Effects of silymarin supplementation on blood lipids: A systematic review and meta‐analysis of clinical trials

Dyslipidemia is a leading cause of endothelial dysfunction and cardiovascular disease. Several studies used silymarin as an herbal supplement in hyperlipidemic subjects. The aim of the present systematic review and meta‐analysis was to examine the effect of silymarin supplementation on blood lipids. PubMed, Scopus, Ovid (Cochrane library), ISI Web of Science, and Google Scholar were systematically searched until March 2018 to find intervention studies that examined the impact of silymarin supplementation on blood lipids in adults. Changes in blood lipids and potential sources of between‐study variation were extracted. We run a subgroup analysis to determine potential sources of inter‐study heterogeneity. Ten clinical trials fulfilled the eligibility criteria. Meta‐analysis indicated that silymarin supplementation in combination with other treatments (not silymarin alone) reduced total cholesterol (change: ?25.45 mg/dl; 95% confidence interval [CI] [?47.89, ?3.01 mg/dl]) and low‐density lipoprotein (change: ?28.25 mg/dl; 95% CI [?53.09, ?3.42 mg/dl]). Also, silymarin increased high‐density lipoprotein concentration (change: 4.82 mg/dl; 95% CI [2.01, 7.63 mg/dl]). Blood concentration of triglyceride was significantly after silymarin supplementation in comparison with controls (change: ?22.55 mg/dl; 95% CI [?44.32, ?0.78 mg/dl]). Present systematic review and meta‐analysis revealed that silymarin supplementation in combination with other treatments had a favorable effect on blood lipids.     

Effects of ginseng supplementation on selected markers of inflammation: A systematic review and meta‐analysis

The present meta‐analysis was performed to evaluate the efficacy of ginseng administration on serum level of inflammatory biomarkers. We performed a systematic search of all available randomized controlled trials (RCTs) conducted up to June 2018 in the following electronic databases: PubMed, Scopus, Cochrane, and Google Scholar. RCTs that investigated the effect ginseng supplementation on high‐sensitivity C‐reactive protein (hs‐CRP), tumor necrosis factor‐α (TNF‐α), and interleukin‐6 (IL‐6) were included for final analysis. A total of seven RCTs were included in the meta‐analysis. Results indicated significant reduction in IL‐6 (mean difference [MD]: ?0.265 pg/ml, 95% CI [?0.396, ?0.135], p < .001) and TNF‐α (MD: ?2.471 pg/ml, 95% CI [?2.904, ?2.039], p < .001) and no significant change in hs‐CRP (MD: ?0.125 mg/L, 95% CI [?0.597, 0.347], p = .604). Although there was publication bias across studies, trim and fill analysis showed that results from unpublished studies could not change the results for CRP. However, removing one study in sensitivity analysis did reveal a significant reduction in CRP. We conclude that ginseng supplementation significantly lowered IL‐6 and TNF‐α but did not significantly lower CRP. However, these findings were not robust, because they showed sensitivity for CRP and IL‐6, and future long‐term well‐designed dose‐escalating trials are required.     

Hesperidin,a major flavonoid in orange juice,might not affect lipid profile and blood pressure: A systematic review and meta‐analysis of randomized controlled clinical trials

Previous studies have led to conflicting results regarding the effect of hesperidin supplementation on cardiometabolic markers. This study aimed to evaluate the efficacy of hesperidin supplementation on lipid profile and blood pressure through a systematic review and meta‐analysis of randomized controlled trials (RCTs). PubMed, Web of Science, Scopus, and Google Scholar, as well as the reference lists of the identified relevant RCTs, were searched up to May 2018. Effect sizes were pooled by using the random effects model. Ten RCTs (577 participants) were eligible to be included in the systematic review. The meta‐analysis revealed that hesperidin supplementation had no effect on serum total cholesterol (weighted mean difference [WMD] = ?1.04 mg/dl; 95% confidence interval [CI]: ?5.65, 3.57), low‐density lipoprotein cholesterol (WMD = ?1.96 mg/dl; 95% CI [?7.56, 3.64]), high‐density lipoprotein cholesterol (WMD = 0.16 mg/dl; 95% CI [?1.94, 2.28]), and triglyceride (WMD = 0.69 mg/dl; 95% CI [?5.91, 7.30]), with no significant between‐study heterogeneity. Hesperidin supplement also had no effect on systolic (WMD = ?0.85 mmHg; 95% CI [?3.07, 1.36]) and diastolic blood pressure (WMD = ?0.48 mmHg; 95% CI [?2.39, 1.42]). Hesperidin supplementation might not improve lipid profile and blood pressure. Future well‐designed trials are still needed to confirm these results.     

The effects of curcumin‐containing supplements on biomarkers of inflammation and oxidative stress: A systematic review and meta‐analysis of randomized controlled trials

Besides other benefits, curcumin is getting more recognized for its antioxidant and anti‐inflammatory properties, highlighting the importance of curcumin application for chronic disease prevention. This systematic review and meta‐analysis of randomized controlled trials (RCTs) was conducted to assess the influence of curcumin‐containing supplements on biomarkers of inflammation and oxidative stress. MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched till January 2018 for eligible studies. The selected studies were evaluated for their quality using the Cochrane risk of bias tool and relevant data were extracted from included studies. Data were pooled using the inverse variance method and expressed as standardized mean difference (SMD) with 95% confidence intervals (95% CI). Fifteen RCTs were included in the final analysis. The meta‐analysis indicated that curcumin supplementation significantly decreased interleukin 6 (IL‐6) (SMD ?2.08; 95% CI [?3.90, ?0.25]; p = 0.02), high‐sensitivity C‐reactive protein (hs‐CRP) (SMD ?0.65; 95% CI [?1.20, ?0.10], p = 0.02), and malondialdehyde (MDA) concentrations (SMD ?3.14; 95% CI [‐4.76, ?1.53], p < 0.001). Though, curcumin supplementation had no significant effect on tumor necrosis factor‐alpha (SMD ?1.62; 95% CI [?3.60, 0.36]; p = 0.10) and superoxide dismutase levels (SMD 0.34; 95% CI [?1.06, 1.74], p = 0.63). Overall, this meta‐analysis suggests that taking curcumin‐containing supplements may exert anti‐inflammatory and antioxidant properties through a significant reduction in IL‐6, hs‐CRP, and MDA levels.     

Effect of garlic supplementation on serum C‐reactive protein level: A systematic review and meta‐analysis of randomized controlled trials

The present study was designed to systematically review randomized controlled trials (RCTs) that report on the effects of garlic supplementation on serum C‐reactive protein (CRP) levels. We conducted a literature search of Scopus, PubMed, Cochrane Library, and Google Scholar up to January 2018. Weighted mean differences (WMD) were estimated for net change in serum CRP. Subgroup analyses were also performed by duration of study, dose of supplementation, baseline CRP level, and the quality of studies. From 438 articles found and screened in our initial search, nine RCTs with the sum of total sample size of 363 were included in the meta‐analysis. Compared with the controls, garlic intake significantly reduced the concentrations of serum CRP by 0.8 mg/L (95% CI [?1.5, ?0.1], p = 0.02) with the evidence of heterogeneity among studies. Subgroup analyses showed that garlic significantly lowered CRP by 0.82 mg/L (95% CI [?1.02, ?0.62], p < 0.001) among studies with a daily garlic dose ≥1,200 mg/day and by 2.44 mg/L (95% CI [?4.02, ?0.87], p = 0.002) among studies with baseline CRP ≥2 mg/L. Current data confirmed that garlic supplementation would reduce serum CRP levels. However, the changes were related to the supplemental doses and baseline levels of serum CRP.     

Effect of Nigella sativa (black seed) supplementation on glycemic control: A systematic review and meta‐analysis of clinical trials

This study was aimed to quantify the antihyperglycemic effect of Nigella sativa (N. sativa). An in‐depth search to identify clinical trials investigating the impact of N. sativa on glycemic indices via MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google scholar databases were performed up to November 2018. We used a random effects model to estimate pooled effect size of fasting plasma glucose (FPG), postprandial blood glucose (PPBG), and hemoglobin A1c (HbA1c). A total of 17 randomized controlled trials investigating the effects of N. sativa on FPG, PPBG, and HbA1c were included. Meta‐analysis suggested a significant association between N. sativa supplementation and reduction in FPG (weighted mean difference [WMD]: ?9.93 mg/dl, 95% CI [?13.44, ?6.41]), PPBG (WMD: ?14.79 mg/dl, 95% CI [?24.19, ?5.39]), and HbA1c (WMD: ?0.57%, 95% CI [?0.77, ?0.37]). Subgroup analysis revealed that N. sativa oil was more effective than N. sativa powder in reduction of FPG. To sum up, N. sativa consumption has a significant lowering effect on glycemic status. Further studies with prolonged durations and powerful design are needed to specify the exact mechanism, optimal dosage, and duration of N. sativa supplementation to obtain a beneficial effect on glycemic status.     

Therapeutic efficacy and safety of chamomile for state anxiety,generalized anxiety disorder,insomnia, and sleep quality: A systematic review and meta‐analysis of randomized trials and quasi‐randomized trials

This systematic review and meta‐analysis aimed to study the efficacy and safety of chamomile for the treatment of state anxiety, generalized anxiety disorders (GADs), sleep quality, and insomnia in human. Eleven databases including PubMed, Science Direct, Cochrane Central, and Scopus were searched to retrieve relevant randomized control trials (RCTs), and 12 RCTs were included. Random effect meta‐analysis was performed by meta package of R statistical software version 3.4.3 and RevMan version 5.3. Our meta‐analysis of three RCTs did not show any difference in case of anxiety (standardized mean difference = ?0.15, 95% CI [?0.46, 0.16], P = 0.4214). Moreover, there is only one RCT that evaluated the effect of chamomile on insomnia and it found no significant change in insomnia severity index (P > 0.05). By using HAM‐A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = ?1.43, 95% CI [?2.47, ?0.39], P = 0.007), (MD = ?1.79, 95% CI [?3.14, ?0.43], P = 0.0097), respectively. Noteworthy, our meta‐analysis showed a significant improvement in sleep quality after chamomile administration (standardized mean difference = ?0.73, 95% CI [?1.23, ?0.23], P < 0.005). Mild adverse events were only reported by three RCTs. Chamomile appears to be efficacious and safe for sleep quality and GAD. Little evidence is there to show its effect on anxiety and insomnia. Larger RCTs are needed to ascertain these findings.     

The effect of saffron on weight and lipid profile: A systematic review,meta‐analysis,and dose–response of randomized clinical trials

Plant derivatives such as carotenoids and phytosterols enrich foods have been shown to reduce plasma triglyceride (TG), low‐density lipoprotein (LDL) cholesterol, and cholesterol concentrations. The aim of this systematic review and meta‐analyses study was to investigate the effects of saffron on lipid profiles, reported in randomized controlled trials (RCTs). We performed a systematic electronic search in PubMed/MEDLINE, Cochrane, and SCOPUS to identify RCTs and screening of relevant articles references up to October 12, 2018. There were no language restrictions. We performed this systematic review and meta‐analysis according to the Preferred Items for Reporting of Systematic Reviews and Meta‐Analyses guidelines. We identified and analyzed 14 eligible studies in this meta‐analysis. Our study found a significant reduction in cholesterol and TG following saffron intervention (weighted mean difference [WMD]: ?6.36 mg/dl, 95% confidence interval, CI, [?10.58, ?2.18] and WMD: ?5.37 mg/dl, 95% CI [?10.25, ?0.48], respectively). There was no significant effect on weight and LDL concentration. A meta‐regression analysis showed that long‐term saffron intervention can increase the high‐density lipoprotein (HDL) levels. In conclusions, our study findings indicate some benefits of saffron on cholesterol, HDL, and TG compared with placebo. However, we recommend the conduct of adequately powered, high‐quality RCTs with short‐ and long‐term follow‐up, evaluating relevant clinical outcomes to allow for making definitive recommendations.     

Effects of quercetin supplementation on glycemic control among patients with metabolic syndrome and related disorders: A systematic review and meta‐analysis of randomized controlled trials

This systematic review and meta‐analysis of randomized controlled trials was performed to determine the effect of quercetin supplementation on glycemic control among patients with metabolic syndrome and related disorders. Databases including PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched until August 30, 2018. Nine studies with 10 effect sizes out of 357 selected reports were identified eligible to be included in current meta‐analysis. The pooled findings indicated that quercetin supplementation did not affect fasting plasma glucose (FPG), homeostasis model of assessment‐estimated insulin resistance, and hemoglobin A1c levels. In subgroup analysis, quercetin supplementation significantly reduced FPG in studies with a duration of ≥8 weeks (weighted mean difference [WMD]: ?0.94; 95% confidence interval [CI; ?1.81, ?0.07]) and used quercetin in dosages of ≥500 mg/day (WMD: ?1.08; 95% CI [?2.08, ?0.07]). In addition, subgroup analysis revealed a significant reduction in insulin concentrations following supplementation with quercetin in studies that enrolled individuals aged <45 years (WMD: ?1.36; 95% CI [?1.76, ?0.97]) and that used quercetin in dosages of ≥500 mg/day (WMD: ?1.57; 95% CI [?1.98, ?1.16]). In summary, subgroup analysis based on duration of ≥8 weeks and used quercetin in dosages of ≥500 mg/day significantly reduced FPG levels.     

Effects of cumin (Cuminum cyminum L.) essential oil supplementation on metabolic syndrome components: A randomized,triple‐blind,placebo‐controlled clinical trial

Prevalence of metabolic syndrome (MetS), as a major health problem, is increasing. Very limited data exist on the effect of Cuminum cyminum L. essential oil (CuEO) on MetS components. Accordingly, this study aimed to examine the effect of CuEO supplementation on anthropometric indices, glycemic control, blood pressure, lipid profile, and insulin resistance in patients with MetS. In a randomized, triple‐blind, placebo‐controlled clinical trial, 56 patients with MetS aged 18–60 years received either 75 mg CuEO or placebo soft gel thrice daily for 8 weeks. Anthropometric indices and biochemical measurements were assessed at baseline and end of the study. At the end of study, except for diastolic blood pressure (DBP), the other assessed variables were not significantly different between two groups. In intra group analysis, placebo and CuEO groups both had nonsignificant decrements in DBP (mean difference [MD] with 95% CI: ?3.31 [?7.11, 0.47] and ?1.77 [?5.95, 2.40] mmHg, respectively). However, DBP was significantly lower in CuEO compared with the placebo group at the end of study (81.41 ± 5.88 vs. 84.09 ± 5.54 mmHg, MD with 95% CI: ?3.98 [?7.60, ?0.35] mmHg, p < .05). The results indicated that CuEO does not have any effect on MetS components, except for DBP in patients with MetS.     

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.     

The impact of pycnogenol supplementation on plasma lipids in humans: A systematic review and meta‐analysis of clinical trials

The effects of pycnogenol on plasma lipids are controversial. A systematic review and meta‐analysis of clinical trials were conducted to obtain a conclusive result in humans. PubMed, Scopus, and Google Scholar were systematically searched until March 2018, to explore the clinical trials that examined the effect of pycnogenol supplementation on lipid parameters among adult human. Methodological quality of the eligible studies was evaluated using the Cochrane Collaboration's tool. To estimate the effect size, changes in blood lipids were implemented. Results were pooled using a random effects model. Potential sources of heterogeneity were explored by subgroup analysis. A systematic review and meta‐analysis of 14 clinical trials with 1,065 participants suggested a significant increase in plasma concentration of high density lipoprotein cholesterol (HDL‐C; 3.27 mg/dL; 95% CI [0.19, 6.36]; p = 0.038). In contrast, plasma levels of total cholesterol (TC; ?4.45 mg/dL, 95% CI [?11.24, 2.34]; p = 0.199), triacylglycerol (TAG; ?3.64 mg/dL; 95% CI [?17.89, 10.61]; p = 0.616), and low density lipoprotein cholesterol (LDL‐C; ?3.61 mg/dl; 95% CI [?8.76, 1.55]; p = 0.171) were not altered. Adjustment for confounding variables was poor in included studies. Also, these studies did not assess dietary lipid intake. The results indicate that pycnogenol supplementation improves levels of HDL‐C; however, the changes in TC, TAG, and LDL‐C were not clinically relevant. Since there are few phytochemicals that have a significant increasing effect on HDL‐C levels, pycnogenol may have important role in prevention of cardiovascular diseases.     

The impact of argan oil on plasma lipids in humans: Systematic review and meta‐analysis of randomized controlled trials

The study aims to investigate the effect of argan oil on plasma lipid concentrations through a systematic review of the literature and a meta‐analysis of available randomized controlled trials. Randomized controlled trials that investigated the impact of at least 2 weeks of supplementation with argan oil on plasma/serum concentrations of at least 1 of the main lipid parameters were eligible for inclusion. Effect size was expressed as the weighted mean difference (WMD) and 95% confidence interval (95% CI). Meta‐analysis of data from 5 eligible trials with 292 participants showed a significant reduction in plasma concentrations of total cholesterol (WMD: ?16.85 mg/dl, 95% CI [?25.10, ?8.60], p < .001), low‐density lipoprotein cholesterol (WMD: ?11.67 mg/dl, 95% CI [?17.32, ?6.01], p < .001), and triglycerides (WMD: ?13.69 mg/dl, 95% CI [?25.80, ?1.58], p = .027) after supplementation with argan oil compared with control treatment, and plasma concentrations of high‐density lipoprotein cholesterol (WMD: 4.14 mg/dl, 95% CI [0.86, 7.41], p = .013) were found to be increased. Argan oil supplementation reduces total cholesterol, low‐density lipoprotein cholesterol, and triglycerides and increases high‐density lipoprotein cholesterol levels. Additionally, larger clinical trials are needed to assess the impact of argan oil supplementation on other indices of cardiometabolic risk and on the risk of cardiovascular outcomes.     

The effect of l‐carnitine supplementation on serum levels of omentin‐1, visfatin and SFRP5 and glycemic indices in patients with pemphigus vulgaris: A randomized,double‐blind,placebo‐controlled clinical trial

Pemphigus vulgaris (PV) is a chronic autoimmune disorder with potentially fatal outcomes. The aim of this study was to investigate the effect of l ‐carnitine (LC) on secreted frizzled‐related protein‐5 (SFRP5), omentin, visfatin, and glycemic indices in PV patients under corticosteroid treatment. In this randomized, double‐blind, placebo‐controlled clinical trial, 52 patients with PV were divided randomly into two groups to receive 2 g of LC or a placebo for 8 weeks. Serum levels of SFRP5, omentin, visfatin, and also glycemic indices were evaluated at the baseline and end of the study. LC supplementation significantly decreased the serum level of visfatin (95% CI [?14.718, ?0.877], p = .05) and increased the serum levels of SFRP5 (95%CI [1.637, 11.380], p < .006) and omentin (95% CI [9.014, 65.286], p < .01). However, LC supplementation had no significant effects on the serum levels of glycemic factors such as insulin (95% CI [?1.125, 3.056], p = .426), fasting blood sugar (95% CI [?4.743, 3.642], p = .894), homeostatic model assessment of insulin resistance (95% CI [?0.305, 0.528], p = .729), and quantitative insulin‐sensitivity check index (95% CI [?0.016, ?0.010], p = .81). LC supplementation decreased visfatin serum level and increased omentin‐1 and SFRP5 serum levels in patients with PV. However, it has no significant effect on the serum levels of insulin and glycemic indices.     

Does turmeric/curcumin supplementation improve serum alanine aminotransferase and aspartate aminotransferase levels in patients with nonalcoholic fatty liver disease? A systematic review and meta‐analysis of randomized controlled trials

We performed a meta‐analysis to evaluate the efficacy of turmeric/curcumin supplementation on serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with nonalcoholic fatty liver disease (NAFLD). We searched PubMed, Scopus, Cochrane Library, ISI Web of Science, and Google Scholar up to November 20, 2018. Studies that examined the effect of turmeric/curcumin on serum concentrations of ALT and AST among patients with NAFLD were included. The mean difference and standard deviation (SD) of changes in ALT and AST between intervention and control groups were used as effect size for the meta‐analysis. A total of six randomized controlled trials (RCTs) were eligible for meta‐analysis. Results from pooled analysis revealed that turmeric/curcumin supplementation reduced ALT (MD: ?7.31 UL/L, 95% CI [?13.16, ?1.47], p = 0.014) and AST (MD: ?4.68 UL/L, 95% CI [?8.75 ?0.60], p = 0.026). When RCTs stratified on the basis of their treatment duration, the significant reduction in serum concentrations of ALT and AST was observed only in studies lasting less than 12 weeks. This review suggests that turmeric/curcumin might have a favorable effect on serum concentrations of ALT and AST in patients with NAFLD. However, further clinical trials are needed to confirm these findings.     

The effect of psyllium consumption on weight,body mass index,lipid profile,and glucose metabolism in diabetic patients: A systematic review and dose‐response meta‐analysis of randomized controlled trials

Water‐soluble dietary fibers have been shown to improve lipid profile and glucose metabolism in diabetes. The aim of this study was to review the effects of psyllium consumption on weight, body mass index, lipid profiles, and glucose metabolism in diabetic patients in randomized controlled trials. A comprehensive systematic search was performed in PubMed/MEDLINE, Web of Sciences, Cochrane, and Scopus by two independent researchers up to August 2019 without any time and language restrictions. The DerSimonian and Laird random‐effects model method performed to calculate the pooled results. Inclusion criteria were randomized controlled trial design, adult subjects, and studies reporting the mean differences with the 95% confidence interval for outcome. Eight studies containing nine arms with 395 participants were identified and included in final analysis. Combined results found a significant reduction in triglycerides, low‐density lipoprotein, fasting blood sugar, and hemoglobin A1c following psyllium consumption (weighted mean differences [WMD]: ?19.18 mg/dl, 95% CI [?31.76, ?6.60], I² = 98%), (WMD: ?8.96 mg/dl, 95% CI [?13.39, ?4.52], I² = 97%), (WMD: ?31.71 ml/dl, 95% CI [?50.04, ?13.38], I² = 97%), and (WMD: ?0.91%, 95% CI [?1.31, ?0.51], I² = 99%), respectively. There was no significant change in high‐density lipoprotein, body mass index, cholesterol, and weight. In conclusion, the results demonstrated a significant reduction in triglycerides, low‐density lipoprotein, fasting blood sugar, and hemoglobin A1c by psyllium intervention among diabetic patients.     

The effect of Aronia consumption on lipid profile,blood pressure,and biomarkers of inflammation: A systematic review and meta‐analysis of randomized controlled trials

Plant derivatives, such as anthocyanin‐rich phytochemicals, have been reported to elicit a positive effect on lipid profile. Therefore, the aim of this study was to systematically review and meta‐analyze the effects of Aronia consumption on lipid profiles, blood pressure, and biomarkers of inflammation in randomized controlled trials. A systematic search was performed in PubMed/MEDLINE, Cochrane, and SCOPUS up to December 2018. Seven studies were identified and analyzed in this meta‐analysis. Our study found a significant increase in high‐density lipoprotein (HDL; weighted mean difference [WMD]: 1.48 mg/dl, 95% confidence interval, CI, [1.29, 1.68]) and diastolic blood pressure (WMD: 2.55 mmHg, 95% CI [0.63, 4.47]) following Aronia consumption. There was no significant effect on systolic blood pressure and C‐reactive protein, tumor necrosis factor, and interleukin‐1. Furthermore, subgroup analysis showed that cholesterol (WMD: ?7.18, 95% CI [?13.90, ?0.46]) and low‐density lipoprotein (LDL; WMD: ?5.84, 95% CI [?6.91, ?4.77]) decreased more significantly in interventions less than 10 weeks in duration. Dose–response analysis demonstrated a significant reduction in triglyceride levels when dose of Aronia was increased to 300 mg/day. In conclusion, the results demonstrated a significant increase in HDL and reduction in total cholesterol and LDL among patients supplementing with Aronia.     

The effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome and related disorders: A systematic review and meta‐analysis of randomized controlled trials

The aim of this systematic review and meta‐analysis was to evaluate the effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome (MetS) and related disorders. Two independent authors systematically searched online database including EMBASE, Scopus, PubMed, Cochrane Library, and Web of Science from inception until April 30, 2019. The Cochrane Collaboration's risk of bias tool was applied to assess the methodological quality of included trials. The heterogeneity among the included studies was assessed using Cochrane's Q test and I‐square (I²) statistic. Pooling effect sizes from studies showed a significant reduction in fasting plasma glucose (FPG; weighted mean difference [WMD]: ?10.31; 95% confidence interval, CI [?16.21, ?4.42]) and insulin concentrations (WMD: ?0.53; 95% CI [?0.62, ?0.44]) following the administration of spirulina. Pooled analysis showed also a significant reduction in total cholesterol (WMD: ?20.50; 95% CI [?38.25, ?2.74]), low‐density lipoprotein cholesterol (LDL‐C; WMD: ?19.02; 95% CI [?36.27, ?1.78]), and very low‐density lipoprotein cholesterol (VLDL‐C) concentrations (WMD: ?6.72; 95% CI [?9.19, ?4.26]) and a significant increase in high‐density lipoprotein cholesterol (HDL‐C) levels (WMD: 1.42; 95% CI [0.16, 2.68]) following spirulina therapy. This meta‐analysis demonstrated the beneficial effects of spirulina supplementation on improving FPG, insulin, total cholesterol, LDL‐C, VLDL‐C, and HDL‐C levels in patients with MetS and related disorders.     

Effect of purslane on blood lipids and glucose: A systematic review and meta‐analysis of randomized controlled trials

Despite a history of purslane usage as a herbal treatment for dyslipidemia and hyperglycemia management, existing evidence from clinical trials is controversial. The aim for the current study was to evaluate the efficacy of purslane supplementation on lipid parameters and glycemic status in adult populations. A systematic review was conducted in PubMed, Scopus, ISI Web of Science, and Google Scholar up to January 15, 2018, searching for randomized controlled trials that assessed the impact of purslane on fasting blood glucose (FBG), triglycerides, total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), and high‐density lipoprotein cholesterol (HDL‐C). Based on the detected heterogeneity between studies, a random‐ or fixed‐effect model was applied in the meta‐analysis. The findings from six randomized controlled trials, comprising 352 participants, indicated that purslane can reduce FBG (?4.54 mg/dl, 95% CI [?7.54, ?1.53]; I² = 0.53%) and triglycerides (?19.16 mg/dl, 95% CI [?38.17, ?0.15]; I² = 0%) levels. Changes in TC, LDL‐C, and HDL‐C concentrations did not reach a statistically significant level. Subgroup analysis showed a favorable effects of purslane on FBG, triglycerides, TC, and LDL‐C in a subset of studies in which purslane was administered >1.5 g/day. Categorization based on gender showed that purslane was more effective in improving FBG, TC and LDL‐C in females compared with males. This systematic review and meta‐analysis suggested that the purslane might be effective on the improvement of blood lipid and glucose levels. Further robust studies with sufficient durations and dosages of supplementation are needed to confirm these results.     

Quercetin reduced the formation of N‐acetyl‐p‐benzoquinoneimine,a toxic metabolite of paracetamol in rats and isolated rat hepatocytes

N‐acetyl‐p‐benzoquinoneimine (NAPQI) is toxic metabolite of paracetamol formed primarily by cytochrome P4502E1 (CYP2E1) metabolic pathway when administered at therapeutic doses or overdose. The influence of quercetin (flavonoid) on the bioactivation of paracetamol to NAPQI was investigated using rat liver microsomes and rats in vivo. Paracetamol (80 mg/kg) was administered orally without or with silymarin (100 mg/kg), a known inhibitor of CYP2E1, CYP3A4 and quercetin (10 and 20 mg/kg) to rats for 15 consecutive days. Area under the plasma concentration–time curve (AUC_0‐∞) and the peakplasma concentration (C_max) of paracetamol were dose‐dependently increased with quercetin (10 and 20 mg/kg) compared to paracetamol control group (p < 0.001). On the other hand, the AUC_0‐∞ and C_max of NAPQI were decreased significantly with quercetin. The same results were observed with silymarin also. The elevated liver and kidney functional enzymes/compounds were significantly reduced by quercetin and silymarin compared to paracetamol control group. The formation of NAPQI was reduced in the incubation samples in presence of quercetin in experiment using isolated rat hepatocytes. The presentstudy results revealed that quercetin might be inhibited the CYP2E1‐mediated metabolism of paracetamol; thereby decreased the formation of NAPQI and protected the liver and kidney.