The effects of blueberry and cranberry supplementation on blood pressure in patients with cardiovascular diseases: A systematic review and meta-analysis of randomized clinical trials.

Blueberries and cranberries are berry fruits with the highest number of randomized clinical trials (RCTs) focusing on blood pressure (BP). This systematic review and meta-analysis of RCTs analyzed the effects of blueberry and cranberry supplementation alone and in concert with systolic BP (SBP) and diastolic BP (DBP) in patients with cardiometabolic diseases. The searches were performed until August 2023 in the following databases: PubMed, Scopus, Web of Science, Cochrane, and Embase. Studies that examined the effects of blueberry or cranberry intake/supplementation were included. The risk of bias was evaluated using the Rob 2 scale. A meta-analysis was performed to estimate the effects of blueberry and cranberry supplementation on BP levels in patients with cardiometabolic diseases. A total of 17 articles were included, from which two found significant results from blueberry and/or cranberry supplementation in reducing BP. Pooled results revealed statistically non-significant reductions of -0.81 mm Hg for SBP (95% confidence interval [CI]: -2.26, 0.63; I2 = 0%) and -0.15 mm Hg for DBP (95% CI: -1.36, 1.05; I2 = 27%). Blueberry and/or cranberry supplementation had neutral effects on SBP and DBP in patients with cardiometabolic diseases, regardless of duration or age. Further high-quality studies are needed to firmly establish clinical efficacy.

Eating more sardines instead of fish oil supplementation: Beyond omega-3 polyunsaturated fatty acids, a matrix of nutrients with cardiovascular benefits.

Omega-3 polyunsaturated fatty acids (n-3 PUFA) play a significant role in the prevention and management of cardiometabolic diseases associated with a mild chronic pro-inflammatory background, including type 2 diabetes, hypertension, hypertriglyceridaemia, and fatty liver disease. The effects of n-3 PUFA supplements specifically, remain controversial regarding reducing risks of cardiovascular events. n-3 PUFA supplements come at a cost for the consumer and can result in polypharmacy for patients on pharmacotherapy. Sardines are a well-known, inexpensive source of n-3 PUFA and their consumption could reduce the need for n-3 PUFA supplementation. Moreover, sardines contain other cardioprotective nutrients, although further insights are crucial to translate a recommendation for sardine consumption into clinical practice. The present review discusses the matrix of nutrients contained in sardines which confer health benefits for cardiometabolism, beyond n-3 PUFA. Sardines contain calcium, potassium, magnesium, zinc, iron, taurine, arginine and other nutrients which together modulate mild inflammation and exacerbated oxidative stress observed in cardiovascular disease and in haemodynamic dysfunction. In a common serving of sardines, calcium, potassium, and magnesium are the minerals at higher amounts to elicit clinical benefits, whilst other nutrients are present in lower but valuable amounts. A pragmatic approach towards the consumption of such nutrients in the clinical scenario should be adopted to consider the dose-response relationship effects on physiological interactions. As most recommendations currently available are based on an indirect rationale of the physiological actions of the nutrients found in sardines, randomised clinical trials are warranted to expand the evidence on the benefits of sardine consumption.

A Scoping Review of Vitamin D for Nonskeletal Health: A Framework for Evidence-based Clinical Practice.

BACKGROUND: Low serum 25-hydroxy-vitamin D [25(OH)D] levels are prevalent worldwide. Although the benefits of vitamin D supplementation have focused on skeletal disorders (eg, rickets, osteomalacia, osteoporosis), emerging evidence for nonskeletal health merits further discussion. PURPOSE: The purpose of this review was to critically examine the vitamin D supplementation literature pertaining to nonskeletal health to help guide clinicians. METHODS: A scoping review that included observational studies and randomized clinical trials (RCTs) was performed. Evidence from meta-analyses and individual RCTs are discussed, and controversies and future directions are considered. FINDINGS: 25(OH)D deficiency is a ubiquitous condition associated with multiple nonskeletal diseases, including cardiometabolic (heart disease, diabetes, and kidney disease), immune (HIV/AIDS and cancer), lung (from traditional chronic disorders to coronavirus disease 2019), and gut diseases. Vitamin D deficiency also affects health across the life span (children, pregnant, and elderly), mental illness, and reproduction in both men and women. In contrast, vitamin D supplementation does not necessarily improve major medical outcomes, even when low 25(OH)D levels are treated. Screening for 25(OH)D status remains an important practice, primarily for high-risk patients (eg, elderly, women with osteoporosis, people with low exposure to sunlight). It is reasonable to supplement with vitamin D to treat 25(OH)D deficiency, such that if beneficial nonskeletal health occurs, this may be considered as a coadjutant instead of the central tenet of the disease. Furthermore, optimizing dosing regimens is an important clinical consideration. IMPLICATIONS: Although 25(OH)D deficiency is prevalent in nonskeletal diseases, there is no uniform evidence that vitamin D supplementation improves major medical outcomes, even when low 25(OH)D levels are corrected. Findings from RCTs warrant caution due to possible selection bias. Overall, vitamin D supplementation must be guided by circulating levels as a reasonable medical practice to correct 25(OH)D deficiency.

The effects of chitosan supplementation on anthropometric indicators of obesity, lipid and glycemic profiles, and appetite-regulated hormones in adolescents with overweight or obesity: a randomized, double-blind clinical trial.

BACKGROUND: Chitosan is one of dietary fiber that has received great attention in improving obesity-related markers, but little is known on its effects on adolescents. OBJECTIVES: To analyze the effects of chitosan supplementation on obesity-related cardiometabolic markers and appetite-related hormones in adolescents with overweight or obesity. METHODS AND ANALYSIS: A randomized clinical trial was performed on 64 adolescents with overweight and obesity, who were randomly allocated to receive chitosan supplementation (n = 32) or placebo as control (n = 32) for 12 weeks. Anthropometric measures, lipid and glycemic profiles, and appetite-related hormones were examined. RESULTS: Sixty-one participants completed study (chitosan = 31, placebo = 30). Chitosan supplementation significantly improved anthropometric indicators of obesity (body weight: - 3.58 ± 2.17 kg, waist circumference: - 5.00 ± 3.11 cm, and body mass index: - 1.61 ± 0.99 kg/m2 and - 0.28 ± 0.19 Z-score), lipid (triglycerides: - 5.67 ± 9.24, total cholesterol: - 14.12 ± 13.34, LDL-C: - 7.18 ± 10.16, and HDL-C: 1.83 ± 4.64 mg/dL) and glycemic markers (insulin: - 5.51 ± 7.52 µIU/mL, fasting blood glucose: - 5.77 ± 6.93 mg/dL, and homeostasis model assessment of insulin resistance: - 0.24 ± 0.44), and appetite-related hormones (adiponectin: 1.69 ± 2.13 ng/dL, leptin - 19.40 ± 16.89, and neuropeptide Y: - 41.96 ± 79.34 ng/dL). When compared with the placebo group, chitosan supplementation had greater improvement in body weight, body mass index (kg/m2 and Z-score), waist circumference, as well as insulin, adiponectin, and leptin levels. Differences were significant according to P-value < 0.05. CONCLUSION: Chitosan supplementation can improve cardiometabolic parameters (anthropometric indicators of obesity and lipid and glycemic markers) and appetite-related hormones (adiponectin, leptin, and NPY) in adolescents with overweight or obesity.

Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials.

Creatine supplementation has been shown to increase measures of lean body mass (LBM); however, there often is high heterogeneity across individual studies. Therefore, the aim of this study was to systematically review and meta-analyze randomized controlled trials (RCTs) investigating creatine supplementation on LBM. Subanalyses were performed based on age, sex, and type of exercise. Based on PRISMA guidelines, we searched the following databases: Pubmed, SPORTDiscus, Web of Science, and Scopus (PROSPERO register: CRD42020207122) until May 2022. RCTs for investigation of creatine supplementation on LBM were included. Animal studies and studies on individuals with specific diseases were excluded. Thirty-five studies were included, with 1192 participants. Overall (i.e., inclusion of all studies with and without exercise training interventions) revealed that creatine increased LBM by 0.68 kg (95% confidence interval [CI], 0.26-1.11). Subanalyses revealed greater gains in LBM when creatine was combined with resistance training (mean difference [MD], 1.10 kg; 95% CI, 0.56-1.65), regardless of age. There was no statistically significant effect of creatine on LBM when combined with mixed exercise (MD, 0.74 kg; 95% CI, -3.89 to 5.36) or without exercise (MD, 0.03 kg; 95% CI, -0.65 to 0.70). Further subanalyses found that males on creatine increased LBM by 1.46 kg (95% CI, 0.47-2.46), compared with a non-significant increase of 0.29 kg (95% CI, -0.43 to 1.01) for females. In conclusion, the addition of creatine supplementation to a resistance training program increases LBM. During a resistance training program, males on creatine respond more favorably than females.

Nonpharmacological Interventions for the Management of Testosterone and Sperm Parameters: A Scoping Review.

PURPOSE: Testosterone replacement and associated pharmacologic agents are effective strategies to treat male hypogonadism; however, nutraceutical agents and lifestyle modification approaches have gained medical interest. The purpose of this scoping review is to highlight the evidence (or lack thereof) of nutraceuticals and lifestyle modification approaches in the management of testosterone levels and sperm parameters. METHODS: A scoping review of nonpharmacologic interventions (supplements, herbal medicines, diets, sleep, and exercise) with the potential to improve male health was undertaken to elucidate changes in testosterone levels and sperm parameters in men with hypogonadism or infertility compared with healthy patients. FINDINGS: A multitude of nutraceuticals and functional nutrients are purported to stimulate testosterone production; however, only a select few have had promising results, such as zinc, vitamin D (in case of hypovitaminosis D), l-arginine, mucuna, and ashwagandha, based on well-controlled randomized clinical trials of men with low testosterone levels and related problems. Except for l-arginine, these natural agents, as well as tribulus and ω3 fatty acids, can improve some degree of sperm parameters in infertile men. Before implementing these nutraceutical agents, adequate sleep, exercise, and weight loss in patients with obesity are imperative. The effects of nonpharmacologic interventions on testosterone levels are modest and hence do not directly translate into clinical benefits. Correspondingly, androgen receptor content, but not endogenous androgens, has been regarded as the principal factor in muscle hypertrophy. IMPLICATIONS: A limited number of supplements and herbal medicines can be considered as adjunctive approaches in the management of testosterone levels and sperm parameters, primarily in men with low testosterone levels and infertility, whereas most nonpharmacologic supplements appear to lack evidence. Although proper physical exercise, sleep, and diet are indisputable approaches because of the general benefits to health, the use of nutraceuticals, if considered, must be personalized by physicians and/or registered dietitians.

Higher Intake of Dietary Magnesium Is Inversely Associated With COVID-19 Severity and Symptoms in Hospitalized Patients: A Cross-Sectional Study.

Background and Aims: Magnesium is an anti-inflammatory mineral that plays a role in the innate immune system, and the relaxation of bronchial smooth muscle warrants additional attention in COVID-19. This study examined the association between magnesium intake and COVID-19 severity and related symptoms in hospitalized patients. Methods: A cross-sectional study was done enrolling 250 COVID-19 patients aged 18 to 65 years. A validated 168-item online food frequency questionnaire (FFQ) was used to assess dietary magnesium intake. COVID-19 Treatment Guidelines were used to determine COVID-19 severity, and symptoms were evaluated using a standard questionnaire. Crude and adjusted analyses were performed (Model 1: age, sex, and energy intake; Model 2: Model 1 + physical activity, supplements, corticosteroids, and antiviral drugs; Model 3: Model 2 + body mass index). Results: The mean age of participants was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients at the highest tertile of dietary magnesium intake had lower serum levels of inflammatory biomarkers, including CRP (11.8 ± 2.2 vs. 29.5 ± 2.1 mg/L, p < 0.001) and ESR (15.8 ± 2.4 vs. 34.7 ± 2.4 mm/hr, p < 0.001), than those at the lowest tertile. After controlling for potential confounders, we observed that a higher dietary magnesium intake was associated with a lower odds of severe COVID-19 (OR: 0.32; 95% CI: 0.15-0.70). Also, we found a significant inverse association between dietary magnesium intake and odds of COVID-19 symptoms. Conclusion: We found that higher intake of dietary magnesium was inversely associated with COVID-19 severity and symptoms.

Therapeutic supplementation with zinc in the management of COVID-19-related diarrhea and ageusia/dysgeusia: mechanisms and clues for a personalized dosage regimen.

Zinc supplementation is indicated for diarrhea and taste disorders, which are both features of COVID-19 . Nevertheless, this strategy has not been tested for the treatment of these secondary complications in the current pandemic. Through an updated review, a practical appraisal was considered as a means of providing a medical nexus of therapeutic zinc regimens as an adjunct in the management of COVID-19-related diarrhea and ageusia/dysgeusia. While diarrhea and taste disorders are consequences of COVID-19, zinc supplementation is useful for non-COVID-19 patients with these clinical problems. The overwhelming evidence for supplementing with zinc in diarrhea and pneumonia is associated with the treatment of children, while for taste disorders the use of supplementing with zinc is more examined in adults. Whereas COVID-19 is more prevalent in adults, precautions should be exercised not to translate the zinc dosage used for children with diarrhea and taste disorders into the current pandemic. Therapeutic doses of zinc used for adults (∼50-150 mg/day of elemental zinc) could be included in the treatment strategies for COVID-19, but this proposal should be examined through randomized studies.

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

BACKGROUND AND AIMS: Guar 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 RESULTS: Five 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). CONCLUSIONS: Guar 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.

Effects of dehydroepiandrosterone (DHEA) supplementation on cortisol, leptin, adiponectin, and liver enzyme levels: A systematic review and meta-analysis of randomised clinical trials.

BACKGROUND AND AIMS: Dehydroepiandrosterone (DHEA) supplementation has been investigated in patients with altered cortisol levels and is proposed to ameliorate the metabolic profile related to adipose tissue. However, further research is warranted and evidence is no compelling for liver safety. Hence, we aimed to meta-analyse the effects of DHEA supplementation on circulating levels of cortisol, liver enzymes, and adipokines. METHODS: We searched literature published in PubMed, Web of Science, Embase and Scopus, until December 2020. We obtained overall results using the generic inverse of variance method with a random-effects model. RESULTS: Through 10 arms, serum cortisol levels decreased significantly after DHEA supplementation [weighted mean difference (WMD): -53.581 nmol/L, 95% confidence interval (CI): -88.2, -18.9, P = .002], without significant heterogeneity (I2  = 36%, P = .117). In contrast, any significance was noted for adiponectin (WMD: -0.045 µg/mL, 95% CI: -0.56, 0.47; P = .865), leptin (WMD: -2.55 µg/mL, 95% CI: -6.2, 1.06; P = .166), aspartate transaminase (AST) (WMD: -3.7 U/L, 95% CI: -10.35, 2.95; P = .276), and alanine aminotransferase (ALT) (WMD: -1.7 U/L, 95% CI: -3.45, 0.06; P = .058). CONCLUSION: DHEA supplementation decreased circulating cortisol but did not alter adiponectin, leptin, AST, and ALT levels. Hence, DHEA supplementation could be considered as an adjunct in the management of hypercortisolaemia and is safe for the liver.

Effects of purslane supplementation on C-reactive protein levels and biomarkers of oxidative stress as marks for metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials.

The antioxidant and antiinflammatory properties of purslane (Portulaca oleracea L.) are known in preclinical studies but further examination is needed to expand their potential into the clinical scenario. A systematic review and meta-analysis of randomized controlled trials were performed to elucidate the effects of purslane supplementation on C-reactive protein (CRP) levels and biomarkers of oxidative stress in metabolic syndrome, its related complications, and other diseases. PubMed/MEDLINE, Web of Science, SCOPUS, and Embase were the databases searched. Heterogeneity was examined using the I-squared (I2 ) statistic, in which the source of heterogeneity was determined if the I2 -value was >50%. After all the screening processes, 10 studies met the eligibility criteria and were analyzed. Following purslane supplementation, CRP levels decreased significantly (weighted mean difference [WMD]: -0.33 mg/dl, 95% confidence interval [CI]: -0.66, -0.004, p = .047) but with significant heterogeneity (I2  = 87.4%, p = .001). Purslane supplementation did not significantly change serum levels of malondialdehyde (MDA) (WMD: -0.353 µm/L; 95% CI: -0.920, 0.213; I2  = 50.7%), total antioxidant capacity (TAC) (WMD: 0.090 mm/L, 95% CI: -0.081, 0.262; I2  = 47.1%), and superoxide dismutase (SOD) (WMD: 6.54 U/ml, 95% CI: -22.150, 35.236; I2  = 70.7%). Thus, this meta-analysis showed a positive effect of purslane supplementation as a tool to decrease CRP levels, but not to MDA, TAC, and SOD levels.

The effect of nigella sativa on biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomized controlled trials.

Inflammation and oxidative stress are involved in the pathogenesis of a myriad of chronic disorders. This systematic review and meta-analysis was designed to determine the effects of Nigella Sativa (NS) seed and seed oil consumption on several biomarkers of inflammation and oxidative stress. The Scopus, Web of Science, and PubMed-MEDLINE databases were systematically searched until August 2019. The quality assessment and heterogeneity of the selected randomized clinical trials (RCTs) were measured using the Jadad checklist, and Q and I2 tests, respectively. Finally, a total of 10 clinical RCTs were found to be eligible for this meta-analysis. The pooled findings showed that NS consumption significantly reduced serum high-sensitivity C-reactive protein (hs-CRP; WMD: -0.67, 95% CI: -1.29, -0.05, I2  = 95.7%), tumor necrosis factor-alpha (TNF-α; WMD: -2.29, 95% CI: -4.48, -0.11, I2  = 93%), and malondialdehyde (MDA; WMD: -1.18, 95% CI: -2.24, -0.12, I2  = 85.4%), and significantly increased total antioxidant capacity (TAC; WMD: 0.35, 95% CI: 0.10, 0.59, I2  = 77.1%), and superoxide dismutase (SOD; WMD: 66.30, 95% CI: 1.03, 131.57, I2  = 99.4%) levels. Overall, the results of this systematic review and meta-analysis imply that NS consumption may decrease inflammatory response and oxidative stress markers. PRACTICAL APPLICATIONS: Overall, the evidence supports the consumption of NS to reduce hs-CRP, TNF-α, and MDA, and to increase SOD and TAC levels. In addition, the subgroup analyses findings concluded that lower dosages of NS, longer durations of the intervention, and the use of NS seed oil may result in more effective action on inflammatory markers, but because of the limited number of trials, the results must be analyzed with caution, especially for the subgroup analysis. However, further prospective studies regarding the effect of NS consumption on biomarkers of inflammation and oxidative stress, with larger sample sizes, from various countries and longer follow-up periods, are required to confirm whether NS possesses veritable anti-inflammatory and antioxidant effects.

Intake of polyunsaturated fatty acids and ω-3 are protective factors for sarcopenia in kidney transplant patients.

OBJECTIVES: The aim of this study was to associate dietary intake with sarcopenia and its components in kidney transplant patients (KTPs). METHODS: A cross-sectional study was performed with 125 KTPs. Strength was evaluated by handgrip strength (HGS) and appendicular muscle mass was estimated by bioelectrical impedance. Functional capacity was assessed by 4-m walking test. Sarcopenia was diagnosed by revised European Consensus on Definition and Diagnosis (2019). Dietary assessment was carried out through two 24-h dietary recalls. It evaluated the consumption of energy (kcal), carbohydrates, protein (total and from animal and vegetable food sources), total fat, saturated fatty acids, monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and ω-3 (g) and ω-6 (g). RESULTS: Intake of ω-3 was positively associated with appendicular skeletal muscle mass index (ASMI; kg/m2). The greater intake of PUFA (g and %) and ω-3 (g) was associated with lower chance to present low ASMI and sarcopenia. None of the other dietary components evaluated in the present study were associated with ASMI and sarcopenia. Walking speed and HGS were not associated with dietary variables. CONCLUSIONS: Intake of ω-3 and PUFAs are protective factors for sarcopenia and low muscle mass, but not for strength and functional capacity, in KTPs.

Melatonin supplementation in the management of obesity and obesity-associated disorders: A review of physiological mechanisms and clinical applications.

Despite the evolving advances in clinical approaches to obesity and its inherent comorbidities, the therapeutic challenge persists. Among several pharmacological tools already investigated, recent studies suggest that melatonin supplementation could be an efficient therapeutic approach in the context of obesity. In the present review, we have amalgamated the evidence so far available on physiological effects of melatonin supplementation in obesity therapies, addressing its effects upon neuroendocrine systems, cardiometabolic biomarkers and body composition. Most studies herein appraised employed melatonin supplementation at dosages ranging from 1 to 20 mg/day, and most studies followed up participants for periods from 3 weeks to 12 months. Overall, it was observed that melatonin plays an important role in glycaemic homeostasis, in addition to modulation of white adipose tissue activity and lipid metabolism, and mitochondrial activity. Additionally, melatonin increases brown adipose tissue volume and activity, and its antioxidant and anti-inflammatory properties have also been demonstrated. There appears to be a role for melatonin in adiposity reduction; however, several questions remain unanswered, for example melatonin baseline levels in obesity, and whether any seeming hypomelatonaemia or melatonin irresponsiveness could be clarifying factors. Supplementation dosage studies and more thorough clinical trials are needed to ascertain not only the relevance of such findings but also the efficacy of melatonin supplementation.

Association of dietary fiber and depression symptom: A systematic review and meta-analysis of observational studies.

BACKGROUND: A potential relationship between depression and the intake of dietary fiber has been hypothesized in several studies. However, no meta-analysis has been conducted so far to explore the association between these two variables. Hence, we designed the present meta-analysis to elucidate the relationship between the intake of dietary fiber and depression. METHODS: A comprehensive search was performed using the PubMed/Medline, Scopus, Web of Science and Google Scholar databases to identify any relevant studies published from inception to October 2019. Observational studies (cross-sectional and case-control) were included in the analysis. RESULTS: Pooled analysis from the random-effects model of four case-control studies revealed that the consumption of dietary fiber in patients with depression was significantly lower versus healthy controls (WMD: -1.41 mg/dl, 95 % CI: -2.32, -0.51, P = 0.002). No significant heterogeneity was demonstrated among the analyzed studies (I2 = 4.0 %, P = 0.37). By pooling 5 effect sizes of cross-sectional studies (with a total of 97,023 subjects), we demonstrated that a higher dietary consumption of fiber was associated with significantly lower odds of depression (OR = 0.76; 95 % CI: 0.64, 0.90; P = 0.010), with a low heterogeneity seen among the retrieved studies (I2 = 43.9 %; P = 0.12). CONCLUSION: An increased intake of total dietary fiber is associated with lower odds of depression. Further studies are needed to evaluate the relationship between the different types of dietary fiber and depression.

Beyond Fish Oil Supplementation: The Effects of Alternative Plant Sources of Omega-3 Polyunsaturated Fatty Acids upon Lipid Indexes and Cardiometabolic Biomarkers-An Overview.

Cardiovascular diseases remain a global challenge, and lipid-associated biomarkers can predict cardiovascular events. Extensive research on cardiovascular benefits of omega-3 polyunsaturated fatty acids (n3-PUFAs) is geared towards fish oil supplementation and fish-rich diets. Nevertheless, vegetarianism and veganism are becoming more popular across all segments of society, due to reasons as varied as personal, ethical and religious values, individual preferences and environment-related principles, amongst others. Due to the essentiality of PUFAs, plant sources of n3-PUFAs warrant further consideration. In this review, we have critically appraised the efficacy of plant-derived n3-PUFAs from foodstuffs and supplements upon lipid profile and selected cardiometabolic markers. Walnuts and flaxseed are the most common plant sources of n3-PUFAs, mainly alpha-linolenic acid (ALA), and feature the strongest scientific rationale for applicability into clinical practice. Furthermore, walnuts and flaxseed are sources of fibre, potassium, magnesium, and non-essential substances, including polyphenols and sterols, which in conjunction are known to ameliorate cardiovascular metabolism. ALA levels in rapeseed and soybean oils are only slight when compared to flaxseed oil. Spirulina and Chlorella, biomasses of cyanobacteria and green algae, are important sources of n3-PUFAs; however, their benefits upon cardiometabolic markers are plausibly driven by their antioxidant potential combined with their n3-PUFA content. In humans, ALA is not sufficiently bioconverted into eicosapentaenoic and docosahexaenoic acids. However, evidence suggests that plant sources of ALA are associated with favourable cardiometabolic status. ALA supplementation, or increased consumption of ALA-rich foodstuffs, combined with reduced omega-6 (n6) PUFAs intake, could improve the n3/n6 ratio and improve cardiometabolic and lipid profile.

Impact of Cinnamon Supplementation on cardiometabolic Biomarkers of Inflammation and Oxidative Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND & OBJECTIVE: To date, cinnamon supplementation has been investigated due to its antioxidant and anti-inflammatory properties. Several studies have confirmed the effects of cinnamon supplementation on several markers of cardiometabolic health. However, the effects of cinnamon supplementation on inflammation and oxidative stress levels warrant further investigation. Hence, the current meta-analysis was conducted to elucidate the impact of cinnamon supplementation on biomarkers of inflammation and oxidative stress. METHODS: To perform this systematic review and meta-analysis, we employed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The systematic search of available clinical trials was performed using the following databases: PubMed/MEDLINE, Scopus, Cochrane Library, Web of Science, Embase, and Google Scholar, up to January 2020. RESULTS: After removing the duplicates, 1145 studies were eligible for analysis and 12 of them were included in the meta-analysis. The dose of cinnamon powder investigated in the included trials ranged from 1.5 to 4 g/day. Cinnamon supplementation resulted in a significant reduction of C-reactive protein (CRP) (weight mean difference (WMD): -2.22 mg/L, 95 % CI: -3.74, -0.69, P = 0.004) and malondialdehyde (MDA) (WMD: -0.79 mmol/L, 95 % CI: -1.28, -0.29, P = 0.002), and marginally statistical significant decrease in interleukin-6 (IL-6) (WMD: -1.48 pg/mL, 95 % CI: -2.96, -0.01, P = 0.049). Moreover, it was associated with an increase in the total antioxidant capacity (TAC) (WMD: 0.34 mmol/L, 95 % CI: 0.04, 0.64, P = 0.026). However, the levels of intercellular adhesion molecule-1 (ICAM-1) (WMD: 1.53 ng/mL, 95 % CI: -12.03, 15.10, P = 0.82) did not change significantly following cinnamon supplementation. CONCLUSIONS: Cinnamon supplementation may be an adjuvant for reducing inflammation and oxidative stress levels in humans.

Walnut intake may increase circulating adiponectin and leptin levels but does not improve glycemic biomarkers: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND & OBJECTIVE: Walnut intake is considered a healthy dietary approach worldwide, particularly as a nutritional tool for the management of obesity and cardiometabolic disorders. Among these lines, leptin and adiponectin, as well as glycemic biomarkers, deserve further attention. We aimed to examine the impact of walnut intake on circulation levels of leptin and adiponectin through a systematic review and meta-analysis of randomized clinical trials (RCTs); secondarily, assessing the glycemic profile as well. METHODS: The literature search was implemented in four following databases: Web of Science, Scopus, PubMed/Medline, and Google Scholar, thus, determining studies that measured the effects of walnut consumption on adiponectin, leptin, and glycemic biomarkers levels from 2004 up to December 2019. RESULTS: Fourteen trials were include in the meta-analysis, with an intervention period ranging from 5 weeks to 12 months.Walnut intake increased leptin (weighted mean difference (WMD): 2.502 ng/mL; 95 % CI: 2.147-2.856, p < 0.001) and adiponectin (WMD: 0.440 ng/mL; 95 % CI: 0.323 to 0.557, p < 0.001) levels. Pertaining to glycemic biomarkers, neither overall analyses nor sub-analyses corroborated with changes in fasting blood glucose (WMD: 0.500 mg/dL, 95 % CI: -0.596, 1.596, p = 0.371), insulin (WMD: -0.21 mg/dL, 95 % CI: -0.67, 0.24, p = 0.367), and glycated hemoglobin (WMD: 0.004 mg/dL, 95 % CI: -0.041, 0.049, p = 0.870) concentrations. CONCLUSION: Walnut intake may increase leptin and adiponectin levels but does not improve glycemic biomarkers.

Effects of intermittent fasting diets on plasma concentrations of inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials.

Intermittent fasting (IF) and energy-restricted diets (ERDs) have emerged as dietary approaches to decrease inflammatory status; however, there are no consistent results regarding humans. To achieve a comprehensive conclusion, we aimed to conduct a meta-analysis of randomized control trials (RCTs) to evaluate the effects of IF or ERDs on plasma concentrations of inflammatory biomarkers. We systematically searched online medical databases including Web of Sciences, PubMed, SCOPUS, and Google Scholar up to June 2019. Evaluations of effect sizes were described employing in weighted mean difference and 95% confidence intervals from the random-effects model. Eighteen eligible RCTs were included in this meta-analysis. The pooled estimation from the random-effect model showed that IF regimens and ERDs significantly reduced C-reactive protein (CRP) concentrations (WMD: -0.024 mg/dL; 95% CI: -0.044 to -0.005, I2 = 7.0%). Additionally, IF regimens (WMD: -0.029; 95% CI: -0.058 to -0.000, I2 = 17.9%) were more effective in reducing CRP levels than ERDs (WMD: -0.001 mg/dL; 95% CI: -0.037 to 0.034, I2 = 0.0%). Moreover, based on the treatment duration and types of the studies' population, a greater reduction was observed in overweight and obese individuals (WMD: -0.03 mg/dL; 95% CI: -0.05 to 0.01, I2 = 42.1%), and in treatment duration ≥8 wk (WMD: -0.03 mg/dL; 95% CI: -0.05 to 0.01, I2 = 0.0%) as well. However, IF and ERDs did not significantly reduced tumor necrosis factor-α (WMD: -0.158 pg/mL; P = 0.549, I2 = 98.3) and interleukin-6 (IL-6) concentrations (WMD: -0.541 pg/mL; P = 0.080, I2 = 94.7%). This meta-analysis demonstrated that IF regimens and ERDs may reduce CRP concentrations, particularly in overweight and obese individuals and through a considerable length of intervention (≥2 mo). However, neither dietary model affected the concentrations of tumor necrosis factor-α or interleukin-6.

Pharmaconutrition in the Clinical Management of COVID-19: A Lack of Evidence-Based Research But Clues to Personalized Prescription.

A scientific interest has emerged to identify pharmaceutical and nutritional strategies in the clinical management of coronavirus disease 2019 (COVID-19). The purpose of this narrative review is to critically assess and discuss pharmaconutrition strategies that, secondary to accepted treatment methods, could be candidates in the current context of COVID-19. Oral medicinal doses of vitamin C (1-3 g/d) and zinc (80 mg/d elemental zinc) could be promising at the first signs and symptoms of COVID-19 as well as for general colds. In critical care situations requiring parenteral nutrition, vitamin C (3-10 g/d) and glutamine (0.3-0.5 g/kg/d) administration could be considered, whereas vitamin D3 administration (100,000 IU administered intramuscularly as a one-time dose) could possess benefits for patients with severe deficiency. Considering the presence of n-3 polyunsaturated fatty acids and arginine in immune-enhancing diets, their co-administration may also occur in clinical conditions where these formulations are recommended. However, despite the use of the aforementioned strategies in prior contexts, there is currently no evidence of the utility of any nutritional strategies in the management of SARS-CoV-2 infection and COVID-19. Nevertheless, ongoing and future clinical research is imperative to determine if any pharmaconutrition strategies can halt the progression of COVID-19.