ORIGINAL ARTICLE Effects of low-fat hard cheese enriched with plant stanol esters on serum lipids and apolipoprotein B in mildly hypercholesterolaemic subjects T Jauhiainen 1,2 , P Salo 3 , L Niittynen 4 , T Poussa 5 and R Korpela 1,2,6 1 Valio Ltd, Helsinki, Finland; 2 Institute of Biomedicine, University of Helsinki, Helsinki, Finland; 3 Raisio Research and Development, Raisio plc, Finland; 4 Nutritionist Leena Niittynen, Vihti, Finland; 5 Stat-Consulting, Tampere, Finland and 6 Foundation for Nutrition Research, Helsinki, Finland Objective: To investigate the cholesterol-lowering effects of a low-fat cheese enriched with plant stanol esters in mildly hypercholesterolaemic subjects, as part of their normal diet. Design: A randomized double-blind parallel-group study. Setting: Valio Ltd, Helsinki. Subjects: Sixty-seven mildly hypercholesterolaemic volunteers (24 men, 43 women) participated in the study, which all of them completed. Interventions: The subjects were randomly assigned to the plant stanol ester group or the control group. During the 5-week intervention, the subjects in the stanol group consumed a cheese enriched with 2 g of plant stanols per day, and the subjects in the control group, a control cheese with no plant stanols. Results: In the stanol ester group, as compared to the control group, both serum total and low-density lipoprotein (LDL) cholesterol decreased significantly, that is, by 5.8% (0.32 mmol/l, 95% CI 0.50 to 0.15 mmol/l, Po0.001) and 10.3% (0.36 mmol/l, 95% CI 0.53 to 0.18 mmol/l, Po0.001), respectively. There were no significant changes in high-density lipoprotein cholesterol (HDL), triglycerides or apolipoprotein B concentrations between the groups. Conclusion: Cheese enriched with 2 g of plant stanol in the form of fatty acid esters decreases serum total and LDL cholesterol significantly. European Journal of Clinical Nutrition (2006) 60, 1253–1257. doi:10.1038/sj.ejcn.1602445; published online 24 May 2006 Keywords: plant stanols; hypercholesterolaemia; serum cholesterol; apolipoprotein B; cheese Introduction Hypercholesterolaemia is one of the major risk factors for coronary heart disease (Stamler et al., 1999, 2000), and considerable efforts have focused on different methods of lowering elevated serum cholesterol levels. Various drugs are used for patients with severe hypercholesterolaemia, whereas for those with mild or moderate hypercholesterolaemia, dietary therapy is used to lower serum cholesterol levels. Non-pharmacological treatment is also considered to be an important alternative for patients with mild or moderate hypercholesterolaemia. One interesting alternative among non-pharmacological treatments is the use of plant sterols. Plant sterols are a group of compounds very similar in structure to cholesterol (Ikeda et al., 1989). The most common plant sterols are b-sitosterol, campesterol and stigmasterol (Pollak, 1985). The saturation of the double bonds of plant sterols results in the formation of plant stanols. Plant stanols reduce the absorption of both dietary and biliary cholesterol by displacing cholesterol from the micellar phase (Ikeda et al., 1989). When the absorption of cholesterol decreases, the synthesis of cholesterol in the Received 7 July 2005; revised 16 January 2006; accepted 2 March 2006; published online 24 May 2006 Correspondence: Dr R Korpela, Foundation for Nutrition Research, PO Box 30, FIN-00039 Helsinki, Finland. E-mail: Riitta.Korpela@Valio.fi Guarantor: R Korpela. Contributors: TJ conducted the study and was responsible for the study design, to which PS also contributed. TJ, PS, LN and TP all contributed to the interpretation of the data. TJ and LN were responsible for the actual writing of the manuscript, and TP was responsible for the statistical analyses. RK is the leader of the group and acted as adviser throughout the work. European Journal of Clinical Nutrition (2006) 60, 1253–1257 & 2006 Nature Publishing Group All rights reserved 0954-3007/06 $30.00 www.nature.com/ejcn