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Phytosterols (PS, comprising plant sterols and plant stanols) have been proven to lower LDL-cholesterol concentrations. The dose–response relationship for this effect has been evaluated in several meta-analyses by calculating averages for different dose ranges or by applying continuous dose–response functions. Both approaches have advantages and disadvantages. So far, the calculation of averages for different dose ranges has not been done for plant sterols and stanols separately. The objective of the present meta-analysis was to investigate the combined and separate effects of plant sterols and stanols when classified into different dose ranges. Studies were searched and selected based on predefined criteria. Relevant data were extracted. Average LDL-cholesterol effects were calculated when studies were categorised by dose, according to random-effects models while using the variance as weighing factor. This was done for plant sterols and stanols combined and separately. In total, 124 studies (201 strata) were included. Plant sterols and stanols were administered in 129 and fifty-nine strata, respectively; the remaining used a mix of both. The average PS dose was 2·1 (range 0·2–9·0) g/d. PS intakes of 0·6–3·3 g/d were found to gradually reduce LDL-cholesterol concentrations by, on average, 6–12 %. When plant sterols and stanols were analysed separately, clear and comparable dose–response relationships were observed. Studies carried out with PS doses exceeding 4 g/d were not pooled, as these were scarce and scattered across a wide range of doses. In conclusion, the LDL-cholesterol-lowering effect of both plant sterols and stanols continues to increase up to intakes of approximately 3 g/d to an average effect of 12 %.

Background The primary aim of this study was to assess whether exposure during fetal life to extra vitamin D from food fortification was associated with a reduction in the risk of subsequently developing gestational diabetes mellitus (GDM). Furthermore, we examined whether the effect of the vitamin D from fortification differed by women’s season of birth. Methods This semi-ecological study is based on the cancellation in 1985 of the mandatory policy to fortify margarine with vitamin D in Denmark, with inclusion of entire national adjacent birth cohorts either exposed or unexposed to extra vitamin D in utero. The identification of GDM cases later in life among both exposure groups was based on the Danish national health registers. Logistic regression analyses generating odds ratios (ORs) and 95% confidence intervals (95% CIs) were performed. Results Women who were prenatally exposed to the extra vitamin D from fortification tended to have a lower risk of subsequently developing GDM than unexposed women (OR 0.87, 95%CI 0.74,1.02, P  = 0.08). When analyses were stratified by women’s season of birth, exposed women born in spring had a lower risk of developing GDM compared to unexposed subjects (OR 0.68, 95%CI 0.50,0.94, p  = 0.02). Conclusion This study suggests that prenatal exposure to extra vitamin D from mandatory fortification may lower the risk of developing gestational diabetes among spring-born women. Trial registration This study is part of the D-tect project, which is registered on clinicaltrials.gov: NCT03330301 .

OBJECTIVES:Despite mandatory fortification of milk and margarine, most Canadians have inadequate vitamin D intake and consequently poor vitamin D status, especially in the winter. Increasing vitamin D fortification is one possible strategy to address this inadequacy. The purpose of our study was to examine the modelled effect of increased vitamin D fortification on the prevalence of inadequacy and the percentage of intakes greater than the Tolerable Upper Intake Level (UL) using different fortification scenarios. METHODS:Dietary intakes (24-h recall) from the 2004 Canadian Community Health Survey 2.2 (n=34,381) were used to model increased vitamin D levels in milk and the addition of vitamin D to cheese and yogurt at various levels to meet label claims of an “excellent source” based on the recommended dietary intakes. The Software for Intake Distribution Evaluation was used to estimate the prevalence of inadequacy and intakes >UL. RESULTS:Fortification of milk, yogurt and cheese at 6.75 μg (270 IU)/serving led to more than doubling of vitamin D intakes across all sex/age groups and a drop in the prevalence of dietary inadequacy from >80% to <50% in all groups. Furthermore, no intakes approached the UL under any fortification scenario in any sex/age group. CONCLUSION:There is a pressing need to improve vitamin D status among Canadians. Increasing vitamin D fortification of dairy products, consistent with their positioning in Canada's Food Guide, can lead to increased intake without a risk of excess. This is a population-wide public health strategy that should be given consideration in Canada.

Objective The growing interest in maintaining good health status through optimal nutrition has boosted the launch of a number of functional foods on the market. The objective of the present study was to theoretically evaluate the nutritional relevance of incorporating selected enriched foods in the diet. Design A 28 d dietary plan, designed to be balanced under the recommended macronutrients criteria, was used as a basal diet. Some conventional foods were exchanged with foods enriched in fibre, calcium, iodine, vitamins A, D, E or n-3 fatty acids. Setting Nutritional composition of basal and modified diets was derived and compared to the Spanish recommended intakes (RI). Results The basal diet covered the recommendations for fibre and calcium with mean intake of 28 g and 1241 mg, respectively. The current intake of salt, if iodized, or bread elaborated with this salt, allowed reaching the daily intake of iodine every day, with a mean supply of 216 μg/d and 278 μg/d, respectively. The deficient supply of vitamin E in the basal diet (mean = 8 mg/d) was covered by including enriched margarine and dairy products (mean = 15 mg/d). The low n-3 fatty acids intake in the basal diet (1·1 g/d) increased up to 1·9 g/d after the use of enriched margarine, butter and biscuits and soya drink instead of milk. Conclusions In order to improve the accomplishment of the RI iodine, vitamin E and n-3 fatty acids, interesting strategies dealing with the incorporation of enriched foods in the diet were successfully initiated.

Qualitative and quantitative methods for the analysis of intact phytosteryl/phytostanyl esters in enriched dairy products with substantial amounts of protein and fat were established. Lipids were extracted after acid digestion in order to achieve a complete extraction of the esters. The extracted lipids were separated via liquid chromatography on a normal phase, and the fraction containing the phytosteryl/phytostanyl esters was subsequently transferred on-line and analyzed by means of capillary gas chromatography. The applicability of the method was demonstrated for the analysis of intact phytosteryl/phytostanyl fatty acid esters in enriched yogurt, cheese-based spread, and milk. The approach enables the determination of individual phytosteryl/phytostanyl esters as well as of their total contents and provides detailed information on the distributions of esterified phytosterols/phytostanols and fatty acids. The employed approach complements the existing GC-based methods for the analysis of phytosteryl/phytostanyl esters in low-fat and fat-based products and thus creates a base for authenticity assessments of these types of novel foods.

The present study describes the consumption of foods enriched with plant sterols (PS) and supplements containing PS, and evaluates PS intakes via the current consumption and for specific consumption scenarios. A market inventory was performed to collate different PS-enriched food items and supplements available in Belgium. An FFQ was developed to investigate the consumption of PS-enriched foods and supplements. A total of 139 pre-school children (2·5–7 years old) and 569 adults (308 women and 261 men) living in Flanders (the northern, Dutch-speaking part of Belgium) participated in the study. Of these, 21 % (Flemish pre-school children) and 28·5 % (Flemish adults) consume PS-enriched food products, leading to a mean PS intake in the consumer group of 0·70 (sd 0·61) g/d for pre-school children and 1·51 (sd 1·42) g/d for adults. Of the adult PS consumers, 23·2 % did not suffer from elevated blood cholesterol levels; 50 % of them had a PS intake less than or equal to 1 g/d and 16·4 % had a PS intake above 3 g/d and 7·8 % even had an intake above 4 g/d. Scenario studies assessed the intake when all Belgian adults would consume PS-enriched margarines without (scenario 1) or with (scenario 2) a daily consumption of a PS-enriched yoghurt drink. This resulted in an intake above 3 g/d in 17 % (women) and 29 % (men) for scenario 1 and 40 % (women) and 53 % (men) for scenario 2. The results indicate that PS-enriched food products are also consumed by the non-target group. Efficient communication tools are needed to inform consumers better about the target group of PS-enriched products, the advised dose per day and alternative dietary strategies to lower the blood cholesterol level.

Objective: To assess the impact of national fortification of fluid milks and margarines with vitamin D on dietary intake and on serum 25-hydroxyvitamin D concentration in Finnish 4-year-old children. Design, subjects and methods: Two cohorts of children were studied during wintertime, one before (n=82) in 2001-2002 and the other after (n=36) the initiation of fortification in 2003-2004. Dietary intake was estimated by 4-day food records and serum 25-hydroxyvitamin D concentration was analyzed by radioimmunoassay. Results: The mean intake of vitamin D was higher the after initiation of fortification (mean (95% confidence interval (CI)); 4.5 (3.8-5.1) micrograms) than before it (2.1 (95% CI 1.8-2.3) micrograms; P<0.001), although there were no differences in consumption of the main food sources of vitamin D between the two cohorts. The difference between the cohorts was also evident when the intake of vitamin D was adjusted for energy intake (0.78 (95% CI 0.70-0.90) and 0.37 (95% CI 0.32-0.42) micrograms/MJ after and before fortification, respectively, P<0.001). After fortification, the mean intake approached that recommended, but was achieved by only 30.6% of the children. Equally, the serum 25-hydroxyvitamin D concentration was higher after fortification (64.9 (95% CI 59.7-70.1) nmol/l) compared to prior it (54.7 (95% CI 51.0-58.4) nmol/l; P=0.002). Conclusions: The results indicate that the national fortification of fluid milks and margarines with vitamin D safely improved the vitamin D status of children. This approach, in view of the novel health effects beyond bone metabolism, encourages fortification of new food sources with vitamin D or use of vitamin D supplements particularly during wintertime.

Observational epidemiological studies have shown that low carotenoid intake and/or low carotenoid blood levels increase the risk of degenerative diseases like age-related macular degeneration. Functional foods enriched with plant sterol or stanol esters may lower serum concentrations of fat-soluble carotenoids. Theoretically, as a result the macular pigment optical density (MPOD), a marker for eye health, may change. We carried out a double-blind placebo-controlled human intervention trial with a duration of 18 months to evaluate the possible effects of plant stanol and sterol esters on serum lutein/zeaxanthin concentration in relation to the MPOD. Forty-seven subjects were randomly assigned to one of the three treatment groups: margarine without added plant sterols or stanols, plant sterol-enriched margarine, or plant stanol-enriched margarine. Serum cholesterol and lutein/zeaxanthine concentrations and the MPOD were evaluated at baseline and at study end. Changes in lipid-adjusted serum lutein/zeaxanthine concentrations between baseline and study end differed significantly between the three groups (P = 0·001). We found no differences in the MPOD between the three treatment groups, despite the differences in both absolute and cholesterol-standardized serum lutein/zeaxanthine concentrations. This shows that the observed reduction in serum carotenoid concentrations during 18 months consumption of these functional foods does not affect MPOD.

A blood cholesterol-lowering margarine containing plant sterolesters was the first functional food placed on the European food market pursuant to the regulation (EC) 258/97. In the following years nine further applicants submitted the request to add plant sterol compounds to dairy products, cheeses, bakery products, sausages, plant oils and other products. The European Scientific Committee on Food (SCF) declared a precautionary intake limit of 3 g plant sterols per d by multiple dietary sources. Using the consumption data of the German National Food Consumption Study, carried out from 1985 to 1988 with 23 209 participants, we hypothetically added 0·3–2 g plant sterols to usual daily servings of ten different food products, selected from the novel food applications. We calculated the prospective plant sterol intake regarding each kind of enriched food and by stepwise accumulation of different functional foods in three enrichment scenarios. Within our enrichment context we find a phytosterol intake satiation, if multiple plant sterol-enriched foods are eaten. An enrichment amount of 2 g plant sterols per proposed food serving size results in an intake maximum of 13 g/d.

Phytosterol-enriched margarines are known to significantly lower total and LDL cholesterol, but little is known about the effect of such margarines in subjects with type 2 diabetes. Investigation of the effect of a phytosterol-enriched spread in subjects with type 2 diabetes mellitus on serum lipids, Hb(A1c), and blood glucose under free-living conditions. Randomized, placebo-controlled, double-blind clinical trial in two parallel groups over 12 weeks; 85 type 2 diabetic patients with serum LDL cholesterol levels >/= 3.60 mmol/l and without hypolipidemic medication were included in the study. Participants consumed 2 x 10 g of spread with or without 8 % phytosterol-esters daily. Fasting blood samples were analyzed at 0, 4, 8, and 12 weeks. After 4 weeks, total and LDL cholesterol were significantly reduced in the phytosterol group by 5.2 % and 6.8 %, respectively, compared to baseline (p < 0.05). After 8 and 12 weeks, these reductions became smaller and were not significant any more compared to baseline or between the groups, but a repeated measurement analysis demonstrated a significant difference for both variables between the two groups (each p < 0.05). HDL cholesterol was significantly increased in the phytosterol group compared to the placebo group after 8 and 12 weeks, but there was no overall difference in the repeated measurement analysis between the two groups. In the phytosterol group, there was a small reduction in Hb(A1c) compared to the control group which was only significant after 4 weeks. This clinical study shows that a phytosterol-enriched spread is effective in lowering total and LDL cholesterol in subjects with type 2 diabetes but also illustrates the difficult maintenance under free-living conditions over time. Although this effect is modest, it may contribute to decreasing the elevated risk of cardiovascular disease in type 2 diabetes.