant sterols and stanols on serum lipids: a systematic review and meta-analysis. J Am Diet Assoc 2010;110(5):719-26. PubMed PMID: 20430133.
Rincón-León F. Functional foods. In: Encyclopedia of Food Sciences and Nutrition. Caballero B, editor. 2th. Oxford: Academic-Press; 2003. p. 2827-2832.
Chan YM, Varady KA, Lin Y, Trautwein E, Mensink RP, Plat J, et al. Plasma concentrations of plant sterols: physiology and relationship with coronary heart disease. Nutr Rev 2006;64(9):385-402. PubMed PMID: 17002235.
Ling WH, Jones PJ. Dietary phytosterols: a review of metabolism, benefits and side effects. Life Sci 1995;57(3):195-206. PubMed PMID: 7596226.
Jones PJ, Raeini-Sarjaz M, Ntanios FY, Vanstone CA, Feng JY, Parsons WE. Modulation of plasma lipid levels and cholesterol kinetics by phytosterol versus phytostanol esters. J Lipid Res 2000;41(5):697-705. PubMed PMID: 10787430.
Calpe-Berdiel L, Escolà-Gil JC, Blanco-Vaca F. New insights into the molecular actions of plant sterols and stanols in cholesterol metabolism. Atherosclerosis 2009;203(1):18-31. PubMed PMID: 18692849.
Jr ORE. Phytosterols in human nutrition. Annu Rev Nutr 2002;22:533-49. PubMed PMID: 12055357.
Palou A, , Picó C, Bonet ML, Oliver P, Serra F, Rodríguez AM, et al. El libro blanco de los EV en alimentación. 2a. Barcelona: Innuo S.L-Instituto Flora-Unilever Foods S.A; 2005.
Valsta LM, Lemström A, Ovaskainen ML, Lampi AM, Toivo J, Korhonen T, et al. Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake. Br J Nutr 2004;92(4):671-8. PubMed PMID: 15522137.
Normen L, Ellegard L, Brants H, Dutta P, Andersson H. A phytosterol database: fatty foods consumed in Sweden and the Netherlands. J Food Compost Anal 2007;20(3-4):193-201.
Jiménez-Escrig A, Santos-Hidalgo AB, Saura-Calixto F. Common sources and estimated intake of plant sterols in the Spanish diet. J Agric Food Chem 2006 May;54(9):3462-71. PubMed PMID: 16637708.
Silbernagel G, März W. Plant sterols: cardiovascular risk factors. J Lab Med 2008;32:209-218.
Weihrauch JL, Gardner JM. Sterol content of foods of plant origin. J Am Diet Assoc 1978;73(1):39-47. PubMed PMID: 659760.
Thurnham DI. Functional foods: cholesterol-lowering benefits of plant sterols. Br J Nutr 1999;82(4):255-6. PubMed PMID: 10655973.
Genser B, Silbernagel G, Backer, G. De , Bruckert E, Carmena R, Chapman MJ, et al. Plant sterols and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J 2012;33(4):444-51. PubMed PMID: 22334625.
Wang P, Chen YM, He LP, Chen CG, Zhang B, Xue WQ, et al. Association of natural intake of dietary plant sterols with carotid intima-media thickness and blood lipids in Chinese adults: a cross-section study. PLoS One 2012;7(3):32736. PubMed PMID: 22412917.
Ostlund RE, Racette SB, Okeke A, Stenson WF. Phytosterols that are naturally present in commercial corn oil significantly reduce cholesterol absorption in humans. Am J Clin Nutr 2002;75(6):1000-4. PubMed PMID: 12036805.
Klingberg S, Ellegård L, Johansson I, Hallmans G, Weinehall L, Andersson H, et al. Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden. Am J Clin Nutr. 2008 Apr;87(4):993-1001. Erratum in:. Am J Clin Nutr 2012;96(3):680. PubMed PMID: 18400724.
National Cholesterol Education Program (NCEP): Third report of the NCEP Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). United States of America: National Heart Lung and Blood Institute; 2002.
Baladia E, Basulto J. Sistema de clasificación de los estudios en función de la evidencia científica. Dietética y Nutrición Aplicada Basadas en la Evidencia (DNABE): una herramienta para el dietista-nutricionista del futuro. Act Diet 2008;12:11-9.
EC. Regulation (EC) No. 258/97 of the European Parliament and of the Council of 27 January 1997 concerning novels foods and novel foods ingredients. Off J Eur Communities 1997;L43:1-7.
Ortega RM, Palencia A, López-Sobaler AM. Improvement of cholesterol levels and reduction of cardiovascular risk via the consumption of phytosterols. Br J Nutr 2006;96(Suppl 1):89-93. PubMed PMID: 16923260.
Commission Regulation (EU) No 432/2012 of 16 May 2012 establishing a list of permitted health claims made on foods, other than those referring to the reduction of disease risk and to children’s development and health. Off J Eur Communities;L136:1-40.
Grupo de trabajo sobre (GPC) . Elaboración de Guías de Práctica Clínica en el Sistema Nacional de Salud. Manual Metodológico. Madrid: Plan Nacional para el SNS del MSC. Instituto Aragonés de Ciencias de la Salud-I+CS; 2007.
Higgins JPT, Green S (editors) . Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011.
European Food Safety Authority (EFSA) . Register of Questions [online database]; 2012. En línea: Http://registerofquestions.efsa.europa.eu/roqFrontend/login [Consulta: 1 de diciembre de 2012]. .
Law M. Plant sterol and stanol margarines and health. BMJ 2000 Mar;320(7238):861-4. PubMed PMID: 10731187.
Wu T, Fu J, Yang Y, Zhang L, Han J. The effects of phytosterols/stanols on blood lipid profiles: a systematic review with meta-analysis. Asia Pac J Clin Nutr 2009;18(2):179-86. PubMed PMID: 19713176.
Moruisi KG, Oosthuizen W, Opperman AM. Phytosterols/stanols lower cholesterol concentrations in familial hypercholesterolemic subjects: a systematic review with meta-analysis. J Am Coll Nutr 2006;25(1):41-8. PubMed PMID: 16522931.
Baker WL, Baker EL, Coleman CI. The effect of plant sterols or stanols on lipid parameters in patients with type 2 diabetes: a meta-analysis. Diabetes Res Clin Pract 2009;84(2):33-7. PubMed PMID: 19243852.
Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R. Stresa Workshop Participants. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 2003;78(8):965-78. PubMed PMID: 12911045.
Naumann E, Plat J, Kester AD, Mensink RP. The baseline serum lipoprotein profile is related to plant stanol induced changes in serum lipoprotein cholesterol and triacylglycerol concentrations. J Am Coll Nutr 2008;27(1):117-26. PubMed PMID: 18460490.
Demonty I, Ras RT, Knaap, H.C. van der , Meijer L, Zock PL, Geleijnse JM, et al. The effect of plant sterols on serum triglyceride concentrations is dependent on baseline concentrations: a pooled analysis of 12 randomised controlled trials. Eur J Nutr 2013;52(1):153-60. PubMed PMID: 22252793.
QuIlez J, GarcIa-Lorda P, Salas-Salvadó J. Potential uses and benefits of phytosterols in diet: present situation and future directions. Clin Nutr 2003;22(4):343-51. PubMed PMID: 12880600.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis. 2012;223(1):1-68.
Grundy SM, Cleeman JI, Merz CN, Brewer HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. J Am Coll Cardiol. 2004; 44(3):720-32.
European Commission (EC) . EU Register on nutrition and health claims. 2012. En línea: Http://ec.europa.eu/nuhclaims/?event=search&formReset=1 [Consulta: 1 de febrero de 2013]. .
Hendriks HF, Weststrate JA, van Vliet T, Meijer GW. 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(4):319-27. PubMed PMID: 10334658.
Weststrate JA, Meijer GW. 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(5):334-43. PubMed PMID: 9630383.
AbuMweis SS, Vanstone CA, Lichtenstein AH, Jones PJ. Plant sterol consumption frequency affects plasma lipid levels and cholesterol kinetics in humans. Eur J Clin Nutr 2009;63(6):747-55. PubMed PMID: 18523440.
Amundsen AL, Ose L, Nenseter MS, Ntanios FY. Plant sterol ester-enriched spread lowers plasma total and LDL cholesterol in children with familial hypercholesterolemia. Am J Clin Nutr 2002;76(2):338-44. PubMed PMID: 12145004.
European Food Safety Authority (EFSA) . Scientific Opinion on the substantiation of a health claim related to 3 g/day plant sterols/stanols and lowering blood LDL-cholesterol and reduced risk of (coronary) heart disease pursuant to Article 19 of Regulation (EC) No 1924/2006. EFSA Journal 2012;10(5):2693.
Agencia Catalana de Seguridad Alimentaria (ACSA) . Alimentos con esteroles / estanoles vegetales añadidos.. Agencia Catalana de Seguridad Alimentaria; 2010.
Gupta AK, Savopoulos CG, Ahuja J, Hatzitolios AI. Role of phytosterols in lipid-lowering: current perspectives. QJM 2011;104(4):301-8. PubMed PMID: 21325285.
Malinowski JM, Gehret MM. Phytosterols for dyslipidemia. Am J Health Syst Pharm 2010 Jul;67(14):1165-73. PubMed PMID: 20592321.
Jenkins DJ, Kendall CW, Nguyen TH, Marchie A, Faulkner DA, Ireland C, et al. Effect of plant sterols in combination with other cholesterol-lowering foods. Metabolism 2008;57(1):130-9. PubMed PMID: 18078870.
Scholle JM, Baker WL, Talati R, Coleman CI. The effect of adding plant sterols or stanols to statin therapy in hypercholesterolemic patients: systematic review and meta-analysis. J Am Coll Nutr 2009;28(5):517-24. PubMed PMID: 20439548.
Nijjar PS, Burke FM, Bloesch A, Rader DJ. Role of dietary supplements in lowering low-density lipoprotein cholesterol: a review. J Clin Lipidol 2010;4(4):248-58. PubMed PMID: 21122657.
Sudhop T, Gottwald BM, von Bergmann K. Serum plant sterols as a potential risk factor for coronary heart disease. Metabolism 2002;51(12):1519-21. PubMed PMID: 12489060.
Escurriol V, Cofán M, Moreno-Iribas C, Larrañaga N, Martínez C, Navarro C, et al. Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort. J Lipid Res 2010;51(3):618-24. PubMed PMID: 19786566.
European Commission (EC) . Opinion on a request for the safety assessment of the use of phytosterol esters in yellow fat spreads. Scientific Committee on Food; 2000.
Myrie SB, Mymin D, Triggs-Raine B, Jones PJ. Serum lipids, plant sterols, and cholesterol kinetic responses to plant sterol supplementation in phytosterolemia heterozygotes and control individuals. Am J Clin Nutr 2012;95(4):837-44. PubMed PMID: 22378727.
European Commission (EC) . General view on the long-term effects of the intake of elevated levels of phytosterols from multiple dietary sources, with particular attention to the effects on ß-carotene. Scientific Committee on Food; 2002.
European Commission (EC) . Opinion of the Scientific Committee on Food on an application from MultiBene for approval of plant-sterol enriched foods. Scientific Committee on Food; 2003.
Guardamagna O, Abello F, Baracco V, Federici G, Bertucci P, Mozzi A, et al. Primary hyperlipidemias in children: effect of plant sterol supplementation on plasma lipids and markers of cholesterol synthesis and absorption. Acta Diabetol 2011;48(2):127-33. PubMed PMID: 21057823.
Lebars MA, Rieu D, Girardet JP. Dietary recommendations for children with hipercolesterolemia. Arch Pediatr 2010;17(7):1126-32.
Amundsen AL, Ntanios F, Put NV, Ose L. Long-term compliance and changes in plasma lipids, plant sterols and carotenoids in children and parents with FH consuming plant sterol ester-enriched spread. Eur J Clin Nutr 2004;58(12):1612-20. PubMed PMID: 15199384.
Tammi A, Rönnemaa T, Gylling H, Rask-Nissilä L, Viikari J, Tuominen J, et al. Plant stanol ester margarine lowers serum total and low-density lipoprotein cholesterol concentrations of healthy children: the STRIP project. Special Turku Coronary Risk Factors Intervention Project. J Pediatr 2000;136(4):503-10. PubMed PMID: 10753249.
Reglamento (CE) 384/2010 de 05/05/2010, sobre la autorización o denegación de autorización de determinadas declaraciones de propiedades saludables en los alimentos relativas a la reducción del riesgo de enfermedad y al desarrollo y la salud de los niños. Off J Eur Communities;L113:6-10.
Reglamento (CE) 983/2009, de 21/10/2009 sobre la autorización o la denegación de autorización de determinadas declaraciones de propiedades saludables en los alimentos relativas a la reducción del riesgo de enfermedad y al desarrollo y la salud de los niños. Modificado por el Reglamento (CE) 376/2010 de 03/05/2010.. Off J Eur Communities;L277:3-12.
Roberfroid MB. A European consensus of scientific concepts of functional foods. Nutrition 2000;16(7-8):689-91. PubMed PMID: 10906599.
Instituto Flora (IF) . Flora pro.activ. 2012. En línea: Http://flora.es/Consumer/Article.aspx?Path=Consumer/CholesterolAdvice/ProActiv/FloraProActivLight y http://flora.es/Consumer/Article.aspx?Path=Consumer/CholesterolAdvice/ProActiv/FloraProActivMilkDrink [Consulta: 1 de febrero de 2013].
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