Phytosterols increase circulating endothelial progenitor cells and insulin-like growth factor-1 levels in patients with nonalcoholic fatty liver disease: A randomized crossover study

• Nonalcoholic fatty liver disease (NAFLD) had decreased circulating endothelial progenitor cells (EPCs) number.
• Daily ingestion of phytosterols for 4 weeks increased circulating EPC number in patients with NAFLD.

The hypothesis that treatment with phytosterols in patients with nonalcoholic fatty liver disease (NAFLD) may increase circulating endothelial progenitor cells (EPCs) levels was tested in the study. Forty patients with an abdominal ultrasonographic diagnosis of NAFLD were randomly assigned to phytosterols powder treatment at 1.8 g/day for 4 weeks (n = 20) or a control group, with crossover to the alternate therapy for another 4 weeks after a 2-week wash-out period. Flow cytometry with quantification of EPC markers in peripheral blood samples was used to assess circulating EPC levels. Phytosterols treatment significantly decreased levels of low-density lipoproteins, fasting glucose, and hemoglobin-A1C. Treatment with phytosterols in patients with NAFLD markedly suppressed high sensitivity C-reactive protein concentrations, and enhanced superoxide dismutase, as compared to baseline. We also showed that administration of phytosterols significantly increased the insulin-like growth factor-1 concentrations (change from baseline of 22.47%, P < 0.0001; 18.49%, P = 0.0002). Moreover, intake of phytosterols significantly enhanced circulating EPC levels (CD34+, CD34+KDR+, CD34+KDR+CD133+, all P < 0.05) in NAFLD patients. Taken together, 4-week treatment with phytosterols in NAFLD patients significantly increased circulating EPC levels, and these findings provide a new strategy in treating patients with NAFLD.