Chinese Herbal Medicine for Mild Cognitive Impairment: A Systematic Review and Meta‐Analysis of Cognitive Outcomes

Mild cognitive impairment (MCI) is a condition that may be prodromal to the development of dementia. There remain, as yet, no approved pharmaceutical interventions for MCI. Chinese herbal medicines (CHMs) have a long history of use for cognitive impairments and some plant ingredients have shown neuroprotective actions in experimental studies. This review assesses the current clinical evidence from controlled clinical trials for the effects of CHMs on cognitive outcomes as measured by Mini‐mental state examination (MMSE) or Alzheimer's Disease Assessment Scale‐Cognitive subscale (ADAS‐Cog). Fifty one studies (4026 participants) were included. These compared CHM with placebo, supportive care, pharmaceutical treatment or combined CHM with a pharmaceutical in an integrative setting. For the eight randomised controlled trials (RCTs) of comparisons with placebo, MMSE was significantly higher in the CHM groups (MD 1.56 [0.78, 2.34] I² = 85%, n = 503), similarly for eight RCTs of comparisons with supportive care (MD 1.77 [1.33, 2.21] I² = 0%, n = 555). Benefits were also evident in comparisons with some pharmaceuticals and with integrative treatment. The small size of most studies and methodological weaknesses mean that these results should be interpreted with caution. Further studies employing rigorous methods are required to investigate the potential benefits of these CHMs for MCI. Copyright © 2016 John Wiley & Sons, Ltd.     

FOLFOX 4 Combined with Herbal Medicine for Advanced Colorectal Cancer: A Systematic Review

This systematic review evaluates the clinical evidence for the addition of herbal medicines (HMs) to FOLFOX 4 for advanced colorectal cancer (ACRC) in terms of tumor response rate (tRR), survival, quality of life and reduction in adverse events (AEs). Seven electronic databases were searched for randomized controlled trials (RCTs) of FOLFOX4 combined with HMs compared to FOLFOX4 alone. Outcome data for 13 randomized controlled trials were analysed using Review Manager 5.1. Risk of bias for objective outcomes including tumor response and survival was judged as low. Publication bias was not evident. Meta‐analyses found the addition of HMs improved tRR (RR 1.25, 95%CI 1.06–1.47, I² = 0%), one year survival (RR 1.51, 95%CI 1.19–1.90, I² = 0%) and quality of life in terms of Karnofsky Performance Status (KPS) gained (RR 1.84, 95%CI 1.54‐2.19, I² = 0%); alleviated grade 3 and 4 chemotherapy‐related AEs for neutropenia (RR 0.33, 95%CI 0.18‐0.60, I² = 0%), nausea and vomiting (RR 0.34, 95%CI 0.17‐0.67, I² = 0%) and neurotoxicity (RR 0.39, 95%CI 0.15‐1.00, I² = 0%), compared to FOLFOX4 alone. The most frequently used herbs were Astragalus membranaceus, Panax ginseng, Atractylodes macrocephala, Poria cocos, Coix lachryma‐jobi and Sophora flavescens. In experimental studies, each of these herbs has shown actions that could have contributed to improved tumor response. Copyright © 2013 John Wiley & Sons, Ltd.     

Integrative Medicine for Relief of Nausea and Vomiting in the Treatment of Colorectal Cancer Using Oxaliplatin‐Based Chemotherapy: A Systematic Review and Meta‐Analysis

The management of chemotherapy‐induced nausea and vomiting (CINV) remains an issue in the treatment of colorectal cancer using oxaliplatin‐based regimens. Certain traditional plant‐based medicines (TMs) have histories of use for nausea and vomiting and have been integrated with conventional therapies for CINV. To assess the effectiveness of integrative management of CINV, meta‐analysis was conducted of 27 randomised controlled studies (1843 participants) published from 2005 to 2013. The oxaliplatin plus TM groups showed significantly reduced CINV (risk ratio 0.65 [0.59, 0.71], I² = 28%) compared with oxaliplatin controls, with or without the addition of conventional anti‐emetics. Further sensitivity analyses based on the ingredients of the TMs identified six plants (Atractylodes macrocephala, Poria cocos, Coix lacryma‐jobi, Astragalus membranaceus, Glycyrrhiza uralensis and Panax ginseng) that were associated with significant reductions in CINV without important heterogeneity. Experimental studies of these six plants have reported inhibitory effects on nausea and vomiting (or its animal equivalent), regulation of gastrointestinal motility, gastroprotective effects and antioxidant actions, which may at least partially explain the effects identified in the meta‐analyses of the clinical trial results. These plants warrant further clinical research as potential additions to chemotherapy regimens in patients whose CINV is not sufficiently well controlled by conventional therapies. Copyright © 2016 John Wiley & Sons, Ltd.     

Cancer Patients at Risk of Herb/Food Supplement–Drug Interactions: A Systematic Review

Herbal medicines and dietary supplements are commonly taken by patients with cancer, leading to concern over interactions with conventional medicines. A literature search was carried out to identify published studies exploring supplement use by patients with a cancer diagnosis. A total of 818 articles were retrieved using the key words, but only 41 are judged to be relevant based on title. Following the review of the abstracts, ten papers were considered to be potentially relevant, but of these, only two met the selection criteria, and three additional papers were identified from published reviews. Of 806 patients surveyed, 433 (53.7%) were reported to be taking combinations of supplements and drugs, and 167 incidents of risk were identified, affecting 60 patients (13.9%). The interactions identified were mainly theoretical and not supported by clinical data. No studies reported any adverse events associated with these combinations; most did not record the actual drug combinations taken, and the risk potential of some supplements appears to have been over‐estimated. More effort should be made to investigate supplement use in this vulnerable patient group, based on sound evidence of plausible interaction, not only to avoid harm but also to provide reassurance where appropriate if the patient wishes to take a particular supplement. Copyright © 2014 John Wiley & Sons, Ltd.     

Herbal Medicines in Idiopathic Heavy Menstrual Bleeding: A Systematic Review

Idiopathic heavy menstrual bleeding (HMB; IHMB) is a common gynecological problem with no pelvic pathology or general bleeding disorder. Herbal remedies are commonly used to treat HMB. This systematic review aimed to assess the effectiveness and safety of herbal preparations for the treatment of IHMB. MEDLINE, Ovid, and the Cochrane Central Register of Controlled Trials were searched from inception to 23 August 2015. Only randomized controlled trials were considered. Three randomized controlled trials were included in this systematic review. Different herbal preparations were used in the included trials. In two studies, Ginger capsules and myrtle fruit syrup significantly reduced the menstrual duration and blood loss compared with placebo based on the pictorial blood loss assessment chart score (p < 0.001, p = 0.01). In another trial, Punica granatum flower capsules were as effective as tranexamic acid capsules in reducing the mean (SD) pictorial blood loss assessment chart score, with no significant difference between the two treatments (p = 0.3). The results show that the methods used in these trials may reduce menstrual bleeding in women with IHMB. Additional well‐designed trials are needed to investigate the safety and efficacy of herbs for the treatment of women with IHMB or other forms of HMB.     

The Clinical Efficacy and Adverse Effects of Interferon Combined with Matrine in Chronic hepatitis B: A Systematic Review and Meta‐Analysis.

Currently, many studies have demonstrated certain beneficial effects of interferon (IFN) combined with matrine (Mat) for chronic hepatitis B (CHB) in China. However, the evidence from these randomized control trials is still controversial. Therefore, the aim of this meta‐analysis was to explore the efficacy and safety of Mat combined with IFN for CHB. We performed a systematic search of seven databases to identify all randomized controlled trials that treated CHB with IFN or IFN plus Mat from their start date to September 30, 2015. The clinical efficacy and adverse effects were evaluated. Nine studies involving 1089 participants were included. Compared with IFN monotherapy, IFN 5 MU combined with Mat 150 mg augmented the hepatitis B e‐antigen negative conversion rate after 3‐month treatment [relative ratio (RR) = 1.41; 95% confidence interval (CI) (1.18, 1.69), p  = 0.0002] and after 12‐month treatment [RR = 1.96; 95% CI (1.21, 3.19), p  = 0.006], hepatitis B virus DNA negative conversion rate after 3‐month treatment [RR = 1.37; 95% CI (1.16, 1.62), p  = 0.0002] and after 12‐month treatment [RR = 1.96; 95% CI (1.21, 3.19), p  = 0.006], hepatitis B virus e antibody (anti‐HBe) conversion rate after 3‐month treatment [RR = 1.47; 95% CI (1.19, 1.81), p  = 0.0003], and AST level after 3‐week treatment [weighted mean difference = ?22; 95% CI (?40.41, ?3.59), p  = 0.02]. Furthermore, IFN 3 MU 3 months combined with Mat 150 mg after 2‐month treatment reduced the risk of leucopenia and thrombocytopenia [RR = 0.55; 95% CI (0.36, 0.85), p  = 0.007]. Unfortunately, all of the included trials were not in favor of hepatitis B surface antigen (HBsAg) negative conversion rate or influenza‐like symptoms. Combination therapy with IFN plus Mat exhibited better clinical efficacy and fewer adverse effects than did IFN monotherapy in patients with CHB, except in the improvement of HBsAg negative conversion rate and influenza‐like symptoms. Given the poor methodological quality of the evidence currently available, future high‐quality, three‐blinded randomized control trials are necessary to confirm these results. Copyright © 2017 John Wiley & Sons, Ltd.     

Dang Shen [Codonopsis pilosula (Franch.) Nannf] Herbal Formulae for Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta‐analysis

This systematic review and meta‐analysis assessed the efficacy and safety of Dang shen [Codonopsis pilosula (Franch.) Nannf., root] formulae for the treatment of chronic obstructive pulmonary disease (COPD). English and Chinese databases were searched, and 48 randomized controlled trials were included. Dang shen formulae improved lung function forced expiratory volume in 1 s compared with conventional pharmacotherapy (CP) [mean difference (MD) 0.22 L, 95% confidence interval (CI) 0.13–0.31, p < 0.001, I² = 5%] and quality of life (St. Georges Respiratory Questionnaire) compared with placebo (MD ?7.19, 95% CI ?10.82 to ?3.56, p < 0.001, I² = 0%) and when combined with CP versus CP (MD ?9.05, 95% CI ?12.72 to ?5.38, p < 0.001, I² = 89%). Dang shen formulae also increased distance walked in 6 min when combined with CP versus CP alone (MD 51.43 m, 95% CI 30.06–72.80, p < 0.001, I² = 27%) and reduced frequency/days with COPD exacerbations. Risk of bias was evaluated using the Cochrane tool. Methodological shortfalls were identified. Adverse events were low and not different between intervention and control groups. Thirty‐three events were reported, including gastrointestinal upset, dry mouth, and insomnia. Dang shen formulae appear to improve some aspects of the included COPD outcomes. However, owing to methodological flaws, the current evidence is inadequate to support the routine use of Dang shen formulae outside of Chinese medicine practice. However, these results justify further investigation. Copyright © 2014 John Wiley & Sons, Ltd.     

Herbal medicine for dementia: a systematic review

This systematic review aimed to assess the effectiveness and safety of herbal medicines (HM) for treating dementia. Databases in English and Chinese were searched from their inceptions to February 2007. References in reviews and randomized controlled trials (RCTs) were screened by hand. Trials comparing orally administered HM with placebo, no intervention or other therapy were considered. Trials on Ginkgo biloba and its extracts were excluded to avoid duplication of existing reviews. Pairs of authors independently applied eligibility criteria, extracted data and assessed methodological quality using the Jadad Scale. Thirteen RCTs met the inclusion criteria of three or above on this scale. Six trials compared herbal medicine with placebo, one with no treatment, and the remainder with pharmaceutical intervention. Meta‐analyses were performed on common cognitive performance outcome measures. All studies reported HM had significant effects in improving symptoms. In studies that employed active controls, HM was at least as effective as the pharmaceutical intervention. Meta‐analyses found HM more effective than no treatment or placebo and at least equivalent to control interventions, although the overall effect was small. No severe adverse events were reported. These trials provide overall positive evidence for the effectiveness and safety of certain HMs for dementia management. Copyright © 2008 John Wiley & Sons, Ltd.     

中医药治疗糖尿病肾病血糖血脂的荟萃分析

目的运用循证医学的方法,评价中医药治疗糖尿病肾病(DN)血糖血脂的疗效。方法收集中西医结合与单纯西医药治疗DN的随机对照试验(RCT)和半随机对照试验(CCT),采用Revman4.2.2软件进行Meta分析。结果纳入56篇RCT和1篇CCT,全部论文被评为C级。Meta分析结果显示:与单纯西医药治疗相比,中西医结合治疗可进一步降低DN患者空腹血糖(WMD=-0.65,95%CI(-0.90,-0.40),P<0.00001)、糖化血红蛋白(WMD=-0.42,95%CI(-0.71,-0.14),P=0.004)、胆固醇(WMD=-0.91,95%CI(-1.16,-0.66),P<0.00001)、三酰甘油(WMD=-0.51,95%CI(-0.68,-0.35),P<0.00001)。结论中医药对DN患者有一定的降糖降脂作用,但由于本系统评价所纳入研究存在方法学上的缺陷,故中医药对DN患者血糖血脂的疗效尚需进一步研究。     

Traditional Chinese Medicine for Diminished Ovarian Reserve: A Systematic Review and Meta-analysis

Objective To assess the effectiveness and safety of traditional Chinese medicine(TCM)for women with diminished ovarian reserve(DOR).Methods A literature search was conducted in eight electronic databases for randomized controlled trials.Results Seventeen randomized controlled trials involving 1174 patients were included.Meta-analysis indicated that TCM was superior to Western medicine(WM)in reducing basal serum FSH level[MD=-1.70,95%CI(-2.63,-0.77);P=0.0004]and FSH/LH(MD=-0.43,95%CI[-0.56,-0.30];P=0.0001),and the effect was more obvious two months after the last treatment(MD=-4.60,95%CI[-6.26,-2.90],P0.000 01 and MD=-0.56,95%CI[-0.85,-0.28],P=0.0001),and increasing antral follicle count(AFC)(MD=0.44,95%CI[0.04-0.83];P=0.03).The review also revealed the positive role of CMM as an adjuvant to IVF-ET in improving pregnancy rate(PR=1.75,95%CI[1.25,2.46];P=0.001).Conclusion TCM,with its unique way of replenishing the kidney,may provide an effective and safe alternative therapy to patients with DOR.     

Role of Medicinal Plants for Liver‐Qi Regulation Adjuvant Therapy in Post‐stroke Depression: A Systematic Review of Literature

Current evidence demonstrated certain beneficial effects of medicinal herbs as an adjuvant therapy for post‐stroke depression (PSD) in China; Chai‐hu (Chinese Thorowax Root, Radix Bupleuri) is an example of a medicinal plant for Liver‐Qi regulation (MPLR) in the treatment of PSD. Despite several narrative reports on the antidepressant properties of MPLR, it appears that there are no systematic reviews to summarize its outcome effects. Therefore, the aim of this review was to assess the effectiveness and safety of MPLR adjuvant therapy in patients with PSD. Seven databases were extensively searched from January 2000 until July 2016. Randomized control trials (RCTs) involving patients with PSD that compared treatment with and without MPLR were taken into account. The pooled effect estimates were calculated based on Cochrane Collaboration's software RevMan 5.3. Finally, 42 eligible studies with 3612 participants were included. Overall, MPLR adjuvant therapy showed a significantly higher effective rate (RR = 1.23; 95% CI = 1.19, 1.27; p < 0.00001) compared to those without. Moreover, the administration of MPLR was superior to abstainers regarding Hamilton Depression Scale (HAMD) score changes after 3 weeks (WMD = ?4.83; 95% CI = ?6.82, ?2.83; p < 0.00001), 4 weeks (WMD = ?3.25; 95% CI = ?4.10, ?2.40; p < 0.00001), 6 weeks (WMD = ?4.04; 95% CI = ?5.24, ?2.84; p < 0.00001), 8 weeks (WMD = ?4.72; 95% CI = ?5.57, ?3.87; p < 0.00001), and 12 weeks (WMD = ?3.07; 95% CI = ?4.05, ?2.09; p < 0.00001). In addition, there were additive benefits in terms of response changes for the National Institutes of Health Stroke Scale (NIHSS) and other self‐rating scores. No frequently occurring or serious adverse events were reported. We concluded that there is supporting evidence that adjuvant therapy with MPLR is effective in reducing the depressive symptoms and enhancing quality of life for patients with PSD. More well‐designed RCTs are necessary to explore the role of MPLR in the treatment of PSD. Copyright © 2016 John Wiley & Sons, Ltd.     

Herbal medicine for hand–foot syndrome induced by fluoropyrimidines: A systematic review and meta‐analysis

The aims of this study were to evaluate the efficacy of herbal medicine for the prevention and management of hand–foot syndrome (HFS) induced by fluoropyrimidines and to identify herbs associated with HFS alleviation for further research. The PubMed, Cochrane, Springer, China National Knowledge Infrastructure, and Wanfang databases were searched up to May 2017 for randomized controlled trials (RCTs) that evaluated herbal medicine for relieving HFS in patients undergoing fluoropyrimidine‐based chemotherapy. Study evaluation and synthesis methods were in accordance with the Cochrane Handbook, and data were analyzed using RevMan 5.3. In total, 35 RCTs (2,668 participants) were included. Meta‐analysis showed that the addition of herbal medicine significantly reduced the incidences of all‐grade and high‐grade HFS. The total effective rate and complete remission rate of HFS patients increased significantly with herbal medicine arm. Further sensitivity analysis identified Paeoniae Radix Alba, Carthami Flos, Cinnamomi Ramulus, and Glycyrrhizae Radix et Rhizoma as being consistently associated with significant reductions in HFS incidence without important heterogeneity. However, the lack of blinding in most studies may have led to overestimation of these effects. More high‐quality RCTs and experimental research are needed to confirm and investigate the efficacy of the herbs identified in this study.     

Topical Herbal Formulae in the Management of Psoriasis: Systematic Review with Meta‐Analysis of Clinical Studies and Investigation of the Pharmacological Actions of the Main Herbs

This systematic review and meta‐analysis of randomized controlled trials (RCTs) examined the topical use of multi‐herbal formulations for the management of psoriasis vulgaris. Studies were identified from PubMed, Cochrane library, EMBASE, and the Chinese databases CNKI and CQVIP. Methods were according to the Cochrane Handbook and meta‐analyses used RevMan 5.1. Nine studies met the inclusion/exclusion criteria. The comparisons were with placebo and/or anti‐psoriatic pharmacotherapy (APP) with two studies having three arms. The pooled meta‐analysis data indicated the topical herbal formulae improved overall clinical efficacy (defined as 50% improvement or greater) when compared with: topical placebo (plus oral herbal co‐intervention); topical APP alone; and topical APP (plus pharmaceutical co‐intervention). Improvement was evident in Modified Psoriasis Area and Severity Index (PASI) score when topical herbal formula was compared to placebo (plus oral herbal co‐intervention). No serious adverse events were reported. The most commonly used herbs were Sophora flavescens root and Lithospermum erythrorhizon root. Experimental studies reported that these herbs and/or their constituents have anti‐inflammatory, anti‐proliferative, anti‐angiogenic, and tissue repair actions. These actions may at least partially explain the apparent benefits of the topical multi‐herbal formulations in psoriasis. Copyright © 2013 John Wiley & Sons, Ltd.     

Panax notoginseng Preparations for Unstable Angina Pectoris: A Systematic Review and Meta‐Analysis

This paper assessed the evidence of Panax notoginseng preparations in patients suffering from UAP using meta‐analysis and systematic review methods. Methods were according to the Cochrane Handbook and analysed using Revman 5.3. A search of PubMed, Cochrane Library, Embase, MEDLINE, Chinese national knowledge infrastructure (CNKI), Vip information database, Wanfang data and Chinese Biomedical Literature Database (SinoMed) was conducted to identify randomized controlled trials (RCTs) of P. notoginseng preparations on UAP regardless of blinding, sex and language. The outcomes include all‐cause mortality, cardiac mortality, cardiovascular events, UAP symptoms, improvement of electrocardiogram and adverse events. Eighteen RCTs including 1828 patients were identified. The level of reporting is generally poor. Among 18 studies, 16 studies were prescribed P. notoginseng injections, and two studies were oral P. notoginseng preparations. Reduction of cardiovascular events (RR:0.35;95% CI:0.13 to 0.94), alleviation of angina pectoris symptoms (RR:1.23;95% CI 1.18 to 1.29), improvement of ECG (RR:1.22;95% CI 1.15 to 1.28) and reduced frequency of angina pectoris (MD:?1.48; 95% CI ?2.49 to ?0.48) were observed. Cardiac mortality and duration of angina pectoris were not statistically significant. Panax notoginseng is beneficial to UAP patients; the results of these reviews may have important implications to clinical work. Copyright © 2017 John Wiley & Sons, Ltd.     

Efficacy of natural,peroxide‐free tooth‐bleaching agents: A systematic review,meta‐analysis,and technological prospecting

The aim of this study is to analyze the efficacy of natural bleaching agents and the current technological development in this research field. Two reviewers performed a literature search up to July 2019 in 15 databases. Five laboratory studies and 25 patents were included. Data regarding natural bleaching agent used, application protocol, and the main findings of studies were analyzed. Laboratory studies that evaluated natural bleaching agents' peroxide‐free or associated to peroxides and patents related to natural bleaching agents were included. The studies evaluated papain, bromelain, chlorine dioxide, sodium chloride plus vinegar and sodium bicarbonate as peroxide‐free agents; and sweet potato extract, lactoperoxidase, and peroxidase associated to peroxide used were included. Twenty‐five patents were included; among the most cited are the papain and the chlorine. The addition of non‐peroxide agents into peroxide showed improvement in bleaching effect with the incorporation of these non‐peroxide agents (p < .05). On the other hand, peroxide‐free agents did not show an improvement in bleaching effect (p < .05). The evidence in literature suggested that natural bleaching agents incorporated to peroxide may improve the bleaching. Therefore, the current literature does not support the use of natural agents as dental bleaching.     

中医治疗冠心病合并糖尿病的系统评价

目的评价中药与西药治疗冠心病合并糖尿病的疗效差异及安全性。方法检索PubMed、CBM、CNKl、VIP、万方等数据库,纳入治疗组采用中药或联合西药,对照组采用西药的临床随机对照试验。采用RevMan5．1．6软件作Meta分析。结果6项Jadad评分较高研究的l临床症状改善合并效应量OR=5．6,95％CI[3．11,10．05],P〈0．01;5项研究的心电图疗效有效率合并效应量OR=2．66,95％CI[1．71,4．12],P〈0．01;其中1项报道了对照组有2例病情加重,治疗组未发生不良反应,其余研究均报道未发生任何肝肾损伤的不良反应。结论现有证据提示中药联合西药治疗冠心病合并糖尿病时,其临床症状和心电图改善情况均优于单纯西药治疗,且不良反应少。     

Panax ginseng in Randomised Controlled Trials: A Systematic Review

Panax ginseng C.A. Meyer is a common herb with many purported health benefits. However, there is no conclusive evidence supporting its use in the treatment of any particular disease. We conducted a systematic review to evaluate randomised controlled trials. Four English databases were searched with no publication date restriction. Included studies evaluated P. ginseng in patients with any type of disease or in healthy individuals. We assessed the quality of studies using the Cochrane risk of bias tool. Of the 475 potentially relevant studies, 65 met the inclusion criteria. These studies examined P. ginseng's effects on psychomotor performance (17 studies), physical performance (ten), circulatory system (eight), glucose metabolism (six), the respiratory system (five), erectile dysfunction (four), immunomodulation (four), quality of life/mood (four), antioxidant function (two), cancer (two), menopausal symptoms (two) and dry mouth (one). The risk of bias was unclear in most studies. Authors evaluated adverse events in 40 studies, with 135 minor events and no serious adverse events reported. P. ginseng shows promising results for improving glucose metabolism and moderating the immune response. This may have implications for several diseases including type 2 diabetes and chronic respiratory conditions. Further studies are needed to explore P. ginseng's potential as an effective treatment for these and other health conditions. Copyright © 2012 John Wiley & Sons, Ltd.     

Effect of the herbal medicines in obesity and metabolic syndrome: A systematic review and meta‐analysis of clinical trials

Obesity is a medical situation in which excess body fat has gathered because of imbalance between energy intake and energy expenditure. In spite of the fact that the variety of studies are available for obesity treatment and management, its “globesity” still remains a big challenge all over the world. The current systematic review and meta‐analysis aimed to evaluate the efficacy, safety, and mechanisms of effective herbal medicines in the management and treatment of obesity and metabolic syndrome in human. We systematically searched all relevant clinical trials via Web of Science, Scopus, PubMed, and the Cochrane database to assess the effects of raw or refined products derived from plants or parts of plants on obesity and metabolic syndrome in overweight and obesity adult subjects. All studies conducted by the end of May 2019 were considered in the systematic review. Data were extracted independently by two experts. The quality assessment was assessed using Consolidated Standards of Reporting Trials checklist. The main outcomes were anthropometric indices and metabolic syndrome components. Pooled effect of herbal medicines on obesity and metabolic syndrome were presented as standardized mean difference (SMD) and 95% confidence interval (CI). A total of 279 relevant clinical trials were included. Herbals containing green tea, Phaseolus vulgaris, Garcinia cambogia, Nigella sativa, puerh tea, Irvingia gabonensis, and Caralluma fimbriata and their active ingredients were found to be effective in the management of obesity and metabolic syndrome. In addition, C. fimbriata, flaxseed, spinach, and fenugreek were able to reduce appetite. Meta‐analysis showed that intake of green tea resulted in a significant improvement in weight ([SMD]: ?0.75 [?1.18, ?0.319]), body mass index ([SMD]: ?1.2 [?1.82, ?0.57]), waist circumference ([SMD]: ?1.71 [?2.66, ?0.77]), hip circumference ([SMD]: ?0.42 [?1.02, ?0.19]), and total cholesterol, ([SMD]: ?0.43 [?0.77, ?0.09]). In addition, the intake of P. vulgaris and N. sativa resulted in a significant improvement in weight ([SMD]: ?0.88, 95 % CI: [?1.13, ?0.63]) and triglyceride ([SMD]: ?1.67, 95 % CI: [?2.54, ?0.79]), respectively. High quality trials are still needed to firmly establish the clinical efficacy of the plants in obesity and metabolic syndrome.     

Curcuminoids Lower Plasma Leptin Concentrations: A Meta‐analysis

Curcumin is a naturally occurring polyphenol that has been suggested to improve several metabolic diseases. Leptin is an adipokine involved in metabolic status and appetite, with marked crosstalk with other systems. Available data suggest that curcumin may affect leptin levels; therefore, this meta‐analysis was performed to evaluate this. A systematic review and meta‐analysis were undertaken on all randomized controlled trials of curcumin studies that included the measurement of leptin. The search included PubMed‐Medline, Scopus, ISI Web of Knowledge, and Google Scholar databases. Quantitative data synthesis was performed by using a random‐effects model, with standardized mean difference and 95% confidence interval as summary statistics. A funnel plot, Begg's rank correlation, and Egger's weighted regression tests assessed the presence of publication bias. Four eligible articles comprising five treatment arms were selected for the meta‐analysis. Meta‐analysis showed a significant decrease in plasma leptin concentrations following curcumin treatment (standardized mean difference: ?0.69, 95% confidence interval: ?1.16, ?0.23, p  = 0.003; I ² = 76.53%). There was no evidence of publication bias. This meta‐analysis showed that curcumin supplementation is associated with a decrease in leptin levels that may be regarded as a potential mechanism for the metabolic effects of curcumin. Copyright © 2017 John Wiley & Sons, Ltd.