Effects of Momordica charantia L on blood pressure: a systematic review and meta- analysis of randomized clinical trials

Sociocultural perceptions of physical activity and dietary habits for hypertension control: voices from adults in a rural sub-district of South Africa

BACKGROUND

Over half of adults from rural South Africa are hypertensive. Apart from pharmaceutical treatment, lifestyle changes such as increasing physical activity and reducing dietary salt have been strongly advocated for the control of hypertension. However, the control rates of hypertension for adults in rural South Africa are low. In this paper we explore whether this is due to the recommended lifestyle intervention not aligning with the individual's socio-cultural determinants of behaviour change.

AIM

To explore the social and cultural beliefs, perceptions and practices regarding physical activity and diet as a hypertension control intervention on hypertensive adults living in a rural sub-district in South Africa.

METHODS

Nine focus group discussions were conducted with hypertensive adults aged 40 years and above from Bushbuckridge sub-district in Mpumalanga Province of South Africa using a semi-structured interview guide. Each session began with introductions of the discussion theme followed by a short discussion on what the participants know about hypertension and the normal blood pressure readings. Physical activity and dietary habits were then introduced as the main subject of discussion. Probing questions were used to get more insight on a specific topic. A thematic analysis approach was used to generate codes, categories, and themes. A manual approach to data analysis was chosen and data obtained through transcripts were analysed inductively.

FINDINGS

Participants had a lack of knowledge about blood pressure normal values. Perceived causes of hypertension were alluded to psychosocial factors such as family and emotional-related issues. Physical activity practices were influenced by family and community members' attitudes and gender roles. Factors which influenced dietary practices mainly involved affordability and availability of food. To control their hypertension, participants recommend eating certain foods, emotional control, taking medication, exercising, praying, correct food preparation, and performing house chores.

CONCLUSION

Lifestyle interventions to control hypertension for adults in a rural South African setting using physical activity promotion and dietary control must consider the beliefs related to hypertension control of this population.

The metabolic effect of Momordica charantia cannot be determined based on the available clinical evidence: a systematic review and meta-analysis of randomized clinical trials

Several studies have shown that Momordica charantia L. (Cucurbitaceae, bitter melon) has beneficial effects on metabolic syndrome (MetS) parameters and exerts antidiabetic, anti-hyperlipidemic, and anti-obesity activities. Since the findings of these studies are contradictory, the goal of this systematic review and meta-analysis was to assess the efficacy of bitter melon in the treatment of metabolic syndrome, with special emphasis on the anti-diabetic effect. Embase, Cochrane, PubMed, and Web of Science databases were searched for randomized controlled human trials (RCTs). The meta-analysis was reported according to the PRISMA statement. The primary outcomes of the review are body weight, BMI, fasting blood glucose, glycated hemoglobin A1c, systolic blood pressure, diastolic blood pressure, serum triglyceride, HDL, LDL, and total cholesterol levels. Nine studies were included in the meta-analysis with 414 patients in total and 4-16 weeks of follow-up. In case of the meta-analysis of change scores, no significant effect could be observed for bitter melon treatment over placebo on fasting blood glucose level (MD = -0.03; 95% CI: -0.38 to 0.31; I2 = 34%), HbA1c level (MD = -0.12; 95% CI: -0.35 to 0.11; I2 = 56%), HDL (MD = -0.04; 95% CI: -0.17 to 0.09; I2 = 66%), LDL (MD = -0.10; 95% CI: -0.28 to 0.08; I2 = 37%), total cholesterol (MD = -0.04; 95% CI: -0.17 to 0.09; I2 = 66%,), body weight (MD = -1.00; 95% CI: -2.59-0.59; I2 = 97%), BMI (MD = -0.42; 95% CI: -0.99-0.14; I2 = 95%), systolic blood pressure (MD = 1.01; 95% CI: -1.07-3.09; I2 = 0%) and diastolic blood pressure levels (MD = 0.24; 95% CI: -1.04-1.53; I2 = 0%). Momordica treatment was not associated with a notable change in ALT, AST, and creatinine levels compared to the placebo, which supports the safety of this plant. However, the power was overall low and the meta-analyzed studies were also too short to reliably detect long-term metabolic effects. This highlights the need for additional research into this plant in carefully planned clinical trials of longer duration.

The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies

High blood pressure (BP) is a major pathological risk factor for the development of several cardiovascular diseases. Diet is a key modifier of BP, but the underlying relationships are not clearly demonstrated. This is an umbrella review of published meta-analyses to critically evaluate the wide range of dietary evidence from bioactive compounds to dietary patterns on BP and risk of hypertension. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception until October 31, 2021, for relevant meta-analyses of randomized controlled trials or meta-analyses of observational studies. A total of 175 publications reporting 341 meta-analyses of randomized controlled trials (145 publications) and 70 meta-analyses of observational studies (30 publications) were included in the review. The methodological quality of the included publications was assessed using Assessment of Multiple Systematic Reviews 2 and the evidence quality of each selected meta-analysis was assessed using NutriGrade. This umbrella review supports recommended public health guidelines for prevention and control of hypertension. Dietary patterns including the Dietary Approaches to Stop Hypertension and the Mediterranean-type diets that further restrict sodium, and moderate alcohol intake are advised. To produce high-quality evidence and substantiate strong recommendations, future research should address areas where the low quality of evidence was observed (for example, intake of dietary fiber, fish, egg, meat, dairy products, fruit juice, and nuts) and emphasize focus on dietary factors not yet conclusively investigated.

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

This systematic review aimed to gather data on the effects of sumac supplementation on lipid profile. A systematic literature search was carried out using electronic databases (PubMed, Scopus, and Web of Science) up to March 2023 to identify eligible randomized controlled trials (RCTs) assessing the effects of sumac intake on lipid profile as an outcome. All participants enrolled in our study were adult individuals who consumed sumac, in various forms, as an intervention. The included articles were assessed using the Cochrane risk of bias assessment tool. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as the weighted mean difference with a 95% confidence interval. In total, seven RCTs with a total sample size of 570 subjects were included. This study found a significant decrease in total cholesterol (TC) (weighted mean difference [WMD]: -10.01 mg/dL; 95% CI: -18.67, -1.34), triglyceride (TG) (WMD: -8.52 mg/dL; 95% CI: -14.79, -2.25), and low-density lipoprotein (LDL)-C levels (WMD: -9.25 mg/dL; 95% CI: -14.56, -3.93); Moreover, a significant increase was observed in high-density lipoprotein (HDL)-C concentration (WMD: 2.97 mg/dL; 95% CI: 0.75, 5.19). The reduction in TG and TC was greater in studies with a duration of ≥12 compared to <12 weeks. The increase in HDL-C was greater in participants with an intervention duration of ≥12 compared to <12 weeks. Moreover, subgroup analysis based on the dose of sumac suggested a significant reduction in TC and LDL, specifically for doses below 3 g. Consumption of sumac significantly decreased serum TC, LDL-C, and TG concentrations. This study suggested significantly positive effects on HDL-C by intake of sumac. Longer interventions (>12 weeks) have a more favorable impact on TC, LDL-C, and HDL-C, while sumac doses below 3 g/day show greater effects on TC and LDL-C. These findings underscore the potential of sumac supplementation as a valuable approach to lipid profile management.

Ischemic Colitis in a Young Female Following Herbal Supplement Ingestion

Ischemic colitis is typically considered a disease of the elderly, given their atherosclerotic risk factors and other comorbidities. Ischemic colitis in the younger population is considered very uncommon. We present an interesting case of a young female presenting with abdominal pain and hematochezia found to have ischemic colitis on pathological biopsy results after a colonoscopy. She was an otherwise healthy female with no medical problems prior to her hospitalization but endorsed recent use of a bitter herbal tea to relieve her symptoms. Here, we review potential causes of ischemic colitis, including herbal remedies, which have been linked to causing hypercoagulable and hypotensive states.

GC-MS profiling and bioactivity prediction of compounds from Momordica charantia L. extract

Momordica species are vegetable crops, belonging to the family of Cucurbitaceae. For the present study plant samples of Momordica charantia were collected from different parts of Barak Valley of Assam, India. Hyphenated technique Gas Chromatography-Mass Spectroscopy (GC-MS) of the chromatographically separated components of the plant extract was performed to identify some of the principles. All the isolated compounds exhibited notable interaction with the enzyme Bone morphogenic protein upon in silico screening. All the compounds were screened in silico for toxicity and then docked with the target enzyme individually. It was found that these compounds are interacting with the target enzyme and is able to inhibit the enzyme activity more efficiently as compared to the reference ligand.