Effect of phytosterols in the treatment of hypercholesterolemia in adults – systematic review with meta-analysis / Efeitos dos fitoesteróis no tratamento da hipercolesterolemia em adultos – revisão sistemática com metanálise

 Increased plasma total cholesterol (TC) and LDL-cholesterol (low-density lipoprotein) are considered risk factors for coronary disease. Phytosterols are among the dietary options for decreasing serum concentrations of TC and LDL-c by up to 15%.To evaluate the scientific evidence on the use of phytosterols in the treatment of hypercholesterolemia in adults.A systematic meta-analysis of the Medline, Embase, Web of Service, VHL, PUBMED, Scopus, Cochrane Library and LILACS databases was performed between November and December 2016. The PICO strategy was used. Inclusion criteria were randomized clinical trials with adults of both sexes using phytosterols longer than 4 weeks intervention. Exclusion criteria were animal and in vitro studies, humans less than 18 years old and individuals with other diseases (cancer, metabolic syndromes, diabetes mellitus, hypertension, renal disease, liver diseases). The risk of bias was assessed by two reviewers. The primary outcomes investigated were TC and LDL-cholesterol. Statistical analyses were conducted using the RevMan 5.3. The standardized effect size was used to estimate the standardized mean difference and 95% CI of TC and LDL-c.Twenty-seven randomized controlled trials were included in this systematic review and 26 studies in the meta-analysis of TC and LDL-cholesterol. The meta-analyzes showed an association with the reduction in plasma TC (-2.54 [-3.04; -2.03]) and LDL-c (-2.8 [-2.63; -1.53]) after intervention with the vegetable esters.The consumption of 1.5 to 2.0 g/day of phytosterols promotes reduction of TC and LDL-c in hypercholesterolemic individuals, regardless of the way they are consumed.