Effects of Whole-Grain Consumption on Selected Biomarkers of Systematic Inflammation: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Whole grains have potential benefits in preventing cardiovascular diseases and diabetes; nevertheless, results from randomized clinical trials (RCTs) on inflammatory markers are controversial. The aim of this meta-analysis of RCTs was to examine the effect of whole grains on inflammatory markers A systematic literature search was conducted by using the online database of PubMed, Embase, Google Scholar, and Scopus for relevant studies up to November 2017, using Medical Subject Headings and other related keywords. Only studies that compared the effects of whole grains on inflammatory markers with refined grains were included. From more than 2278 articles, 17 RCTs met the inclusion criteria and were systematically reviewed. Weighted mean differences were estimated and pooled effect size was calculated by random effects model. Thirteen RCTs with 466 participants were included in the meta-analysis. Whole-grain consumption had a significant effect on serum concentration of high-sensitivity C-reactive protein (hs-CRP; Hedges’ g: ?0.22; 95% confidence interval (CI): ?0.45, 0.00; p?=?0.047), interleukin-6 (IL-6; ?0.28?pg/mL; 95% CI: ?0.55, ?0.02; p?=?0.037) but did not result in a significant decline in serum concentration of tumor necrosis factor alpha (TNF-α; ?0.12?pg/mL; 95% CI: ?0.39, 0.15; p?=?0.396). Significant heterogeneity was observed between studies for hs-CRP (I²?=?69.0%, p?<?0.0001), IL-6 (I²?=?96.6%, p?<?0.001), and TNF-α (I²?= 95.4%, p?<?0.001). In sensitivity analysis, the effect of whole grain intake on hs-CRP, IL-6, and TNF-α was not substantially modified by the result of a single study. Meta-regression for duration showed no significant association between the duration of study and changes in serum C-reactive protein levels (β coefficient?=?0.006, standard error?=?0.036; p?=?0.870).

Conclusions: This meta-analysis of RCTs suggested that whole grains might affect health status via improving systematic inflammation.

• Key teaching points:

• We conducted a systematic review and meta-analysis of randomized controlled trials.

• Whole grains consumption was associated with lower serum levels of hs-CRP and IL-6.

• Whole grains cannot significantly decrease serum levels of TNF-α.

• We could not found any source for heterogeneity.

• The effect of whole grains on serum inflammatory biomarkers was independent from duration.

     

Role of Whole Grain Consumption in Glycaemic Control of Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Observational studies have indicated beneficial effects of whole grain consumption on human health. However, no evidence based on randomized controlled trials has been established. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials to assess the effects of whole grain consumption in glycaemic control of diabetic patients. Methods: A comprehensive search in four databases (Web of Science, Pubmed, Scopus and Cochrane library) was conducted to collect potential articles which measured the roles of whole grain consumption on glycaemic control up to October 2021. Results: A total of 16 eligible trials involving 1068 subjects were identified to evaluate the pooled effect. The overall results indicated that compared with the control group, whole grain intake presented a significantly reduced concentration in fast plasma glucose (WMD = −0.51 mmol/L, 95% CI: −0.73, −0.28; I2 = 88.6%, p < 0.001), a homeostasis model assessment of insulin resistance (WMD = −0.39 μU × mol/L², 95% CI: −0.73, −0.04; I2 = 58.4%, p = 0.014), and glycosylated haemoglobin (WMD = −0.56%, 95% CI: −0.88, −0.25, I2 = 88.5%, p < 0.001), while no significant difference was observed in fast plasma insulin level between groups (SMD = −0.05, 95% CI: −0.25, 0.14; I2 = 40.7%, p = 0.120). In terms of incremental area under the curve (iAUC), data suggested that whole grain effected a significant decrease in Glucose-iAUC (WMD = −233.09 min × mmol/L, 95% CI: −451.62, −14.57; I2 = 96.1%, p < 0.001) and Insulin-iAUC (SMD = −4.80, 95% CI: −8.36, −1.23; I2 = 89.9%, p = 0.002), although only in a small number of studies. Of note, there is evidence for modest unexplained heterogeneity in the present meta-analysis. Conclusion: Whole grain consumption confers a beneficial effect on glucose metabolism in patients with diabetes. Regrettably, since relevant studies were scarce, we failed to provide confident evidence of whole grain consumption on acute effects including Glucose-iAUC and Insulin-iAUC, which should be addressed in further trials.     

The Effects of Isocaloric Intermittent Fasting vs Daily Caloric Restriction on Weight Loss and Metabolic Risk Factors for Noncommunicable Chronic Diseases: A Systematic Review of Randomized Controlled or Comparative Trials

BackgroundIntermittent fasting (IF) has gained favor as an alternative regimen to daily caloric restriction (DCR). Therefore, there is a need for systematic reviews of randomized controlled/comparison trials examining the effects of isocaloric IF vs DCR on metabolic risk factors for noncommunicable chronic diseases.ObjectiveTo systematically investigate the effects of isocaloric IF vs DCR on metabolic risk factors for noncommunicable chronic diseases in adults with overweight and obesity.MethodsFive online databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar) were searched for articles published from January 2000 through April 2022. The updated Cochrane Risk of Bias Assessment tool for randomized controlled/comparison trials was used to assess risk of bias in the included studies. This review includes randomized controlled/comparison trials with matched energy intakes (isocaloric) between IF and DCR among adults with overweight and obesity with ≥8-week durations, that assessed risk factors related to obesity and for diabetes, cardiovascular diseases, and cancers.ResultsThirteen randomized controlled/comparison trials with matched energy intakes (isocaloric) between IF and DCR were identified. The effects of IF on weight loss and metabolic risk markers of diabetes, cardiovascular diseases, and cancers were varied but generally comparable with DCR. IF (4:3 and 5:2 diets) was superior to DCR for improving insulin sensitivity in two studies. Reductions in body fat were significantly greater with IF (5:2 diet and time-restricted eating) than DCR in two studies of isocaloric diets.ConclusionsWith matched energy intakes, IF interventions produced similar beneficial effects for weight loss and chronic disease risk factors compared with DCR. Very limited evidence suggests that IF may be more effective vs DCR for fat loss and insulin sensitivity, but conclusions cannot be drawn based on the current evidence. Future clinical studies with larger populations and longer durations are needed for further elucidation of any potential effects of IF regimens for prevention of noncommunicable chronic diseases.     

The Effect of Saffron Supplementation on Blood Pressure in Adults: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials

Background: The favorable influences of saffron supplementation on metabolic diseases have previously been shown. We aimed to assess the effects of saffron supplementation on blood pressure in adults. Methods: A systematic search was performed in Scopus, Embase, and the Cochrane library databases to find randomized controlled trials (RCTs) related to the effect of saffron supplementation on blood pressure in adults up to March 2021. The primary search yielded 182 publications, of which eight RCTs were eligible. Results: Our results showed that saffron supplementation resulted in a significant decrease in systolic blood pressure (weighted mean difference (WMD): −0.65 mmHg; 95% CI: −1.12 to −0.18, p = 0.006) and diastolic blood pressure (DBP) (WMD: −1.23 mmHg; 95% CI: −1.64 to −0.81, p < 0.001). Moreover, saffron supplementation reduced DBP in a non-linear fashion, based on duration (r = −2.45, p-nonlinearity = 0.008). Conclusions: Saffron supplementation may significantly improve both systolic and diastolic blood pressure in adults. It should be noted that the hypotensive effects of saffron supplementation were small and may not reach clinical importance.     

β-Carotene Supplementation and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

β-carotene is widely available in plant-based foods, while the efficacy of β-carotene supplementation on cardiovascular disease (CVD) risk remains controversial. Hence, we performed a systematic review and meta-analysis on randomized controlled trials to investigate the associations between β-carotene supplementation and CVD risk as well as mortality. We conducted literature searches across eight databases and screened the publications from January 1900 to March 2022 on the topic of β-carotene treatments and cardiovascular outcomes. There were 10 trials and 16 reports included in the meta-analysis with a total of 182,788 individuals enrolled in the study. Results from the random-effects models indicated that β-carotene supplementation slightly increased overall cardiovascular incidence (RR: 1.04; 95% CI: 1.00, 1.08) and was constantly associated with increased cardiovascular mortality (RR: 1.12; 95% CI: 1.04, 1.19). Subgroup analyses suggested that, when β-carotene treatments were given singly, a higher risk of cardiovascular outcomes was observed (RR: 1.06; 95% CI: 1.01, 1.12). In addition, cigarettes smoking was shown to be a risk behavior associated with increased cardiovascular incidence and mortality in the β-carotene intervention group. In sum, the evidence of this study demonstrated that β-carotene supplementation had no beneficial effects on CVD incidence and potential harmful effects on CVD mortality. Further studies on understanding the efficacy of multivitamin supplementation in nutrient-deficient or sub-optimal populations are important for developing the tolerable upper intake level for β-carotene of different age and sex groups.     

Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA_1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA_1c (MD = −0.15%; 95%-CI: −0.26, −0.05%), FG (MD = −0.53 mmol/L; 95%-CI: −0.92, −0.13 mmol/L) and FI (MD = −10.09 pmol/L; 95%-CI: −17.31, −2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial Registration: ClinicalTrials.gov registration number: {"type":"clinical-trial","attrs":{"text":"NCT02037321","term_id":"NCT02037321"}}NCT02037321.     

Whole Grains,Refined Grains,and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies

PubMed, Web of Science, and the Cochrane Database of Systematic Reviews were searched for meta-analyses that provided risk estimates (±95% confidence intervals) for associations between intakes of whole and refined grains and risk of total and site-specific cancer. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Only meta-analyses that included whole grains and refined grains as separate food groups, and not as part of dietary patterns, were included. A total of 17 publications were identified that met inclusion criteria. Within these, results from a total of 54 distinct meta-analyses were reported for whole grains and 5 meta-analyses for refined grains. For total cancer mortality, 7 meta-analyses of cohort studies indicated that whole grain intake was associated with 6% to 12% lower risk in comparison of highest vs. lowest intake groups, and 3% to 20% lower risk for doses ranging from 15 to 90 g/day. For site-specific cancers, meta-analyses indicated that whole grain intake was consistently associated with lower risks of colorectal, colon, gastric, pancreatic, and esophageal cancers. Limited data were available for refined grains, with only 4 publications providing risk estimates, and only 1 of the meta-analyses included more than 3 studies. High intake of refined grains was associated with increased risk of colon and gastric cancer. By contrast, in the only dose-response meta-analysis, each 90 g/day consumption of refined grains was associated with a 6% lower risk of total cancer. In addition to the limited number of published meta-analyses on refined grains, results were also weakened due to the fact that refined grains were frequently defined to include both staple grain foods and indulgent grain foods, and the majority of studies included in the meta-analyses provided no specific definition of refined grains. Overall, meta-analyses of cohort and case-control studies consistently demonstrate that whole grain intake is associated with lower risk of total and site-specific cancer, and support current dietary recommendations to increase whole grain consumption. By contrast, the relationship between refined grain intake and cancer risk is inconclusive.     

腹部手术患者应用生长激素的随机对照研究的系统评价

目的评价腹部手术患者围手术期应用生长激素的安全性和有效性。方法检索中国生物医学文摘数据库(CBM)、MEDLINE、EMBASE和Cochrane图书馆,收集所有相关随机对照试验,对其逐个进行质量评价,并进行Meta-分析。结果纳入18个随机对照试验,共治疗646例患者。分析结果表明,腹部手术患者围手术期应用生长激素:(1)有助于纠正负氮平衡:共有11个试验233例患者,合并后的标化均数差值(standardizedmeandifferenceSMD)为3.3795%CI2.464.27P<0.00001;(2)有助于缩短住院时间:共有3个试验218例患者,合并后的加权均数差值(weightedmeandifferenceWMD)为-2.0795%CI-3.03-1.11P<0.00001;(3)有助于减轻术后疲劳综合征的程度:共有3个试验84例患者,合并后的SMD为-1.8395%CI-2.37-1.30P<0.00001;(4)引起血糖升高:共有6个试验265例患者,合并后的WMD为0.9195%CI0.561.25P<0.00001。结论在无禁忌证的腹部手术患者围手术期应用生长激素是安全有效的,但应关注血糖的变化。进行更多、大样本、高质量的随机对照试验仍有必要。     

Fennel for Reducing Pain in Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Fennel is used as an alternative treatment for primary dysmenorrhea. This review aims to evaluate the effectiveness and safety of fennel for reducing pain in primary dysmenorrhea. Twenty databases, including English, Korean, Chinese, Japanese, Iranian, and Spanish databases, were searched from inception to 20 October 2020. All randomized controlled trials (RCTs) investigating the effectiveness of fennel for treating primary dysmenorrhea were considered. Two reviewers conducted the data extraction and risk of bias assessment independently. Any discrepancies were resolved through discussion with a third reviewer. A total of 12 studies were included in this review. The pooled results of seven trials showed that the effect of fennel is similar to that of conventional drug therapies in alleviating pain (n = 502, standardized mean difference (SMD): 0.07, 95% confidence interval(CI): −0.08 to 0.21, p < 0.37, I² = 0%). In comparison with placebo, fennel was seen to have favorable effects on reducing pain in primary dysmenorrhea (n = 468, SMD: −3.27, 95% CI: −5.28 to −1.26, p = 0.001, I² = 98%). Only three studies assessed adverse events (AEs), and one study reported minor AEs. Although the risk of bias for all the included studies was moderate, potential publication bias was observed due to the presence of a greater number of small studies with favorable effects. This systematic review concludes that fennel is as effective as conventional drug therapies in alleviating pain in primary dysmenorrhea. More studies that include more diverse populations and robust evidence of fennel’s effects will be needed in future research endeavors.     

Using Virtual Reality Exposure Therapy in Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ObjectivesThis study aimed to assess the effectiveness of virtual reality (VR) in managing different types of pain in different age groups and to provide evidence for the clinical application of new alternative strategy for pain management.MethodsElectronic databases, including the Cochrane Library, PubMed, EMBASE, and the Web of Science, were searched for studies published up to October 2020. Randomized controlled trials that reported on VR for pain management were included.ResultsA total of 31 randomized controlled trials were included. As for the pain intensity, the increase of visual analog scale score in the VR group was 1.62 scores less than that in the control group. In juvenile patients, the VR group had 1.79 scores lower than that in control group. For adult patients, the VR group had 1.34 scores lower than that in control group. As for other pain-related indicators, the VR group had lower levels of anxiety, lower pain unpleasantness, lower pulse rate, and shorter duration of dressing change and spent less time thinking about pain. Nevertheless, there was no statistical difference in pain tolerance. VR can effectively alleviate acute pain. In terms of chronic low back pain and cancer-related pain, there was no statistical difference between VR therapy and standard therapy.ConclusionsVR is a feasible alternative therapy for both juveniles and adults in pain management, and it has a greater potential for juveniles. VR can effectively alleviate acute pain. Nevertheless, VR showed little effectiveness in increasing pain tolerance, which may explain in part the ineffectiveness of VR therapy in pain management for chronic pain.     

Multinutrients for the Treatment of Psychiatric Symptoms in Clinical Samples: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This systematic review and meta-analysis focused on randomized controlled trials (RCT) of multinutrients consisting of at least four vitamins and/or minerals as interventions for participants with psychiatric symptoms. A systematic search identified 16 RCTs that fit the inclusion criteria (n = 1719 participants) in six psychiatric categories: depression, post-disaster stress, antisocial behavior, behavioral deficits in dementia, attention-deficit/hyperactivity disorder, and autism. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to rate the evidence base. Significant clinical benefit was assessed using minimal clinically important differences (MIDs). Due to heterogeneity in participants, multinutrient formulas, outcome measures, and absence of complete data, only the Attention-Deficit/Hyperactivity Disorder (ADHD) category was eligible for meta-analyses. In ADHD populations, statistically and clinically significant improvements were found in global functioning, Mean Difference (MD) −3.3, p = 0.001, MID −3.26; Standardized Mean Difference (SMD) −0.49 p = 0.001 MD −0.5), clinician ratings of global improvement (MD −0.58, p = 0.001, MID −0.5) and ADHD improvement (MD −0.54, p = 0.002, MID −0.5), and clinician (but not observer) measures of ADHD inattentive symptoms (MD −1.53, p = 0.05, MID −0.5). Narrative synthesis also revealed a pattern of benefit for global measures of improvement, for example: in autism, and in participants with behavioral deficits in dementia. Post-natural disaster anxiety and the number of violent incidents in prison populations also improved. Broad-spectrum formulas (vitamins + minerals) demonstrated more robust effects than formulas with fewer ingredients. This review highlights the need for robust methodology-RCTs that report full data, including means and standard deviations for all outcomes-in order to further elucidate the effects of multinutrients for psychiatric symptoms.     

Effectiveness of Oral Nutritional Supplements on Older People with Anorexia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Nutrition plays an important role in maintaining the overall health of older people. Inadequate intake may lead to impaired body function, higher morbidity, and mortality. Oral nutritional supplements (ONS) showed positive effect on the nutritional status of the elderly; however, systematic evidence is currently lacking on the effect of ONS on the elderly with anorexia. Aims: The current systematic review and meta-analysis included randomized controlled trial (RCT) articles to investigate the effectiveness of ONS on the main aspects of anorexia of aging (AA). Methods: By using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, researchers independently searched PubMed/MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library, China National Knowledge Infrastructure (CNKI) and other gray literature resources for publications that met the inclusion criteria by October 2020. The Cochrane Risk of Bias Tools were used for quality assessment. The inverse-variance method was used for the fixed model (FM) while the DerSimonian–Laird method was used for the random model (RM). Respective 95% confidence intervals (95% CIs), mean difference (MD) or standardized mean difference (SMD) was used for indices in terms of effect size (ES). Results: 2497 records were found through the systematic search, while 17 RCTs (n = 1204) were included, with a mean age of 81.9 years (range: 74–87 years). Supplementation occurred in the morning, mid-day, and evening, while the times varied from one to three times a day. The results of meta-analysis showed that, generally, ONS had a positive effect on the overall appetite, MD = 0.18, 95% CI (0.03, 0.33), p = 0.02, and consumption, MD = 1.43, 95% CI (0.01, 2.86), p = 0.05; but not significant in terms of other aspects of appetite: hunger, p = 0.73; fullness, p = 0.60; desire to eat, p = 0.80; preoccupation, p = 0.15. Additionally, it showed an increase in the overall energy intake, SMD = 0.46, 95% CI (0.29, 0.63), p < 0.001, in protein intake, SMD = 0.59, 95% CI (0.16, 1.02), p = 0.007, and in fat intake, MD = 3.47, 95% CI (1.98, 4.97), p < 0.001, while no positive effect was found on carbohydrates intake, p = 0.06. Significance differences were also found in the body weight, SMD = 0.53, 95% CI (0.41, 0.65), p < 0.001, and body mass index (BMI), MD = 0.53, 95% CI (0.12, 0.95), p = 0.01. Moreover, subgroup analyses were conducted according to the nutrient density with no positive results showed except for the low-density ONS on overall energy intake. Conclusions: The results of the present study indicated that ONS had beneficial effects on overall appetite, energy intake, body weight and BMI.     

Effect of Ketogenic Diet on Quality of Life in Adults with Chronic Disease: A Systematic Review of Randomized Controlled Trials

Background: Chronic diseases adversely affect quality of life (QOL). The ketogenic diet (KD) may improve the QOL. Objective: The aim of this systematic review was to summarize the available evidence of randomized controlled trials (RCTs) to establish the effect of KD on the QOL in adults with chronic diseases. Methods: Reporting followed PRISMA guidelines. We included randomized controlled trials (RCTs) conducted on adults with chronic disease including an intervention group that received KD and a control group, and where QOL was reported as outcome. We searched PubMed, APA PsycInfo, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov, and the references of the included articles and previous relevant reviews, without language or time restrictions. We critically appraised included studies and narratively synthesized their findings. Results: Nine RCTs were included. The risk of bias was low, except of allocation concealment and blinding. In patients with cancer: one RCT found an improvement in overall QOL, another reported improved physical component summary, and one found no superiority of KD in all QOL domains. In patients with neurological disorders: improved QOL was reported in Alzheimer’s disease patients, whereas no difference in mental and physical health QOL was noted in patients with multiple sclerosis. In patients with obesity and type II diabetes: one RCT reported superiority of energy-restricted KD in improving role functioning, mental health, health perceptions, and pain compared with guideline-based diet, whereas in another RCT, high and low carbohydrate diets achieved comparable improvements. Among patients with knee osteoarthritis, no differences between KD and low-fat groups were noted. Dietary compliance with the KD, reported in three studies, was shown to be high. Side effects were mostly noted during the first weeks of intervention, and adverse events were not markedly different with KD and the comparison diet. Conclusions: The evidence from RCTs investigating the effect of KD on QOL in adults with chronic disease is inconclusive. The promising effect noted in some included studies and the low rates of adverse events and side effects encourage future investigations in this regard.     

The Use of Behavior Change Theories in Dietetics Practice in Primary Health Care: A Systematic Review of Randomized Controlled Trials

BackgroundBehavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored.ObjectiveTo systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings.MethodsMedline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table.ResultsThirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions.ConclusionsInterventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.     

Dietary Advanced Glycation End Products and Risk Factors for Chronic Disease: A Systematic Review of Randomised Controlled Trials

Dietary advanced glycation end-products (AGEs) form during heating and processing of food products and are widely prevalent in the modern Western diet. Recent systematic reviews indicate that consumption of dietary AGEs may promote inflammation, oxidative stress and insulin resistance. Experimental evidence indicates that dietary AGEs may also induce renal damage, however, this outcome has not been considered in previous systematic reviews. The purpose of this review was to examine the effect of consumption of a high AGE diet on biomarkers of chronic disease, including chronic kidney disease (CKD), in human randomized controlled trials (RCTs). Six databases (SCOPUS, CINHAL, EMBASE, Medline, Biological abstracts and Web of Science) were searched for randomised controlled dietary trials that compared high AGE intake to low AGE intake in adults with and without obesity, diabetes or CKD. Twelve dietary AGE interventions were identified with a total of 293 participants. A high AGE diet increased circulating tumour necrosis factor-alpha and AGEs in all populations. A high AGE diet increased 8-isoprostanes in healthy adults, and vascular cell adhesion molecule-1 (VCAM-1) in patients with diabetes. Markers of CKD were not widely assessed. The evidence presented indicates that a high AGE diet may contribute to risk factors associated with chronic disease, such as inflammation and oxidative stress, however, due to a lack of high quality randomised trials, more research is required.     

Efficacy of Probiotics in Rheumatoid Arthritis and Spondyloarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: We aimed to provide a systematic review and meta-analysis of randomized controlled trials assessing the effect of probiotics supplementation on symptoms and disease activity in patients with chronic inflammatory rheumatic diseases (rheumatoid arthritis (RA), spondylarthritis (SpA), or psoriatic arthritis). Methods: A systematic literature review and meta-analysis from RA and SpA randomized controlled trials were conducted searching for articles in MEDLINE/PubMed and abstracts from recent international rheumatology meetings. The control group was a placebo or another dietary intervention. The risk of bias of the selected studies was evaluated using the Cochrane Collaboration tool and the Jadad scale. Results: The initial search yielded 173 articles. Of these, 13 studies were included in the qualitative synthesis, 8 concerning a total of 344 RA patients and 2 concerning a total of 197 SpA patients. Three meta-analyses were also analyzed. Probiotic strains and quantities used were different among trials (5 studies using Lactobacillus sp., 1 trial Bacillus coagulans and the others a mix of different probiotic strains). Time to assess response ranged from 8 weeks to one year. Two studies associated probiotic supplementation with a dietary intervention. Meta-analysis showed a statistically significant decrease of C-reactive protein (CRP) concentration (mean difference (MD)) −3.04 (95% CI −4.47, −1.62) mg/L, p < 0.001; I² = 20%, n patients = 209) with probiotics in RA. However, after excluding high-risk-of-bias trials of meta-analysis, there was no difference between probiotics and placebo on DAS28 (standard MD −0.54; 95% CI −1.94 to 0.85, p = 0.45, I² 93%, n patients = 143). The two studies on SpA patients showed no efficacy of probiotics. Conclusions: Probiotic supplementation might decrease RA activity with a moderate decrease effect on CRP, but lack of evidence and studies’ heterogeneity do not allow us to propose them to patients with inflammatory arthritis to control their disease. Further RCTs are required in the future to determinate the efficacy of probiotics and the optimal administration design.     

Effects of Canola Oil Consumption on Lipid Profile: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

Hyperlipidemia is a well- known risk factor of cardiovascular disease. A healthy diet containing vegetable oils such as canola oil (CO) may help to reduce serum lipids. This study aimed to quantify the effects of CO on lipid parameters using a systematic review and meta-analysis of randomized controlled trials. PubMed, Web of Science, Scopus, ProQuest, and Embase were systematically searched until December 2017, with no time and design restrictions. Also, a manual search was performed to find extra relevant articles. Lipid parameters including total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), triglycerides (TG), apolipoprotein A1 (Apo A1), and apolipoprotein B (Apo B) were entered the meta-analysis. Weighed mean difference (WMD) and 95% confidence interval (CI) were stated as the effect size. Sensitivity analyses and prespecified subgroup were conducted to evaluate potential heterogeneity. Twenty-seven trials, comprising 1359 participants, met the eligibility criteria. Results of this study showed that CO consumption significantly reduced TC (?7.24?mg/dl, 95% CI, ?12.1 to ?2.7), and LDL (?6.4?mg/dl, 95% CI, ?10.8 to ?2), although it had no effects on HDL, TG, Apo B, and Apo A1. Effects of CO on TC and LDL significantly decreased after CO consumption in subgroups of >50 years of age participants and >30 intervention duration subgroup. Moreover, CO decreased LDL and TC compared to sunflower oil and saturated fat. This meta-analysis suggested that CO consumption improves serum TC and LDL, which could postpone heart disease progression.

• Key Teaching Points

• CO consumption could decrease serum TC and LDL, although it had no effects on other blood lipids.

• There was an overall significant effect of canola oil on TC and LDL compared to sunflower oil and saturated fats.

• CO could have beneficial effects on serum TC and LDL just when consumed longer than 30 days.

• CO consumption improved lipid profiles in participants older than 50 years.

     

Effect of Spirulina Supplementation on Systolic and Diastolic Blood Pressure: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Spirulina is a microalga that presents various important pro-health properties, for instance lowering blood pressure in the research. The study aims to appraise the efficacy of Spirulina administration on systolic (SBP) and diastolic blood pressure (DBP). Randomized controlled trials (RCTs) were retrieved by a systematic search of PubMed, Web of Science, and the Cochrane Library databases from inception to June 2021 according to a standardized protocol. The effect size of each study was counted from mean and standard deviation before and after the intervention and shown as Un-standardized mean difference and 95% confidence interval. Sensitivity analyses were performed. Meta-analysis on 5 RCTs with 230 subjects was eligible. The amount of Spirulina ranged from 1 to 8 g per day, and intervention durations ranged from 2 to 12 weeks. Data analysis indicated that Spirulina supplementation led to a significant lowering of SBP (Mean Difference (MD): −4.59 mmHg, 95% Confidence Interval (CI): −8.20 to −0.99, I square statistic (I²) = 65%) and significant lowering of DBP (MD: −7.02 mmHg, CI: −8.86 to −5.18, I² = 11%), particularly in a subgroup of hypertensive patients. Spirulina administration might have a supportive effect on the prevention and treatment of hypertension. More exact randomized controlled trials are needed to clarify the effect of Spirulina supplementation on blood pressure.