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The aim of this study was to compare the lipid-lowering effect of a novel functional tomato sauce with a well-known functional food with a lipid-lowering effect, i.e. a sterol-enriched yogurt.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this cross-over study, we evaluated a population of 108 ambulatory patients affected by polygenic hypercholesterolemia of both gender, who were allocated to a tomato sauce (namely OsteoCol) 150\u00a0ml\/day or a sterol-enriched yogurt (containing sterols 1.6\u00a0g\/die) treatment, for 6\u00a0weeks. Carotenoids content was 3.5\u00a0mg per gram of product. We measured serum lipids and creatinine and transaminases at basal and follow-up visit.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 91 subjects completed the protocol. A significant difference in LDL-cholesterol change was found between participants taking yogurt, tomato sauce (high adherence) and tomato sauce (low adherence) (\u2212\u00a016; \u2212\u00a012<jats:italic>;<\/jats:italic>\u2009+\u20098\u00a0mg\/dl respectively; p\u2009&lt;\u20090.001). We found a greater LDL-cholesterol reduction in the participants with a basal LDL-cholesterol more than 152\u00a0mg\/dl (15% for sterol-enriched yogurt and 12% for tomato sauce at high adherence).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A novel functional tomato sauce from vine-ripened tomatoes compares favourably with a commercialised sterol-enriched yogurt in term of absolute LDL-cholesterol change. Intake of a tomato sauce with a high carotenoid content may support treatment of patients affected by common hypercholesterolemia. The present study has various limitations. The presence of other dietary components, which may have influenced the results, cannot be ruled out. Of course, these results cannot be extrapolated to other populations. Furthermore, there was a low adherence rate in the tomato sauce group. Moreover, we did not report serum carotenoids data.<\/jats:p><jats:p><jats:italic>Trial registration<\/jats:italic>: ID: 13244115 on the ISRCTN registry, retrospectively registered in 2019-5-14. 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