International Journal of Molecular Sciences Review Cardiovascular Disease Prevention: The Earlier the Better? A Review of Plant Sterol Metabolism and Implications of Childhood Supplementation Bianca Scolaro, Leticia F.S. de Andrade and Inar A. Castro * Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, 05508-000 São Paulo, Brazil;
[email protected] (B.S.);
[email protected] (L.F.S.d.A.) * Correspondence:
[email protected]; Tel.: +55-11-3091-1481 Received: 28 July 2019; Accepted: 24 August 2019; Published: 24 December 2019 Abstract: Atherosclerosis is the underlying cause of major cardiovascular events. The development of atherosclerotic plaques begins early in life, indicating that dietary interventions in childhood might be more effective at preventing cardiovascular disease (CVD) than treating established CVD in adulthood. Although plant sterols are considered safe and consistently effective in lowering plasma cholesterol, the health effects of early-life supplementation are unclear. Studies suggest there is an age-dependent effect on plant sterol metabolism: at a younger age, plant sterol absorption might be increased, while esterification and elimination might be decreased. Worryingly, the introduction of low-cholesterol diets in childhood may unintentionally favor a higher intake of plant sterols. Although CVD prevention should start as early as possible, more studies are needed to better elucidate the long-term effects of plant sterol accumulation and its implication on child development. Keywords: Atherosclerosis; plant sterol; cholesterol-lowering; diet 1. Introduction Childhood nutrition is known to play a major role in the onset of chronic diseases later in life. A large body of evidence has convincingly shown that childhood obesity is correlated with risk factors for cardiovascular disease (CVD), metabolic syndrome, and early development of atherosclerosis in adulthood.