British Journal of Nutrition

Metabolism and Metabolic Studies

Effects of plant sterol esters in skimmed milk and vegetable-fat-enriched milk on serum lipids and non-cholesterol sterols in hypercholesterolaemic subjects: a randomised, placebo-controlled, crossover study

Patricia Casas-Agustencha1a2, Mercè Serraa1a2, Ana Pérez-Herasa1a2, Montserrat Cofána1a2, Xavier Pintóa3, Elke A. Trautweina4 and Emilio Rosa1a2 c1

a1 Lipid Clinic, Service of Endocrinology and Nutrition, Institut d'Investigations Biomediques August Pi Sunyer, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain

a2 Ciber Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Spain

a3 Lipids and Vascular Risk Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

a4 Unilever Research and Development, Vlaardingen, The Netherlands


Plant sterol (PS)-supplemented foods are recommended to help in lowering serum LDL-cholesterol (LDL-C). Few studies have examined the efficacy of PS-enriched skimmed milk (SM) or semi-SM enriched with vegetable fat (PS-VFM). There is also insufficient information on factors predictive of LDL-C responses to PS. We examined the effects of PS-SM (0·1 % dairy fat) and PS-VFM (0·1 % dairy fat plus 1·5 % vegetable fat) on serum lipids and non-cholesterol sterols in hypercholesterolaemic individuals. In a placebo-controlled, crossover study, forty-three subjects with LDL-C>1300 mg/l were randomly assigned to three 4-week treatment periods: control SM, PS-SM and PS-VFM, with 500 ml milk with or without 3·4 g PS esters (2 g free PS). Serum concentrations of lipids and non-cholesterol sterols were measured. Compared to control, LDL-C decreased by 8·0 and 7·4 % (P < 0·015, both) in the PS-SM and PS-VFM periods, respectively. Serum lathosterol:cholesterol (C) ratios increased by 11–25 %, while sitosterol:C and campesterol:C ratios increased by 70–120 % with both the PS-fortified milk. Adjusted LDL-C reductions were variably enhanced in participants with basal low serum lathosterol/C or conversely high sitosterol/C and campesterol/C. Subjects with post-treatment serum PS:C ratios above the median showed mean LDL-C changes of − 5·9 to − 10·4 %, compared with 1·7 to − 2·9 % below the median. In conclusion, consumption of 2 g/d of PS as PS-SM and PS-VFM lowered LDL-C in hypercholesterolaemic subjects to a similar extent. Basal and post-treatment changes in markers of cholesterol metabolism indicating low cholesterol synthesis and high cholesterol absorption predicted improved LDL-C responses to PS.

(Received March 22 2011)

(Revised August 10 2011)

(Accepted August 18 2011)

(Online publication October 10 2011)


c1 Corresponding author: Dr E. Ros, fax +34 934537829, email


Abbreviations: BP, blood pressure; C, cholesterol; HDL-C, HDL-cholesterol; LDL-C, LDL-cholesterol; PS, plant sterols; SM, skimmed milk; VFM, vegetable fat-enriched milk