Download Flora pro-activ with plant sterols. Clinically proven to lower cholesterol.

Flora
pro-activ with
plant sterols.
Clinically
proven
to lower
cholesterol.
Information for Healthcare Professionals
Contents
02 Introduction
03 Diet and lifestyle play a key role
in reducing risk of cardiovascular
disease
04 Plant sterols -proven doseresponse reduction of LDL
cholesterol
05 Plant sterols reduce cholesterol
absorption in the gut
06 Plant sterols occur naturally in
everyday foods
07 The optimum intake of plant
sterols is 2g/day
08 National and International
Recommendations
10 Plant Sterol Safety
11 Plant sterols – effective in
combination with statins
12 Clinical Applications
13 Flora pro-activ spreads
14 References
16 Summary
Introduction
Globally, cardiovascular disease (CVD) is the leading cause of
morbidity and mortality. However, about 80% of heart disease
and stroke could be prevented by positive lifestyle changes, such
as eating a healthy diet, exercise and abstinence from smoking1.
Elevated LDL-cholesterol is widely accepted as one of the major
modifiable risk factors.
There are many diet and lifestyle changes that may help control
elevated LDL-cholesterol and therefore help in reducing the risk
of coronary heart disease (CHD). They include recommendations
for the use of specific foods with cholesterol lowering benefits,
such as plant sterol enriched foods2,3. These additional options
can enhance the effectiveness of a typical healthy diet low
in saturated fat, rich in polyunsaturated fat and controlled in
energy intake.
Flora pro-activ spreads contain plant sterols, in many human
studies it has been shown that plant sterols significantly lower
LDL-cholesterol.
Combined with other diet and lifestyle changes plant sterolenriched foods can contribute to increasing the effectiveness
of diet, in lowering cholesterol and offer a valuable addition to
reduce CHD risk reduction strategies.
This brochure contains information on plant sterols and Flora
pro-activ spreads for health care professionals.
02
Diet and lifestyle play
a key role in reducing
risk of Cardiovascular
Disease
Elevated LDL-cholesterol is widely accepted as a key modifiable
risk factor for CHD, the main form of CVD, and is prevalent in the
Australian and New Zealand population.
Many dietary factors affect LDL-cholesterol levels. Making
positive dietary changes like replacing saturated fats with
polyunsaturated fats are well known to lower LDL-cholesterol.4
Every year heart disease is responsible for around 40%
of deaths in New Zealand and around 15% of deaths in
Australia5,6. It was recently estimated that lowering the
mean LDL-cholesterol of the Australian adult population by
10% would reduce the number of cardiovascular deaths by
approximately 3000 annually.7
Several diet and lifestyle factors affect serum LDL-cholesterol
factors (Table 1). The single most effective way to lower
LDL-cholesterol with dietary change is to include plant sterols
or stanols. Eating 2-2.5 g of plant sterols daily can lower
LDL-cholesterol by up to 15% when combined with the move to
a healthy diet and lifestyle.†8
† Average 10% reduction over 3 weeks based on daily consumption of 2g plant sterols and
an additional 5% from the move to a healthy diet and lifestyle.
Table 1: Effect of diet and lifestyle factors on LDL- cholesterol 4, 8-11.
Component
LDL-reduction (%)
Recommendation
10
2 – 2.5g/day
5 – 10
<7% energy
3
5 – 10% energy
5
<200mg/day
Soluble dietary fibres
5
5 – 10g/day
Body weight reduction
5
Lose ~5kg
3–5
25g/day
Plant sterols
Saturated fatty acids
reduction in intake
Polyunsaturated fatty acids
Dietary cholesterol
reduction in intake
Soy protein
03
Plant sterols proven dose-response
reduction of LDL
cholesterol
The cholesterol lowering effect of plant sterols has been known
since the early 1950’s. A large body of scientific evidence of
more than 120 studies has proven plant sterols significantly
lower LDL-cholesterol. Since the late 1980s, Unilever, in
collaboration with many independent scientific investigators,
has researched the cholesterol-lowering properties of plant
sterols in Flora pro-activ spreads in over 30 clinical trials.
A meta-analysis shows the continuous dose-response
relationship between plant sterol intake and LDL-cholesterol
levels8 (figure 1).
There is a continuous dose-response relationship between
the intake of plant sterols and their effect on LDL-cholesterol
levels.12,13
The more plant sterol consumed, the greater the reduction in
LDL-cholesterol up to about 2-2.5g plant sterol per day. Intakes
above 2.5g/day are not recommended as this provides little
further benefit.8
Figure 1: The effect of plant sterols on LDL-cholesterol levels8
Plant sterols (grams per day)
LDL-cholesterol lowering
(%reduction)
0
0.5 1 1.5 2 2.5 33.5
-5
-10
- 15
95% confidence interval
Optimal
intake
Consuming more than 3g of plant sterols per day does not provide additional benefits.
04
Little further
benefit
Plant sterols reduce cholesterol
absorption in the gut
The key benefit of plant sterols lies in their ability to reduce
the absorption of cholesterol from the gut into the blood
stream. Cholesterol is an essential building block in the human
body and plays a key role in maintaining cell membranes. It
is naturally produced in the liver but is also delivered through
foods containing cholesterol in the diet. As a part of normal
metabolism, cholesterol in the gut mixes with bile salts,
lecithin and triglycerides to form micelles. Micelles then deliver
cholesterol to the cells lining the gut wall where the cholesterol
is re-packaged and released into the bloodstream.
Plant sterols have a similar chemical structure to cholesterol. It
is thought that when plant sterols reach the gut they displace
cholesterol from the micelles14. In this way, less cholesterol
reaches the lining of the gut wall in a form that can be absorbed.
Consuming 2g of plant sterols a day reduces the absorption of
cholesterol by 30-40%15. The cholesterol that is not incorporated
into the micelles is then excreted (along with virtually all the
plant sterols). In this way, cholesterol is removed from the body.
Subsequently, levels of LDL-cholesterol are lowered but HDLcholesterol and triglyceride levels remain unaffected.
The effects of plant sterols on cholesterol absorption
Without plant sterols
Cholesterol
With plant sterols
liver
liver
Plant Sterols
More cholesterol
absorbed =
higher blood
cholesterol levels
Less cholesterol
absorbed =
lower cholesterol
levels
micelle
micelle
gutgut
blood
blood
Plant sterols partially block the absorption of cholesterol
from the gut, significantly lowering blood cholesterol levels
05
Plant sterols occur naturally in
everyday foods
Plant sterols are found naturally in everyday foods like vegetable
oils, nuts, seeds, grain products, fruit and vegetables, however,
only in very small quantities. The average daily intake of plant
sterols from regular foods is about 0.3g per day. Western
populations consume 0.15-0.31g plant sterols per day.16,17,18
Diets that contain plant sterol-rich foods in abundance, such as
vegetarian diets, provide 0.6g plant sterols per day.19
The optimal intake of plant sterols for significant cholesterol
lowering is 2-2.5g/day. To reach this recommended intake, very
large quantities of regular foods would need to be consumed.
The quantity of regular foods required to provide
2g plant sterols 20,21,22
2g plant sterols =
150
apples*
83
oranges*
*where each individual item weighs 100g.
06
425
tomatoes*
70
slices of
wholemeal
bread*
210
carrots*
11
cups of
peanuts*
The optimum intake
of plant sterols is
2g/day
To achieve optimal results, and lower LDL-cholesterol by 10%
(on average), at least 2g of plant sterols per day is required. This
equates to 1 rounded tablespoon (25g) of Flora pro-activ per
day, the amount typically spread on 2-3 slices of bread. Plant
sterol spreads may also be melted over vegetables and used in
cooking and baking. Consuming more than 2.5g of plant sterols
provides little additional cholesterol lowering benefit.
Plant sterol-enriched foods start to lower cholesterol absorption
soon after consumption. If consumed regularly, the cholesterol
lowering benefit can be achieved in about 3 weeks13, 23. Longer
term studies have shown that this benefit can be sustained,
providing regular consumption continues24. If plant sterolenriched foods are not consumed, the cholesterol-lowering
effect is lost.
For optimum benefit, Flora pro-activ spreads should be
consumed as part of a healthy diet and lifestyle. It is
recommended that plant sterols are consumed every day for
continued cholesterol-lowering effects.
07
National and
International
Recommendations
Australia
New Zealand
The Heart Foundation of Australia produced a ‘Summary of
evidence. Dietary fats and dietary cholesterol for cardiovascular
health’ in 200925. Its key findings are based on the scientific
literature and include:
The New Zealand Cardiovascular Guidelines Handbook
recommends considering the addition of plant sterol or stanolfortified spreads for lipid modification.
•
•
•
•
Phytosterols lower LDL-cholesterol in people with
normocholesterolemia, hypercholesterolaema and diabetes.
For people with increased risk of CVD, consuming
phytosterol/stanol enriched foods provides an additional
option for risk reduction through lowering the level of
cholesterol.
A daily intake of approximately 2g of phytosterol/stanol
enriched margarine reduces LDL-C levels by approximately
10% but has little effect on HDL-cholesterol (HDL-C) or
triglycerides.
Phytosterol/stanol enriched foods have an additive effect in
lowering LDL-C when combined with statins.
International recommendations
Evidence-based dietary recommendations for the management
of cholesterol and the prevention of coronary heart disease
have now been developed by several international authorities.
Many of these now include plant sterols, including the
recommendations of the US National Cholesterol Education
Program Adult Treatment Panel III2, 3, the International
Atherosclerosis Society, American Heart Association, Dutch
Heart Foundation, Finnish Nutrition Association, Finnish
Medical Society and Spanish Atherosclerosis Society who have
all included plant sterols in their dietary recommendations for
cholesterol management.
The Heart Foundation concludes26 that people at high absolute
risk for coronary disease benefit from the cholesterol-lowering
effect of consuming 2-3g of plant sterols naturally occurring in
plant foods and food products enriched with plant sterols.*
* People using phytosterols should also choose at least one daily serve of fruit or vegetable high in beta-carotene (GOR A; 2007p)26
08
To improve cardiovascular health in all Australians the Heart Foundation makes
the following recommendations with respect to dietary fats and dietary sterols.26
All Australians:
1. Reduce their intake of saturated fatty acids (SFA) to < 7% of total energy intake and trans fatty
acids (tFA) to < 1% of total energy intake
2. Replace SFA with monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA)
as a strategy for reducing the intake of SFA
3. Consume 500 mg per day of combined docosahexaenoic acid (DHA) and eicosapentaenoic acid
(EPA) through a combination of the following: 2–3 serves (150 g per serve) of oily fish per week,
fish oil capsules or liquid and food and drinks enriched with marine n-3 PUFA*
4. Consume at least 2 g per day ALA by including foods, such as canola- or soybean-based oils and
margarine spreads, seeds (especially linseeds), nuts (particularly walnuts), legumes (including
soybeans), eggs and green leafy vegetables (GOR A; 2008f)
5. Consume 8–10% of total energy intake as n-6 PUFA
6. May consume up to six eggs per week within a cardio protective eating pattern (reduced SFA)
without increasing their risk of CVD
Those with high absolute risk of CVD, elevated LDL-C, familial
hypercholesterolaemia or type 2 diabetes
1. Consume 2–3 g of phytosterols per day from margarine, breakfast cereal, reduced fat yoghurt
or reduced fat milk enriched with phytosterols (approximately 2–3 serves per day of these
enriched foods). *People using phytosterols should also choose at least one daily serve of fruit
or vegetable high in beta-carotene.
2. Include phytosterol enriched foods in addition to statin therapy
3. Continue compliance with cholesterol-lowering medication
* women who are pregnant, women planning pregnancy and children should follow the advice from Food Standards Australia and New Zealand
on mercury in fish (2008f).
09
Plant Sterols Safety
As components of whole plant foods, plant sterols are natural
components of a normal diet. The safety of consuming high
intakes of plant sterols to lower cholesterol has been studied
extensively since the 1950s and reviewed by independent
experts and regulatory authorities internationally.
Despite the absence of any adverse effects in previously
published trials, before launching plant sterol-enriched Flora
pro-activ spread, Unilever conducted a thorough safety program
researching the effect of an increased consumption of plant
sterols 27,28,29. No significant adverse effects were seen in these
clinical trials, even with high intakes of plant sterols. Safety
tests of up to a 100-fold safety factor indicated a lack of toxicity
and no significant effects on gut flora, bile acids, oestrogen
metabolism, clinical chemistry, haematology or urinary analysis.
Clinical studies confirmed that very low levels of plant sterols
are absorbed and that serum plant sterol levels are only
modestly increased, remaining within the normal range obtained
with healthy diets (less than 1% of total sterol concentration)23.
Some studies show decreases of 10-20% in blood carotenoids
(alpha- and beta-carotene and lycopene)30. These reductions
are considered to be biologically insignificant and serum levels
remain well within the typical range of seasonal variation, which
is around 30%. This reduction in blood carotenoid levels can be
prevented by following dietary advice to consume an extra serve
of carotenoid-rich fruit or vegetables each day31 , such as carrots,
sweet potatoes, tomatoes or spinach.
The results of the above studies were an important part of the
dossier submitted for independent review by food regulators in
many countries. Plant sterol-enriched foods are approved for
sale in Australia, New Zealand, United States, European Union,
Japan, South Africa, Brazil, Israel, Iceland and Switzerland.
10
Eating plant sterol
enriched foods in
combination with
statins
Complementary cholesterol lowering
effects of plant sterols with statins33
Clinical evidence shows that eating plant sterol enriched foods
in combination with statins, can have a greater cholesterollowering effect than statins alone1.
Cumulative benefits
•
•
Statins reduce LDL-cholesterol levels by an average of 25%3.
•
Including a plant sterol-enriched spread can help lower
cholesterol by a further 10%.
Moving to a healthy diet and lifestyle can lower cholesterol
by 5%; and
This combination of statins, plant sterols and a healthy diet and
lifestyle can lead to a greater reduction in cholesterol levels.
Doubling a statin dose has been shown to achieve just a 6%
further reduction4.
% LDL-cholesterol lowering
A combination of statins, plant sterols, diet and lifestyle
changes can work together to help patients achieve targets for
cholesterol reduction2. They work in different ways and therefore
the effect is additive:
0
10
Statins
Statins
20
Diet and lifestyle
30
Plant Sterols
40
Flora pro-activ spread has been shown to be a useful adjunct
to statins and fibrates, offering additional cholesterol lowering
benefits 32. However, dietary approaches should not be a
substitute for lipid lowering medications and vice versa. If people
are taking statins and/or fibrates and consuming plant sterol
enriched foods as part of a heart healthy diet, the dosage of
medication may need to be adjusted.
11
Clinical Applications
Eating a diet where saturated fats are replaced with
polyunsaturated fats is an established way to lower
cholesterol. However, the cholesterol lowering benefits of
plant sterols is additional to that of a healthy diet. Plant sterol
enriched foods significantly lower cholesterol in:
Patients at moderate absolute risk of CHD
Plant sterol spread should be considered as part of
comprehensive dietary intervention for patients at moderate
coronary risk irrespective of their initial cholesterol levels.34
Although plant sterols lower LDL-cholesterol in individuals with
both moderate and elevated blood cholesterol levels, in absolute
terms the LDL-lowering effect will be more pronounced in
individuals with higher cholesterol levels.
People with type II diabetes and familial
hypercholesterolaemia (FH)
Individuals with type 2 diabetes are at increased risk of
developing CVD and most will benefit from cholesterol lowering.
Clinical studies have shown that plant sterol spreads lower
serum LDL-cholesterol in this group35. Children with family
history and their parents who participated in a free living
setting trial experienced 11% LDL-cholesterol lowering after
consuming plant sterols for 6 months24. Plant sterol spread may
be considered as an integral part of the dietary management of
people with type 2 diabetes and children and adults with family
history.
12
Pregnant or breast-feeding women and children
Plant sterol-enriched foods are generally not recommended for
pregnant or breastfeeding women or for normal children under
5 years of age as they have different nutritional needs.
Sitosterolaemia: a contraindication
Homozygous sitosterolaemia is a very rare condition (c. 1 in
6 million) characterised by excessive plant sterol absorption,
reduced excretion and elevated serum levels of plant sterols.
Individuals with homozygous sitosterolemia should avoid eating
all foods rich in plant sterols, including plant sterol spreads.
Plant sterol-enriched foods are safe for individuals heterozygous
for sitosterolaemia.36
Flora pro-activ
spreads
Flora pro-activ spread, the first plant sterol-enriched food
launched in Australia and New Zealand, was developed for
individuals who want to actively lower their LDL-cholesterol
levels through dietary changes. The Flora pro-activ range now
includes 5 variants with varying oil blends and total fat contents:
Flora pro-activ Original (64%), Flora pro-activ Buttery (65%),
Flora pro-activ Olive (48%), Flora pro-activ Light (40%) and
Flora pro-activ Ultralight (22.7%). All variants of Flora pro-activ
contain the same amount of plant sterols per gram of spread.
Flora pro-activ range
Why a spread?
Enriching a spread with plant sterols helps your patients to ‘kill
two birds with one stone’ i.e. to get the cholesterol-lowering
benefit of plant sterols and an improved ratio of dietary
unsaturated to saturated fatty acids. The type of dietary fat
is a key determinant of serum cholesterol levels, contrary to
the common misconception that the best dietary means of
lowering cholesterol is to eat a diet low in fat. The advantage of
incorporating a plant sterol-enriched spread into a cholesterollowering diet was well demonstrated in a trial conducted at the
University of Otago in Dunedin, New Zealand37. The serum
LDL-cholesterol of subjects on a low saturated fat diet including
a plant sterol spread was 8% lower than when they were on a
low fat diet. Vegetable oil-based spreads are also major sources
of the essential fatty acids, vitamin D and vitamin E.38
What about weight control?
25g of Flora pro-activ Original – the full-fat variant – can easily
be incorporated in a reduced-energy, weight-reducing diet.
However, if for any reason a lower fat intake is required one of
the lower fat variants of Flora pro-activ may be considered.
Flora pro-activ Ultralight has 38% of the kilojoules of
Flora pro-activ Original.
13
References:
1. World Health Organisation (WHO). Diet, nutrition and the prevention of chronic
diseases. Report of a joint WHO/FAO Expert Consultation. WHO Technical Report Series
916. Geneva, 2003.
2. National Cholesterol Education Program. Executive summary of the third report of the
National Cholesterol Education Program (NCEP) expert panel on detection, evaluation
and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA
2001; 285: 2486-2497.
3. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak
RC, Smith SC Jr, Stone NJ; for the Coordinating Committee of the National Cholesterol
Education Program. Implication of recent clinical trials for the National Cholesterol
Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227239.
4. Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol:
quantitative meta-analysis of metabolic ward studies. BMJ 1997; 314(7074): 112-117.
5. The New Zealand guidelines group, the national heart foundation of New Zealand
and the stroke foundation of New Zealand. The assessment and management of
cardiovascular risk. Evidence-based best practice guideline. New Zealand guidelines
Group. December 2003.
6. Australian Bureau of Statistics 3303.0 - Causes of Death, Australia, 2010
7. Huxley R, Clifton P, Perkovic V, 7.Woodward M, Neal B. How many Australian deaths
from heart disease and stroke could be avoided by a small reduction in population
cholesterol levels? Nutr Diet 2009; 66: 158–63.
8. Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R; Stresa Workshop
Participants. Efficacy and safety of plant stanols and sterols in the management of
blood cholesterol levels. Mayo Clin Proc 2003 Aug; 78(8): 965-978. Review.
13. Hendriks HF, Weststrate JA, Van Vliet T, Meijer GW. Spreads enriched with three
different levels of vegetable oil sterols and the degree of cholesterol lowering in
normocholesterolaemic and mildly hypercholesterolaemic subjects. Eur J Clin Nutr
1999;53:319-327.
14. Trautwein EA, Duchateau GSMJE, Lin YG, Mel’nikov SM, Molhuizen HOF, Ntanios FY.
Proposed mechanisms of cholesterol-lowering action of plant sterols. Eur J Lipid Sci
Tech 2003; 105: 171-185.
15. Tikkanen MJ, Hogstrom P, Tuomilehto J et al. Effect of a diet based on low-fat foods
enriched with nonesterified plant sterols and mineral nutrients on serum cholesterol.
Am J Cardiol 2001; 88:1157-1162.
16. Normen AL, Brants HA, Voorrips LE, Andersson HA, van den Brandt PA, Goldbohm RA.
Plant sterol intakes and colorectal cancer risk in the Netherlands Cohort Study on Diet
and Cancer. Am J Clin Nutr 2001;74(1):141-148.
17. Andersson SW, Skinner J, Ellegard L, Welch AA, Bingham S, Mulligan A, Andersson
H, Khaw KT. Intake of dietary plant sterols is inversely related to serum cholesterol
concentration in men and women in the EPIC Norfolk population: a cross-sectional
study. Eur J Clin Nutr 2004;58(10):1378-1385.
18. Valsa LM, Lemstrom A, Ovaskainen ML, Lampi AM, Toivo J, Korhonen T, Piironen V.
Estimation of plant sterol and cholesterol intake in Finland: quality of new values and
their effect on intake. Br J Nutr 2004;92(4):671-678(8).
19. Vuoristo M, Miettinen TA. Absorption, metabolism, and serum concentrations
of cholesterol in vegetarians: effects of cholesterol feeding. Am J Clin Nutr
1994;59(6):1325-1331.
20. Normen L, Johnsson M, Andersson H, van Gameran Y, Dutta P. Plant sterols in
vegetables and fruits commonly consumed in Sweden. Eur J Nutr 1999;38:84-89.
9. Jenkins DJA, Kendall CWC, Axelson M, Augustin LSA, Vuksan V. Viscous and nonviscous
fibres, nonabsorbable and low glycaemic index carbohydrates, blood lipids and
coronary heart disease. Curr Opin Lipidol 2000;11:49-56.
21. Normen L, Bryngelsson S, Johnsson M, Evheden P et al. They phytosterol content of
some cereal foods commonly consumed in Sweden and in the Netherlands. J Food
Comp Analysis 2002;15(6):693-704.
10. Mensink RP, Zock PL, Kester ADM, Katan B. Effects of dietary fatty acids and
carbohydrates on the ratio of serum total to HDL-cholesterol and on serum lipids and
apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr 2003;77: 114655.
22. Weihrauch JL, Gardner JM. Sterol content of foods of plant origin. J Am Diet Assoc
1978;73(1):39-47.
11. Weggemans RM, Trautwein EA. Relation between soy-associated isoflavones and LDL
and HDL cholesterol concentrations in humans: a meta-analysis. Eur J Clin Nutr 2003;
57: 940–6.
12. Law M. Plant sterol and stanol margarines and health. BMJ 2000;320:861-864.
14
23. Weststrate JA, Meijer GW. Plant sterol-enriched margarines and reductions in plasma
total-and LDL-cholesterol concentrations in normocholesterolaemic and mildly
hypercholesterolaemic subjects. Eur J Clin Nutr 1998;52:334-343.
24. Amundsen Å &, Ntanios F, Put N V.d, Ose L. Long-term compliance and changes in
plasma lipids, plant sterols and carotenoids in children and parents with FH consuming
plant sterol ester-enriched spread. Eur J Clin Nutr 2004; 58(12): 1612-1620.
25. Summary of evidence. National Heart Foundation of Australia. Dietary fats and dietary
cholesterol for cardiovascular health, 2009.
26. National Heart foundation of Australia. Position statement. Dietary fats and dietary
sterols for cardiovascular health, 2009.
27. Weststrate JA, Ayesh R, Bauer-Plank C, Drewitt PN. Safety evaluation of phytosterol
esters. Part 4. Faecal concentrations of bile acids and neutral sterols in healthy
normolipidaemic volunteers consuming a controlled diet either with or a phytosterol
esterenriched margarine. Food Chem Toxicol 1999; 37: without 1063–1071.
28. Ayesh R, Weststrate JA, Drewitt PN, Hepburn PA. Safety evaluation of phytosterol
esters. Part 5. Faecal short-chain fatty acid and microflora content, faecal bacterial
enzyme activity and serum female sex hormones in healthy normolipidaemic
volunteers consuming a controlled diet either with or without a phytosterol esterenriched margarine. Food Chem Toxicol 1999; 37: 1127–1138.
36. Stalenhoef AFH, Hectors M, Demacker PNM. Effect of plant sterol-enriched margarine
on plasma lipids and sterols in subjects heterozygous for phytosterolaemia. J Intern
Med 2001; 249:163–166.
37. Skeaff CM, Thoma C, Mann J, Chisholm A,Williams S, Richmond K. Isocaloric
substitution of plant sterol-enriched fat spread for carbohydrate-rich foods in a low-fat,
fibre-rich diet decreases plasma low-density lipoprotein cholesterol and increases high
density lipoprotein concentrations. Nutr Metab Cardiovasc Dis 2005; 15: 337–344.
38. Shrapnel B, Baghurst K. Adequacy of essential fatty acid, vitamin D and vitamin E
intake: implications for the ‘core’ and ‘extras’ food group concept of the Australian
Guide to Healthy Eating. Nutr Diet 2007; 64: 78
29. Lea LJ and Hepburn PA. Safety evaluation of phytosterol-esters. Part 9: Results
of a European post-launch monitoring programme. Food Chem Toxicol 2006; 44:
1213–1222.
30. Judd JT, Baer DJ, Chen SC, Clevidence BA, Muesing RA, Kramer M, Meijer GW. Plant
sterol esters lower plasma lipids and most carotenoids in mildly hypercholesterolemic
adults. Lipids 2002; 37: 33–42.
31. Noakes M, Clifton P, Ntanios F, Shrapnel W, Record I,McInerney J. An increase in dietary
carotenoids when consuming plant sterols or stanols is effective in maintaining plasma
carotenoid concentrations. Am J Clin Nutr 2002; 75: 79–86.
32. Simons LA. Additive effect of plant sterol-ester margarine and cerivastatin in lowering
low-density lipoprotein cholesterol in primary hypercholesterolemia. Am J Cardiol
2002; 90:737-740.
33. Scholle JM, Baker WL, Talati R, Coleman CI. The effect of adding plant sterols or stanols
to statin therapy in hypercholesterolemic patients: systematic review and metaanalysis. J Am Coll Nutr 2009; 28(5): 517-524.
34. Clifton P, Shrapnel B, Colquhoun D, Hewat C, Jones P, Litt J, Noakes M, O’Brien R, Skeaff
M. Comprehensive dietary intervention to lower serum cholesterol: a report from an
expert roundtable. Aust Fam Physician 2009 (accepted for publication).
35. Lee YM, Haastert B, Scherbaum W, Hauner H. A phytosterol-enriched spread improves
the lipid profile of subjects with type 2 diabetes mellitus - a randomized controlled trial
under free-living conditions. Eur J Nutr 2003; 42(2): 111-117.
15
Summary
Facts about Flora pro-activ spreads
16
•
Flora pro-activ spreads are everyday foods enriched with
plant sterols.
•
Plant sterols lower serum total and LDL-cholesterol by
partially blocking cholesterol absorption from the gut.
•
Daily use of Flora pro-activ lowers LDL-cholesterol by about
10%, based on the findings of over 30 clinical trials.
•
25g of Flora pro-activ spread should be included in a heart
healthy diet each day. This will ensure plant sterol intake
falls in the optimal intake range of 2 - 2.5g per day.
•
The efficacy of plant sterol-enriched spreads is recognised
by international and national health authorities including
the National Heart Foundation of Australia and the Heart
Foundation of New Zealand.
•
Plant sterol-enriched spreads are safe, though they are not
generally recommended for pregnant and breastfeeding
women, and children under 5 years of age.
17