Effects of zinc supplementation on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

Background and aimFindings on the effects of zinc supplementation on the lipid profile in patients with type 2 diabetes mellitus (T2DM) are conflicting. The current comprehensive systematic review and meta-analysis aimed to summarize available evidence in this regard.Methods and resultsAfter a systematic search in the online databases, we included the randomized controlled trials (RCTs) investigating the effect of zinc supplementation on lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)] in patients with T2DM. Altogether, 9 studies with a total sample size of 424 patients with T2DM were included in the analysis. Combining 9 effect sizes from 9 RCTs, we found a significant lowering effect of zinc supplementation on serum levels of TG (weighted mean difference (WMD): −17.08, 95% CI: −30.59, −3.58 mg/dL, P = 0.01) and TC (WMD: −26.16, 95% CI: −49.69, −2.62 mg/dL, P = 0.02). Although the overall effect of zinc supplementation on LDL-C levels was not significant, a beneficial effect was seen in studies that administered <100 mg/d zinc. Based on the non-linear dose–response analysis, a greater reduction in serum levels of TC and LDL-C following zinc supplementation was seen at <12 weeks’ duration of intervention. Unlike the overall effect size, we found a significant increasing effect of zinc supplementation on serum HDL-C concentrations in most subgroups of RCTs according to the subgroup analyses.ConclusionWe found that zinc supplementation may beneficially influence lipid profile in patients with T2DM.     

Effects of dehydroepiandrosterone (DHEA) supplementation on the lipid profile: A systematic review and dose-response meta-analysis of randomized controlled trials

Background and aimsDehydroepiandrosterone (DHEA) supplementation has gained attention in individuals with adrenal insufficiency, and as a tool for increasing androgens and estrogens whereby is proposed to improve the accretion of muscle and bone mass. However, DHEA supplementation has demonstrated negative effects on the lipid profile and, thus, we aimed to analyze the body of evidence in this regard.Methods and resultsA systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) was performed employing in Scopus, PubMed/Medline, Web of Science, Embase and Google Scholar, then including relevant articles that addressed the effects of DHEA supplementation on the lipid profile, up to February 2020. Combined findings were generated from 23 eligible articles. Hence, total cholesterol (TC) (weighted mean difference (WMD): −3.5 mg/dl, 95% confidence interval (CI): −8.5 to 1.6)), low-density lipoprotein-cholesterol (LDL-C) (WMD: 0.34 mg/dl, 95% CI: −3 to 3.7) and triglycerides (TG) levels (WMD: −2.85 mg/dl, 95% CI: −9.3 to 3.6) did not alter in DHEA group compared to the control, but HDL-C levels significantly reduced in DHEA group (WMD: −3.1 mg/dl, 95% CI: −4.9 to −1.3). In addition, a significant reduction in HDL-C values was observed in studies comprising women (WMD: −5.1 mg/dl, 95% CI: −7.2 to −3) but not in males (WMD: 0.13 mg/dl, 95% CI: −1.4 to 1.7).ConclusionsOverall, supplementation with DHEA did not change circulating values of TC, LDL-C and TG, whereas it may decrease HDL-C levels. Further long-term RCTs are required to investigate the effects of DHEA particularly on major adverse cardiac events.     

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

Background and aimsGuar gum can be used as an adjuvant in the treatment of dyslipidemia. However, based on data from different studies, the effectiveness of this product is not uniform. Therefore, we conducted a dose–response meta-analysis between guar gum supplementation and lipid profile.Methods and resultsFive databases (Scopus, Web of Science, PubMed/Medline, Embase, and Google Scholar) were searched to identify relevant articles published up to July 2020. The weighted mean difference (WMD) was derived based on the random-effects model. Overall findings were generated from 25 eligible trials. Patients’ conditions included hyperlipidemia, diabetes, metabolic syndrome, hypertension, overweight, carotid endarterectomy, and menopausal women. Prescribed gum dose varied between 100 mg/d and 30 g/d for 1–24 months. Compared with control groups, guar gum supplementation decreased total cholesterol (TC) by −20.41 mg/dL (95% CI: −26.76 to −14.07; P < 0.001) and low-density lipoprotein-cholesterol (LDL-C) by −17.37 mg/dL (95% CI: −23.60 to −11.13; P < 0.001), but did not change triglycerides (TG) (WMD: −6.53 mg/dL, 95% CI: −16.03 to 2.97; P = 0.178) and high-density lipoprotein-cholesterol (HDL-C) (WMD: −0.62 mg/dL, 95% CI: −1.68 to 0.44, P = 0.252).ConclusionsGuar gum supplementation significantly reduced serum LDL-C and TC levels in patients with cardiometabolic problems, but had neutral effects on TG and HDL-C levels.     

Cross-sectional associations of dietary patterns characterized by fat type with markers of cardiometabolic health

Background and aimsIndividual dietary fats can differentially impact on cardiometabolic health. However, their impact within a dietary pattern is not well understood, and warrants comparison with diet quality scores with a dietary fat focus. The aim of this study was to investigate cross-sectional associations between a posteriori dietary patterns characterized by fat type and cardiometabolic health markers, and compare these with two diet quality scores.Methods and resultsUK Biobank adults with ≥two 24-h dietary assessments and data on cardiometabolic health were included (n = 24 553; mean age: 55.9 y). A posteriori dietary patterns (DP1; DP2) were generated through reduced rank regression (response variables: SFA, MUFA, PUFA). Mediterranean Diet Score (MDS) and Dietary Approaches to Stop Hypertension (DASH) dietary patterns were created. Multiple linear regression analyses were used to investigate associations between standardized dietary patterns and cardiometabolic health (total cholesterol, HDL-C, LDL-C and VLDL-C cholesterol, triglycerides, C-reactive protein [CRP], glycated hemoglobin [HbA1c]). DP1, positively correlated with SFAs, MUFAs and PUFAs, characterized by higher nuts, seeds and vegetables intake and lower fruits and low-fat yoghurt intake, was associated with lower HDL-C (β: −0.07; 95% CI: −0.10, −0.03) and triglycerides (−0.17; −0.23, −0.10) and higher LDL-C (0.07; 0.01,0.12), CRP (0.01; 0.01, 0.03) and HbA1c (0.16; 0.11,0.21). DP2, positively correlated with SFAs, negatively correlated with PUFAs, characterized by higher butter and high-fat cheese intake and lower nuts, seeds and vegetable intake, was associated with higher total cholesterol (0.10; 0.01, 0.21), VLDL-C (0.05; 0.02, 0.07), triglycerides (0.07; 0.01, 0.13), CRP (0.03; 0.02, 0,04) and HbA1c (0.06; 0.01, 0.11). Higher adherence to MDS and DASH was associated with favorable cardiometabolic health markers concentration.ConclusionsIrrespective of the method used, dietary patterns that encourage healthy fat consumption were associated with favorable cardiometabolic health biomarkers. This study strengthens the evidence for incorporation of dietary fat type into policy and practice guidelines for CVD prevention.     

Association of serum triglyceride-to-HDL cholesterol ratio with carotid artery intima-media thickness,insulin resistance and nonalcoholic fatty liver disease in children and adolescents

Background and aimsThe triglyceride (TG)/high-density lipoprotein-cholesterol (HDL-C) ratio has been reported as a useful marker of atherogenic lipid abnormalities, insulin resistance, and cardiovascular disease. We evaluated in a large sample of children and adolescents the association of TG/HDL-C ratio with early signs of morphological vascular changes and cardiometabolic risk factors including nonalcoholic fatty liver disease (NAFLD).Methods and resultsThe study population, including 548 children (aged 6–16 years), of whom 157 were normal-weight, 118 overweight, and 273 obese, had anthropometric, laboratory, liver and carotid ultrasonography (carotid artery intima-media thickness-cIMT) data collected. Subjects were stratified into tertiles of TG/HDL-C. There was a progressive increase in body mass index (BMI), BMI-SD score (SDS), waist circumference, blood pressure (BP), liver enzymes, glucose, insulin, homeostasis model assessment of insulin resistance, high-sensitivity C-reactive protein (hsCRP), and cIMT values across TG/HDL-C tertiles. The odds ratios for central obesity, insulin resistance, high hsCRP, NAFLD, metabolic syndrome, and elevated cIMT increased significantly with the increasing tertile of TG/HDL-C ratio, after adjustment for age, gender, pubertal status, and BMI-SDS. In a stepwise multivariate logistic regression analysis, increased cIMT was associated with high TG/HDL-C ratio [OR, 1.81 (95% CI, 1.08–3.04); P < 0.05], elevated BP [5.13 (95% CI, 1.03–15.08); P < 0.05], insulin resistance [2.16 (95% CI, 1.30–3.39); P < 0.01], and NAFLD [2.70 (95% CI, 1.62–4.56); P < 0.01].ConclusionTG/HDL-C ratio may help identify children and adolescents at high risk for structural vascular changes and metabolic derangement.     

Differences in vitamin D concentration between metabolically healthy and unhealthy obese adults: Associations with inflammatory and cardiometabolic markers in 4391 subjects

AimThis study aimed to compare concentrations of serum 25-hydroxy vitamin D and inflammatory markers in metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and to determine whether the relationship between vitamin D levels and both cardiometabolic and inflammatory markers differs between MHO and MUO.MethodsThis cross-sectional study comprised 4391 obese subjects aged > 18 years. A panel of cardiometabolic and inflammatory markers, including anthropometric variables, glycaemic indices, lipid profiles, liver enzymes, homocysteine, C-reactive protein (CRP), fibrinogen and serum 25-hydroxy vitamin D levels, was investigated. All cardiometabolic and inflammatory markers in MHO and MUO as well as in vitamin D deficiency were compared.ResultsPrevalence of MHO was 41.9% in our obese subjects using International Diabetes Federation criteria. Considering insulin resistance and inflammation, the prevalence of MHO was 38.4%. Individuals with MHO had significantly higher vitamin D concentrations compared with MUO, and this difference in vitamin D status persisted after accounting for BMI and waist circumference. Subjects with MHO had significantly better metabolic status, lower liver enzymes, lower inflammatory markers and higher serum 25-hydroxy vitamin D than those with MUO. Associations between vitamin D levels and inflammatory and cardiometabolic markers differed according to MHO/MUO status. Among MUO subjects, vitamin D deficiency was associated with higher liver marker and homocysteine levels. Serum vitamin D was negatively associated with fasting plasma glucose and HbA_1c in MHO only.ConclusionSerum 25-hydroxy vitamin D levels were lower in MUO vs MHO, and reduced vitamin D concentrations were more strongly associated with cardiometabolic and inflammatory markers in MUO than in MHO subjects. These findings suggest that a deficiency in vitamin D could be a key component of MUO.     

Effects of virgin coconut oil consumption on metabolic syndrome components and asymmetric dimethylarginine: A randomized controlled clinical trial

Background and aimsThere is some promising evidence regarding the beneficial effect of coconut oil on cardiometabolic risk factors. This study aimed to assess the effects of virgin coconut oil (VCO) consumption on metabolic syndrome (MetS) components, as well as, asymmetric dimethylarginine (ADMA) in adults with MetS.Methods and resultsIn this randomized controlled trial, 48 subjects, aged 20–50 years, with MetS were allocated into two groups; the intervention group was given 30 ml of VCO per day to substitute the same amounts of fat in their usual diet for four weeks. The control group was advised to follow their usual diet. VCO consumption significantly reduced serum levels of triglyceride (TG) (P = 0.001), very low-density lipoprotein (VLDL) (P = 0.001), and fasting blood sugar (FBS) (P = 0.015) compared to the control group. The levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC) were significantly increased in the VCO group when compared to the control group (P = 0.001). Circulatory ADMA also increased in the VCO group compared to the control group (P = 0.003). No significant differences were observed in the LDL-C/HDL-C ratio, anthropometric parameters, and blood pressure measurements between the two groups at the end of the study (P > 0.05).ConclusionVCO consumption increased the values of HDL-C while reduced TG and FBS levels. Blood pressure and waist circumference did not change. However, levels of TC, LDL-C, and ADMA elevated by VCO consumption. Caution is warranted until the results of further studies become available to explain the long-term effects of VCO consumption.Registration numberIRCT20131125015536N11.     

Identifying the threshold for vitamin D insufficiency in relation to cardiometabolic markers

Background and aimsTo determine the association between vitamin D status and cardiometabolic indicators, and to determine the vitamin threshold that affects these parameters.Methods and resultsHigh-tech employees were recruited from a periodic occupational health examination clinic and via the study's website. Diastolic and systolic blood pressure (DBP, SBP), body mass index (BMI), and waist circumference were measured. Serum concentrations of 25(OH)D, fasting plasma insulin (FPI), fasting plasma glucose (FPG), triglycerides (TG), and high sensitive C-Reactive Protein (hs-CRP) were measured in fasting blood samples.Of the 400 men who agreed to participate, 358 (90%) completed the study. Mean age was 48.8 ± 10.2 y, BMI 27.0 ± 3.8 k/m², serum 25(OH)D 22.1 ± 7.9 ng/l. Deficiency (defined as serum 25(OH)D < 12 ng/ml) was observed among 10.6%, 29.9% were insufficient (12 < 25(OH)D < 20 ng/ml), and 59.5% had sufficient levels (25(OH)D > 20 ng/ml). BMI, waist circumference, FPI, HOMA-IR, TG, hs-CRP levels, DBP, and SBP were negatively associated with serum 25(OH)D. A curved linear association was found with insulin and HOMA-IR with a significant spline knot at 11 ng/ml. For hs-CRP a spline knot at 14 ng/ml was observed. TG, SBP, and DBP exhibited linear associations with 25(OH)D.ConclusionsVitamin D status is related to cardiometabolic indicators in healthy men. We suggest a 25(OH)D threshold of 11–14 ng/ml for these outcomes. Future studies are required to address temporal relationships and the impact of vitamin D supplementation.     

Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis

IntroductionLow vitamin D status has been found to be associated with impaired glycemic control in patients who suffer from type 2 diabetes; however, whether vitamin D supplementation is associated with improved glycemic status remains controversial. The aim of this study was to summarize evidence from randomized controlled trials (RCTs) to assess the efficacy of vitamin D supplementation in reducing glycosylated haemoglobinA1c (HbA1c) and fasting blood glucose (FBG) levels.Materials/MethodsWe searched PubMed, Web of Science and the Cochrane Library for reports published up to March 2017. We selected parallel RCTs investigating the effect of vitamin D or vitamin D analogues on HbA1c or FBG levels in type 2 diabetes patients. Cohen's d was calculated to represent the standardized mean difference (SMD) for each study, and the SMDs with 95%confidence intervals (CIs) were pooled using a random effects model.ResultsTwenty-four studies were included that evaluated HbA1c levels and 18 studies were included that evaluated FBG levels. Meta-analyses showed that vitamin D supplementation was associated with reduced HbA1c levels (standardized mean difference (SMD) − 0.25 [− 0.45 to − 0.05]) but had no influence on FBG levels (SMD − 0.14 [− 0.31 to 0.03]). However, the subgroup analyses suggested that vitamin D supplementation was associated with reduced HbA1c levels (SMD − 0.39 [− 0.67 to − 0.10]) and FBG (SMD − 0.27 [− 0.46 to − 0.07]) among patients with 25-hydroxyvitamin D (25(OH) D) deficiency at baseline. Significantly reduced HbA1c levels were also observed in association with vitamin D supplementation in the subgroup including type 2 diabetes patients with a body mass index (BMI) < 30 kg m^− 2 (SMD − 0.30 [− 0.54 to − 0.07]).ConclusionsVitamin D supplementation could be effective at improving glycemic control in vitamin D deficient or non-obese type 2 diabetes patients.     

Vitamin D replacement in children,adolescents and pregnant women in the Middle East and North Africa: A systematic review and meta-analysis of randomized controlled trials

IntroductionHypovitaminosis D affects one-third to two-thirds of children and pregnant women from the Middle East and North Africa (MENA) region.ObjectiveTo evaluate in infants, children, adolescents and pregnant women, from the MENA region, the effect of supplementation with different vitamin D doses on the change in 25-hydroxyvitamin D [25(OH)D] level reached, and other skeletal and non-skeletal outcomes.MethodsThis is a systematic review of randomized controlled trials of vitamin D supplementation conducted in the MENA region. We conducted a comprehensive literature search in 7 databases, without language or time restriction, until November 2016. Two reviewers abstracted data from the included studies, independently and in duplicate. We calculated the mean difference (MD) and 95% CI of 25(OH)D level reached when at least 2 studies were eligible in each comparison (low (< 800 IU), intermediate (800–2000 IU) or high (> 2000 IU) daily dose of vitamin D, or placebo). We pooled data using RevMan version 5.3.ResultsWe identified a total of 15 eligible trials: one in infants, 4 in children and adolescents and 10 in pregnant women.In children and adolescents, an intermediate vitamin D dose (1901 IU/d), resulted in a mean difference in 25(OH)D level of 13.5 (95% confidence interval (CI) 8.1–18.8) ng/ml, compared to placebo, favoring the intermediate dose (p < 0.001). The proportion of children and adolescents reaching a 25(OH)D level ≥ 20 ng/ml was 74% in the intermediate dose group.In pregnant women, four trials started supplementation at 12–16 weeks of gestation and continued until delivery, and six trials started supplementation at 20–28 weeks' gestation and stopped it at delivery. The MD in 25(OH)D level reached was 8.6 (95% CI 5.3–11.9) ng/ml (p < 0.001) comparing the high dose (3662 IU/d) to the intermediate dose (1836 IU/d), and 12.3 (95% CI 6.4–18.2) ng/ml (p < 0.001), comparing the high dose (3399 IU/d) to the low dose (375 IU/d). Comparing the intermediate (1832 IU/d) to the low dose (301 IU/d), the MD in 25(OH)D level achieved was 7.8 (95% CI 4.5–10.8) ng/ml (p < 0.001). The proportion of pregnant women reaching a 25(OH)D level ≥ 20 ng/ml was 80%–90%, 73% and 27%–43% in the high, intermediate, and low dose groups, respectively.The risk of bias in the included studies, for children, adolescents and pregnant women, ranged from low to high across all doamins.ConclusionIn children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1000–2000 IU daily may be necessary to allow for the majority of the population to reach a desirable 25(OH)D level of 20 ng/ml. Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various clinically important outcomes.     

The effects of green coffee bean extract supplementation on lipid profile in humans: A systematic review and meta-analysis of randomized controlled trials

Background and aimThis systematic review and meta-analysis aimed to assess the effects of green coffee bean extract (GCBE) supplementation on lipid profile in adults.Methods and resultsThe PubMed/Medline, Scopus, Web of sciences, and Google Scholar were systematically searched for randomized controlled trials available in English and published before February 2019. The meta-analysis was conducted using fixed effects models, and between-study heterogeneity was assessed by Cochran's Q test and I². A total of 17 effect sizes were included in the meta-analysis. Combined effect sizes on serum total cholesterol concentrations revealed significant effects of GCBE supplementation on serum total cholesterol [weighted mean difference (WMD): −4.51 mg/dL, 95% confidence interval (CI): −6.89, −2.12, p < 0.001], low density lipoprotein-cholesterol (LDL-C) (WMD: −4.38 mg/dL, 95% CI: −6.44, −2.31, p < 0.001), and high density lipoprotein-cholesterol (HDL-C) (WMD: 2.63 mg/dL, 95% CI: 2.20, 3.07, p < 0.001) compared to controls. Nevertheless, no significant changes were observed in serum triglycerides levels (WMD: −4.34 mg/dL, 95% CI: −9.00, 0.32, p = 0.068).ConclusionThe evidence from available studies suggests that the GCBE supplementation leads to significant reductions in total cholesterol, HDL-C, and LDL-C levels, and has modest, but, non-significant effects on triglycerides levels.     

Effects of vitamin D supplementation along with endurance physical activity on lipid profile in metabolic syndrome patients: A randomized controlled trial

Background and objectivesThis study was conducted to determine the effects of vitamin D supplementation along with endurance physical activity on lipid profile among metabolic syndrome patients.Materials and methodsIn a parallel randomized placebo controlled trial, 70 metabolic syndrome patients, were randomly assigned into three groups. Biochemical tests were assessed as baseline and after 12 weeks of intervention. Statistical analysis was performed using SPSS version 20.ResultsThe mean vitamin D levels was increased significantly in both vitamin D and vitamin D plus physical activity groups (P value < 0.05). No significant change was observed in the placebo group. Additionally, there was a significant decrease in total cholesterol and LDL-C in vitamin D plus physical activity group (P value < 0.05). No significant differences in changes of triglycerides and HDL-C among the three groups (P value > 0.05). While, in vitamin D group a decreased in total cholesterol, HDL-C, LDL-C and increase in triglycerides were observed, but did not reach a statistically significant.ConclusionDaily supplementation of vitamin D for 12 weeks, along with moderate endurance physical activity, significantly increase vitamin D concentration and induce a significant reduction in lipid profile in metabolic syndrome patients.     

The association between the ratio of triglyceride to HDL-C and insulin resistance according to waist circumference in a rural Korean population

Background and aimsThis study aimed to examine the association between an increased ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) and insulin resistance as well as to investigate the interactive effect of TG/HDL-C and waist circumference on insulin resistance in a rural Korean population.Methods and resultsThis study, employing a cross-sectional design, included 8411 participants from the Korean Genomic Rural Cohort Study. Levels of fasting insulin, lipid profiles and anthropometric data were assessed for all participants. Insulin resistance was defined as a value greater than the 75th percentile on the homeostasis model assessment of insulin resistance (HOMA-IR). The TG/HDL-C ratio was positively correlated with waist circumference, total cholesterol, low-density lipoprotein cholesterol (LDL-C), TG and HOMA-IR, and negatively correlated with HDL-C when the calculations were controlled for gender. In comparison with the lowest quartile group of TG/HDL-C (≤1.92 in men, ≤1.63 in women), the odds ratios (ORs) (95% confidence interval) for insulin resistance in the highest quartile group of TG/HDL-C (>4.90 in men, >3.93 in women) were 2.33 (1.72–3.16) in men and 2.16 (1.73–2.71) in women, after adjusting for multiple covariates including waist circumference. Following stratification of waist circumference into quartiles, the effect of TG/HDL-C on insulin resistance remained significant irrespective of the waist circumference quartile.ConclusionThe TG/HDL-C ratio was linearly associated with insulin resistance in a rural Korean cohort independently of waist circumference in both genders, albeit not interactive.     

Improved risk assessment of coronary artery disease by substituting paraoxonase 1 activity for HDL-C: Novel cardiometabolic biomarkers based on HDL functionality

Background and aimsDeveloping laboratory assays to evaluate HDL functions and improve cardiovascular disease (CVD) risk assessment has recently emerged as a challenge. The present study was conducted to help predict the risk of coronary artery disease (CAD) by investigating new cardiometabolic risk factors based on substituting paraoxonase 1 (PON1) as a critical enzyme in the functionality of HDL for that of HDL-C.Methods and resultsThe present study recruited 274 subjects undergoing diagnostic coronary angiography, 92 without significant CAD (non-CAD), and 182 with a severe CAD. The diagnostic accuracy of the new biomarkers in non-CAD versus multi-vessel disease was obtained in descending order of AUC as 0.72 (P < 0.001) for log (TG/PON1), 0.70 (P < 0.001) for nonHDL-C/PON1, and 0.67 (P < 0.001) for LDL-C/PON1. After performing a multivariate adjustment for age, gender, BMI, statin therapy, and diabetes mellitus, the increased odds of CAD remained significant for the new cardiometabolic ratios as independent variables [adjusted OR = 1.47 (1.15–1.88), p = 0.002 for LDL-C/PON1; adjusted OR = 2.15 (1.41–3.5), p = 0.009 for nonHDL-C/PON1; adjusted OR = 5.03 (2.14–13.02), p = 0.004 for log (TG/PON1)]. CAD was diagnosed with an optimal discriminating cutoff of 1.84 for LDL-C/PON1, 2.8 for nonHDL-C/PON1, and 0.48 for log (TG/PON1).ConclusionsTo improve CAD's risk assessment, the PON1 activity was proposed as an alternative to HDL-C in the commonly used atherogenic lipid ratios. Substituting the PON1 activity for the HDL-C concentration can provide an index of the HDL activity. The present study sought to exploit the lipoprotein-related risk factors of CAD from a more effective perspective.     

Aerobic exercise and lipids and lipoproteins in children and adolescents: a meta-analysis of randomized controlled trials

OBJECTIVE: Use the meta-analytic approach to examine the effects of aerobic exercise on total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) in children and adolescents. STUDY DESIGN: Randomized controlled trials which were limited to aerobic exercise >or=4 weeks in children and adolescents 5-19 years of age. RESULTS: Twelve outcomes representing 389 subjects were available for pooling. Using random-effects modeling, a trend for statistically significant decreases of 12% was found for TG (X +/-S.E.M., -11.0+/-6.1mg/dl; 95% CI, -22.8-0.8 mg/dl) with no statistically significant changes for TC, HDL-C, and LDL-C. Decreases in LDL-C were associated with increased training intensity (r=-0.89; 99% CI, -0.99 to -0.04) and older age (r=-0.90; 99% CI, -0.99 to -0.25) while increases in HDL-C were associated with lower initial HDL-C (r=-0.75; 99% CI, -0.94 to -0.80). Statistically significant decreases in TG were observed in overweight/obese subjects with a trend for increases in HDL-C (TG, X +/-S.E.M., -23.9+/-7.0mg/dl; 95% CI, -37.6 to -10.1mg/dl; HDL-C, X +/-S.E.M., 4.0+/-2.3mg/dl; 95% CI, -0.5-8.5mg/dl). CONCLUSIONS: Aerobic exercise decreases TG in overweight/obese children and adolescents.     

The effects of Canola oil on cardiovascular risk factors: A systematic review and meta-analysis with dose-response analysis of controlled clinical trials

Background and aimsCanola oil (CO) is a plant-based oil with the potential to improve several cardiometabolic risk factors. We systematically reviewed controlled clinical trials investigating the effects of CO on lipid profiles, apo-lipoproteins, glycemic indices, inflammation, and blood pressure compared to other edible oils in adults.Methods and resultsOnline databases were searched for articles up to January 2020. Forty-two articles met the inclusion criteria. CO significantly reduced total cholesterol (TC, −0.27 mmol/l, n = 37), low-density lipoprotein cholesterol (LDL-C, −0.23 mmol/l, n = 35), LDL-C to high-density lipoprotein cholesterol ratio (LDL/HDL, −0.21, n = 10), TC/HDL (−0.13, n = 15), apolipoprotein B (Apo B, −0.03 g/l, n = 14), and Apo B/Apo A-1 (−0.02, n = 6) compared to other edible oils (P < 0.05). Compared to olive oil, CO decreased TC (−0.23 mmol/l, n = 9), LDL-C (−0.17 mmol/l, n = 9), LDL/HDL (−0.39, n = 2), and triglycerides in VLDL (VLDL-TG, −0.10 mmol/l, n = 2) (P < 0.05). Compared to sunflower oil, CO improved LDL-C (−0.14 mmol/l, n = 11), and LDL/HDL (−0.30, n = 3) (P < 0.05). In comparison with saturated fats, CO improved TC (−0.59 mmol/l, n = 11), TG (−0.08 mmol/l, n = 11), LDL-C (−0.49 mmol/l, n = 10), TC/HDL (−0.29, n = 5), and Apo B (−0.09 g/l, n = 4) (P < 0.05). Based on the nonlinear dose–response curve, replacing CO with ~15% of total caloric intake provided the greatest benefits.ConclusionCO significantly improved different cardiometabolic risk factors compared to other edible oils. Further well-designed clinical trials are warranted to confirm the dose–response associations.     

Long-term burden of higher body mass index from childhood on adult cardiometabolic biomarkers: A 30-year cohort study

Background and aimsData are limited regarding the association between long-term burden of higher body mass index (BMI) from childhood and cardiometabolic biomarkers.Methods and resultsA total of 1553 individuals aged 6–15 years, who were examined 4 or more times for BMI since childhood and followed for 30 years were included in our analysis. Total area under the curve (AUCt) and incremental AUC (AUCi) were calculated as the long-term burden and trends of BMI. Cardiometabolic biomarkers including serum uric acid (SUA), fasting blood-glucose (FBG), and triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) were obtained from venous blood samples. The results showed a positive association of BMI AUCt and AUCi with cardiometabolic biomarkers. After adjusting for demographic variables, the AUCt and AUCi of BMI were significantly associated with a higher level of SUA (β = 3.71; 2.87), FBG (β = 0.09; 0.09), and TG/HDL-C (β = 0.14; 0.11). We performed further studies after dividing subjects into four groups according to AUCt and AUCi of BMI by quartiles. Compared with the lowest quartile group, the highest quartile group had significantly increased risk ratios of hyperuricemia (RR = 2.01; 1.74), type 2 diabetes mellitus (RR = 8.18; 3.96), and high-risk TG/HDL-C (RR = 4.05; 3.26).ConclusionOur study identifies all subjects’ BMI growth curve from childhood and indicates that the long-term burden of higher BMI significantly increases the cardiometabolic risk, and the impact of excessive body weight on cardiometabolic health originates in early life. We emphasize the importance of weight control from childhood for cardiometabolic health.     

Effect of vitamin D supplementation on endothelial function – An updated systematic review with meta-analysis and meta-regression

Background and aimsAtherogenesis and endothelial dysfunction contribute to cardiovascular risk and vitamin D has been implemented in endothelial repair. This systematic review, meta-analysis and meta-regression aims to establish the effect of vitamin D supplementation on endothelial function.Methods and ResultsTo conduct the systematic review we searched the Cochrane Library of Controlled Trials, PubMed, ProQuest and EMBASE for randomized controlled trials that investigated the effects of vitamin D supplementation on flow-mediated dilation (FMD%), pulse wave velocity (PWV), and central augmentation index (AIx). Meta-analysis was based on a random effects model and inverse-variance methods to calculate either mean difference (MD) or standardized mean difference (SMD) as effects sizes. This was followed by meta-regression investigating the effect of baseline vitamin D concentrations, vitamin D dosing and study duration. Risk of bias was assessed using the JADAD scale and funnel plots.We identified 1056 studies of which 26 studies met inclusion criteria for quantitative analysis. Forty-two percent of the 2808 participants had either deficient or insufficient levels of vitamin D. FMD% (MD 1.17% (95% CI −0.20, 2.54), p = 0.095), PWV (SMD −0.09 m/s (95% CI −0.24, 0.07), p = 0.275) and AIx (SMD 0.05% (95% CI −0.1, 0.19), p = 0.52) showed no improvement with vitamin D supplementation. Sub-analysis and meta-regression revealed a tendency for AIx and FMD% to increase as weekly vitamin doses increased; no other significant relationships were identified.ConclusionsVitamin D supplementation showed no improvement in endothelial function. More evidence is required before recommendations for management of endothelial dysfunction can be made.     

Clinical analysis of the relationship between cystatin C and metabolic syndrome in the elderly

ObjectiveStudies have shown that both cystatin C and metabolic syndrome (MetS) are associated with inflammation. We set out to investigate the correlation between serum cystatin C levels and MetS in the elderly.MethodsThis prospective study was conducted in 380 elderly individuals, including 135 patients with MetS, 142 patients with metabolic disturbance (MetD), and 103 healthy elderly individuals (control group). Waist–hip ratio, waist circumference, waist–height ratio, body mass index (BMI), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein (HDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure and cystatin C were measured and their mutual relations were analyzed.ResultsThe higher the MetS scores, the higher the serum cystatin C concentration in these patients. Serum cystatin C concentration was closely related to waist–hip ratio, waist circumference, waist–height ratio, BMI, TG, FPG, and blood pressure, not related to LDL-C levels, and negatively correlated with HDL-C levels. Logistic regression analysis indicated that cystatin C, waist–height ratio, waist circumference, FPG, TG, SBP and pulse pressure were significantly associated with MetS (OR between cystatin C and MetS 2.164, 95% CI 1.136–8.259).ConclusionCystatin C was significantly associated with MetS in the elderly. As MetS scores rose, serum cystatin C levels increased.     

Effects of Flaxseed on Blood Lipids in Healthy and Dyslipidemic Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

To address hyperlipidemia, flaxseed demonstrates a great impact on experimental and clinical trials. Therefore, the effects of flaxseed on lipid profiles of healthy and dyslipidemic subjects were assayed. The literature search was performed based on English reports of randomized control trials (RCTs) up to April 2021 to seek the effect of flaxseed on lipid profiles of healthy and dyslipidemic subjects. A total of 14 RCTs with 1107 participants were evaluated. Based on results, flaxseed significantly improves the lipid profile in dyslipidemic patients comprising total cholesterol (TC), low-density lipoprotein (LDL-C) and triglyceride (TG) in comparison with the control group. Nevertheless, no significant changes were observed in high-density lipoprotein (HDL-C). Although in healthy individual flaxseed significantly increased HDL-C, LDL-C and TG. Subgroup analysis on healthy subjects showed that flaxseed improved LDL-C on overweight subjects with BMI>25. The evidence suggests that flaxseed significantly improved TC, LDL-C and TG in dyslipidemic subjects and additionally improved the HDL-C on healthy subjects.