Could squalene be an added value to use olive by-products?

Squalene (SQ) is an intermediate hydrocarbon in the biosynthesis of phytosterols and terpenes in plants. It is widely used for applications such as skin moisturizers, vaccines, or in carriers for active lipophilic molecules. It has commonly been obtained from sharks, but restrictions on their use have created a need to find alternative sources. We present a review of studies concerning SQ in olive groves to characterize its content and to provide new aspects that may increase the circular economy of the olive tree. There is a large variation in SQ content in virgin olive oil due to cultivars and agronomic issues such as region, climate, types of soil, crop practices, and harvest date. Cultivars with the highest SQ content in their virgin olive oil were 'Nocellara de Belice', 'Drobnica', 'Souri', and 'Oblica'. An interaction between cultivar and aspects such as irrigation practices or agricultural season is frequently observed. Likewise, the production of high SQ content needs precise control of fruit maturation. Leaves represent an interesting source, if its extraction and yield compensate for the expenses of their disposal. Supercritical carbon dioxide extraction from olive oil deodorizer distillates offers an opportunity to obtain high-purity SQ from this derivative. Exploiting SQ obtained from olive groves for the pharmaceutical or cosmetic industries poses new challenges and opportunities to add value and recycle by-products. © 2019 Society of Chemical Industry.

The effectiveness and cost-effectiveness of plant sterol or stanol-enriched functional foods as a primary prevention strategy for people with cardiovascular disease risk in England: a modeling study.

This study appraises the effectiveness and cost-effectiveness of consumption of plant sterol-enriched margarine-type spreads for the prevention of cardiovascular disease (CVD) in people with hypercholesterolemia in England, compared to a normal diet. A nested Markov model was employed using the perspective of the British National Health Service (NHS). Effectiveness outcomes were the 10-year CVD risk of individuals with mild (4-6 mmol/l) and high (above 6 mmol/l) cholesterol by gender and age groups (45-54, 55-64, 65-74, 75-85 years); CVD events avoided and QALY gains over 20 years. This study found that daily consumption of enriched spread reduces CVD risks more for men and older age groups. Assuming 50% compliance, 69 CVD events per 10,000 men and 40 CVD events per 10,000 women would be saved over 20 years. If the NHS pays the excess cost of enriched spreads, for the high-cholesterol group, the probability of enriched spreads being cost-effective is 100% for men aged over 64 years and women over 74, at £20,000/QALY threshold. Probabilities of cost-effectiveness are lower at younger ages, with mildly elevated cholesterol and over a 10-year time horizon. If consumers bear the full cost of enriched spreads, NHS savings arise from reduced CVD events.

Lowering cholesterol - a review on the role of plant sterols.

BACKGROUND: Plant sterols are an important but underused dietary component in the treatment of elevated blood cholesterol. OBJECTIVE: This review discusses the background to plant sterol use and reviews evidence about its use in clinical practice. DISCUSSION: When consumed in the recommended amounts, sterols alone decrease low density lipoprotein cholesterol; in combination with other dietary changes, low density lipoprotein can be further lowered. Most patients, whether they are on cholesterol lowering drugs or not, would benefit from using plant sterols, which are now available in milk and yoghurt as well as spreads. In animal models, plant sterols have been shown to reduce atherosclerosis despite an elevation in the blood level, however there is no hard end point data for this in humans.

Targeted versus global approaches to the management of hypercholesterolaemia.

AIMS: The role of statins in secondary prevention of cardiovascular disease is well established. However, there is debate about the most effective approach to primary prevention. This study simulated the effects of directed versus global approaches for intervention on coronary heart disease (CHD) event rates. METHODS: A primary prevention population was generated by computer simulation derived from data from the National Health Survey for England. The efficacy of reductions in cholesterol, treatment to cardiovascular risk targets and effects of phytosterols or statins were assessed. RESULTS: A 0.5 mmol/L reduction in population total cholesterol would result in a 10.4% reduction in CHD events, while 1.0 mmol/L, 1.5 mmol/L and 2.0 mmol/L reductions would achieve 21.0%, 30.6% and 41.9% reductions respectively. In statin-based cardiovascular risk targeted strategies, use of simvastatin 40 mg would result in 1.8% reduction by UK National Service Framework targets of 30%/decade CHD risk and 7.2% reduction in events for a 20%/decade target assuming perfect adherence. Similarly, aggressive primary prevention with 40 mg atorvastatin would result in a 2.5% or 10% reduction in events. Universal use of 10 mg simvastatin following an over-the-counter approach would result in a 25% reduction in CHD events. In contrast, whole population consumption of sitostanol/sitosterol products would result in 11.8% reduction. CONCLUSION: Targeting and treating high-risk individuals may be beneficial for them and rewarding for medical practitioners. However, this approach has minimal effects on the population burden of atherosclerotic disease. This study suggests that universal therapy with phytosterols and/or wider availability of statins has the potential to dramatically decrease rates of CHD.

Cost-benefit analysis of a plant sterol containing low-fat margarine for cholesterol reduction.

For decreasing the risk of coronary heart disease (CHD) it has been proposed to enrich food such as margarine with plant sterol esters which have been shown to reduce total and LDL cholesterol concentrations, two of the major risk factors. A Markov model was developed to assess the costs and benefits of consuming a low-fat plant sterol containing margarine (PS margarine). A health insurer's perspective was taken with a time frame of 10 years. Transition probabilities for CHD and CHD-related death were calculated on the basis of the Framingham risk equations. These were applied to a representative sample of the German population. The alteration in cholesterol levels after intake of PS margarine was estimated based on a meta-analysis of ten randomized controlled trials with parallel or crossover design that found a reduction of 5.7% in total cholesterol. Average annual costs of CHD were assumed to be at 3,000 euro. Costs for "no CHD" and "CHD-related death" were set to 0 euro since the intervention would solely be paid by the consumers. Sensitivity analyses were performed with regard to annual costs, risk estimation, PS margarine reduction in total cholesterol, discount factor, and risk of CHD-related death. The 10-year CHD risks are 6.1% (PS margarine) vs. 6.5% (control). Thus expected 10-year CHD costs are 696 euro (PS margarine) vs. 748 euro (control). The cost savings of 52 euro varied between 32 euro and 74 euro in the sensitivity analysis. A projection at the level of the population for which evidence (randomized controlled trials) exists that plant sterols lower cholesterol (25.35 million) leads to a reduction of 117,000 CHD cases over 10 years and a cost reduction of 1.3 billion euro for this time period (sensitivity analysis 0.8-1.9 billion euro).