Original Article

European Journal of Clinical Nutrition (2009) 63, 821–827; doi:10.1038/ejcn.2008.49; published online 5 November 2008

Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials

Z-h Wei1,2, H Wang1,2, X-y Chen1, B-s Wang1, Z-x Rong1, B-s Wang1, B-h Su1 and H-z Chen1

1Department of Pharmacology and Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, China

Correspondence: Professor H-z Chen, Department of Pharmacology and Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, 200025, Shanghai, China. E-mail: yaoli@shsmu.edu.cn

2These authors contributed equally to this work.

Received 27 December 2007; Revised 21 August 2008; Accepted 18 September 2008; Published online 5 November 2008.

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Abstract

Objectives:

 

Evidences from randomized clinical trials and meta-analysis have claimed an association between the use of soluble dietary fiber from psyllium and a cholesterol-lowering effect. However, there is still uncertainty as to the dose–response relationship and its long-term lipid-lowering efficacy. This meta-analysis was primarily conducted to address the dose–response relationship between psyllium and serum cholesterol level and time-dependent effect of psyllium in mild-to-moderate hypercholesterolemic subjects.

Methods:

 

Twenty-one studies, which enrolled a total of 1030 and 687 subjects receiving psyllium or placebo, respectively, were included in the meta-analysis. The studies were randomized placebo-controlled trials, double blinded or open label, on subjects with mild-to-moderate hypercholesterolemia. The dose of psyllium was between 3.0 and 20.4 g per day and intervention period was more than 2 weeks. Any type of diet background was permitted. Diet lead-in period was between 0 and 8 weeks.

Results:

 

Compared with placebo, consumption of psyllium lowered serum total cholesterol by 0.375 mmol/l (95% CI: 0.257–0.494 mmol/l), and LDL cholesterol by 0.278 mmol/l (95% CI: 0.213–0.312 mmol/l). With random-effect meta-regression, a significant dose–response relationship were found between doses (3–20.4 g/day) and total cholesterol or LDL cholesterol changes. Regression model of total cholesterol was -0.0222+0.2061 times log (dose+1), and that of LDL cholesterol was 0.0485+0.1390 times log (dose+1). There was a time effect of psyllium on total cholesterol (equation: 6.3640–0.0316 times treatment period) and on LDL cholesterol (equation: 4.3134–0.0162 times treatment period), suggesting that psyllium reduced serum total cholesterol more quickly than LDL cholesterol.

Conclusions:

 

Psyllium could produce dose- and time-dependent serum cholesterol-lowering effect in mild and moderate hypercholesterolemic patients and would be useful as an adjunct to dietary therapy for the treatment of hypercholesterolemia.

Keywords:

hypercholesterolemia, total cholesterol, LDL cholesterol, meta-analysis, randomized controlled trials

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