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Ghaedi K, Ghasempour D, Jowshan M, Zheng M, Ghobadi S, Jafari A. Effect of zinc supplementation in the management of type 2 diabetes: A grading of recommendations assessment, development, and evaluation-assessed, dose-response meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2023:1-12. [PMID: 37183697 DOI: 10.1080/10408398.2023.2209802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The question of whether zinc supplementation may improve cardio-metabolic health in patients with type 2 diabetes mellitus (T2DM) remains controversial and require further evaluation. This study aimed to summarize the effectiveness of oral zinc supplementation in improving cardio-metabolic risk markers in people with T2DM. We searched PubMed, Scopus, and Web of Science from inception to April 2023, for randomized controlled trials (RCTs). RCTs of type 2 diabetic adults (aged ≥18 years) comparing zinc supplementation with placebo were included. We excluded studies if not randomized, involved co-supplementation, and were conducted in children or pregnant women. Glycemic indices, lipid profiles, blood pressure, anthropometric measure, c-reactive protein (CRP), creatinine, and serum zinc were extracted. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methods. We used a random-effect model to perform the dose-response analysis. Effect sizes were presented as mean difference (MD) and 95% confidence interval (CI). 22 studies (n = 1442 participants) were included. The certainty of the evidence was rated as moderate to high. Zinc supplementation significantly reduced glycemic indices: including two-hour postprandial glucose (2hpp) (mean difference (MD): -34.34 mg/dl; 95%CI: -51.61∼ -17.07), fast blood sugar (FBS) (MD: -23.32 mg/dl; 95% CI: -33.81∼ -12.83), and hemoglobin A1c (HbA1c) (MD: -0.47; 95% CI: -0.71∼ -0.23). Zinc had a favorable effect on lipid profiles low-density lipoprotein (LDL) (MD: -10.76 mg/dl; CI: -17.79∼-3.73), triglyceride (TG) (MD: -18.23 mg/dl; CI: -32.81∼-3.65), total cholesterol (TC) (MD: -12.74 mg/dl; CI: -21.68∼-3.80), VLDL (MD: -5.39 mg/dl; CI: -7.35∼-3.43) and high-density lipoprotein (HDL) (MD: 4.04 mg/dl; CI: 0.96 ∼ 7.12). Systolic blood pressure (SBP) (MD): -3.64 mmHg; 95% CI: -6.77∼ -0.52), weight (MD: 1.00 kg; 95% CI: 0.34∼1.66), CRP (MD: -3.37 mg/l, 95% CI: -4.05∼ -2.70), and serum zinc (MD: 15.38 µg/dl; 95% CI: 10.74∼ 20.02) changed to a statistically significant extent with zinc supplementation. There was also a linear association between additional 10 mg/d zinc treatment with FBS, HbA1c, HDL, LDL, TG, TC, and serum zinc. A non-linear dose-response gradient was seen for FBS, HDL, and SBP (p < 0.05). Egger's test showed no substantial publication bias. Our findings strongly suggest a potential beneficial effect of zinc supplementation on type 2 diabetic patients. Further high-quality research is needed to determine the optimal form, dosage, and duration of zinc supplementation for this population.
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Affiliation(s)
- Kimia Ghaedi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dorsa Ghasempour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Jowshan
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Saeed Ghobadi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - Alireza Jafari
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Hosseini R, Karajibani M, Montazerifar F, Shahraki E, Babakhani K, Mohammad Mokhtari A, Sahebkar A. The impact of zinc supplementation on galectin-3 and metabolic markers in diabetic patients on hemodialysis: A randomized, double-blind, placebo-controlled trial. J Diabetes Metab Disord 2022; 21:743-750. [PMID: 35673488 PMCID: PMC9167385 DOI: 10.1007/s40200-022-01044-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/15/2022] [Indexed: 11/25/2022]
Abstract
Purpose There is little information about the association between zinc sulfate (ZnSO4) supplementation and metabolic profiles in zinc-deficient diabetic patients on hemodialysis (DHPs). Therefore, we aimed to investigate the association between ZnSO4 supplementation and serum levels of galectin-3 (Gal-3) and cardiometabolic parameters in zinc-deficient DHPs. Methods In the present randomized double-blind placebo-controlled clinical trial, 46 zinc-deficient DHPs (35-62 years) were included and assigned to receive either 220 mg/d ZnSO4 or placebo for 8 weeks. Serum levels of Gal-3, lipid profile, and blood pressure (BP) were assessed at baseline and the end of trial. Results We found a significant effect of ZnSO4 intake on the reduction of serum Gal-3 (P = < 0.001), triglycerides (P = < 0.001), total cholesterol (P = < 0.001), low-density lipoprotein cholesterol (P = < 0.001) and increased high-density lipoprotein cholesterol (P = < 0.001) as compared to the control group. Additionally, systolic blood pressure (SBP) (P = 0.006) and diastolic blood pressure (DBP) (P = 0.01) were significantly reduced following 8 weeks of ZnSO4 supplementation. Conclusion Taken together, 220 mg ZnSO4 supplementation per day for 8 weeks among zinc-deficient DHPs had beneficial effects on Gal-3 and metabolic profiles. Iranian Registry of Clinical Trials Identifier IRCT20191217045765N1, date of registration: 2020-02-09.
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Affiliation(s)
- Razieh Hosseini
- Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mansour Karajibani
- Health Promotion Research Center, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Farzaneh Montazerifar
- Pregnancy Health Research Center, Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Elham Shahraki
- Genetics of Non-Communicable Disease Research Center, Department of Nephrology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Khatereh Babakhani
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Ali Mohammad Mokhtari
- Department of Epidemiology and Biostatistics, School of Health, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Mousavi SM, Mofrad MD, do Nascimento IJB, Milajerdi A, Mokhtari T, Esmaillzadeh A. The effect of zinc supplementation on blood pressure: a systematic review and dose-response meta-analysis of randomized-controlled trials. Eur J Nutr 2020; 59:1815-1827. [PMID: 32090294 DOI: 10.1007/s00394-020-02204-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Despite previous investigations on the effects of zinc supplementation on blood pressure, inconsistent findings are available in this regard. Therefore, we conducted a systematic review and meta-analysis of randomized clinical trials on the effects of zinc supplementation on blood pressure (BP) in adults. METHODS Relevant studies published up to September 2019 were searched through PubMed/Medline, Scopus, ISI Web of Science, and Google Scholar using suitable keywords. All randomized clinical trials (RCTs) that examined the effect of oral zinc supplementation on systolic blood pressure (SBP) or diastolic blood pressure (DBP) in adults were included. RESULTS Overall, nine trials were included in our study. Zinc supplementation significantly reduced SBP compared to the control [weighted mean differences (WMD) - 1.49 mmHg; 95% CI - 2.85 to - 0.13; P = 0.03]. However, zinc supplementation had no significant effects on DBP (WMD - 0.88 mmHg; 95% CI - 2.04 to 0.29; P = 0.14). Nonlinear analysis failed to indicate a significant influence of supplementation dosage or duration on both SBP and DBP. Sensitivity analysis showed that no individual study had a significant impact on our final results. In addition, we found no evidence for the presence of small-study effects among studies for both SBP and DBP. CONCLUSION We found a significant reduction in SBP following zinc supplementation. However, zinc supplementation had no significant effect on DBP. In addition, no nonlinear association was found between supplementation dosage and duration with changes in both SBP and DBP. Further RCTs using different dosages of zinc in various durations are required to confirm our conclusion.
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Affiliation(s)
- Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Manije Darooghegi Mofrad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | | | - Alireza Milajerdi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - Tahereh Mokhtari
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, USA
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran. .,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular, Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Kovacevic S, Ivanov M, Miloradovic Z, Brkic P, Vajic UJ, Zivotic M, Mihailovic-Stanojevic N, Jovovic D, Karanovic D, Jeremic R, Nesovic-Ostojic J. Hyperbaric oxygen preconditioning and the role of NADPH oxidase inhibition in postischemic acute kidney injury induced in spontaneously hypertensive rats. PLoS One 2020; 15:e0226974. [PMID: 31914135 PMCID: PMC6948727 DOI: 10.1371/journal.pone.0226974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI) and hypertension might contribute to the increased incidence of AKI. The purpose of this study was to investigate the effects of single and combined hyperbaric oxygen (HBO) preconditioning and NADPH oxidase inhibition on oxidative stress, kidney function and structure in spontaneously hypertensive rats (SHR) after renal ischemia reperfusion injury. HBO preconditioning was performed by exposing to pure oxygen (2.026 bar) twice a day for two consecutive days for 60 minutes, and 24h before AKI induction. For AKI induction, the right kidney was removed and ischemia was performed by clamping the left renal artery for 45 minutes. NADPH oxidase inhibition was induced by apocynin (40 mg/kg b.m., intravenously) 5 minutes before reperfusion. AKI significantly increased renal vascular resistance and reduced renal blood flow, which were significantly improved after apocynin treatment. Also, HBO preconditioning, with or without apocynin treatment showed improvement on renal hemodynamics. AKI significantly increased plasma creatinine, urea, phosphate levels and lipid peroxidation in plasma. Remarkable improvement, with decrease in creatinine, urea and phosphate levels was observed in all treated groups. HBO preconditioning, solitary or with apocynin treatment decreased lipid peroxidation in plasma caused by AKI induction. Also, combined with apocynin, it increased catalase activity and solitary, glutathione reductase enzyme activity in erythrocytes. While AKI induction significantly increased plasma KIM– 1 levels, HBO preconditioning, solitary or with apocynin decreased its levels. Considering renal morphology, significant morphological alterations present after AKI induction were significantly improved in all treated groups with reduced tubular dilatation, tubular necrosis in the cortico-medullary zone and PAS positive cast formation. Our results reveal that NADPH oxidase inhibition and hyperbaric oxygen preconditioning, with or without NADPH oxidase inhibition may have beneficial effects, but their protective role should be evaluated in further studies.
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Affiliation(s)
- Sanjin Kovacevic
- Department of Pathophysiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
- * E-mail: (SK); (JNO)
| | - Milan Ivanov
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Zoran Miloradovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Predrag Brkic
- Department of Medical Physiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Una Jovana Vajic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Maja Zivotic
- Department of Pathology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Nevena Mihailovic-Stanojevic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Djurdjica Jovovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Danijela Karanovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Rada Jeremic
- Department of Medical Physiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Nesovic-Ostojic
- Department of Pathophysiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
- * E-mail: (SK); (JNO)
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Ivanov M, Mihailović-Stanojević N, Marković-Lipkovski J, Jovović Đ, Karanović D, Miloradović Z, Grujić-Milanović J. Combined Angiotensin II Type-1 Receptor Blockade and Superoxide Anion Scavenging Affect the Post-Ischemic Kidney in Hypertensive Rats. ACTA VET-BEOGRAD 2016. [DOI: 10.1515/acve-2016-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Ischemic acute kidney injury is characterized by renal vasoconstriction, filtration failure, tubular obstruction, tubular backleak and overproduction of angiotensin II and reactive oxygen species. Considering this complexity, the aim of our study was to investigate the effects of angiotensin II type-1 receptor blocker - Losartan and superoxide anion scavenger - Tempol, in a combined treatment on acute kidney injury in postischemic hypertensive rats.
The experiment was performed in anesthetized, adult male spontaneously hypertensive rats. The right kidney was removed and the left renal artery was occluded for 40 minutes. Experimental groups received combined treatment (Losartan + Tempol) or saline in the femoral vein 5 minutes before, during and 175 minutes after clamp removal.
Hemodynamics and biochemical parameters were measured and kidney specimens were collected 24h after reperfusion. Histological examination was performed by optical microscopy.
Combined treatment improves renal haemodynamics parameters which were exacerbated due to acute kidney injury. Acute kidney injury significantly decreased creatinine and urea clearance and increased lipid peroxidation in the plasma. Treatment with Losartan and Tempol induced a significant increase of creatinine and urea clearance. Lipid peroxidation in the plasma decreased and glutathione peroxidase enzyme activity in the erythrocytes increased after Losartan + Tempol treatment. This combined treatment reduced cortico-medullary necrosis and tubular dilatation in the kidney.
Our results indicate that synergism of Losartan and Tempol treatment could have beneficial effects on blood pressure and kidney function, during postischemic acute kidney injury development in experimental hypertension.
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Affiliation(s)
- Milan Ivanov
- Institute for Medical Research University of Belgrade, Belgrade, Serbia
| | | | | | - Đurđica Jovović
- Institute for Medical Research University of Belgrade, Belgrade, Serbia
| | | | - Zoran Miloradović
- Institute for Medical Research University of Belgrade, Belgrade, Serbia
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