2015-05-05 08:55:02
Naturally present in plants, in particular the seeds of oilseeds, phytosterols, having a structure similar to that of cholesterol, compete with it at the intestinal level and thus limit its absorption. Phytostanols are derived from the hydrogenation of phytosterols.
European regulations authorize the use, on the labeling of products enriched with phytosterols and phytostanols, of a claim indicating that these substances lower blood cholesterol, and specifying that lowering blood cholesterol can reduce the risk of coronary heart disease.
Following certain questions, the Consumer Association UFC-Que Choisir contacted the Agency to assess the risk and benefit associated with the consumption of food products enriched with phytosterols and phytostanols.
Products enriched with phytosterols: what are they? Who consumes it?
An analysis of the French market shows that products enriched with phytosterols currently concentrate on three sectors: margarines, fresh and similar dairy products and condiment sauces and represent approximately 4% of their respective market shares.
According to the INCA 2 study (national individual study of food consumption) conducted by ANSES, consumers of these products represented, in 2006-2007, approximately 3% of adults and 0.7% of children. Among adults, the age group of 46-79 years, which can be considered as the most at risk of hypercholesterolemia, was the most represented. Among consumers of foods fortified with phytosterols, children accounted for 12.5%.
Consumption of phytosterols: risks and benefits still insufficiently documented
If phytosterols indeed contribute to an average reduction of around 10% in total cholesterolemia and in circulating LDL-Cholesterol (commonly called “bad cholesterol”), the individual variability of response to phytosterols is great. In approximately 30% of subjects, the consumption of foods enriched with phytosterols does not induce a drop in LDL-Cholesterol.
The consumption of foods enriched with phytosterols also leads to an increase in plasma concentrations of phytosterols, the consequences of which on cardiovascular risk are not known.
In addition, a decrease in the plasma concentration of β-carotene is also observed following the consumption of phytosterols, which is likely to increase the cardiovascular risk.
Finally, there are no studies on the effects of phytosterols directly on cardiovascular events that would make it possible to decide on the result of the effects of phytosterols on all of these intermediate parameters (LDL-Cholesterol, plasma phytosterols, β- plasma carotene). To date, we cannot conclude on the effects of phytosterols on the prevention of cardiovascular risks.
Phytosterols are not an appropriate means of preventing cardiovascular diseases at the population level
Faced with these elements of scientific uncertainty, ANSES considers that the data currently available do not allow it to consider foods fortified with phytosterols as an appropriate means of preventing cardiovascular disease at the population level.
Although blood LDL-Cholesterol is recognized as a risk factor for cardiovascular diseases, ANSES points out that these diseases are multifactorial, involving a large number of risk factors and protective factors. Therefore, the reduction of a single risk factor does not necessarily lead to a reduction in the risk of disease.
It also recalls that there are many recognized lifestyle and dietary prevention levers such as quitting smoking, increasing physical activity, reducing physical inactivity and improving dietary balance by ensuring adequate consumption of fruits and vegetables, a balanced intake of fatty acids and a moderate consumption of sugars and salt. At the individual level, it is up to the physician to adapt the various possible measures to patients with hypercholesterolemia.
The Agency’s recommendations
Consequently, ANSES recommends:
- people concerned regarding their cholesterol levels to consult a health professional who can, in particular, advise them on the lifestyle and dietary measures best suited to their situation;
- to consumers of products enriched with phytosterols to make sure to achieve a minima the recommendations of the National Health Nutrition Program (PNNS) for fruit and vegetables in order to compensate for the drop in β-carotene caused by the consumption of these products;
- avoid consumption products enriched with phytosterols by children ;
- avoid consumption products enriched with phytosterols by pregnant and breastfeeding women.
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