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Atherosclerosis. 2016 May;248:76-83. doi: 10.1016/j.atherosclerosis.2016.01.035. Epub 2016 Jan 28.

Effects of phytosterols on markers of inflammation: A systematic review and meta-analysis.

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Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
Unilever Research and Development Vlaardingen, Vlaardingen, The Netherlands.
Lipid Clinic, Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil. Electronic address:



Regular intake of phytosterols (PS) is proven to dose-dependently lower LDL-cholesterol (LDL-C). Whether PS consumption can also impact low-grade inflammation is unclear. Considering the low feasibility of outcomes studies involving PS consumption, investigation of surrogate markers of atherosclerosis represents a valuable approach. This study assessed the anti-inflammatory effect of PS consumption, according to inflammatory biomarkers, mainly C-reactive protein (CRP).


A systematic search of Medline, Cab Abstracts, and Food Science & Technology Abstracts was conducted through January 2015. Our study selection included randomized controlled trials (RCT), involving intake of PS-enriched foods as active treatment, and measurement of plasma inflammatory biomarkers. Random-effects meta-analyses were performed using average baseline and end-of-intervention concentrations and control-adjusted absolute changes in CRP and blood lipids. There were 20 eligible RCTs including a total of 1308 subjects. The absolute change of plasma CRP levels with PS consumption was -0.10 mg/L (95%CI -0.26; 0.05), a non-significant change, and heterogeneity had borderline significance (I(2) = 29.1; p-value = 0.073). The absolute reduction of LDL-C was -14.3 mg/dL (95%CI -17.3; -11.3). Meta-regression analyses showed that both the dose and duration of PS intake significantly influenced the absolute changes in plasma CRP (β = -0.35, p = 0.0255 and β = -0.03, p = 0.0209, respectively).


In this meta-analysis, regular intake of PS-enriched foods did not significantly change CRP, whilst LDL-C concentrations were significantly reduced. Further studies with higher PS doses may provide more definite conclusions on a potential anti-inflammatory effect of PS intake.


Atherosclerosis; C-reactive protein; Cholesterol; Inflammation; Phytosterols; Plant sterols; Stanols

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