Plant sterol and stanol margarines and health

doi:10.1136/bmj.320.7238.861

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Malcolm Law (M.R.Law@mds.qmw.ac.uk), reader

Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's and the Royal London School of Medicine and Dentistry, London EC1M 6BQ

Accepted 5 November 1999

A new polyunsaturated margarine with added plant stanols, Benecol, was introduced in several European countries last year, and a similar margarine with added plant sterols will be introduced under the Flora label later this year. These products lower serum concentrations of cholesterol, but they are expensive.1^–14 In Great Britain the cost is about £2.50 ($4.00) for a 250 g tub compared with 60p for ordinary polyunsaturated margarine and 90p for butter. This article considers quantitatively the health aspects of adding plant sterols and stanols to margarines and other foods.

Summary points

Plant sterols and stanols reduce the absorption of cholesterol from the gut and so lower serum concentrations of cholesterol

Plant sterols or stanols that have been esterified to increase their lipid solubilitycan be incorporated into foods

The 2 g of plant sterol or stanol added to an average daily portion of margarine reduces serum concentrations of low density lipoprotein cholesterol by an average of 0.54 mmol/l in people aged 50-59, 0.43 mmol/l in those aged 40-49, and 0.33 mmol/l in those aged 30-39

A reduction in the risk of heart disease of about 25% would be expected for this reduction in low density lipoprotein cholesterol; this is larger than the effect that could be expected to be achieved by people reducing their intake of saturated fat

The added costs of £70 per person per year will limit consumption; however, if stanols and sterols become cheaper, their introduction into the food chain will make them an important innovation in the primary prevention of heart disease

Methods

Randomised trials included in this review were identified by a Medline search using the term “plant sterols.” Additional trials were identified from citations in these papers and in review articles. Other trials in children with familial hypercholesterolaemia were not included.