Skip to main content Accessibility help

Associations between usual food intake and faecal sterols and bile acids: results from the Cooperative Health Research in the Augsburg Region (KORA FF4) study

  • Patricia Mitry (a1) (a2), Nina Wawro (a1) (a2), Sapna Sharma (a3) (a4), Jennifer Kriebel (a3) (a4), Anna Artati (a5), Jerzy Adamski (a5) (a6) (a7), Margit Heier (a3), Christa Meisinger (a1) (a2), Barbara Thorand (a3), Harald Grallert (a3) (a4), Annette Peters (a3) (a4) and Jakob Linseisen (a1) (a2) (a8)...


Animal sterols, plant sterols and bile acids in stool samples have been suggested as biomarkers of dietary intake. It is still unknown whether they also reflect long-term habitual dietary intake and can be used in aetiological research. In a subgroup of the Cooperative Health Research in the Augsburg Region (KORA FF4) study, habitual dietary intake was estimated based on repeated 24-h food list and a FFQ. Stool samples were collected according to a standard operating procedure and those meeting the quality criteria were extracted and analysed by means of a metabolomics technique. The present study is based on data from 513 men and 495 women with a mean age of 60 and 58 years, respectively, for which faecal animal and plant sterols and bile acids concentrations and dietary intake data were available. In adjusted regression models, the associations between food intake and log-normalised metabolite concentrations were analysed. Bonferroni correction was used to account for multiple testing. In this population-based sample, associations between habitual dietary intake and faecal concentrations of animal sterols were identified, while the impact of usual diet on bile acids was limited. A habitual diet high in ‘fruits’ and ‘nuts and seeds’ is associated with lower animal faecal sterols concentrations, whereas a diet high in ‘meat and meat products’ is positively related to faecal concentrations of animal sterols. A positive association between glycocholate and fruit consumption was found. Further studies are necessary for evaluation of faecal animal sterols as biomarkers of diet. The findings need to be confirmed in other populations with diverse dietary habits.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Associations between usual food intake and faecal sterols and bile acids: results from the Cooperative Health Research in the Augsburg Region (KORA FF4) study
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Associations between usual food intake and faecal sterols and bile acids: results from the Cooperative Health Research in the Augsburg Region (KORA FF4) study
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Associations between usual food intake and faecal sterols and bile acids: results from the Cooperative Health Research in the Augsburg Region (KORA FF4) study
      Available formats


This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

*Corresponding author: Dr Nina Wawro, email


Hide All
1.Lubinus, T, Barnsteiner, A, Skurk, T, et al. (2013) Fate of dietary phytosteryl/-stanyl esters: analysis of individual intact esters in human feces. Eur J Nutr 52, 9971013.
2.Reddy, BS (1981) Diet and excretion of bile acids. Cancer Res 41, 37663768.
3.De Smet, E, Mensink, RP & Plat, J (2012) Effects of plant sterols and stanols on intestinal cholesterol metabolism: suggested mechanisms from past to present. Mol Nutr Food Res 56, 10581072.
4.Cuevas-Tena, M, Alegria, A & Lagarda, MJ (2017) Determination of fecal sterols following a diet with and without plant sterols. Lipids 52, 871884.
5.Racette, SB, Lin, X, Ma, L, et al. (2015) Natural dietary phytosterols. J AOAC Int 98, 679684.
6.Ferezou, J, Gouffier, E, Coste, T, et al. (1978) Daily elimination of fecal neutral sterols by humans. Digestion 18, 201212.
7.Kaddurah-Daouk, R, Baillie, RA, Zhu, H, et al. (2011) Enteric microbiome metabolites correlate with response to simvastatin treatment. PLoS ONE 6, e25482.
8.Gerard, P (2013) Metabolism of cholesterol and bile acids by the gut microbiota. Pathogens 3, 1424.
9.Azadmard-Damirchi, S & Dutta, PC (2010) Chapter 27 - Phytosterol classes in olive oils and their analysis by common chromatographic methods. In Olives and Olive Oil in Health and Disease Prevention, pp. 249257 [Preedy, VR and Watson, RR, editors]. San Diego, CA: Academic Press.
10.Klingberg, S, Ellegard, L, Johansson, I, et al. (2008) Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden. Am J Clin Nutr 87, 9931001.
11.Valsta, LM, Lemstrom, A, Ovaskainen, ML, et al. (2004) Estimation of plant sterol and cholesterol intake in Finland: quality of new values and their effect on intake. Br J Nutr 92, 671678.
12.Escurriol, V, Mari-Dell’Olmo, M, Rohlfs, I, et al. (2009) Plant sterol intake and education level in the Spanish EPIC cohort. Nutrition 25, 769773.
13.Ling, WH & Jones, PJ (1995) Dietary phytosterols: a review of metabolism, benefits and side effects. Life Sci 57, 195206.
14.Penchala Raju, M, Aravind Babu, DG, Rakesh Kumar, B, et al. (2013) The role of phytosterols enriched foods—a review. IOSR J Environ Sci Toxicol Food Technol 7, 4047.
15.Gylling, H & Miettinen, TA (2005) The effect of plant stanol- and sterol-enriched foods on lipid metabolism, serum lipids and coronary heart disease. Ann Clin Biochem 42, 254263.
16.Holle, R, Happich, M, Lowel, H, et al. (2005) KORA – a research platform for population based health research. Gesundheitswesen 67, Suppl. 1, S19S25.
17.Freese, J, Feller, S, Harttig, U, et al. (2014) Development and evaluation of a short 24-h food list as part of a blended dietary assessment strategy in large-scale cohort studies. Eur J Clin Nutr 68, 324329.
18.Carroll, RJ, Midthune, D, Subar, AF, et al. (2012) Taking advantage of the strengths of 2 different dietary assessment instruments to improve intake estimates for nutritional epidemiology. Am J Epidemiol 175, 340347.
19.Department of Epidemiology of the German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE) (2019) Internet based assessment tools in Epidemiology.
20.Bohlscheid-Thomas, S, Hoting, I, Boeing, H, et al. (1997) Reproducibility and relative validity of energy and macronutrient intake of a food frequency questionnaire developed for the German part of the EPIC project. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26, Suppl. 1, S71S81.
21.Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung & Schweizerische Gesellschaft für Ernährung (2016) Referenzwerte für die Nährstoffzufuhr. 2 ed. (Reference Levels for Nutrient Intake, 2nd ed.). Neustadt an der Weinstraße: Neuer Umschau Buchverlag.
22.Reddy, BS, Hanson, D, Mangat, S, et al. (1980) Effect of high-fat, high-beef diet and of mode of cooking of beef in the diet on fecal bacterial enzymes and fecal bile acids and neutral sterols. J Nutr 110, 18801887.
23.Reddy, BS & Wynder, EL (1973) Large-bowel carcinogenesis: fecal constituents of populations with diverse incidence rates of colon cancer. J Natl Cancer Inst 50, 14371442.
24.Hentges, DJ, Maier, BR, Burton, GC, et al. (1977) Effect of a high-beef diet on the fecal bacterial flora of humans. Cancer Res 37, 568571.
25.Weststrate, JA, Ayesh, R, Bauer-Plank, C, et al. (1999) Safety evaluation of phytosterol esters. Part 4. Faecal concentrations of bile acids and neutral sterols in healthy normolipidaemic volunteers consuming a controlled diet either with or without a phytosterol ester-enriched margarine. Food Chem Toxicol 37, 10631071.
26.Racette, SB, Lin, X, Lefevre, M, et al. (2010) Dose effects of dietary phytosterols on cholesterol metabolism: a controlled feeding study. Am J Clin Nutr 91, 3238.
27.Katan, MB, Grundy, SM, Jones, P, et al. (2003) Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc 78, 965978.
28.Talati, R, Sobieraj, DM, Makanji, SS, et al. (2010) The comparative efficacy of plant sterols and stanols on serum lipids: a systematic review and meta-analysis. J Am Diet Assoc 110, 719726.
29.Abumweis, SS, Barake, R & Jones, PJ (2008) Plant sterols/stanols as cholesterol lowering agents: a meta-analysis of randomized controlled trials. Food Nutr Res 52, 10.3402/fnr.v52i0.1811.
30.Ras, RT, Geleijnse, JM & Trautwein, EA (2014) LDL-cholesterol-lowering effect of plant sterols and stanols across different dose ranges: a meta-analysis of randomised controlled studies. Br J Nutr 112, 214219.
31.Gylling, H, Plat, J, Turley, S, et al. (2014) Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease. Atherosclerosis 232, 346360.
32.Sudhop, T, Sahin, Y, Lindenthal, B, et al. (2002) Comparison of the hepatic clearances of campesterol, sitosterol, and cholesterol in healthy subjects suggests that efflux transporters controlling intestinal sterol absorption also regulate biliary secretion. Gut 51, 860863.
33.Lin, X, Racette, SB, Lefevre, M, et al. (2010) The effects of phytosterols present in natural food matrices on cholesterol metabolism and LDL-cholesterol: a controlled feeding trial. Eur J Clin Nutr 64, 14811487.
34.Jaceldo-Siegl, K, Lutjohann, D, Sirirat, R, et al. (2017) Variations in dietary intake and plasma concentrations of plant sterols across plant-based diets among North American adults. Mol Nutr Food Res 61, 10.1002/mnfr.201600828.
35.Normen, L, Frohlich, JJ & Trautwein, EA (2004) Role of plant sterols in cholesterol lowering. In Phytosterols as Functional Food Components and Nutraceuticals, pp. 243315 [PC Dutta, editor]. New York: Marcel Dekker.
36.Reddy, BS, Hedges, AR, Laakso, K, et al. (1978) Metabolic epidemiology of large bowel cancer: fecal bulk and constituents of high-risk North American and low-risk Finnish population. Cancer 42, 28322838.
37.Ajouz, H, Mukherji, D & Shamseddine, A (2014) Secondary bile acids: an underrecognized cause of colon cancer. World J Surg Oncol 12, 164.
38.Jenkins, DJ, Wolever, TM, Rao, AV, et al. (1993) Effect on blood lipids of very high intakes of fiber in diets low in saturated fat and cholesterol. N Engl J Med 329, 2126.
39.Bosaeus, I, Belfrage, L, Lindgren, C, et al. (1992) Olive oil instead of butter increases net cholesterol excretion from the small bowel. Eur J Clin Nutr 46, 111115.
40.Setchell, KD, Ives, JA, Cashmore, GC, et al. (1987) On the homogeneity of stools with respect to bile acid composition and normal day-to-day variations: a detailed qualitative and quantitative study using capillary column gas chromatography-mass spectrometry. Clin Chim Acta 162, 257275.
41.Loftfield, E, Vogtmann, E, Sampson, JN, et al. (2016) Comparison of collection methods for fecal samples for discovery metabolomics in epidemiologic studies. Cancer Epidemiol Biomarkers Prev 25, 14831490.
42.Matysik, S, Le Roy, CI, Liebisch, G, et al. (2016) Metabolomics of fecal samples: a practical consideration. Trends Food Sci Tech 57, 244255.
43.Keller, S & Jahreis, G (2004) Determination of underivatised sterols and bile acid trimethyl silyl ether methyl esters by gas chromatography-mass spectrometry-single ion monitoring in faeces. J Chromatogr B 813, 199207.
44.Expert Panel on Detection (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP), evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285, 24862497.


Type Description Title
Supplementary materials

Mitry et al. supplementary material
Mitry et al. supplementary material 1

 Word (25 KB)
25 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed