Ultra-processed food consumption and adult obesity risk: a systematic review and dose-response meta-analysis.

We performed this systematic review and meta-analysis to evaluate observational studies assessing the association between ultra-processed food (UPF) consumption and the risk of overweight, obesity, and abdominal obesity in the general population. We searched the databases PubMed/MEDLINE, Scopus, Embase, and ISI Web of Science from inception until December 2020. Data were extracted from 12 studies (nine cross-sectional and three cohort studies). Odds ratio (OR) were pooled using a random-effects model. UPF consumption was associated with an increased risk of obesity (OR = 1.55; 95% CI: 1.36, 1.77; I2 = 55%), overweight (OR = 1.36; 95% CI: 1.14, 1.63; I2 = 73%), and abdominal obesity (OR = 1.41; 95% CI: 1.18, 1.68; I2 = 62%). Furthermore, every 10% increase of UPF consumption in daily calorie intake was associated with a 7%, a 6%, and a 5% higher risk of overweight, obesity, and abdominal obesity, respectively. Dose-response meta-analysis of cross-sectional studies showed a positive linear association between UPF consumption and abdominal obesity. There was also a positive linear association between UPF consumption and risk of overweight/obesity in the analysis of cross-sectional studies and a positive monotonic association in the analysis of cohort studies. Our study suggests that UPF consumption is associated with an increased risk of excess weight or abdominal obesity.

The effects of nano-curcumin supplementation on Th2/tregulatory axis in migraine patients: a randomized, double-blind, placebo-controlled trial.

AIM: In the present study we aimed to investigate the effects of nano-curcumin supplementation on gene expression and serum levels of IL-4 and TGF-ß in migraine patients. METHODS: Forty participants with episodic migraine were randomly allocated to receive 80 mg nano-curcumin (n = 20) or placebo (n = 20) in a randomized double-blind clinical trial for two months. At the beginning and the end of the study, the interictal serum levels and gene expression of IL-4 and TGF-ß in peripheral blood mononuclear cells (PBMCs) isolated from migraine patients were measured, using ELISA and real-time PCR methods, respectively. RESULTS: Intra-group assays showed a significant rise in the gene expression of both IL-4 and TGF-ß (p < 0.05) in nano-curcumin group after two months of treatment, however the serum levels were only significantly changed for IL-4 (p < 0.05). On the contrast, inter-group assays revealed no statistical differences between nano-curcumin and placebo group in terms of IL-4 and TGF-ß gene expression, while the serum levels of IL-4 was observed to be increased significantly (p = 0.03) following two month nano-curcumin supplementation. CONCLUSION: The findings of the present trial suggest that the treatment with nano-curcumin could induce significant levels of IL-4, in favour of anti-inflammatory effects, while has a minimal effects on the both gene expression and serum levels of TGF-ß. Further studies are required to determine the exact mechanism of action of curcumin in patients with migraine.

The effect of zinc supplementation in children with attention deficit hyperactivity disorder: A systematic review and dose-response meta­analysis of randomized clinical trials.

OBJECTIVE: The present systematic review and dose-response meta-analysis was conducted to quantify the efficacy of zinc supplementation on clinical symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. METHODS: Electronic databases including PubMed, Scopus, ISI web of science, and Google Scholar were searched until January 2021. Results were reported as standardized mean difference (SMD) with a 95% confidence interval (CI) using Hedges's adjusted g method. RESULTS: six randomized clinical trials with 489 school-aged children were identified for the meta-analysis. Our findings showed a significant effect of zinc supplementation on ADHD total scores (SMD: -0.62 Hedges' g; 95% CI: -1.24 to -0.002, p = 0.04) but not in hyperactivity scores (SMD: -0.93 Hedges' g; 95% CI: -3.31 to 1.45, p = 0.44) and inattention scores (SMD: 0.21 Hedges' g; 95% CI: -0.09 to 0.51, p = 0.17) compared to the control group. Besides, the dose-response analysis did not find any significant non-linear association between zinc supplementation dosage or duration on ADHD total scores. The certainty of the evidence was rated moderate to very low for all outcomes. CONCLUSION: Zinc supplementation may have beneficial effects in improving ADHD symptoms in children with ADHD. Future well-designed, large-scale randomized controlled trials are needed to establish the benefit of zinc supplementation for ADHD.

The effects of oral magnesium supplementation on glycaemic control in patients with type 2 diabetes: a systematic review and dose-response meta-analysis of controlled clinical trials.

The current systematic review and meta-analysis were conducted to evaluate the effects of oral Mg supplementation on glycaemic control in type 2 diabetes mellitus (T2DM) patients. Related articles were found by searching the PubMed, SCOPUS, Embase and Web of Science databases (from inception to 30 February 2020). A one-stage robust error meta-regression model based on inverse variance weighted least squares regression and cluster robust error variances was used for the dose-response analysis between Mg supplementation and duration of intervention and glycaemic control factors. Eighteen eligible randomised clinical trials were included in our final analysis. The dose-response testing indicated that the estimated mean difference in HbA1c at 500 mg/d was -0·73 % (95 % CI: -1·25, -0·22) suggesting modest improvement in HbA1c with strong evidence (P value: 0·004). And in fasting blood sugar (FBS) at 360 mg/d was -7·11 mg/dl (95 % CI: -14·03, -0·19) suggesting minimal amelioration in FBS with weak evidence (P value: 0·092) against the model hypothesis at this sample size. The estimated mean difference in FBS and HbA1c at 24 weeks was -15·58 mg/dl (95 % CI: -24·67, -6·49) and -0·48 (95 % CI: -0·77, -0·19), respectively, suggesting modest improvement in FBS (P value: 0·034) and HbA1c (P value: 0·001) with strong evidence against the model hypothesis at this sample size. Oral Mg supplementation could have an effect on glycaemic control in T2DM patients. However, the clinical trials so far are not sufficient to make guidelines for clinical practice.

The effect of almond intake on glycemic control: A systematic review and dose-response meta-analysis of randomized controlled trials.

Number trials have evaluated the effect of almond intake on glycemic control in adults; however, the results remain equivocal. Therefore, the present meta-analysis aims to examine the effectiveness of almond intake on glycemic parameters. Online databases including PubMed, Scopus, ISI web of science, Embase, and Cochrane Library were searched up to August 2021 for trials that examined the effect of almond intake on glycemic control parameters including fasting blood sugar (FBS), insulin, HOMA-IR, and HbA1C. Treatment effects were expressed as mean difference (MD) and the standard deviation (SD) of outcomes. To estimate the overall effect of almond intake, we used the random-effects model. In total, 24 studies with 31 arms were included in our analysis. The meta-analysis revealed that almond intake did not significantly change the concentrations of FBS, HbA1c, insulin levels, and HOMA-IR. In conclusion, there is currently no convincing evidence that almonds have a clear beneficial effect on glycemic control. Future studies are needed before any confirmed conclusion could be drowned.

Dietary patterns and risk of non-alcoholic fatty liver disease.

BACKGROUND: Nutrition is a modifiable risk factor that plays an important role in the prevention or delaying of the onset of non-alcoholic fatty liver disease (NAFLD). Previous studies have focused on NAFLD and individual nutrients, which does not take into account combinations of food that are consumed. Therefore, we aimed to investigate the relationship between major dietary patterns and NAFLD. METHODS: This case-control study was conducted on 225 newly diagnosed NAFLD patients and 450 healthy controls. Usual dietary intake over the preceding year was assessed using a validated 168-item semi-quantitative food frequency questionnaire. Major dietary patterns were determined by exploratory factor analysis. RESULTS: Three dietary patterns, including "western dietary pattern", "healthy dietary pattern", and "traditional dietary pattern" were identified. Subjects in the highest tertile of healthy dietary pattern scores had a lower odds ratio for NAFLD than those in the lowest tertile. Compared with those in the lowest tertile, people in the highest tertile of "western dietary pattern" scores had greater odds for NAFLD. After adjusting for potential confounding factors, "western dietary pattern" had a positive significant effect on NAFLD occurrence. In contrast, "healthy dietary pattern" was associated with a decreased risk of NAFLD. Furthermore, Higher consumption of the "traditional dietary pattern" was significantly associated with NAFLD, albeit in the crude model only. CONCLUSION: This study indicated that healthy and western dietary patterns may be associated with the risk of NAFLD. The results can be used for developing interventions in order to promote healthy eating for the prevention of NAFLD.

The effect of grapes/grape products on glycemic response: A systematic review and meta-analysis of randomized controlled trials.

The aim of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) to examine the effect of grapes/grape products supplementation on glycemic indices in adults. Our systematic search to find relevant RCTs was performed up to February 2020 using PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar. Based on the heterogeneity between included studies, a random effects or a fixed model was applied in the meta-analysis, and results were expressed as weighted mean differences (WMD) with 95% confidence intervals (CI). Twenty-nine clinical trials (1,297 participants) fulfilled the eligibility criteria of the present meta-analysis. Overall, the grapes/grape products supplementation significantly reduced homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: -0.54, 95% CI: -0.91, -0.17, p = . 004) but did not affect fasting insulin levels (WMD: -0.90 µIU/ml, 95% CI: -1.04, 2.84, p = .362) and hemoglobin A1C (Hb1Ac) percentage (WMD: 0.00%, 95% CI: -0.10, 0.11, p = . 916) in the main analyses. In addition, changes to fasting blood glucose (FBG) levels were in favor of the control group (WMD: 1.19 mg/dl, 95% CI: 0.05, 2.34, p = .041). We found that giving grapes/grape products to adults might have beneficial effects on the HOMA-IR. Further, large-scale RCTs with longer duration are required to confirm these results.

Effect of flaxseed supplementation on markers of inflammation and endothelial function: A systematic review and meta-analysis.

OBJECTIVES: The rationale for the current study was to evaluate the efficacy of flaxseed supplementation on important adhesion molecules and inflammatory cytokines in adults. METHODS: We conducted searches of published literature in PubMed, Scopus, Web of Science, and Google Scholar databases from inception until May 2019. All randomized controlled trials (RCTs) which investigated the effects of flaxseed supplementation on the circulating concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), vascular cell adhesion protein 1 (VCAM-1), E-selectin, and intercellular adhesion molecule 1 (ICAM-1) were included in our analysis. Results were summarized using weighted mean differences (WMDs) by random-effects model. RESULTS: Forty eligible RCTs, including 2520 participants were identified. The results of the meta-analysis revealed flaxseed supplementation reduced the concentrations of CRP (WMD = -0.387 mg/L; 95% CI: -0.653, -0.121, p = 0.004), IL-6 (WMD = -0.154 pg/Ml; 95% CI: -0.299, -0.010, p = 0.036), and VCAM-1 (WMD = -22.809 ng/ml; 95% CI: -41.498, -4.120, p = 0.017) but had no significant effect on TNF-α (WMD = -0.077 pg/mL; 95% CI: -0.317, 0.163, p = 0.530), ICAM-1 (WMD = -8.610 ng/ml; 95% CI: -21.936, 4.716, p = 0.205), and E-selectin (WMD = -1.427 ng/ml; 95% CI: -4.074, 1.22, p = 0.291). CONCLUSIONS: These findings showed that flaxseed supplementation may improve some circulating concentrations of specific adhesion molecules and inflammatory cytokines. However, well-designed trials are needed to confirm the range of non-significant and/or equivocal findings.

Effect of Bariatric Surgery on the Circulating Level of Adiponectin, Chemerin, Plasminogen Activator Inhibitor-1, Leptin, Resistin, and Visfatin: A Systematic Review and Meta-Analysis.

Different adipokines secreted from adipose tissue, exert a range of physiological effects. The aim of present systematic review and meta-analysis was to critically investigate the consequence of bariatric surgery on circulating adipokines, that is, adiponectin, leptin, visfatin, resistin, plasminogen activator inhibitor, and chemerin. After systematically checking the following electronic databases: ISI web of Science, Scopus and PubMed without limitation in time and language up to February 2019, a pool based on a random effect model was established. Eighty-five eligible studies were entered for quantitative analysis. Our meta-analysis revealed that circulating adiponectin increased significantly after bariatric surgery [Standardized mean difference (SMD)=1.401, 95% CI: 1.101, 1.701, p<0.001]; whilst leptin (SMD=-2.178, 95% CI: -2.433, -1.923, p<0.001), PAI-1 (-14.928 ng/ml 95% CI: -21.794, -8.063, p<0.001), and chemerin (-50.238 ng/ml 95% CI: -85.708, -14.768, p<0.001) decreased. However, serum visfatin (2.05 ng/ml, 95% CI: -5.07, 9.17, p=0.573) and resistin (-2.080 ng/ml, 95% CI: -5.352, 1.192, p=0.21) were unchanged. In conclusion, bariatric surgery is associated with a reduction in specific adipokines including leptin, chemerin, and PAI-1, whereas adiponectin is raised, adaptations that could be indicative of improved fat mass and function.

Beneficial effects of l-carnitine supplementation for weight management in overweight and obese adults: An updated systematic review and dose-response meta-analysis of randomized controlled trials.

Despite preclinical studies demonstrating the efficacy of l-carnitine supplementation for weight management, findings in clinical setting are contradictory. Electronic bibliographical databases were systematically searched up to February 2019 with no limitation in language, including Scopus, PubMed, ISI Web of Science and Cochrane Library. Clinical trials registry platform were also searched. All randomized controlled trials (RCTs) which reported an effect of l-carnitine supplementation on obesity-related indices were included. Weighted mean difference (WMD) was estimated using a random-effect model (DerSimonian-Laird method). Eventually 43 eligible RCTs were included for quantitative analysis. Meta-analysis results revealed that l-carnitine supplementation significantly decreased weight (WMD: -1.129 kg, 95 % CI: -1.590, -0.669; I2: 63.4), body mass index (BMI) (WMD: -0.359 kg/m2, 95 % CI: -0.552, -0.167; I2: 85.2) and fat mass (WMD: -1.158 kg, 95 % CI: -1.763, -0.554, I2: 15.5). However, l-carnitine supplementation did not change body fat percentage (WMD: -0.874 %, 95 % CI: -1.890, 0.142, I2: 98.2) or waist circumference (WMD: -0.883 mg/dl, 95 % CI: -1.770, 0.004, I2: 74.8). l-Carnitine supplementation changed weight (r = -0.98) and BMI (r = -0.67) in a non-linear fashion based on carnitine dosage and BMI according to trial duration (r = -0.04). Interestingly subgroup analysis revealed that l-carnitine showed anti-obesity effects only in overweight and obese subjects; l-carnitine decreased weight, and BMI alone when combined with other lifestyle modifications. Anthropometric indexes were not changed following l-carnitine supplementation among patients' undergoing hemodialysis. Our study revealed that l-carnitine supplementation might have a positive effects in achieving an improved body weight and BMI especially in overweight and obese subjects.

Effect of flaxseed supplementation on lipid profile: An updated systematic review and dose-response meta-analysis of sixty-two randomized controlled trials.

Raised plasma lipids are one the most important risk factors for cardiovascular disease. Flaxseed contains considerable amounts of α-linolenic acid, phenolic compounds, and lignans, which each have the capacity to reduce circulating lipid concentrations. This study aimed to systematically review current evidence to identify the potential effects of flaxseed supplementation on blood lipid profiles using a meta-analysis of randomized controlled trials (RCTs). PubMed, Scopus, Web of Science, and Google Scholar databases were searched for publications between January 1900 and May 2019. Weighted mean differences (WMDs) were analyzed using a random-effects model. The Cochrane Collaboration tool was also used to assess the risk of bias of the studies included. Sixty-two RCTs with a total of 3772 participants met the eligibility criteria. Our analysis showed that flaxseed supplementation significantly reduced total cholesterol (TC) (WMD = -5.389 mg/dL; 95% CI: -9.483, -1.295, p = 0.010), triglyceride (TG) (WMD = -9.422 mg/dL; 95% CI: -15.514, -3.330, p = 0.002), and low-density lipoprotein cholesterol (LDL-C) (WMD = -4.206 mg/dl; 95% CI: -7.260, -1.151, p = 0.007) concentrations. However, it had no effects on high-density lipoprotein cholesterol (WMD = 0.047 mg/dl; 95% CI: -0.777, 0.872, p = 0.910). This meta-analysis suggested that flaxseed supplementation improves serum TC, TG, and LDL-C, which could delay the progression of heart disease. Further studies with large-scale and better design are now needed to confirm these results.

Efficacy of synbiotic supplementation in obesity treatment: A systematic review and meta-analysis of clinical trials.

Several investigations have been reported the beneficial effects of synbiotic in participants with obesity, but these findings have been inconsistent. Therefore, we systematically reviewed available randomized clinical trials (RCTs) to elucidate the overall effects of synbiotic supplementation on anthropometric indices among participants with overweight or obesity. Five electronic databases including PubMed, Scopus, ISI Web of science, Cochrane Library and Google Scholar were searched up to October 2018. All RCTs using synbiotic supplements to treat obesity included in this systematic review and meta-analysis. Weighted mean difference (WMD) was pooled using a random-effects model. The present meta-analysis of 23 randomized trials indicated that supplementation with synbiotic can decrease body weight (WMD: -0.80 kg; 95% CI: -1.56 to -0.03, p = 0.04) and WC (WMD: -2.07 cm; 95% CI: -3.11 to -1.03, p < 0.001). In contrast, synbiotic did not have favorite effects on BMI (WMD: -0.12 kg/m2; 95% CI: -0.40 to 0.16, p = 0.39) and body fat (WMD: 0.02%; 95% CI: -1.27 to 1.87, p = 0.74) compared with the placebo group. Meta-regression analyses revealed that the dosage of probiotic did not have any effect on anthropometric measures. Based on our findings, modulation of gut microbiota composition through synbiotic supplementation might have modest effects on body weight and waist circumference. In this field, however, our knowledge is progressing.

Phytosterol Supplementation Could Improve Atherogenic and Anti-Atherogenic Apolipoproteins: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials.

Phytosterol and phytostanol (PS) supplementation is reported to improve atherogenic and anti-atherogenic apolipoproteins (Apo). The purpose of the present study is to critically investigate the effectiveness of PS supplementation on Apo in adults.A comprehensive search was conducted of all randomized controlled trials (RCTs) conducted up to September 2018 in the following databases: PubMed, Web of Science, Cochrane Library, and Scopus. Mean difference with 95% confidence intervals (CIs) were pooled using a random-effects model (DerSimonian-Laird method).Fifty-one arms from 37 RCTs were included in the present meta-analysis. Findings showed that PS supplementation and fortification increased Apo-AI (weighted mean difference [WMD]: 0.014 mg/dl, 95% CI: 0.001, 0.028, p = 0.042) and Apo-CII (WMD: 0.303 mg/dl, 95% CI: 0.084, 0.523, p = 0.007) and lowered Apo-B (WMD: -0.063 mg/dl, 95% CI: -0.075, -0.051, p < 0.001), Apo-B/Apo-A-I ratio (WMD: -0.044 mg/dl, 95% CI: -0.062, -0.025, p < 0.001), and Apo-E (WMD: -0.255 mg/dl, 95% CI: -0.474, -0.036, p = 0.023). However, PS supplementation did not have significant effects on Apo-AII and Apo-CIII. PS supplementation or fortification significantly changes Apo-E (r = -0.137, p nonlinearity = 0.006) and Apo-CIII (r = 1.26, p nonlinearity = 0.028) based on PS dosage (mg/d) and Apo-CIII (r = 3.34, p nonlinearity = 0.013) and Apo-CII (r = 1.09, p nonlinearity = 0.017) based on trial duration (weeks) in a nonlinear fashion.Based on our findings, supplements or fortified foods containing PS might have a considerable favorite effect in achieving Apo profile target; however, due to high heterogeneity among included studies, results must be interpreted with caution.KEY TEACHING POINTSCardiovascular diseases (CVDs) recognized as main public health concern worldwide with considerable mortality of all global deaths.Apo-lipoproteins are amphipathic molecules involved in the lipoprotein metabolism which introduced as biomarkers in the evaluation of CVD risk.Phytosterols bioactive components of plants have important biological functions in cholesterol metabolism in humans.Here we showed that phytosterols and phytostanols improve apo-lipoproteins profile of humans; finding from meta-analysis of randomized controlled trials.Phytosterols supplementation lowered atherogenic apo-lipoproteins (Apo-B and Apo-E) and increased anti-atherogenic apo-lipoproteins (Apo-AI, Apo-CII).

Food insecurity and mental health: a systematic review and meta-analysis.

OBJECTIVE: Food security has been suggested to be a risk factor for depression, stress and anxiety. We therefore undertook a systematic review and meta-analysis of available publications to examine these associations further. DESIGN: Relevant studies were identified by searching Web of Science, Embase, Scopus and PubMed databases up to January 2019. SETTING: OR was pooled using a random-effects model. Standard methods were used for assessment of heterogeneity and publication bias. PARTICIPANTS: Data were available from nineteen studies with 372 143 individual participants from ten different countries that were pooled for the meta-analysis. RESULTS: The results showed there was a positive relationship between food insecurity (FI) and risk of depression (OR = 1·40; 95 % CI: 1·30, 1·58) and stress (OR = 1·34; 95 % CI: 1·24, 1·44) but not anxiety. Subgroup analysis by age showed that subjects older than ≥65 years exhibited a higher risk of depression (OR = 1·75; 95 % CI: 1·20, 2·56) than younger participants (OR = 1·34; 95 % CI: 1·20, 1·50), as well as a greater risk of depression in men (OR = 1·42; 95 % CI: 1·17, 1·72) than women (OR = 1·30; 95 % CI: 1·16, 1·46). Finally, subgroup analysis according to geographical location illustrated that food insecure households living in North America had the highest risk of stress and anxiety. CONCLUSIONS: The evidence from this meta-analysis suggests that FI has a significant effect on the likelihood of being stressed or depressed. This indicates that health care services, which alleviate FI, would also promote holistic well-being in adults.

Sleep duration and sarcopenia risk: a systematic review and dose-response meta-analysis.

PURPOSE: Present systematic literature review and dose-response meta-analysis were carried out to evaluate the association between sleep duration and sarcopenia risk. METHODS: Related studies were found by searching ISI Web of science databases, Scopus, and PubMed, up to May, 2019. Data were available from four studies. A total odds ratio of 17551 participants in these studies was pooled for the current study. RESULTS: Pooled outcomes from random effects model demonstrated that lowest category of sleep duration (under 6 h) versus reference category (6-8 h) was significantly related with increased risk of sarcopenia (OR: 1.71 95% CI, 1.11, 2.64). Pooled OR also indicated that highest category (more than 8 h) of sleep duration versus reference category (6-8 h) was significantly associated with increased risk of sarcopenia (OR: 1.52 95% CI, 1.23, 1.88). Moreover, subgroup analysis by sex showed that women were affected by both short and long sleep while men were only affected by long sleep duration. The nonlinear dose-response meta-analysis revealed a U-shaped association between sleep duration and the risk of sarcopenia, with a nadir at 8 h per day. The linear dose-response meta-analysis illustrated that the risk of sarcopenia did not change significantly nor for a 0.5-h increment neither for 1-h increment in sleep duration per day. CONCLUSION: The outcomes from this meta-analysis indicate that the public should be made aware of the negative consequences of long and short sleep for sarcopenia especially among women. Further studies should now be undertaken to establish possible links between risk of sarcopenia and sleep duration.

Efficacy of synbiotic supplementation in patients with nonalcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials: Synbiotic supplementation and NAFLD.

Objective: We systematically reviewed available randomized clinical trials (RCTs) to elucidate the overall effects of synbiotic supplementation in patients with nonalcoholic fatty liver disease (NAFLD). Methods: PubMed, Scopus, ISI Web of science and Google Scholar were searched up to December, 2017. All RCTs using synbiotic supplements to treat NAFLD included in this systematic review and meta-analysis. Mean Difference (MD) was pooled using a random-effects model. Results: Eleven eligible databases from seven RCTs were identified for the present meta-analysis. Our results showed that synbiotic supplementation can decrease body weight, fasting blood sugar, insulin, low density lipoprotein cholesterol, total cholesterol, triglyceride, high-sensitivity C-reactive protein, tumor necrosis factor alpha, alanine transaminase and aspartate transaminase levels among patients with NAFLD. In contrast, synbiotic did not have favorable effects on body mass index (BMI), waist circumference, homeostasis model assessment for insulin resistance (HOMA-IR), and high density lipoprotein cholesterol (HDL) levels compared with the placebo group. Conclusion: The current study revealed that synbiotic supplementation has favorable effect on inflammatory factors, liver enzymes and some anthropometric indices, lipid profiles and glucose homeostasis parameters in patients with NAFLD.

Efficacy of l-carnitine supplementation for management of blood lipids: A systematic review and dose-response meta-analysis of randomized controlled trials.

BACKGROUND AND AIM: l-carnitine has an important role in fatty acid metabolism and could therefore act as an adjuvant agent in the improvement of dyslipidemia. The purpose of present systematic review and meta-analysis was to critically assess the efficacy of l-carnitine supplementation on lipid profiles. METHODS AND RESULTS: We performed a systematic search of all available randomized controlled trials (RCTs) in the following databases: Scopus, PubMed, ISI Web of Science, The Cochrane Library. Mean difference (MD) of any effect was calculated using a random-effects model. In total, there were 55 eligible RCTs included with 58 arms, and meta-analysis revealed that l-carnitine supplementation significantly reduced total cholesterol (TC) (56 arms-MD: -8.53 mg/dl, 95% CI: -13.46, -3.6, I2: 93%), low-density lipoprotein-cholesterol (LDL-C) (47 arms-MD: -5.48 mg/dl, 95% CI: -8.49, -2.47, I2: 94.5) and triglyceride (TG) (56 arms-MD: -9.44 mg/dl, 95% CI: -16.02, -2.87, I2: 91.8). It also increased high density lipoprotein-cholesterol (HDL-C) (51 arms-MD:1.64 mg/dl, 95% CI:0.54, 2.75, I2: 92.2). l-carnitine supplementation reduced TC in non-linear fashion based on dosage (r = 21.11). Meta-regression analysis indicated a linear relationship between dose of l-carnitine and absolute change in TC (p = 0.029) and LDL-C (p = 0.013). Subgroup analyses showed that l-carnitine supplementation did not change TC, LDL-C and TG in patients under hemodialysis treatment. Intravenous l-carnitine and lower doses (>2 g/day) had no effect on TC, LDL-C and triglycerides. CONCLUSION: l-carnitine supplementation at doses above 2 g/d has favorable effects on patients' lipid profiles, but is modulated on participant health and route of administration.

Does ginger supplementation lower blood pressure? A systematic review and meta-analysis of clinical trials.

The aim of the present systematic review and meta-analysis was to determine the efficacy of ginger supplementation on blood pressure (BP). PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar were comprehensively searched until September 2018. Human clinical trials, which reported the effect of ginger supplementation on aortic and/or brachial BP, were included. Mean differences were pooled using a random effects model. Standard methods were used for assessment of heterogeneity, sensitivity analysis, and publication bias. Total of six randomized clinical trials (345 participants) were included in the meta-analysis. Pooled analysis suggested that ginger supplementation can reduced systolic BP (MD: -6.36 mmHg, 95% confidence interval [-11.27, -1.46]; I2  = 89.8%; P = .011) and diastolic BP (MD: -2.12 mmHg, 95% confidence interval [-3.92, -0.31]; I2  = 73.4%; P = .002). When studies were categorized based on participants' mean age, ginger dosage and duration of intervention, systolic BP and diastolic BP were significantly decreased only in the subset of studies with mean age ≤ 50 years, follow-up duration of ≤8 weeks and ginger doses ≥3 g/d. Our findings revealed that ginger supplementation has favorable effects on BP. Nonetheless, further studies are warranted before definitive conclusions may be reached.

The Effects of Beta-Hydroxy-Beta-Methylbutyrate Supplementation on Recovery Following Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis.

BACKGROUND: Growing evidence suggests beta-hydroxy-beta-methylbutyrate's (HMB) positive effects on recovery following exercise-induced muscle damage (EIMD). However, findings vary substantially across studies. OBJECTIVE: A meta-analysis of randomized controlled trials was conducted to assess the effects of HMB supplementation on recovery following EIMD by assessing indirect markers of muscle damage, namely creatine kinase (CK) and lactate dehydrogenase (LDH) serum levels among healthy participants. METHOD: A comprehensive search was performed on electronic databases (Medline, Scopus, Cochrane Library, and Google Scholar) up to October 2017 for trials evaluating the effects of HMB on recovery following EIMD. Mean ± standard deviation of follow-up CK and LDH concentrations were extracted to calculate the effect size for meta-analysis. RESULTS: A total of 324 participants for CK and 229 participants for LDH were found from the 10 and 8 studies, respectively. The results revealed a significant effect of HMB supplementation on CK (weighted mean difference [WMD] = -60.71 UL-1; 95% confidence interval [CI], -78.12 to -43.29; I2 = 4.1%; pheterogeneity = 0.40) and LDH reduction (WMD = -15.42 UL-1; 95% CI, -22.2 to -8.6; I2 = 0.0%; pheterogeneity = 0.53). In addition, a subgroup analysis based on study duration (< 6 weeks vs. ≥ 6 weeks) suggested that HMB effectiveness on EIMD was statistically significant in studies over 6 weeks (p < 0.001). CONCLUSIONS: The current evidence revealed a time-dependent effect of HMB in reducing LDH and CK serum levels among adults. HMB, therefore, may be seen as a priority muscle damage recovery agent in interventions.

The Impact of Probiotic Soy Milk Consumption on Oxidative Stress Among Type 2 Diabetic Kidney Disease Patients: A Randomized Controlled Clinical Trial.

OBJECTIVE: Diabetic kidney disease (DKD) is one the most important complications of diabetes leading to end-stage renal disease. This study aimed to determine the effects of probiotic soy milk consumption on oxidative stress biomarkers in type 2 DKD patients. METHODS: Forty-eight patients were randomly assigned to consume a diet containing 200 mL/day probiotic soy milk in the intervention group or soy milk in the control condition. As determinants of oxidative stress, malondialdehyde, 8-iso-prostaglandin F2α, oxidized glutathione, total antioxidant capacity, reduced glutathione (GSH), glutathione peroxidase, and glutathione reductase were measured after 8 weeks of intervention according to the standard protocol. RESULTS: Between groups analysis showed that DKD patients in the probiotic soy milk group had a higher mean value of GSH compared with those in the soy milk group. In the final adjusted model, this difference remained significant. Consistently, oxidized glutathione concentration was significantly reduced among patients in the probiotic soy milk group. Also, for activity levels of antioxidant enzymes including glutathione peroxidase and glutathione reductase, significant increased levels were observed between 2 intervention groups in the final adjusted model. However, no significant reduction of the serum 8-iso-prostaglandin F2α or malondialdehyde and no induction of TAC concentrations within and between the 2 groups in the crude and adjusted models were detected. CONCLUSION: Overall, the results demonstrate that probiotic soy milk consumption could improve some oxidative stress factors among DKD patients. Further longitudinal studies with consideration of individual variation should be conducted.