Cholesterol-lowering effects of plant sterol esters and non-esterified stanols in margarine, butter and low-fat foods

Eur J Clin Nutr. 2001 Dec;55(12):1084-90. doi: 10.1038/sj.ejcn.1601264.


Objectives: To determine the efficacy on plasma cholesterol-lowering of plant sterol esters or non-esterified stanols eaten within low-fat foods as well as margarine.

Design: Randomised, controlled, single-blind study with sterol esters and non-esterified plant stanols provided in breakfast cereal, bread and spreads. Study 1 comprised 12 weeks during which sterol esters (2.4 g) and stanol (2.4 g)-containing foods were eaten during 4 week test periods of cross-over design following a 4 week control food period. In Study 2, in a random order cross-over design, a 50% dairy fat spread with or without 2.4 g sterol esters daily was tested.

Subjects: Hypercholesterolaemic subjects; 22 in study 1 and 15 in study 2.

Main outcome measures: Plasma lipids, plasma sterols, plasma carotenoids and tocopherols.

Results: Study 1-median LDL cholesterol was reduced by the sterol esters (-13.6%; P<0.001 by ANOVA on ranks; P<0.05 by pairwise comparison) and by stanols (-8.3%; P=0.003, ANOVA and <0.05 pairwise comparison). With sterol esters plasma plant sterol levels rose (35% for sitosterol, 51% for campesterol; P<0.001); plasma lathosterol rose 20% (P=0.03), indicating compensatory increased cholesterol synthesis. With stanols, plasma sitosterol fell 22% (P=0.004), indicating less cholesterol absorption. None of the four carotenoids measured in plasma changed significantly. In study 2, median LDL cholesterol rose 6.5% with dairy spread and fell 12.2% with the sitosterol ester fortified spread (P=0.03 ANOVA and <5% pairwise comparison).

Conclusion: 1. Plant sterol esters and non-esterified stanols, two-thirds of which were incorporated into low-fat foods, contributed effectively to LDL cholesterol lowering, extending the range of potential foods. 2. The LDL cholesterol-raising effect of butter fat could be countered by including sterol esters. 3. Plasma carotenoids and tocopherols were not reduced in this study.

Sponsorship: Meadow Lea Foods, Australia.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anticholesteremic Agents / administration & dosage
  • Anticholesteremic Agents / metabolism
  • Anticholesteremic Agents / therapeutic use*
  • Antioxidants / metabolism
  • Butter / analysis
  • Carotenoids / blood
  • Cholesterol / blood*
  • Cross-Over Studies
  • Diet, Fat-Restricted
  • Esters
  • Female
  • Humans
  • Hypercholesterolemia / drug therapy*
  • Male
  • Margarine / analysis
  • Middle Aged
  • Phytosterols / administration & dosage
  • Phytosterols / metabolism
  • Phytosterols / therapeutic use*
  • Phytotherapy*
  • Single-Blind Method
  • Treatment Outcome
  • Vitamin E / blood


  • Anticholesteremic Agents
  • Antioxidants
  • Esters
  • Phytosterols
  • Vitamin E
  • Carotenoids
  • Butter
  • Margarine
  • Cholesterol