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Plant Sterols – a product case study Jacqui Morrell Unilever nutritionist.

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Presentation on theme: "Plant Sterols – a product case study Jacqui Morrell Unilever nutritionist."— Presentation transcript:

1 Plant Sterols – a product case study Jacqui Morrell Unilever nutritionist


3 Cardiovascular disease (CVD) is the leading cause of mortality worldwide 16.7 million deaths worldwide from CVD in –7.2 million deaths from coronary heart disease 3.8 million men 3.4 million women –5.5 million deaths from stroke 2.5 million men 3 million women 1.Mackay and Mensah, The atlas of heart disease and stroke, WHO 2004

4 Coronary heart disease (CHD) mortality rates in Europe European cardiovascular disease statistics, 2005: Age-standardised death rates for men aged 35–74, latest year CHD is the main cause of death in Europe 83– – – – –839 Deaths per 100,000

5 Major risk factors for coronary heart disease Modifiable risk factors Abnormal blood lipid levels –high total cholesterol –high LDL cholesterol –low HDL cholesterol –high triglycerides High blood pressure Lifestyle factors smoking, physical inactivity, obesity, unhealthy diet Non-modifiable risk factors Increased age Gender Family history Ethnicity or race

6 1.Martin et al. Lancet 1986 Lower cholesterol levels associated with lower risk for coronary heart disease (CHD) CHD mortality (age-adjusted per 1000 men in 6-years) 1 Total serum cholesterol (mmol/l, [mg/dl]) 3.8 [147] [201]6.5 [251] 7.6 [294]

7 Contribution of selected risk factors to coronary heart disease: high cholesterol a major factor Mackay and Mensah, The atlas of heart disease and stroke, WHO 2004 Low fruit & vegetable intake Physical inactivity High blood cholesterol Suboptimal blood pressure systolic BP >115 mmHg 22% 31% 49% 56%


9 Prevalence of elevated blood cholesterol globally 1.MONICA data: age-standardised, estimated from average men and women: Total cholesterol >5.0 mmol/l Tolonen et al. Int J Epidemiol 2005 Switzerland Germany Czech Republic Sweden France UK Belgium Denmark Italy Canada Poland Spain Russia USA China Prevalence of high cholesterol (%) 1

10 Guidelines for desirable blood lipid levels 1.Third European Joint Task Force, De Backer Eur J Cardio Prev Rehab National Cholesterol Education Program Expert Panel, JAMA 2001 European Guidelines 1 NCEP Guidelines 2 Total cholesterol<5.0 mmol/l (190 mg/dl)<200 mg/dl LDL cholesterol<3.0 mmol/l (115 mg/dl)<100 mg/dl HDL cholesterol>1.0 mmol/l (40 mg/dl) male >1.2 mmol/l (46 mg/dl) female >40 mg/dl Triglycerides<1.7 mmol/l (150 mg/dl)<150 mg/dl

11 Cholesterol, plant sterols and stanols have similar structures HO Cholesterol Plant sterol- -Sitosterol Plant sterol- Campesterol Plant stanol- -Sitostanol

12 Plant sterols are natural components of the human diet Average daily intake of adults mg/day (higher in vegetarians)

13 Plant sterols… Old-timers Reduction of Blood Cholesterol in Man By O.J.POLLAK, M.D., Ph.D. Dietary-cholesterol contributes to the development and maintenance of hypercholesterolemia in man. Intake of sitosterol prevents cholesterol resorption. This results in lowering of blood cholesterols to a basal endogenous levels. Upon cessation of sitosterol intake hemocholesterols return to the original level. Excess supply of plant sterol was required in clinical experiments because the material used contained but 75 to 80 per cent of sitosterol and because of the large amount of endogenous cholesterol which has to be inactivated by the sitosterol, besides exogenous cholesterol. Circulation Volume VII. May 1953

14 Plant sterol-enriched food products: why use plant sterol esters? Esterification of plant sterols with fatty acids increases their solubility in food products sterol sterol ester esterification fatty acid HO O C O

15 Overview of clinical trials assessing efficacy of plant sterols plant sterols (g/d) LDL cholesterol (% change) 41 trials with plant sterols/stanols: 95% CI from meta-analysis Katan et al. Mayo Clin Proc 2003 LDL cholesterol from pro.activ sponsored studies 2–2.5 g of plant sterols daily significantly reduces LDL cholesterol by ~10%

16 Substantial impact of plant sterol consumption on heart health Scientific evidence is sufficient to promote use of plant sterols for lowering LDL cholesterol levels in persons at increased risk for coronary heart disease Reduction in LDL cholesterol levels of about 10% could be expected to reduce the incidence of coronary heart disease by about 12–20% over 5 years Longer-term risk reduction would be about 20% Expert Workshop: Katan et al. Mayo Clin Proc 2003

17 Dietary recommendations for prevention of coronary heart disease Clinical Guidelines, International Atherosclerosis Society, 2003 Saturated fat: <7% of total energy Trans fatty acids: low n-3 fatty acids: >1% of total energy (2–3 g/day) Dietary cholesterol: <200 mg/day Viscous fibre: ~10 g/day Fruits and vegetables: 5 servings daily Folic acid: 400–1000 µg/day Alcohol: <20–30 ml/day (men) and 10–20 ml/day (women) Consider plant stanol/sterol: 2 g/day

18 Therapeutic Lifestyle Changes (TLC) according to NCEP ATP III guidelines Main features of the TLC: Weight reduction Increase physical activity Total fat intake: 25–35% total energy Reduce saturated fat and cholesterol intake: –saturated fat <7% total energy –cholesterol <200 mg/day Option for enhancing LDL lowering: –plant sterols/stanols 2 g/day –increased viscous, soluble fibre intake to 10–25 g/day National Cholesterol Education Program Expert Panel, JAMA 2001

19 Cholesterol-lowering effect of plant sterols is additive to a healthy diet and to lipid-lowering medication (statins) * low in saturated fat and cholesterol ** 2g/day *** based on average statin effects Based on: Katan et al. Mayo Clin Proc 2003; 78: 965–978 Edwards & Moore BMC Family Practice 2003; 4– healthy diet*healthy diet plant sterol-enriched foods ** Statin treatment*** healthy diet plant sterol-enriched foods % LDL cholesterol-lowering

20 Cholesterol-lowering with plant sterol-enriched foods Reproducible, robust effects Sustained with longer-term use Independent of the background diet (typical Western or low-fat) Proven compliance and efficacy in free-living populations (adults and familial hypercholesterolemia children) Additive effect to low saturated fat, low cholesterol lipid-lowering diet Additive effect to lipid-lowering medication (statins and fibrates) No adverse effect on HDL cholesterol

21 pro.activ product range

22 35% low-fat spread Enriched with plant sterols proven to reduce cholesterol Per 10 g serving: –33 calories –0.75 g of sterols Made from vegetable oils High in polyunsaturated fatty acids and low in saturated fatty acids Can be used like any other low-fat spread Virtually free from trans fatty acids pro.activ spread

23 pro.activ milk drink Milk drink: –enriched with plant sterols –semi-skimmed milk drink (1.8% fat) –Can be used like any other semi-skimmed milk –Per 250 ml serving: 125 calories 0.75 g of plant sterols

24 pro.activ yoghurts Yoghurts: –enriched with plant sterols –low-fat (0.5% fat) –range of flavours Per 125 g pot: –97–101 calories (depending on flavour) –0.75 g of plant sterols

25 pro.activ yoghurt mini drinks Enriched with plant sterols Semi-skimmed yoghurt drink Contains probiotic Bifidobacterium lactis Bb12 A range of flavours Per bottle: –87 calories –2 g of plant sterols

26 Optimal daily plant sterol intake for cholesterol- lowering: servings or portions The plant sterols in 3 portions of pro.activ foods (or one yoghurt mini drink) are clinically proven to lower LDL (bad) cholesterol levels significantly 1 mini drink = 2 g plant sterols 3 portions of milk, spread, yoghurts = 2.25 g plant sterols


28 The most significant advancement in the dietary management of cholesterol in thirty years Professor Leon Simons, Head of Lipids Department, St Vincents Cholesterol Clinic, Australia, speaking on National TV news

29 Conclusions Cholesterol-lowering efficacy of plant sterol-enriched foods has been proven in more than 40 clinical studies. The results are reproducible and sustainable in the long-term The 10% reduction in LDL cholesterol levels can reduce the risk of coronary heart disease by up to 20% Plant sterol-enriched foods are safe, approved and endorsed internationally Plant sterols are recommended in dietary guidelines for cholesterol-lowering

30 Volume +50% Value +35% Flora pro.activ performance Source: AC Nielsen MAT TO WE vs MAT TO WE

31 The CL market still showing strong growth with Unilever boasting over 58% share of the value.

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