Clinical trial NCT06929403: Effect of Bergamot and Plant Sterols Extract on Serum Lipid Profile
Official title: Effect of Dietary Supplement Containing Bergamot and Plant Sterols Extract on Serum Lipid Profile
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Dyslipidemia
Cardiac Disease
Cardiovascular Diseases
Keywords: dyslipidemia
hyperlipidemia
plant sterols
Bergamot
complementary therapy
Lead sponsor: Istanbul Bilgi University
Sponsor class: OTHER
First posted: 2025-04-16
Enrollment: 69
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The consumption of 2 grams of plant sterols per day has been demonstrated to positively affect total cholesterol and low density lipoprotein (LDL) cholesterol, as supported by various clinical guidelines. These compounds do not exhibit any adverse side effects. The European Society of Cardiology's Dyslipidemia Guidelines indicate that among lifestyle modifications aimed at reducing total cholesterol and LDL, the consumption of functional foods enriched with phytosterols should be included as a high-level recommendation.

Bergamot is a citrus fruit rich in flavonoids. Research on bergamot fruit extract has indicated its ability to lower total cholesterol, LDL cholesterol, and triglyceride levels while increasing high density lipoprotein(HDL) cholesterol levels. Furthermore, evidence suggests that it may help reduce high serum uric acid levels, which can pose a risk for cardiovascular diseases. The flavonoids in bergamot fruit extract contribute to the reduction of cholesterol synthesis in the liver. Additionally, it has a high capacity to prevent LDL oxidation. A study on individuals with metabolic syndrome observed significant and sustained reductions in serum cholesterol, triglyceride levels, and glucose in those consuming bergamot. This effect was accompanied by significant improvements in vascular reactivity in patients with hyperlipidemia and elevated serum glucose levels.

Bergamot also exhibits the ability to inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. Due to their structural similarity to cholesterol, plant sterols help block the intestinal absorption of dietary cholesterol. They provide benefits at the absorption level and increase cholesterol excretion via bile and fecal pathways. The existence of known side effects associated with cholesterol-lowering medications, such as statins- including muscle cramps, myopathy, increased risk of muscle toxicity, liver damage, and neuropathy-has created a need for complementary or alternative approaches to treating dyslipidemia. This research will consider the potential of both plant sterols and bergamot as dietary supplements.

While cholesterol-lowering diets assist in reducing LDL, glucose, total cholesterol, and triglyceride levels, they do not enhance HDL levels. Because bergamot is known to increase HDL, it could provide an additional benefit in lipid profile regulation. A meta-analysis that studied various phytochemical supplements found that bergamot was the most effective in reducing total cholesterol, LDL, and triglyceride levels while increasing HDL levels. This study examines the effects of dietary supplementation containing plant sterols and bergamot on blood lipid profiles.

Detailed description: This randomised clinical study, which aims to recruit 69 participants, will include individuals with abnormalities in their blood lipid profiles. Participants will be randomly assigned to one of three groups: Group 1 will receive a cholesterol-lowering diet; Group 2 will take bergamot with phytosterol/stanol supplements; and Group 3 will follow both a cholesterol-lowering diet and consume bergamot with phytosterol/stanol supplements. Participation in the study is voluntary and ethics committee approval has been obtained. Participants will take 2 tablets of bergamot and phytosterol/stanol supplements daily for 12 weeks, either on an empty stomach or with meals. Each 2-tablet dose will contain 375 mg of bergamot fruit extract containing 150 mg of flavonoids and 800 mg of plant sterols obtained from coniferous trees. Participants will be given detailed information about the study at the beginning and those who wish to participate will be asked to sign an informed consent form. Sample Size The sample size for the study was calculated using G\*Power 3.1.9.7 software. Considering the research design, sample calculations were performed using ANOVA F test for group differences. Based on Cohen's medium effect size (d=0.5), 0.05 significance level (α=0.05) and desired power of 0.95, the minimum sample size required for inclusion in the study was determined as 66.

Statistical Analyses The findings of the study will be analyzed using Statistical Package for Social Sciences (IBM-SPSS) version 25. In the thesis, categorical variables will be summarized using frequency distributions, while quantitative variables will be defined using mean, standard deviation, minimum and maximum values. In order to reveal the relationships between variables and the differences between variable levels, both parametric and nonparametric methods will be used depending on the normality of the data. The normality of quantitative variables will be evaluated using Kolmogorov-Smirnov and Shapiro-Wilk tests. Parametric methods will be used for variables that show a normal distribution, and nonparametric alternatives will be used for variables that do not conform to a normal distribution. Significance will be determined at the p\<0.05 level.

Eligibility criteria: Inclusion Criteria:

* Adults individuals who were diagnosed hyperlipidemia
* Individuals suitable for taking supplement

Exclusion Criteria:

* Chronic liver disease,
* Chronic kidney disease,
* Heart failure, infarction or cerebrovascular disease,
* Pregnant and breastfeeding women,
* Severe psychiatric disorders,
* Oncological diseases,
* People using medications that may interact with black seed oil (anticoagulant, antihypertensive, etc.)
* People using antilipidemic or anticholesterolemic medications in the last 3 months
* People with citrus allergies
* People who do not do heavy exercise
* People using any dietary supplements
* People with a known history of allergies
* People who do not regularly consume alcohol
* People with special dietary requirements

Primary outcomes:
measure: Biochemical Measurements - Fasting blood glucose
timeFrame: 12 weeks
measure: Biochemical Measurement - Lipid Profile
timeFrame: 12 weeks
measure: Biochemical Measurements - Liver Enzymes
timeFrame: 12 weeks
measure: Biochemical Measurements - CRP
timeFrame: 12 weeks
measure: Biochemical Measurements - Uric Acid Levels
timeFrame: 12 weeks
measure: Anthropometric Measurements - Body weight (kg)
timeFrame: 12 weeks
measure: Anthropometric Measurements - Height
timeFrame: 1 week
measure: Body Mass Index
timeFrame: 12 weeks
measure: Body Mass Index Classification
timeFrame: 12 weeks
measure: Anthropometric Measurements - Fat Mass
timeFrame: 12 weeks
measure: Anthropometric Measurements - Fat ratio calculation
timeFrame: 12 weeks
measure: Anthropometric Measurements - Fat-free mass
timeFrame: 12 weeks
measure: Anthropometric Measurements - Muscle mass
timeFrame: 12 weeks
measure: Anthropometric Measurements - Total body water
timeFrame: 12 weeks
measure: Anthropometric Measurements - Waist circumference
timeFrame: 12 weeks
measure: Anthropometric Measurements - Hip circumference
timeFrame: 12 weeks
measure: Anthropometric Measurements - Waist/Height Ratio
timeFrame: 12 weeks
measure: Anthropometric Measurements - Waist/Hip Ratio
timeFrame: 12 weeks
Secondary outcomes:
measure: Physical Activity Levels
timeFrame: 1 week
measure: Food Consumption Record
timeFrame: 3 days
measure: Food Consumption Record
timeFrame: 3 days
measure: Food Consumption Record
timeFrame: 3 days
measure: Food Consumption Record
timeFrame: 3 days
Other outcomes:
Locations:
city: İstanbul
country: Turkey
facility: İstanbul Bilgi University
Study officials:
affiliation: İstanbul Bilgi University
name: Hande Seven Avuk
role: PRINCIPAL_INVESTIGATOR
References:
citation: Norgan NG. Laboratory and field measurements of body composition. Public Health Nutr. 2005 Oct;8(7A):1108-22. doi: 10.1079/phn2005799.
citation: Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, Pratt M, Ekelund U, Yngve A, Sallis JF, Oja P. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003 Aug;35(8):1381-95. doi: 10.1249/01.MSS.0000078924.61453.FB.
citation: Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.
citation: Guasch-Ferre M, Babio N, Martinez-Gonzalez MA, Corella D, Ros E, Martin-Pelaez S, Estruch R, Aros F, Gomez-Gracia E, Fiol M, Santos-Lozano JM, Serra-Majem L, Bullo M, Toledo E, Barragan R, Fito M, Gea A, Salas-Salvado J; PREDIMED Study Investigators. Dietary fat intake and risk of cardiovascular disease and all-cause mortality in a population at high risk of cardiovascular disease. Am J Clin Nutr. 2015 Dec;102(6):1563-73. doi: 10.3945/ajcn.115.116046. Epub 2015 Nov 11.
citation: Osadnik T, Golawski M, Lewandowski P, Morze J, Osadnik K, Pawlas N, Lejawa M, Jakubiak GK, Mazur A, Schwingschackl L, Gasior M, Banach M. A network meta-analysis on the comparative effect of nutraceuticals on lipid profile in adults. Pharmacol Res. 2022 Sep;183:106402. doi: 10.1016/j.phrs.2022.106402. Epub 2022 Aug 18.
citation: Racette SB, Lin X, Lefevre M, Spearie CA, Most MM, Ma L, Ostlund RE Jr. Dose effects of dietary phytosterols on cholesterol metabolism: a controlled feeding study. Am J Clin Nutr. 2010 Jan;91(1):32-8. doi: 10.3945/ajcn.2009.28070. Epub 2009 Nov 4.
citation: Ferro Y, Maurotti S, Mazza E, Pujia R, Sciacqua A, Musolino V, Mollace V, Pujia A, Montalcini T. Citrus Bergamia and Cynara Cardunculus Reduce Serum Uric Acid in Individuals with Non-Alcoholic Fatty Liver Disease. Medicina (Kaunas). 2022 Nov 26;58(12):1728. doi: 10.3390/medicina58121728.
citation: Gliozzi M, Walker R, Muscoli S, Vitale C, Gratteri S, Carresi C, Musolino V, Russo V, Janda E, Ragusa S, Aloe A, Palma E, Muscoli C, Romeo F, Mollace V. Bergamot polyphenolic fraction enhances rosuvastatin-induced effect on LDL-cholesterol, LOX-1 expression and protein kinase B phosphorylation in patients with hyperlipidemia. Int J Cardiol. 2013 Dec 10;170(2):140-5. doi: 10.1016/j.ijcard.2013.08.125. Epub 2013 Sep 8.
citation: Toth PP, Patti AM, Nikolic D, Giglio RV, Castellino G, Biancucci T, Geraci F, David S, Montalto G, Rizvi A, Rizzo M. Bergamot Reduces Plasma Lipids, Atherogenic Small Dense LDL, and Subclinical Atherosclerosis in Subjects with Moderate Hypercholesterolemia: A 6 Months Prospective Study. Front Pharmacol. 2016 Jan 6;6:299. doi: 10.3389/fphar.2015.00299. eCollection 2015.
citation: Gylling H, Plat J, Turley S, Ginsberg HN, Ellegard L, Jessup W, Jones PJ, Lutjohann D, Maerz W, Masana L, Silbernagel G, Staels B, Boren J, Catapano AL, De Backer G, Deanfield J, Descamps OS, Kovanen PT, Riccardi G, Tokgozoglu L, Chapman MJ; European Atherosclerosis Society Consensus Panel on Phytosterols. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis. 2014 Feb;232(2):346-60. doi: 10.1016/j.atherosclerosis.2013.11.043. Epub 2013 Nov 23.
citation: Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Z, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT; ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016 Oct 14;37(39):2999-3058. doi: 10.1093/eurheartj/ehw272. Epub 2016 Aug 27. No abstract available.
citation: Expert Dyslipidemia Panel of the International Atherosclerosis Society Panel members. An International Atherosclerosis Society Position Paper: global recommendations for the management of dyslipidemia--full report. J Clin Lipidol. 2014 Jan-Feb;8(1):29-60. doi: 10.1016/j.jacl.2013.12.005. Epub 2013 Dec 17.