Phytosterols in human health: Biochemical mechanisms of action and disease-modulating effects

Table 1 Summary of principal biological mechanisms, evidence strength, and reported health outcomes of phytosterols across major disease domains

Domain	Main mechanisms	Evidence strength	Reported outcomes
Cardiovascular health	Reduced intestinal cholesterol absorption; LDL-C lowering; improved endothelial function	Strong (randomized controlled trials/meta-analyses)	Lower LDL-C; improved vascular markers
Diabetes/glucose metabolism	AMP-activated protein kinase activation; peroxisome proliferator-activated receptors modulation; reduced inflammation; improved insulin signaling	Moderate	Improved insulin sensitivity; better glycemic markers
Metabolic dysfunction-associated steatotic liver disease/fatty liver	Reduced lipogenesis; enhanced fatty acid oxidation; anti-inflammatory effects	Moderate (mainly preclinical)	Reduced hepatic lipid accumulation
Obesity	Adipocyte metabolism modulation; anti-inflammatory effects	Limited-moderate	Improved metabolic profile; uncertain weight loss
Gut–metabolism axis	Microbiota shifts; bile acid signaling (farnesoid X receptor/Takeda G protein-coupled receptor 5); short-chain fatty acid-related effects	Emerging (mainly preclinical)	Potential metabolic benefits
Antioxidant/inflammation	Nuclear factor kappa B suppression; nuclear factor erythroid-2-related factor 2 activation; reduced NADPH oxidase activity	Moderate (mostly experimental)	Reduced oxidative stress and inflammation
Anticancer	Cell-cycle arrest; apoptosis; membrane signaling effects	Preliminary (preclinical)	Mechanistic potential only
Neuroprotection	Anti-inflammatory and antioxidant actions; lipid signaling	Preliminary (preclinical)	Mechanistic potential only

LDL-C: Low-density lipoprotein cholesterol.