Original paper

Double-blind randomized placebo controlled trial demonstrating serum cholesterol lowering efficacy of a smoothie drink with added plant stanol esters in an Indonesian population

  • A clinical study has demonstrated that a smoothie drink with 1 gram of added plant stanols, taken twice daily after meals, lowers blood total and low- density lipoprotein cholesterol (LDL-C) in Indonesian adults with raised cholesterol.
  • The effect was seen within two weeks of taking the plant stanols and was maintained over the four-week study period.
  • This study is important because it expands the evidence for the LDL-C lowering benefit of plant stanols to an Indonesian population with different dietary patterns.
  • The study also demonstrates the usefulness of adding plant stanols into a smoothie drink.

The prevalence of cardiovascular disease (CVD) in the Indonesian population is rising1 and accounts for 37% of all deaths in Indonesia 2. The major risk factors for CVD in Indonesia are similar to that of the rest of the world; elevated blood pressure, elevated blood cholesterol and cigarette smoking1.  Finding practical ways to help reduce overall CVD risk is important especially through primary prevention with diet and lifestyle3.

This randomised, double blind, placebo controlled, parallel design, trial tested the effects of dietary advice and twice daily consumption of a plant stanol ester enriched smoothie drink on the blood lipid profiles of 99 Indonesian adults with hypercholesterolemia. Study participants were divided into two groups with fifty receiving a control smoothie drink and the remaining 49 receiving the plant stanol ester-enriched smoothie drink (2 g plant stanols per day); all received also dietary advice. A serving (100 ml) of the smoothie drink was consumed immediately after the main morning and evening meal each day. Clinical, anthropometric, and biochemical variables including blood lipids were measured at baseline, 2 weeks and 4 weeks.  The dietary advice delivered by two trained dieticians was based upon Indonesian Heart Foundation recommendations.

Compared with the control group, the group consuming the smoothie drink  with added plant stanols reduced their serum LDL-C concentration by 7.6%(p<0.05) and 9.0% (p<0.05) over two and four weeks, respectively.

In comparison with the habitual baseline diet, LDL-cholesterol was reduced by 9.3% (p<0.05) and 9.8% (p<0.05) at two and four weeks respectively in the active arm of the study.

Adverse events were generally mild gastrointestinal effects and no difference was detected between the two groups.

This is the first study to demonstrate the efficacy of plant stanols in lowering LDL-C for the Indonesian population. The reported effect is similar to that already demonstrated in other populations. The study also demonstrates that plant stanols are effective in a non-fermented smoothie drink. It adds to the growing wealth of evidence supporting the use of plant stanols and sterols in reducing LDL-C, a key modifiable risk factor for CVD.