Epa Dha and Plant Sterols in the Diet
Review
. 2014 Jun 10;2014(6):CD001918.
doi: 10.1002/14651858.CD001918.pub3.
Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia
Affiliations
- PMID: 24913720
- PMCID: PMC7063855
- DOI: 10.1002/14651858.CD001918.pub3
Free PMC article
Review
Dietary interventions (plant sterols, stanols, omega-3 fatty acids, soy protein and dietary fibers) for familial hypercholesterolaemia
Anita Malhotra et al. Cochrane Database Syst Rev. .
Free PMC article
Abstract
Background: A cholesterol-lowering diet and several other dietary interventions have been suggested as a management approach either independently or as an adjuvant to drug therapy in children and adults with familial hypercholesterolaemia (FH). However, a consensus has yet to be reached on the most appropriate dietary treatment. Plant sterols are commonly used in FH although patients may know them by other names like phytosterols or stanols.
Objectives: To examine whether a cholesterol-lowering diet is more effective in reducing ischaemic heart disease and lowering cholesterol than no dietary intervention in children and adults with familial hypercholesterolaemia. Further, to compare the efficacy of supplementing a cholesterol-lowering diet with either omega-3 fatty acids, soya proteins, plant sterols or plant stanols.
Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Inborn Errors of Metabolism Trials Register, which is compiled from electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL) (updated with each new issue of The Cochrane Library), quarterly searches of MEDLINE and the prospective handsearching of one journal - Journal of Inherited Metabolic Disease. Most recent search of the Group's Inborn Errors of Metabolism Trials Register: 22 August 2013. We also searched PubMed to 05 February 2012.
Selection criteria: Randomised controlled trials, both published and unpublished, where a cholesterol-lowering diet in children and adults with familial hypercholesterolaemia has been compared to other forms of dietary treatment or to no dietary intervention were included.
Data collection and analysis: Two authors independently assessed the trial eligibility and risk of bias and one extracted the data, with independent verification of data extraction by a colleague.
Main results: In the 2014 update of the review, 15 trials have been included, with a total of 453 participants across seven comparison groups. The included trials had either a low or unclear risk of bias for most of the parameters used for risk assessment. Only short-term outcomes could be assessed due to the short duration of follow up in the included trials. None of the primary outcomes, (incidence of ischaemic heart disease, number of deaths and age at death) were evaluated in any of the included trials. No significant differences were noted for the majority of secondary outcomes for any of the planned comparisons. However, a significant difference was found for the following comparisons and outcomes: for the comparison between plant sterols and cholesterol-lowering diet (in favour of plant sterols), total cholesterol levels, mean difference 0.30 mmol/l (95% confidence interval 0.12 to 0.48); decreased serum LDL cholesterol, mean difference -0.60 mmol/l (95% CI -0.89 to -0.31). Fasting serum HDL cholesterol levels were elevated, mean difference -0.04 mmol/l (95% CI -0.11 to 0.03) and serum triglyceride concentration was reduced, mean difference -0.03 mmol/l (95% CI -0.15 to -0.09), although these changes were not statistically significant. Similarly, guar gum when given as an add on therapy to bezafibrate reduced total cholesterol and LDL levels as compared to bezafibrate alone.
Authors' conclusions: No conclusions can be made about the effectiveness of a cholesterol-lowering diet, or any of the other dietary interventions suggested for familial hypercholesterolaemia, for the primary outcomes: evidence and incidence of ischaemic heart disease, number of deaths and age at death,due to the lack of data on these. Large, parallel, randomised controlled trials are needed to investigate the effectiveness of a cholesterol-lowering diet and the addition of omega-3 fatty acids, plant sterols or stanols, soya protein, dietary fibers to a cholesterol-lowering diet.
Conflict of interest statement
None declared.
Figures
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 1 Fasting serum total cholesterol concentration (mmol/l).
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 5 Fasting serum apolipoprotein A1 concentration (g/l).
Comparison 1 Cholesterol‐lowering diet compared to no dietary intervention or nutritional advice, Outcome 6 Fasting serum apolipoprotein B‐100 concentration (g/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 1 Fasting serum total cholesterol concentration (mmol/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 5 Fasting serum apolipoprotein A1 concentration (g/l).
Comparison 2 ω‐fatty acids added to background cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 6 Fasting serum apolipoprotein B‐100 concentration (g/l).
Comparison 3 Plant stanols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet alone, Outcome 1 Fasting serum total cholesterol concentration (mmol/l).
Comparison 3 Plant stanols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet alone, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 3 Plant stanols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet alone, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 3 Plant stanols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet alone, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 1 Fasting serum total cholesterol concentration(mmol/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 5 Fasting serum apolipoprotein A1concentration (g/l).
Comparison 4 Plant sterols added to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 6 Fasting serum apolipoprotein B‐100 concentratiom (g/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 1 Fasting serum total cholesterol concentration (mmol/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 5 Fasting serum apolipoprotein A1 concentration (g/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 6 Fasting serum apolipoprotein B‐100 concentration (g/l).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 7 Weight (kg).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 8 Height (cm).
Comparison 5 Soy protein in addition to cholesterol‐lowering diet compared to cholesterol‐lowering diet, Outcome 9 Body mass index.
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 1 Fasting serum total cholesterol concentration (mmol/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 2 Fasting serum LDL cholesterol concentration (mmol/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 3 Fasting serum HDL cholesterol concentration (mmol/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 4 Fasting serum triglyceride concentration (mmol/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 5 Fasting serum apolipoprotein A1 concentration (g/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 6 Fasting serum apolipoprotein B‐100 concentration (g/l).
Comparison 6 Dietary fibers as a form of dietary intervention compared to another form of dietary intervention or drug or no treatment, Outcome 7 Weight.
Update of
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Dietary treatment for familial hypercholesterolaemia.
Shafiq N, Singh M, Kaur S, Khosla P, Malhotra S. Shafiq N, et al. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001918. doi: 10.1002/14651858.CD001918.pub2. Cochrane Database Syst Rev. 2010. PMID: 20091526 Updated. Review.
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Epa Dha and Plant Sterols in the Diet
Source: https://pubmed.ncbi.nlm.nih.gov/24913720/
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