Plant Sterols

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Plant Sterols a product case study

• Jacqui Morrell
• Unilever nutritionist

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(No Transcript)
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Cardiovascular disease (CVD) is the leading cause
of mortality worldwide

• 16.7 million deaths worldwide from CVD in 20021
• 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

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Coronary heart disease (CHD) mortality ratesin
Europe
CHD is the main cause of death in Europe
Deaths per 100,000
83151 152210 211296 297507 508839
European cardiovascular disease statistics,
2005Age-standardised death rates for men aged
3574, latest year
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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 factorssmoking, physical inactivity,
  obesity, unhealthy diet

• Non-modifiable risk factors
• Increased age
• Gender
• Family history
• Ethnicity or race

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Lower cholesterol levels associated with lower
risk for coronary heart disease (CHD)
20
15
CHD mortality (age-adjusted per 1000 men in
6-years)1
10
5
0
3.8 147
5.2 201
6.5 251
7.6 294
Total serum cholesterol (mmol/l, mg/dl)

1. Martin et al. Lancet 1986

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Contribution of selected risk factors to coronary
heart disease high cholesterol a major factor
High blood cholesterol
Low fruit vegetable intake
Suboptimal blood pressure systolic BP gt115 mmHg
Physical inactivity
Mackay and Mensah, The atlas of heart disease and
stroke, WHO 2004
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Prevalence of elevated blood cholesterol globally

1. MONICA data age-standardised, estimated from
   average men and womenTotal cholesterol gt5.0
   mmol/l Tolonen et al. Int J Epidemiol 2005

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Guidelines for desirable blood lipid levels
European Guidelines1 NCEP Guidelines2
Total cholesterol lt5.0 mmol/l (190 mg/dl) lt200 mg/dl
LDL cholesterol lt3.0 mmol/l (115 mg/dl) lt100 mg/dl
HDL cholesterol gt1.0 mmol/l (40 mg/dl) male gt1.2 mmol/l (46 mg/dl) female gt40 mg/dl
Triglycerides lt1.7 mmol/l (150 mg/dl) lt150 mg/dl

1. Third European Joint Task Force, De Backer Eur J
   Cardio Prev Rehab 2003
2. National Cholesterol Education Program Expert
   Panel, JAMA 2001

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Cholesterol, plant sterols and stanols have
similar structures
HO
HO
Plant sterol- Campesterol
Cholesterol
HO
Plant sterol- b-Sitosterol
HO
Plant stanol- b-Sitostanol
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Plant sterols are natural components of the
human diet
Average daily intake of adults 150-400
mg/day (higher in vegetarians)

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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 hypercholesterolemi
  a 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

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Plant sterol-enriched food products why use
plant sterol esters?

• Esterification of plant sterols with fatty acids
  increases their solubility in food products

sterol
fatty acid
esterification
HO
sterol ester
O
O
C
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Overview of clinical trials assessingefficacy of
plant sterols
plant sterols (g/d)
0.5
1
1.5
2
2.5
3
3.5
0
22.5 g of plant sterols daily significantly
reduces LDL cholesterol by 10
-4
-8
LDL cholesterol ( change)
-12
-16
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
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Substantial impact of plant sterol consumptionon
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 1220 over 5
  years
• Longer-term risk reduction would be about 20

Expert Workshop Katan et al. Mayo Clin Proc 2003
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Dietary recommendations for prevention of
coronary heart disease

• Saturated fat lt7 of total energy
• Trans fatty acids low
• n-3 fatty acids gt1 of total energy (23 g/day)
• Dietary cholesterol lt200 mg/day
• Viscous fibre 10 g/day
• Fruits and vegetables 5 servings daily
• Folic acid 4001000 µg/day
• Alcohol lt2030 ml/day (men) and 1020 ml/day
  (women)
• Consider plant stanol/sterol 2 g/day

Clinical Guidelines, International
Atherosclerosis Society, 2003
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Therapeutic Lifestyle Changes (TLC) according to
NCEP ATP III guidelines

• Main features of the TLC
• Weight reduction
• Increase physical activity
• Total fat intake 2535 total energy
• Reduce saturated fat and cholesterol intake
• saturated fat lt7 total energy
• cholesterol lt200 mg/day
• Option for enhancing LDL lowering
• plant sterols/stanols 2 g/day
• increased viscous, soluble fibre intake to 1025
  g/day

National Cholesterol Education Program Expert
Panel, JAMA 2001
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Cholesterol-lowering effect of plant sterols is
additive to a healthy diet and to lipid-lowering
medication (statins)
0
healthy diet
healthy diet
healthy diet
plant sterol-enriched foods
-10
Statin treatment
LDL cholesterol-lowering
-20

-30
plant sterol-enriched foods
-40
low in saturated fat and cholesterol 2g/day
based on average statin effects Based on
Katan et al. Mayo Clin Proc 2003 78
965978 Edwards Moore BMC Family Practice 2003
418
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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

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pro.activ product range
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pro.activ spread

• 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 polyunsaturatedfatty acids and low
  insaturated fatty acids
• Can be used like any other low-fat spread
• Virtually free from trans fatty acids

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pro.activ milk drink

• Milk drink
• enriched with plant sterols
• semi-skimmed milk drink (1.8 fat)
• Can be used like any othersemi-skimmed milk
• Per 250 ml serving
• 125 calories
• 0.75 g of plant sterols

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pro.activ yoghurts

• Yoghurts
• enriched with plant sterols
• low-fat (0.5 fat)
• range of flavours
• Per 125 g pot
• 97101 calories(depending on flavour)
• 0.75 g of plant sterols

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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

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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

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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

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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

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Flora pro.activ performance
Volume 50
Value 35
Source AC Nielsen MAT TO WE 26.02.05 vs MAT TO
WE 25.02.06
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The CL market still showing strong growth with
Unilever boasting over 58 share of the value.