European Journal of Clinical Nutrition

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é??ç¸?uropean Journal of Clinical Nutrition

Correspondence: L Elleg Department of Clinical Nutrition, University of G Sahlgrenska University Hospital, S413 45 G Sweden.Subjects: A total of nine volunteers with conventional ileostomies.Interventions: Two 3day diet periods; controlled diet including 75 g of rapeseed oil or olive oil.Main outcome measures: Cholesterol absorption, ileal excretion of cholesterol, and bile acids. Serum levels of cholesterol and bile acid metabolites. Differences between diets evaluated with Wilcoxon's signed rank sum test.Results: Rapeseed oil diet contained 326 mg more plant sterols than the olive oil diet. Rapeseed oil tended to decrease cholesterol absorption by 11% (P=0.050), and increased excretion of cholesterol, woolrich outlet bile acids, and their sum as sterols by 9% (P=0.021), 32% (P=0.03, and 51% (P=0.011) compared to olive oil. A serum marker for bile acid synthesis (7hydroxy4cholesten3one) increased by 28% (P=0.03 within 10 h of consumption, and serum cholesterol levels decreased by 7% (P=0.024), whereas a serum marker for cholesterol synthesis (lathosterol) as well as serum levels of plant sterols remained unchanged.Conclusions: Rapeseed oil and olive oil have different effects on cholesterol metabolism. Rapeseed oil, tends to decrease cholesterol absorption, increases excretion of cholesterol and bile acids, increases serum marker of bile acid synthesis, and decreases serum levels of cholesterol compared to olive oil. This could in part be explained by different concentrations of natural plant sterols. Sterol balance studies have been performed to evaluate the dietary effects on sterol excretion (Connor et al, 1969; Grundy Ahrens, 1969; Nestel et al, 1975). These metabolic ward investigations were elaborate, but due to bacterial degradation and varying transit time, precision was insufficient to settle the question of dietary effects on sterol excretion (Andersson Bosaeus, 1993).We have readressed the question of <a href="http://www.biennalecarrara.it/spacciowoolrichbologna/">woolrich outlet milano</a> dietary effects on sterol excretion by studying ileostomy subjects without resection of the small intestine (Sandberg et al, 1981). In ileostomy subjects, transit time is both shorter and less variable, and with far less bacterial degradation than in normal subjects (Sandberg et al, 1981). Thus, even short time studies in ileostomy subjects are feasible, to examine dietary effects on cholesterol metabolism. (Andersson Bosaeus, 1993). With this approach, diets with the potential to reduce serum cholesterol levels have been shown to increase sterol excretion from the small bowel, either as bile acids or as cholesterol, within 2 days, in carefully controlled dietary studies. This has been shown with diets low in giuseppe zanotti sale fat, or high in polyunsaturated fat (Bosaeus Andersson, 1987), high in monounsaturated fat (Bosaeus et al, 1992), pectin (Bosaeus et al, 1986), and with oatbran (Lia et al, 1995). Reducing cholesterol intake increases net cholesterol excretion <a href="http://www.biennalecarrara.it/replica+borse/">replica borse gucci italia</a> as woolrich outlet milano shown previously (Elleg Bosaeus, 1994). We have also reported increased cholesterol excretion from a 'prudent' diet, that is, a diet in accordance with contemporary dietary <a href="http://www.photo2video.co.uk/giuseppezanottisneakers/">giuseppe zanotti sale</a> guidelines of less saturated fat and more fibrerich foods (Elleg Bosaeus, 1991). The combination of both modifications reduces cholesterol absorption, and increases cholesterol and sterol excretion from the small intestine (Ellegard et al, 2000b). The decrease in cholesterol absorption was correlated to plant sterol excretion, implying dietary plant sterol content to be an important determinant of cholesterol metabolism, together with cholesterol itself (Ellegard et al, 2000b). Thus, we speculated whether plant sterol content may be as important as fatty acid composition and dietary fat content in the regulation of sterol balance in humans.In order to investigate this relationship, we compared the effects of two monounsaturated oils, rapeseed oil (high in plant sterols) and olive oil (low in plant sterols), of similar although not identical fatty acid composition, on cholesterol metabolism in subjects with conventional ileostomies.Top of pageSubjects, materials and methodsSubjectsNine persons (three female, six male) volunteered for the study. Clinical data on the subjects are presented in Table 1. All subjects had previously undergone proctocolectomy for ulcerative colitis (n=7) or Crohn's disease (n=2) and had wellfunctioning ileostomies for at least 2 y. No additional smallbowel resections had been performed in any of the subjects. Seven of the nine subjects used some medication (listed in Table 1), but these medications were kept constant during the study. Subjects using thyroxine had normal serum thyroxine levels. One subject was overweight, and had <a href="http://www.cai-catanzaro.it/abercrombie/">abercrombie milano via</a> elevated serum glucose twice, and thus was diagnosed as diabetic during the study. His results did not differ from those of the other subjects. No subjects had any signs of anaemia, inflammation, hepatic, or renal disease as judged by history, hospital records, and standard laboratory tests, except the oldest subject who had slightly elevated CRPlevels because of arthritis. All subjects had stable bowel function at the time of the study. The study protocol was approved by the Ethics Committee of Sahlgrenska University Hospital.Top of pageMaterialsDietsThe diets were composed of common food items with identical dishes in the two diets. The compositions of the diets, given in Table 2, were calculated from Swedish food composition tables (Swedish National Food Administration, 1996) and from analyses of energy, plant sterols, and cholesterol. To meet energy demands, one subject ( had 50% larger than normal portions of all items on the menu. The first day of each period was used for adaptation and to minimise any carryover effects from the habitual diets of the participants. There was a washout period of at least 4 days between the dietary periods. The order of the diets was randomised for each subject, and the diets were blinded for the laboratory staff, the investigators and the subjects.On the second day, 8.7 kBq of beta4[14C]sitosterol and 17.4 kBq of 1a, 2an[3H]cholesterol were added at breakfast, lunch, and dinner, in three divided doses, to measure cholesterol absorption. Isotopes were purchased from Amersham International, Buckinghamshire, UK.Collection of ileostomy contentsIleostomy contents were collected during the last 2 days of each period. Ileostomy bags were changed every second hour during the daytime and directly after awakening. The bags were immediately frozen on dry ice in Dewar vessels which the subjects kept at home. Each morning, the bags were delivered to the metabolic ward and freeze dried before chemical analysis.Chemical analysesWet weight and dry weight of ileostomy effluent were determined as previously described (Sandberg et al, 1981). Energy of the diets was abercrombie milano via determined by combustion in a Gallenkamp bomb calorimeter (Loughborough, Leicestershire, UK). Determinations of cholesterol and plant sterols in the diets, as well as cholesterol, bile acids, and plant sterols in the ileostomy contents were made by GLC, as previously described (Bosaeus Andersson, 1987). Variation coefficients in duplicate samples from food and ileostomy excreta were 3.6% for cholesterol and 3.4% for bile acids.Before starting the study, standard laboratory tests including total serum cholesterol, triglycerides, and apo E phenotype, were determined by current methods at the Central Laboratory for Clinical Chemistry, Sahlgrenska University replica borse gucci italia Hospital. Serum samples for analyses specific to the study were collected on the second day of the diet period after overnight fast, before breakfast at 0800 hours and before supper at 1800 hours. Serum concentrations of lathosterol, cholesterol, and plant sterols (betasitosterol, stigmasterol and campesterol) were determined by GLC (Miettinen, 1982). Lathosterol was expressed in mmol cholesterol as simultaneously <a href="http://www.postzegels-poststukken.eu/woolrichjassen/">woolrich outlet</a> derived during analysis. Variation coefficients in duplicate samples of sera were 4.4% for lathosterol, 3.6% for cholesterol, and 4.9% for plant sterols.