Phytosterol Supplementation Could Improve Atherogenic and Anti-Atherogenic Apolipoproteins: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Does flaxseed supplementation affect apo-lipoproteins? A GRADE-assessed systematic review and meta-analysis

Several studies indicated the ameliorating effects of flaxseed supplementation on apolipoproteins, although others have conflicting results. Therefore, the present research was conducted in order to accurately and definitively understand the effect of flaxseed on apolipoproteins in adults. All articles published up to Juan 2024 were systematically searched through PubMed, Scopus, Embase, and Web of Science to collect all randomized clinical trials (RCTs). A random effects model was used to measure the combined effect sizes. Also, standardized mean difference (SMD) and 95 % confidence interval (CI) were used to report the combined effect size. Our results showed that flaxseed supplementation significantly reduced apo-BI (SMD: -0.57; 95 % CI: -0.95, -0.19, p = 0.003; I2 = 83.2 %, heterogeneity p < 0.001) and lipo(a) decreased (SMD: -0.34; 95 % CI: -0.59, -0.09, p=0.007; I2=30.3 %, heterogeneity p=0.197). However, flaxseed did not change apo-AI levels (SMD: -0.37; 95 % CI: -0.87, 0.13, p = 0.146; I2 = 89.2 %, p-heterogeneity < 0.001). This meta-analysis has shown that flaxseed supplementation may have beneficial effects on apolipoproteins. Future high-quality, long-term clinical trials are needed to confirm our results.

The effect of phytosterol supplementation on lipid profile: A critical umbrella review of interventional meta-analyses

Despite multiple investigations assessing the impact of phytosterol supplementation on serum lipid levels, there is still a great deal of debate regarding the benefits of this intervention in the management of dyslipidemia. Therefore, we aimed at clarifying this dilemma by conducting the present umbrella review of interventional meta-analyses. Scopus, PubMed, Web of Science, and EMBASE were used to search for pertinent publications on the effect of phytosterol supplementation on the lipid profile in humans up to June 2023. To compute the overall effect size (ES) and confidence intervals (CI), the random-effects model was used. The I2 statistic and Cochrane's Q-test were applied to estimate the heterogeneity among the studies. Seventeen meta-analyses with 23 study arms were included in the umbrella meta-analysis. Data pooled from the 23 eligible arms revealed that phytosterol supplementation reduces low-density lipoprotein cholesterol (LDL-C) (ES = -11.47 mg/dL; 95% CI: -12.76, -10.17, p < 0.001), total cholesterol (TC) (ES = -13.02 mg/dL; 95% CI: -15.68, -10.37, p < 0.001), and triglyceride (TG) (ES = -3.77 mg/dL; 95% CI: -6.04, -1.51, p = 0.001). Subgroup analyses showed that phytosterol administration with dosage ≥2 g/day and duration over 8 weeks and in hypercholesterolemic subjects was more likely to decrease LDL-C, TC, and TG. Phytosterol administration did not significantly modify HDL-C (ES = 0.18 mg/dL; 95% CI: -0.13, -0.51, p = 258) levels when compared to controls. The present umbrella meta-analysis confirms that phytosterol administration significantly reduces LDL-C, TC, and TG, with a greater effect with doses of ≥2 g/day and treatment duration >8 weeks, suggesting its possible application as a complementary therapy for cardiovascular risk reduction. Further studies are needed to determine the efficacy of phytosterols in patients with specific health conditions, as well as to ascertain the adverse effects, the maximum tolerable dose, and the maximum recommended duration of phytosterol administration.

Health outcomes associated with phytosterols: An umbrella review of systematic reviews and meta-analyses of randomized controlled trials

BACKGROUND

Phytosterols (PS), as a kind of plant active ingredients, have many benefits to human health. However, there is currently no comprehensive overview of the clinical evidence and an assessment of the evidence quality.

PURPOSE

We conducted an umbrella review, which incorporated verification spanning a number of meta-analyses and systematic reviews to clarify the link that existed between PS consuming and health outcomes.

METHODS

The databases PubMed, Embase, Web of Science and The Cochrane Library were searched for appropriate research and ultimately included 23 articles involving 79 results. Methodological quality and the validity of evidence received designation in the included meta-analyses leveraging the Assessment of Multiple Systematic Reviews (AMSTAR-2) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).

RESULTS

The consumption of PS makes a contribution to the alleviation of metabolic conditions such as hypercholesterolemia, diabetes, obesity, and hypertension. Its most essential function is to decrease cholesterol absorption, leading to dramatically reductions in total cholesterol and low density lipoprotein cholesterol. Furthermore, utilizing PS products can have a favorable impact on managing apolipoprotein levels along with decreasing the probability of obtaining atherosclerotic cardiovascular disease.

CONCLUSION

This umbrella review summarized a range of beneficial functions of PS to humans, highlighting the promising potential for the development of PS into functional foods.

Lipoprotein (a) as a predictor of diabetic retinopathy in patients with type 2 diabetes: A systematic review

BACKGROUND

Lipoprotein a (LP(a)), an LDL-like lipoprotein, known as a risk factor for cardiovascular diseases, has a controversial association with diabetic retinopathy in patients with type 2 diabetes-the current systematic review aimed to critically assess the association between LP(a) and diabetic retinopathy.

METHODS

A systematic review of relevant studies was conducted after a thorough search in PubMed, Scopus, and Google Scholar electronic databases. We used English observational, case-control, and prospective cohort studies published up to August 2022, including type 2 diabetic patients as the population, diabetic retinopathy as the outcome, and LP(a) as the intervention.

RESULT

17 relevant studies, including 4688 patients with diabetes, were included in this systematic review. While in 13 studies, Lipoprotein(a) was recognized as a risk factor for diabetic retinopathy, only three studies reported no evidence of a relationship between the two. Also, another study showed a mixed outcome of the relationship between LP(a) and diabetic retinopathy.

CONCLUSION

High serum lipoprotein(a) in patients with type 2 diabetes is considered a risk factor for diabetic retinopathy. However, further large-scaled cohort studies are still required to validate this finding.

The Effect of Dietary Supplementation with Plant Sterols on Total and LDL-Cholesterol in Plasma Is Affected by Adherence to Mediterranean Diet: Insights from the DESCO Randomized Clinical Study

Plant sterols are well-known natural lipid-lowering agents. The DESCO (Diet and plant sterols in the control of cholesterolemia) study was a single-center, randomized, double-blind, placebo-controlled, two-way crossover clinical trial designed to investigate the effect of a once-a-day ready-to-drink dietary supplement containing 2.5 g of phytosterols on the lipid profile, also in relation to the quality of the diet, in a cohort of 50 Italian individuals with polygenic hypercholesterolemia and low global cardiovascular risk. Eligible individuals were enrolled in a run-in period of 2 weeks. Then, participants who qualified for continuation in the study were randomly allocated (1:1) to a 3-week treatment with either phytosterols or placebo. After a 2-week washout period, enrolled individuals were crossed over to receive the alternative treatment. Dietary supplementation with phytosterols was associated with significant improvement in plasma levels of total cholesterol (TC; -11.8 ± 4.0 mg/dL, p = 0.016), low-density lipoprotein cholesterol (LDL-C; -7.8 ± 7.7 mg/dL, p = 0.021), and apolipoprotein B-100 (Apo B-100, -3.7 ± 4.1 mg/dL, p = 0.048) compared to baseline. The changes in TC and LDL-C were also significant compared to placebo, and greater adherence to the Mediterranean diet was significantly associated with greater reductions in LDL-C. Dietary supplementation with phytosterols was well tolerated and adherence to treatment was high. According to the findings of DESCO, the once-a-day ready-to-drink dietary supplement we tested is able to quickly and significantly decrease plasma levels of TC, LDL-C, and Apo B-100, with a greater effect in individuals more adhering to the Mediterranean dietary pattern.

Functional foods and nutraceuticals in the treatment of hypercholesterolemia: Statement of the Spanish Society of Arteriosclerosis 2023

In the management of hypercholesterolemia, besides advising a healthy, plant-based diet, it may be useful to recommend functional foods or nutraceutical with cholesterol-lowering properties. Given the progressive increase in the number of these products and their rising use by the population, the Spanish Society of Arteriosclerosis (SEA) has considered it appropriate to review the available information, select the results of the scientifically more robust studies and take a position on their usefulness, to recommend to health professionals and the general population their potential utility in terms of efficacy and their possible benefits and limitations. The following clinical scenarios have been identified in which these products could be used and will be analyzed in more detail in this document: (1) Hypolipidemic treatment in subjects with statin intolerance. (2) Hypolipidemic treatment «a la carte» in individuals in primary prevention. (3) Long-term cardiovascular prevention in individuals with no indication for lipid-lowering therapy. (4) Patients with optimized lipid-lowering treatment who do not achieve therapeutic objectives.

Designing healthier plant-based foods: Fortification, digestion, and bioavailability

Many consumers are incorporating more plant-based foods into their diets as a result of concerns about the environmental, ethical, and health impacts of animal sourced foods like meat, seafood, egg, and dairy products. Foods derived from animals negatively impact the environment by increasing greenhouse gas emissions, land use, water use, pollution, deforestation, and biodiversity loss. The livestock industry confines and slaughters billions of livestock animals each year. There are concerns about the negative impacts of some animal sourced foods, such as red meat and processed meat, on human health. The livestock industry is a major user of antibiotics, which is leading to a rise in the resistance of several pathogenic microorganisms to antibiotics. It is often assumed that a plant-based diet is healthier than one containing more animal sourced foods, but this is not necessarily the case. Eating more fresh fruits, vegetables, nuts, and whole grain cereals has been linked to improved health outcomes but it is unclear whether next-generation plant-based foods, such as meat, seafood, egg, and dairy analogs are healthier than the products they are designed to replace. Many of these new products are highly processed foods that contain high levels of saturated fat, sugar, starch, and salt, and low levels of micronutrients, nutraceuticals, and dietary fibers. Moreover, they are often rapidly digested in the gastrointestinal tract because processing disrupts plant tissues and releases the macronutrients. Consequently, it is important to formulate plant-based foods to reduce the levels of nutrients linked to adverse health effects and increase the levels linked to beneficial health effects. Moreover, it is important to design the food matrix so that the macronutrients are not digested and absorbed too quickly, but the micronutrients are highly bioavailable. In this article, we discuss how next-generation plant-based foods can be made healthier by controlling their nutrient profile, digestibility, and bioavailability.

The effects of vegetarian diets on glycemia and lipid parameters in adult patients with overweight and obesity: a systematic review and meta-analysis

Several randomized controlled trials have reported the effects of vegetarian diets on blood lipids and glucose homeostasis in adults, but not in overweight or obese individuals. Thus, the purpose of this study was to evaluate the effects of vegetarian diets on blood lipids and glucose homeostasis in overweight or obese adults by systematic review and meta-analysis. We searched Medline, Embase, and the Cochrane Library through October 2021. We chose to include overweight or obese patients in the studies of the vegetarian diet for metabolic control. Seven trials with a total of 783 overweight or obese adult were included in the meta-analysis. The analysis of the data revealed that the vegetarian diets significantly reduced low-density lipoprotein cholesterol (LDL-C) (WMD, -0.31; 95% CI, -0.46 to -0.16), total cholesterol (TC) (WMD, -0.37; 95% CI, -0.52 to -0.22), and HbA1c (WMD (%), -0.33; 95% CI, -0.55 to -0.11). The vegetarian diets had an elevated effect on blood triglycerides (WMD, 0.29; 95% CI, 0.11-0.47). However, there were no significant effects of vegetarian diets on high-density lipoprotein cholesterol (HDLC), Fasting plasma glucose(FPG), and HOMA-IR in these individuals. The results of this study suggest that vegetarian diets effectively reduce LDL-C, TC, and HbA1c levels, thus functioning as a promising therapeutic strategy for improving the metabolic dysfunction in overweight or obese individuals. However, further large-scale clinical trials are required to confirm the validity of these findings.

Therapeutic Properties and Use of Extra Virgin Olive Oil in Clinical Nutrition: A Narrative Review and Literature Update

Extra virgin olive oil (EVOO) is a cornerstone of the Mediterranean diet (MedD). In this narrative review, we synthesize and illustrate the various characteristics and clinical applications of EVOO and its components—such as oleic acid, hydroxytyrosol, and oleuropein—in the field of clinical nutrition and dietetics. The evidence is split into diet therapy, oleic acid-based enteral nutrition formulations and oral supplementation formulations, oleic acid-based parenteral nutrition, and nutraceutical supplementation of minor components of EVOO. EVOO has diverse beneficial health properties, and current evidence supports the use of whole EVOO in diet therapy and the supplementation of its minor components to improve cardiovascular health, lipoprotein metabolism, and diabetes mellitus in clinical nutrition. Nevertheless, more intervention studies in humans are needed to chisel specific recommendations for its therapeutic use through different formulations in other specific diseases and clinical populations.

A systematic review and meta-analysis on the impact of oral vitamin E supplementation on apolipoproteins A1 and B100

BACKGROUND AND AIM

Cardiovascular diseases (CVDs) are the number one cause of mortality worldwide. Apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), and ApoB/ApoA1 ratio are considered as predictors of CVD alongside with lipid profile. Evidence suggest that nutrients with antioxidant properties, especially vitamin E, are essential for a healthy cardiovascular system. The aim of present meta-analysis was to determine the effect alpha-tocopherol on ApoA1 and ApoB levels.

METHODS

PubMed-Medline and SCOPUS databases and Google Scholar were searched up to July 2021. Random-effects model was employed to perform meta-analysis. In order to find heterogeneity sources, subgroup analysis was performed. Trim and fill analysis was performed in case of presence of publication bias. Quality assessment was performed using Cochrane Collaboration's tool.

RESULTS

Seven eligible studies, involving 1284 individuals were included. Mean age of participants ranged between 25.4 and 59 years. There was no significant effect of vitamin E supplementation on Apo A1 (SMD = 0.22 IU/d; 95% CI: -0.38, 0.28; P = 0.481) and Apo B levels (SMD = -0.62 IU/d; 95% CI: -1.94, 0.70; P = 0.360).

CONCLUSION

No remarkable effect of vitamin E supplementation was observed on ApoA1 and ApoB levels in adults. Additional studies investigating the influence of vitamin E on apolipoproteins as primary outcome with larger sample size are suggested.

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.

Dietary Bioactive Lipids: A Review on Absorption, Metabolism, and Health Properties

Dietary lipids are an indispensable source of energy and nutrition in human life. Numerous studies have shown that dietary bioactive lipids have many health benefits, including prevention or treatment of chronic diseases. The different chemical compositions and structural characteristics of bioactive lipids not only affect their digestion, absorption, and metabolism but also affect their health properties. In this review, the major dietary bioactive lipids (fatty acids, carotenoids, phytosterols, phenolic lipids, fat-soluble vitamins, and sphingomyelins) in foods are systematically summarized, from the aspects of composition, digestion, absorption, metabolism, source, structural characteristics, and their health properties. In particular, the relationship between the compositional and structural changes of bioactive lipids and their absorption and metabolism is discussed as well as their effect on health properties. This review provides a comprehensive summary toward health properties of dietary bioactive lipids.

Phytonutrient supplements and metabolic biomarkers of cardiovascular disease: An umbrella review of meta-analyses of clinical trials

Phytonutrients exert several pharmacological effects on humans. In this study, we performed an umbrella review of the association of phytonutrient supplements (PNSs) with biomarkers of cardiovascular disease. Relevant published systematic reviews and meta-analyses of clinical trials were identified by searching PubMed, Embase, and Cochrane Library until July 4, 2020. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) for summarized effects and I² statistics of heterogeneity were extracted from individual studies or reanalyzed using a random-effects model. Of the 50 included studies, pooled effects of PNSs on blood pressure, lipid profiles, and glycemic control were reported in 16, 25, and 14 articles, respectively. The findings appeared to be highly heterogeneous among individual trials of included systematic reviews and meta-analyses. Ginger (WMD = -6.36 mmHg, 95% CI = -11.27, -1.46) and Hibiscus sabdariffa (WMD = -7.58 mmHg, 95% CI = -9.69, -5.46) were associated with lowered systolic blood pressure, whereas Aloe vera, Nigella sativa, and spirulina were associated with beneficial effects on both lipid profiles and glycemic control. In summary, this umbrella review has provided up-to-date evidence for the effect of PNSs on biomarkers related to hypertension, dyslipidemia, and diabetes. The results must be interpreted with caution due to potential heterogeneity.

How should we judge edible oils and fats? An umbrella review of the health effects of nutrient and bioactive components found in edible oils and fats

Dietary guidelines for many Western countries base their edible oil and fat recommendations solely on saturated fatty acid content. This study aims to demonstrate which nutritional and bioactive components make up commonly consumed edible oils and fats; and explore the health effects and strength of evidence for key nutritional and bioactive components of edible oils. An umbrella review was conducted in several stages. Food composition databases of Australia and the United States of America, and studies were examined to profile nutrient and bioactive content of edible oils and fats. PUBMED and Cochrane databases were searched for umbrella reviews, systematic literature reviews of randomized controlled trials or cohort studies, individual randomized controlled trials, and individual cohort studies to examine the effect of the nutrient or bioactive on high-burden chronic diseases (cardiovascular disease, type 2 diabetes mellitus, obesity, cancer, mental illness, cognitive impairment). Substantial systematic literature review evidence was identified for fatty acid categories, tocopherols, biophenols, and phytosterols. Insufficient evidence was identified for squalene. The evidence supports high mono- and polyunsaturated fatty acid compositions, total biophenol content, phytosterols, and possibly high α-tocopherol content as having beneficial effects on high-burden health comes. Future dietary guidelines should use a more sophisticated approach to judge edible oils beyond saturated fatty acid content.

Association Between Lipoprotein (A) and Diabetic Nephropathy in Patients With Type 2 Diabetes Mellitus: A Meta-Analysis

BACKGROUND

Lipoprotein (a) [Lp (a)] has been well recognized as a risk factor of cardiovascular disease. However, the association between serum Lp (a) and diabetic nephropathy in patients with type 2 diabetes mellitus (T2DM) remains unknown. We performed a meta-analysis to comprehensively evaluate the above association.

METHODS

Observational studies aiming to evaluate the independent association between serum Lp (a) and diabetic nephropathy in T2DM patients were identified by systematic search of PubMed and Embase databases. A random-effect model which incorporated the potential intra-study heterogeneity was used for the meta-analysis.

RESULTS

Eleven observational studies with 9304 T2DM patients were included. Results showed that compared to those with the lowest Lp (a), patients with the highest Lp (a) level had higher odds of diabetic nephropathy (adjusted odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.25-2.14, I² = 54%, P < 0.001). Meta-analysis of studies in which Lp (a) was presented as continuous variables showed consistent result (adjusted OR: 1.13 for 1 mg/dl increment of Lp (a), 95% CI: 1.03-1.24, I2 = 36%, P = 0.008). Subgroup analyses showed that study characteristics such as definitions of diabetic nephropathy and study design did not significantly affect the association (P for subgroup difference all > 0.05).

CONCLUSIONS

Higher serum Lp (a) in patients with T2DM is independently associated with higher odds of diabetic nephropathy. Large scale prospective cohort studies are needed to validate this finding. Moreover, the potential influence of Lp (a) lowering on renal function in T2DM patients may be further investigated.

The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk

Convincing evidence supports the intake of specific food components, food groups, or whole dietary patterns to positively influence dyslipidemia and to lower risk of cardiovascular diseases (CVD). Specific macro- and micro-components of a predominantly plant-based dietary pattern are vegetable fats, dietary fibers, and phytonutrients such as phytosterols. This review summarizes the current knowledge regarding effects of these components on lowering blood lipids, i.e., low-density lipoprotein cholesterol (LDL-C) and on reducing CVD risk. The beneficial role of a plant-based diet on cardiovascular (CV) health has increasingly been recognized. Plant-based dietary patterns include a Mediterranean and Nordic diet pattern, the dietary approaches to stop hypertension (DASH), and Portfolio diet, as well as vegetarian- or vegan-type diet patterns. These diets have all been found to lower CVD-related risk factors like blood LDL-C, and observational study evidence supports their role in lowering CVD risk. These diet patterns are not only beneficial for dyslipidemia management and prevention of CVD but further contribute to reducing the impact of food choices on environmental degradation. Hence, the CV health benefits of a predominantly plant-based diet as a healthy and environmentally sustainable eating pattern are today recommended by many food-based dietary as well as clinical practice guidelines.

The effect of barberry (Berberis vulgaris L.) on glycemic indices: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We performed a meta-analysis to evaluate the efficacy of barberry (Berberis vulgaris L.) supplementation on glycemic indices in adults.

METHODS

A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and ISI Web of Science from inception up to January 2020, to identify randomized controlled trials (RCTs) investigating the effect of barberry supplementation on glycemic markers including fasting blood sugar (FBS) concentrations, insulin levels, homeostatic model assessment for insulin resistance (HOMA-IR), and glycosylated hemoglobin (HbA1c) percentage. The results of this meta-analysis were reported, based on the random effects model.

RESULTS

In total, 7 studies, comprising 452 participants, were included in the systematic review. The meta-analysis revealed that barberry significantly reduces insulin levels (Hedges's: -0.67; 95% CI: -1.31 to -0.03, P = 0.04, I² = 73.3%). However, no considerable changes was observed for FBS levels (WMD: -8.06 mg/dL; 95% CI: -20.46 to 4.33, P = 0.23, I² = 96.1%), HbA1c percentage (WMD: -0.83 %; 95% CI: -2.33 to 0.67, P = 0.27, I² = 88.3%), and HOMA-IR index (WMD: -0.55; 95% CI: -1.60 to 0.50, P = 0.30, I² = 99.4%).

CONCLUSION

The present study suggests that although barberry supplementation significantly improves insulin levels; however, other glycemic indices might not be affected. However, more high-quality RCTs with longer duration are needed to further clarify the effects of barberry on blood glucose control, especially among patients with diabetes.

Effects of Phytosterols supplementation on blood glucose, glycosylated hemoglobin (HbA1c) and insulin levels in humans: a systematic review and meta-analysis of randomized controlled trials

Background

In the literature, there are still controversies regarding the effect of phytosterol(PS) supplementation on fasting blood sugar (FBS), insulin levels and glycosylated hemoglobin (HbA1c) in humans. We aimed to assess the impact of PS supplementation on FBS, HbA1c and insulin levels by conducting a systematic review and meta-analysis of the available randomized controlled trials (RCTs).

Methods

A comprehensive search was conducted to identify all RCTs published up to May 2019 in the following databases: PubMed-MEDLINE, Web of Science, Cochrane Library and Scopus. The mean difference with 95% confidence intervals (CIs) was pooled using a random-effects model (DerSimonian-Laird method).

Results

Twenty-six arms from 20 RCTs were included in the present meta-analysis. Our findings show that PS supplementation decreases insulin levels (mean difference [MD]: -6.426 μU/ml, 95% CI: -7.187, -5.665, P- value = 0.000). However, PS supplementation did not have significant effects on FBS and HbA1c levels. Following PS supplementation, significant changes in FBS (mean difference [MD]: -1.942 mg/dl, 95% CI: -3.637, -0.246, P- value = 0.025) and HbA1c (mean difference [MD]: -0.059%, 95% CI: -0.114, -0.004, P- value = 0.035) based on PS dosage (mg/d) were recorded.

Conclusions

In patients with a baseline BMI <25 kg/m², PS consumption significantly increased FBS levels. Patients who consumed 1-2 g/day of PS had a lower FBS and lower HbA1c levels.

Effects of cardamom supplementation on lipid profile: A systematic review and meta-analysis of randomized controlled clinical trials

Cardiovascular disease is a highly prevalent issue worldwide and one of its main manifestations, dyslipidemia, needs more attention. Recent studies have suggested that cardamom has favorable effects beyond lipid lowering, but the result are contradictory. Our objective was to conduct a systematic review and meta-analysis on randomized controlled trials (RCTs) that assessed the effect of cardamom on lipids. The search included PubMed, Scopus, ISI Web of Science, Google Scholar, and the Cochrane library (up to March, 2019) to identify RCTs investigating the effects of cardamom supplementation on serum lipid parameters. Weighted mean differences (WMDs) were pooled using a random-effect model. Meta-analysis of data from five eligible RCTs showed that cardamom supplementation did not significantly change the concentrations of total cholesterol (WMD: -6.11 mg/dl, 95% CI [-13.06, 0.83], I² = 0.0%), low-density lipoprotein cholesterol (WMD: -4.31 mg/dl, 95% CI [-9.75, 1.13], I² = 0.0%), or high-density lipoprotein cholesterol (WMD: 1.75 mg/dl, 95% CI [-1.95 to 5.46], I² = 71.4%). However, a significant reduction was observed in serum triglyceride (TG; WMD: -20.55 mg/dl, 95% CI [-32.48, -8.63], I² = 0.0%) levels after cardamom supplementation. Cardamom might be able to change TG, but for confirming the results, more studies exclusively on dyslipidemia patients and considering the intake of lipid lowering agents as exclusion criteria are necessary.

Efficacy of l-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials

BACKGROUND AND AIM

l-carnitine has an important role in fatty acid metabolism and could therefore act as an adjuvant agent in the improvement of dyslipidemia. The purpose of present systematic review and meta-analysis was to critically assess the efficacy of l-carnitine supplementation on lipid profiles.

METHODS AND RESULTS

We performed a systematic search of all available randomized controlled trials (RCTs) in the following databases: Scopus, PubMed, ISI Web of Science, The Cochrane Library. Mean difference (MD) of any effect was calculated using a random-effects model. In total, there were 55 eligible RCTs included with 58 arms, and meta-analysis revealed that l-carnitine supplementation significantly reduced total cholesterol (TC) (56 arms-MD: -8.53 mg/dl, 95% CI: -13.46, -3.6, I²: 93%), low-density lipoprotein-cholesterol (LDL-C) (47 arms-MD: -5.48 mg/dl, 95% CI: -8.49, -2.47, I²: 94.5) and triglyceride (TG) (56 arms-MD: -9.44 mg/dl, 95% CI: -16.02, -2.87, I²: 91.8). It also increased high density lipoprotein-cholesterol (HDL-C) (51 arms-MD:1.64 mg/dl, 95% CI:0.54, 2.75, I²: 92.2). l-carnitine supplementation reduced TC in non-linear fashion based on dosage (r = 21.11). Meta-regression analysis indicated a linear relationship between dose of l-carnitine and absolute change in TC (p = 0.029) and LDL-C (p = 0.013). Subgroup analyses showed that l-carnitine supplementation did not change TC, LDL-C and TG in patients under hemodialysis treatment. Intravenous l-carnitine and lower doses (>2 g/day) had no effect on TC, LDL-C and triglycerides.

CONCLUSION

l-carnitine supplementation at doses above 2 g/d has favorable effects on patients' lipid profiles, but is modulated on participant health and route of administration.