Update on the ANSES (French agency for food, environmental and occupational health & safety) recommendations

Recently, ANSES gave a prudent advice concerning consumption of plant sterols/stanols in order to lower cardiovascular risk. In particular, two of the main reasons for this advice were the inter-individual variability in the response to diet supplemented with these products on one side, and a relationship between plasma levels of plant sterols and cardiovascular risk on the other side. These two points are discussed in the present review. There is a large inter-individual variability in the response to plant sterols/stanols consumption, with a lack of response (LDLC lowering) in 20-42% of the subjects. In some of the non-responders, plasma LDLC were found to be increased. LDLC decrease is correlated with initial LDLC concentration. The response is positively correlated with cholesterol absorption and inversely with synthesis rate. The genetic influence on response remains to demonstrate since most of the studies on this matter were statistically underpowered. Concerning relationship between phytosterolemia and cardiovascular risk, many discrepant results have been published. A recent meta-analysis has shown a lack of association, but there was significant heterogeneity between studies, which precludes from firm conclusions. In genome wide association studies, variants associated with higher plasma plant sterol levels were also associated with higher cardiovascular risk. Phytosterolemia is correlated with cholesterol absorption. Absorption might be the causative factor of the relationship between plasma plant sterols and cardiovascular risk, but a direct deleterious effect of the phytosterols cannot be excluded. The ANSES considered that clinical studies are needed before conclusions on the cardiovascular impact of plant sterols/stanols consumption can be drawn.