In general , markers for cholesterol absorption and synthesis displayed reciprocal patterns , showing that cholesterol metabolism is tightly regulated by the interplay of intestinal absorption and endogenous synthesis .
Distinctive patterns for cholesterol absorption or cholesterol synthesis could be identified , suggesting that metabolic disorders can be classified as ' cholesterol absorbers or cholesterol synthesizers ' .
Non-cholesterol sterols are vali date d biomarkers for intestinal cholesterol absorption and endogenous cholesterol synthesis .
However , their use in metabolic disturbances has not been systematic ally explored .
Therefore , we conducted a systematic review to provide an overview of non-cholesterol sterols as markers for cholesterol metabolism in different metabolic disorders .
Phytosterol plasma concentrations and coronary heart disease in the prospective Spanish EPIC cohort
Phytosterol intake with natural foods , a measure of healthy dietary choices , increases plasma levels , but increased plasma phytosterols are believed to be a coronary heart disease ( CHD ) risk factor . To address this paradox , we evaluated baseline risk factors , phytosterol intake  , and  plasma noncholesterol sterol levels  in participants of a case control study nested within the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) Spanish cohort who developed CHD ( n = 299 ) and matched controls ( n = 584 ) who remained free of CHD after a 10 year follow-up .  Sitosterol-to-cholesterol ratios increased across tertiles of phytosterol intake ( P = 0.026 ) . HDL-cholesterol level increased , and adiposity measures , cholesterol/HDL ratios , and levels of glucose , triglycerides , and lathosterol , a cholesterol synthesis marker , decreased across plasma sitosterol tertiles ( P < 0.02 ; all ) . Compared with controls , cases had nonsignificantly lower median levels of phytosterol intake and plasma sitosterol . The multivariable-adjusted odds ratio for CHD across the lowest to highest plasma sitosterol tertile was 0.59 ( 95 % confidence interval , 0.36–0.97 ) . Associations were weaker for plasma campesterol . The apolipoprotein E genotype was unrelated to CHD risk or plasma phytosterols . The data suggest that plasma sitosterol levels are associated with a lower CHD risk while being markers of a lower cardiometabolic risk in the EPIC-Spain cohort , a population with a high phytosterol intake
In general , markers for cholesterol absorption and synthesis displayed reciprocal patterns , showing that cholesterol metabolism is tightly regulated by the interplay of intestinal absorption and endogenous synthesis .
Distinctive patterns for cholesterol absorption or cholesterol synthesis could be identified , suggesting that metabolic disorders can be classified as ' cholesterol absorbers or cholesterol synthesizers ' .
Non-cholesterol sterols are vali date d biomarkers for intestinal cholesterol absorption and endogenous cholesterol synthesis .
However , their use in metabolic disturbances has not been systematic ally explored .
Therefore , we conducted a systematic review to provide an overview of non-cholesterol sterols as markers for cholesterol metabolism in different metabolic disorders .