Nutritional advice

Objectives:
Which disease-modifying osteoarthritis drugs improve knee and hip osteoarthritis among adults?

Study design:
This review article included 28 randomized controlled trials (RCTs) with 11,890 patients.

Results and conclusions:
The investigators found glucosamine supplements significantly improved both structure [minimum joint width or cartilage volume: network results: SMD = 0.16, 95% CI = 0.04 to 0.28] and symptoms [pain = -0.15, 95% CI = -0.25 to -0.05 and function = -0.17, 95% CI = -0.28 to -0.07] of knee and hip osteoarthritis among adults.

The investigators found chondroitin supplements significantly improved both structure [minimum joint width or cartilage volume: network results: SMD = 0.21, 95% CI = 0.10 to 0.32] and symptoms [pain = -0.06, 95% CI = -0.15 to -0.03 and function = -0.15, 95% CI = -0.26 to -0.03] of knee and hip osteoarthritis among adults.

The investigators found strontium supplements significantly improved structure [minimum joint width or cartilage volume: SMD = 0.20, 95% CI = 0.20 to 0.38] of knee and hip osteoarthritis among adults.

The investigators found vitamin D supplements significantly improved symptoms [pain = -0.15, 95% CI = -0.27 to -0.03 and function = -0.18, 95% CI = -0.31 to -0.06] of knee and hip osteoarthritis among adults.  

The investigators found, although doxycycline also demonstrated a favorable efficacy ranking, its safety profile was poor [withdrawal: network relative risk = 1.69, 95% CI = 1.03 to 2.75].

The investigators concluded glucosamine and chondroitin supplements yield statistically significant but clinically questionable long-term benefit on structure and symptoms of knee and hip osteoarthritis among adults, though both have favorable safety profiles.
Strontium supplements improve structure and vitamin D supplements improve symptoms of knee and hip osteoarthritis among adults. Although doxycycline has a favorable efficacy ranking, its safety profile is poor.
None of the 12 classes of drugs appears to have long-term clinically significant benefit.

Original title:
The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis-a Systematic Review and Network Meta-Analysis by Yang W, Sun C, […], Zhuo Q.

Link:
https://pubmed.ncbi.nlm.nih.gov/33846938/

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Objectives:
Patients with kidney failure often present with reduced cardiovascular functional reserve and exercise tolerance. Previous studies on cardiorespiratory fitness examined with cardiopulmonary-exercise-testing (CPET) in kidney-transplant-recipients (KTR) had variable results. Therefore, this review article has been conducted.

Does cardiovascular functional reserve improve after kidney-transplantation?

Study design:
This review article included 8 studies with 461 participants.

Results and conclusions:
The investigators found kidney-transplant-recipients had significantly higher oxygen consumption at peak/max exercise (VO2 peak/VO2 max) compared to patients with kidney failure [SMD = 0.70, 95% CI = 0.31 to 1.10, I2 = 70%, p = 0.002]. 

The investigators found, in subgroup analyses, similar differences were evident among 7 studies comparing kidney-transplant-recipients and hemodialysis patients [SMD = 0.64, 95% CI = 0.16 to 1.12, I2 = 65%, p = 0.009] and 2 studies comparing kidney-transplant-recipients with peritoneal dialysis subjects [SMD = 1.14, 95% CI = 0.19 to 2.09, I2 = 50%, p = 0.16]. 

The investigators found across 4 studies with relevant data, oxygen consumption during peak/max exercise showed significant improvement after kidney-transplantation compared to pre-transplantation values [WMD = 2.43, 95% CI = 0.01 to 4.85, I2 = 68%, p = 0.02].

The investigators concluded kidney-transplant-recipients exhibit higher cardiovascular functional reserve during cardiopulmonary-exercise-testing compared to patients with kidney failure. Cardiovascular reserve is also improved after kidney-transplantation in relation to pre-surgery levels.

Original title:
Cardiorespiratory fitness in kidney transplant recipients compared to patients with kidney failure: a systematic review and meta-analysis by Theodorakopoulou MP, Boutou AK, […], Sarafidis P.

Link:
https://pubmed.ncbi.nlm.nih.gov/34170572/

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Cardiac reserve or cardiovascular reserve refers to the difference between the rate at which the heart pumps blood and its maximum capacity for pumping blood at any given time. A measurement of the cardiovascular reserve may be a health indicator for some medical conditions, like patients with kidney failure.

Objectives:
Does supplementation of thiamine (vitamin B1) combined vitamin C reduce mortality in patients with sepsis or septic shock?

Study design:
This review article included 7 randomized controlled trials (RCTs) with a total of 868 patients.

Results and conclusions:
The investigators found there was no statistical difference between the thiamine combined vitamin C intervention group and the control group for in-hospital mortality [OR = 1.11, 95% CI = 0.79 to 1.56, p = 0.55].
No statistical because OR of 1 was found in the 95% CI of 0.79 to 1.56. OR of 1 means no risk/association.

The investigators found significant improvements of sequential organ failure assessment (SOFA) score during the first 72 h after enrollment and duration of vasopressor use for the thiamine combined vitamin C intervention group.
However, no other significant associations were found.

The investigators concluded despite widespread enthusiasm for thiamine (vitamin B1) combined with vitamin C for sepsis and septic shock, this meta-analysis only shows an association with reduced sequential organ failure assessment (SOFA) score and time of vasopressor use. There is no association with in-hospital mortality in patients with sepsis or septic shock.

Original title:
Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis by Ge Z, Huang J, [...], Li Y.

Link:
https://pubmed.ncbi.nlm.nih.gov/33709993/

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Vasopressors are a group of medicines that contract (tighten) blood vessels and raise blood pressure.
 

Objectives:
The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. Therefore, this review article has been conducted.

Does consumption of white meat reduce mortality and morbidity rate?

Study design:
This review article included 22 prospective cohort studies with 3,132,149 subjects.
11 studies (14 data-sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular mortality and 10 studies (11 datasets) on non-fatal cardiovascular events.
The evaluation of methodological quality of each study showed a median NOS score of 6.

Funnel plot examination suggested the absence of publication bias and of small-study effect, confirmed by the Egger’s test for all-cause mortality.

Results and conclusions:
The investigators found the analysis of the 11 studies (14 datasets) on all-cause mortality showed a statistically significant lower mortality rate of 6% for subjects in the highest vs. lowest unprocessed white meat consumption category [OR = 0.94, 95% CI = 0.90 to 0.97, p 0.001, I2 = 95.6%, p 0.001].

The investigators found an overall neutral association between high unprocessed white meat consumption and cardiovascular mortality and morbidity.

The investigators concluded that consumption of unprocessed white meat reduces all-cause mortality.

Original title:
White Meat Consumption, All-Cause Mortality, and Cardiovascular Events: A Meta-Analysis of Prospective Cohort Studies by Lupoli R, Vitale M, […], Vaccaro O.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924043/

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Objectives:
The literature showed that grape products containing polyphenols (GPCP) had anti-oxidant activity. However, the effects of GPCP on different biomarkers of oxidative stress are still controversial. Therefore, this review article (meta-analysis) has been conducted.

Does supplementation of grape products containing polyphenols improve status of oxidative stress (like TAC, ORAC and SOD)?

Study design:
This review article included 17 eligible RCTs with a total of 633 participants.

Results and conclusions:
The investigators found supplementation of grape products containing polyphenols significantly increase total antioxidant capacity (TAC) [WMD = 1.524 mmol/L, 95% CI = 0.83 to 2.21].

The investigators found supplementation of grape products containing polyphenols significantly enhanced superoxide dismutase (SOD) [WMD = 0.450 mmol/L, 95% CI = 0.23 to 0.66], total antioxidant capacity (TAC) [WMD = 2.829 mmol/L, 95% CI = 0.13 to 5.52] and oxygen radical absorbance capacity (ORAC) [WMD = 0.524 μmol/L, 95% CI = 0.42 to 0.62] among healthy participants. 

The investigators found in subgroup analyses, that higher grape products containing polyphenols doses significantly increased SOD [WMD = 0.539 U/mgHb, 95% CI = 0.24 to 0.82] and ORAC [WMD = 0.377 μmol/L, 95% CI = 0.08 to 0.67], whereas longer intervention periods significantly enhanced ORAC [WMD = 0.543 μmol/L, 95% CI = 0.43 to 0.64].

The investigators concluded that supplementation of grape products containing polyphenols partly improves status of oxidative stress, but further well-designed trials are required to confirm these results.

Original title:
The effect of grape products containing polyphenols on oxidative stress: a systematic review and meta-analysis of randomized clinical trials by Sarkhosh-Khorasani S, Sangsefidi ZS, […], Hosseinzadeh M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971097/

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Polyphenols are divived into 2 general classes, one is flavonoids and other is phenolic acids. Flavonoids are divided into flavones, flavononse, flavonols, flavanols, isoflavones, while phenolic acids are generally classified into hydroxybenzoic and hydroxycinnamic acids.

Objectives:
Does vitamin B supplementation have positive effects on patients with mouth ulcers?

Study design:
This review article included 16 RCTs with 1,534 patients (767 in the treatment group and 767 in the control group).
Patients who did not receive treatment were taken as controls, while those who were treated with vitamin B alone or vitamin B combined with pantothenic acid were included in the treatment group.

Results and conclusions:
The investigators found, in comparison with the control group, the effective rate was higher [OR = 5.24, 95% CI = 3.72 to 7.37, p 0.001] while the recurrence rate was lower [OR = 0.194, 95% CI = 0.128 to 0.295, p 0.001] in the treatment group.
Sensitivity analysis revealed that the results did not change significantly after pooling, suggesting that the result was stable and less likely to be affected by heterogeneit

The investigators found, additionally, both the ulcer healing time [SMD = -2.15, 95% CI = -2.80 to -1.50, p 0.001] and treatment time [SMD = -2.31, 95% CI = -2.67 to -1.96, p 0.001] in the treatment group were shorter than those of the control group.  
Additionally, the low sensitivity was also supported by the above results and indicated the robustness of the above results.

The investigators concluded that vitamin B supplementation (both vitamin B alone or vitamin B combined with pantothenic acid) enables a higher effective rate and lower recurrence rate, accelerates ulcer healing and shortens the course of treatment. Collectively, vitamin B has a high clinical value in treating patients with mouth ulcers.

Original title:
Clinical efficacy of vitamin B in the treatment of mouth ulcer: a systematic review and meta-analysis by Shi J, Wang L, [...], Zhi D.

Link:
https://apm.amegroups.com/article/view/72221/html

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Objectives:
L-carnitine is an amino acid derivative that is thought to be helpful for treating renal anemia in hemodialysis patients. However, the mechanism remains to be fully elucidated. Therefore, this review article (meta-analysis) has been conducted.

Does L-carnitine supplementation/therapy have positive effects on renal anemia in hemodialysis patients?

Study design:
This review article included 18 RCTs with 1,090 participants.

Results and conclusions:
The investigators found L-carnitine supplementation significantly increased plasma free L-carnitine levels [MD = 140.53, 95% CI = 102.22 to 178.85, p 0.00001]. 

The investigators found L-carnitine supplementation significantly decreased the erythropoietin responsiveness index (ERI) [MD = -2.72, 95% CI = -3.20 to -2.24, p 0.00001] and the required erythropoiesis-stimulating agent (ESA) doses [MD = -1.70, 95% CI = -2.04 to -1.36, p 0.00001].

The investigators found, however, the use of L-carnitine was not associated with a higher hemoglobin level [MD = 0.18, 95% CI = -0.20 to 0.55, p = 0.35] and hematocrit level [MD = 1.07, 95% CI = -0.73 to 2.87, p = 0.24].

The investigators found, in subgroup analyses, the effects of L-carnitine supplementation on renal anemia in patients on hemodialysis were independent of the treatment duration and intervention routes. 

The investigators concluded that L-carnitine supplementation/therapy increases plasma L-carnitine concentrations, improves the response to erythropoiesis-stimulating agent, decreases the required erythropoiesis-stimulating agent doses in patients receiving hemodialysis and maintains hemoglobin and hematocrit levels. L-carnitine supplementation should be supported in hemodialysis patients. However, the relationship between L-carnitine treatment and long-term outcomes is still unclear. Further high-quality RCTs are needed to verify these findings.

Original title:
Effect of L-carnitine supplementation on renal anemia in patients on hemodialysis: a meta-analysis by Zhu Y, Xue C, […], Deng J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33713287/

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Erythropoietin responsiveness index (ERI) is defined as average weekly erythropoietin (EPO) dose per kg body weight (wt) per average hemoglobin (Hgb), over a 3-month period (ERI = (EPO/wt)/Hgb).

Epoetin alfa and darbepoetin alfa are erythropoiesis-stimulating agents (ESAs), approved for the treatment of anemia (low red blood cells) resulting from chronic kidney disease.
 

Objectives:
Does carotenoid (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) supplementation have protective effects on inflammatory biomarkers (like C-reactive protein and interleukin-6)?

Study design:
This review article included 26 RCTs with 35 effect sizes.

Results and conclusions:
The investigators found carotenoid supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.54 mg/L, 95% CI = -0.71 to -0.37, p 0.001].
Significantly because the calculated p-value of 0.001 was less than the p-value of 0.05.

The investigators found carotenoid supplementation significantly reduced interleukin-6 (IL-6) [WMD = -0.54 pg/mL, 95% CI = -1.01 to -0.06, p = 0.025].
Significant means that there is an association with a 95% confidence.

The investigators found in subgroup analyses that astaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.51 to -0.09, p = 0.005].

The investigators found in subgroup analyses that lutein/zeaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.45 to -0.15, p 0.001].

The investigators found in subgroup analyses that β-cryptoxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.35 mg/L, 95% CI = -0.54 to -0.15, p 0.001].

The investigators found in subgroup analyses that lycopene supplementation significantly reduced interleukin-6 (IL-6) [WMD = -1.08 pg/mL, 95% CI = -2.03 to -0.12, p = 0.027].

The investigators concluded that carotenoid supplementation (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) has protective effects on inflammatory biomarkers.

Original title:
Carotenoids supplementation and inflammation: a systematic review and meta-analysis of randomized clinical trials by Hajizadeh-Sharafabad F, Zahabi ES, […], Alizadeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33998846/

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Objectives:
Does coffee or tea consumption reduce the risk of glioma?

Study design:
This review article included 12 unique studies (cohort and case-control studies) comprising of 1,960,731 participants with 2,987 glioma cases.

Results and conclusions:
The investigators found in pooled analyses that higher tea consumption was significantly associated with a lower risk of 16% for glioma [RR = 0.84, 95% CI = 0.71 to 0.98, p = 0.030, I2 = 16.42%].

The investigators found in cohort studies that higher coffee consumption was significantly associated with a lower risk of 15% for glioma [RR = 0.85, 95% CI = 0.72 to 1.00, p = 0.046, I2 = 0%].

The investigators found in cohort studies that higher tea consumption was significantly associated with a lower risk of 19% for glioma [RR = 0.81, 95% CI = 0.70 to 0.93, p = 0.004, I2 = 0%].

The investigators found in dose-response meta-analysis that every one cup of coffee per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 0.99, p = 0.016, p non-linearity = 0.054]. 

The investigators found in dose-response meta-analysis that every one cup of tea per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 1.00, p = 0.048]. 

The investigators found meta-regression showed that the association between coffee and glioma was reduced by smoking [p = 0.029].

The investigators concluded both coffee (at least one cup of coffee per day) and tea consumption (at least one cup of tea per day) reduce the risk of glioma.

Original title:
Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis by Pranata R, Feraldho A, […], July J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33750490/

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Glioma is a type of tumor that occurs in the brain and spinal cord. About 33 percent of all brain tumors are gliomas, which originate in the glial cells that surround and support neurons in the brain, including astrocytes, oligodendrocytes and ependymal cells.
Gliomas can affect all ages, but they are most often seen in adults. Gliomas are slightly more likely to occur in men than in women and more common in Caucasians than in African Americans.

Objectives:
The associations of alcohol consumption and venous thromboembolism (VTE) have been investigated widely, but the conclusions were inconsistent. Therefore, this review article has been conducted.

Does alcohol intake decrease risk of venous thromboembolism?

Study design:
This review article included 14 cohort studies and 4 case-control studies.

Results and conclusions:
The investigators found, compared with non-drinkers, the risk of venous thromboembolism was significantly decreased with 7% [RR = 0.93, 95% CI = 0.88 to 0.99] for alcohol drinkers.

The investigators found, compared with no alcohol intake, the risk of venous thromboembolism was significantly decreased with 9% [RR = 0.91, 95% CI = 0.84 to 0.99] for low to moderate alcohol intake (0.1-14.0 drinks/week).

The investigators concluded that low to moderate alcohol intake (0.1-14.0 drinks/week) decreases risk of venous thromboembolism. However, precautions are needed when providing personal drinking advice considering the potential harm of alcohol. Further studies are warranted to determine whether moderate alcohol consumption has a causal role in venous thromboembolism.

Original title:
Meta-analysis of alcohol consumption and venous thromboembolism by Zhang X, Chen X, [...], Li K.

Link:
https://pubmed.ncbi.nlm.nih.gov/33824981/

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Objectives:
Dyslipidemia/hyperlipidemia is recognized among the risk factors for lifestyle related diseases. A healthy diet, rich in vegetable oils such as rice bran oil (RBO), may aid to improve serum lipid levels. Therefore, this review article has been conducted.

Does rice bran oil decrease causally the levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglyceride (TG) levels in adults?

Study design:
This review article included 8 eligible RCTs with 14 effect sizes.
The effect sizes were expressed as weighted mean difference (WMD) with 95% confidence intervals (CI).
 
Results and conclusions:
The investigators found that the consumption of rice bran oil significantly decreased serum
total cholesterol [WMD = -7.29 mg/dL, 95% CI = -11.32 to -3.25, p = 0.000];
LDL- cholesterol (bad cholesterol) [WMD = -7.62 mg/dL, 95% CI = -11.10 to -4.14, p = 0.000] and;
triglyceride [WMD = -9.19 mg/dL, 95% CI = -17.99 to -0.38, p = 0.041] levels in adults.
Significantly because the calculated p-value of = 0.041 was less than the p-value of 0.05.

The investigators concluded that the consumption of rice bran oil causally decreases serum
total cholesterol, LDL-cholesterol (bad cholesterol) and triglyceride levels in adults. Hence, it may play a role in reducing dyslipidemia/hyperlipidemia risk.

Original title:
The impact of rice bran oil consumption on the serum lipid profile in adults: a systematic review and meta-analysis of randomized controlled trials by Pourrajab B, Sohouli MH, […], Shidfar F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33715544/

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Objectives:
Recently, it has been shown that coronavirus disease 2019 (COVID-19), which has caused a pandemic since December 2019, can be accompanied by some neurological disorders and therefore, this review article has been conducted.

What are the most prevalent neurological manifestations of COVID-19 infection?

Study design:
This review article included 26 observational studies and 31 case reports with a total of 6,597 COVID-19 patients.

Results and conclusions:   
The investigators found the most prevalent general symptoms were fever, cough and dyspnea with 84.6% [95% CI = 75.3 to 92.1, I2 = 98.7%], 61.3% [95% CI = 55.3 to 67.0, I2 = 94.6%] and 34.2% [95% CI = 25.6 to 43.4, I2 = 97.7%], respectively.

The investigators found neurological symptoms observed among COVID-19 patients were fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea with 42.9% [95% CI = 36.7 to 49.3, I2 = 92.8%], 35.4% [95% CI = 11.2 to 64.4, I2 = 99.2%], 28.9% [95% CI = 19.9 to 38.8, I2 = 96.3%], 25.3% [95% CI = 1.6 to 63.4, I2 = 99.6%], 10.1% [95% CI = 2.7 to 21.0, I2 = 99.1%], 6.7% [95% CI = 3.7 to 10.5, I2 = 87.5%] and 5.9% [95% CI = 3.1 to 9.5, I2 = 94.5%], respectively.

The investigators found the most prevalent neurological comorbidity in COVID-19 was cerebrovascular disease with 4.3% [95% CI = 2.7 to 6.3, I2 = 78.7%].

The investigators concluded the most prevalent neurological manifestations of COVID-19 include fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea. Cerebrovascular disorders can either act as a risk factor for poorer prognosis in COVID-19 patients or occur as a critical complication in these patients. Guillain-Barre syndrome, encephalitis and meningitis have also been reported as complications of COVID-19.

Original title:
Neurological Symptoms, Comorbidities, and Complications of COVID-19: A Literature Review and Meta-Analysis of Observational Studies by Vakili K, Mobina Fathi  M, […], Rezaei-Tavirani M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34044408/

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Objectives:
Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown. Therefore, this review article has been conducted.

Do the associations of fish consumption with risk of cardiovascular disease or of mortality differ between individuals with and individuals without vascular disease?

Study design:
This review article included 4 cohort studies from 58 countries with 191,558 participants with a mean (SD) age of 54.1 (8.0) years and 91,666 (47.9%) were male.
 
Results and conclusions:
The investigators found during 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major cardiovascular disease [HR = 0.95, 95% CI = 0.86 to 1.04] or total mortality [HR = 0.96, 95% CI = 0.88 to 1.05].
Not associated because HR of 1 was found in the 95% CI of 0.86 to 1.04. HR of 1 means no risk/association.

The investigators found, by contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major cardiovascular disease [HR = 0.84, 95% CI = 0.73 to 0.96] and total mortality [HR = 0.82, 95% CI = 0.74 to 0.91] was lowest with dietary intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. 

The investigators found fish with higher amounts of ω-3 fatty acids (also called oily fish) were strongly associated with a lower risk of cardiovascular disease [HR = 0.94, 95% CI = 0.92 to 0.97 per 5-g increment of intake], whereas other fish were neutral (collected in 1 cohort of patients with vascular disease).
The association between fish intake and each outcome varied by cardiovascular disease status, with a lower risk found among patients with vascular disease but not in general populations [for major cardiovascular disease: I2 = 82.6%, p = 0.02 and for death: I2 = 90.8%, p = 0.001].

The investigators concluded that fish intake of 175-350g weekly is associated with lower risk of major cardiovascular disease and mortality among patients with prior cardiovascular disease but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

Original title:
Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries by Mohan D, Mente A, […], Yusuf S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33683310/

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Objectives:
Does coenzyme Q10 supplementation improve oxidative stress variables?

Study design:
This review article included 17 RCTs with 972 participants.

Results and conclusions:
The investigators found the pooled analysis of primary studies showed that coenzyme Q10 supplementation increased serum total antioxidant capacity [SMD = 0.62 mmol/L, 95% CI = 0.18 to 1.05, I2 = 76.1%, p ˂ 0.001] and superoxide dismutase [SMD = 0.40 U/mg, 95% CI = 0.12 to 0.67, I2 = 9.6%, p ˂ 0.345] levels and decreased malondialdehyde [SMD = -1.02 mmol/L, 95% CI = -1.60 to -0.44, I2 = 88.2%, p ˂ 0.001] level significantly compared to the placebo group.

The investigators found, however, the effect of coenzyme Q10 supplementation on nitric oxide [SMD = 1.01 µmol/L, 95% CI = -1.53 to 3.54, I2 = 97.8%, p ˂ 0.001] and glutathione peroxidase [SMD -0.01 mmol/L, 95% CI = -0.86 to 0.84, I2 = 88.6%, p ˂ 0.001] was not significant.

The investigators concluded that coenzyme Q10 supplementation improves antioxidant defense status against reactive oxygen species.

Original title:
Diabetes, Age, and Duration of Supplementation Subgroup Analysis for the Effect of Coenzyme Q10 on Oxidative Stress: A Systematic Review and Meta-Analysis by Hajiluian G, Heshmati J, […], Shidfar F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33866314/

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Oxidative stress is an imbalance between the reactive oxygen species and antioxidant system.
Total antioxidant capacity (TAC), superoxide dismutase, malondialdehyde, nitric oxide and glutathione peroxidase are biomarkers of oxidative stress.

Objectives:
Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of vitamin B2 may positively contribute to migraine. Therefore, this review article has been conducted.

Does vitamin B2 supplementation decrease migraine?

Study design:
This review article included 8 randomized controlled trials and 1 controlled clinical trial with 673 subjects.

Results and conclusions:
The investigators found 400 mg/day vitamin B2 supplementation for 3 months significantly decreased migraine days [p = 0.005, I2 = 89%], duration [p = 0.003, I2 = 0], frequency [p = 0.001, I2 = 65%] and pain score [p = 0.015, I2 = 84%].

The investigators concluded that 400 mg/day vitamin B2 supplementation for 3 months has significant effect on days, duration, frequency and pain score of migraine attacks.

Original title:
Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis by Chen YS, Lee HF, […], Hu FW.

Link:
https://pubmed.ncbi.nlm.nih.gov/33779525/

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Objectives:
Soy has several beneficial effects on cardiovascular disease (CVD). However, results of clinical trial studies are equivocal. Therefore, this review article has been conducted.

Is there a causal relationship between soy consumption and improvements in blood pressure in adults?

Study design:
This review article included 17 RCTs.

Results and conclusions:
The investigators found pooled effects from 17 studies revealed a significant improvement in systolic blood pressure (SBP) [MD = -1.64, 95% CI = -3.25 to -0.04 mmHg, I2 = 50.5%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found pooled effects from 17 studies revealed a significant improvement in diastolic blood pressure (DBP) [MD = -1.21, 95% CI = -2.29 to -0.12 mmHg, I2 = 50.7%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found subgroup analysis demonstrated a reduction in both systolic blood pressure and diastolic blood pressure in younger participants with lower baseline blood pressure and intervention durations of 16 weeks.

The investigators concluded there is a causal relationship between soy consumption and improvements in blood pressure in adults.

Original title:
Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials by Mosallanezhad Z, Ranjbar S, […], Jalali M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33636295/

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Objectives:
What are the blood concentrations of zinc, iron, manganese, magnesium, selenium and copper of patients with multiple sclerosis (MS)?

Study design:
This review article included 32 studies with 1,567 MS patients and 1,328 controls (people without MS).

Results and conclusions:
The investigators found pooled results using random-effects model indicated that the levels of zinc [WMD = -7.83 mcg/dL, 95% CI = -12.78 to -2.87, z = 3.09, p = 0.002] and iron [WMD = -13.66 mcg/dL, 95% CI = -23.13 to -4.19, z = 2.83, p = 0.005] were significantly lower in MS patients than in controls.

The investigators found, however, the levels of manganese [WMD = 0.03 mcg/dL, 95% CI = 0.01 to 0.04, z = 2.89, p = 0.004] were significantly higher in MS patients.

The investigators found no significant differences in the levels of magnesium, selenium and copper between both groups.

The investigators concluded that the circulating levels of zinc and iron are significantly lower in MS patients and that manganese level is significantly higher than those in the control group (people without MS).

Original title:
Blood Trace Element Status in Multiple Sclerosis: a Systematic Review and Meta-analysis by Nirooei E, Kashani SMA, […], Akbari H.

Link:
https://pubmed.ncbi.nlm.nih.gov/33611740/

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Objectives:
Resistant starch type 2 (RS2) has been documented to regulate gut microbiota and to improve the clinical outcomes of several diseases. However, whether RS2 may benefit patients with end-stage renal disease under maintenance hemodialysis (MHD) remains unknown. Therefore, this review article has been conducted.

Do patients with end-stage renal disease under maintenance hemodialysis benefit from resistant starch type 2 supplementation?

Study design:
This review article included 5 RCTs with 179 patients under maintenance hemodialysis.

Resistant starch type 2 was used for 4 weeks to 2 months.

Results and conclusions:
The investigators found a significant decrease of blood urea nitrogen [WMD = -6.91, 95% CI = -11.87 to -1.95, I2 = 0%, p = 0.006], serum creatinine [WMD = -1.11, 95% CI = -2.18 to -0.05, I2 = 44%, p = 0.04] and interleukin (IL)-6 in blood [SMD = -1.08, 95% CI = -1.64 to -0.53, I2 = 35%, p = 0.0001] was revealed in the resistant starch type 2 group.

The investigators found analyses of blood levels of uric acid, p-cresyl sulfate, indoxyl sulfate, high sensitive C-reaction protein, albumin and phosphorus yielded no significant difference.

The investigators concluded that resistant starch type 2 improves the residual renal function of patients under maintenance hemodialysis and mitigate a proinflammatory response. Nevertheless, results should be cautiously interpreted, because of the limited sample size and different treatment dosages. Large and pragmatic multicenter trials are thus necessary to corroborate the beneficial effects of resistant starch type 2 supplementation on end-stage renal disease.

Original title:
Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis by Jia L, Dong X, […], Zhang HL.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797550/

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Resistant starch (RS) is starch, including its degradation products, that escapes from digestion in the small intestine of healthy individuals, but rather turned into short-chain fatty acids (such as acetate, butyrate and propionate) by intestinal bacteria in the colon (large intestine). Short chain fatty acids can be absorbed into the body from the colon or stay put and be used by colonic bacteria for energy.

Different types of resistant starch are RS1, RS2 and RS3. 

Resistant starch is present in whole grains, fruits, vegetables and beans/legumes.

Resistant starch type 2 (resistant granules) is intrinsically resistant to digestion and contains high amounts of amylose. Resistant starch type 2 is found in fruits, potatoes, hi-maize RS products, corn and some legumes.

The more “raw” or “uncooked” a food is, the more resistant starch it tends to have, since heat results in gelatinization of starch - making it more accessible to digestion. Type 3 starch is the exception to this rule.

All starches are composed of 2 types of polysaccharides: amylose and amylopectin.

Amylopectin is highly branched, leaving more surface area available for digestion in the small intestine. Amylopectin is broken down quickly, which means it produces a larger rise in blood sugar (glucose) and subsequently, a large rise in insulin.

Amylose is a straight chain, which limits the amount of surface area exposed for digestion. Amylose predominates in resistant starch. Foods high in amylose are digested more slowly. They’re less likely to spike blood glucose or insulin.

Since resistant starch is incompletely digested, we only extract about 2 calories of energy per gram (versus about 4 calories per gram from other starches).
 

Objectives:
N-acetylcysteine (NAC) is an antioxidant that can regenerate glutathione and is primarily used for acetaminophen overdose. NAC has been tested and used for preventing iatrogenic acute kidney injury or slowing the progression of chronic kidney disease, with mixed results. Therefore, this review article has been conducted.

Has NAC administration a positive effect on the serum creatinine level and the serum cystatin C level?

Study design:
This review article included 6 studies (4 studies were before/after single-arm prospective trials and 2 were parallel randomized controlled trials, comparing NAC against placebo) with a total of 199 participants.

Overall, these studies are small, with a median sample size of 30 (range: 10-60).
The proportion of men ranged from 48% to 83%.
The mean patient age ranged from 33 to 71 years.
The follow-up periods were mostly short.
There was no evidence of publication bias both by visual examination or the Egger test for the analysis of NAC and cystatin C.

Results and conclusions:
The investigators found there was a small but significant decrease in serum creatinine after n-acetylcysteine (NAC) administration overall [WMD = -2.80 μmol/L, 95% CI = -5.6 to 0.0, p = 0.05].

This was greater with non-Jaffe methods [WMD = -3.24 μmol/L, 95% CI = -6.29 to -0.28, p = 0.04] than Jaffe [WMD = -0.51 μmol/L, 95% CI = -7.56 to 6.53, p = 0.89] and in particular with intravenous [WMD = -31.10 μmol/L, 95% CI = -58.37 to -3.83, p = 0.03] compared with oral NAC [WMD = -2.5 μmol/L, 95% CI = -5.32 to 0.32, p = 0.08].

The investigators found there was no change in cystatin C after n-acetylcysteine (NAC) administration [WMD = -0.84 μmol/L, 95% CI = -3.14 to 1.47, p = 0.48, I2 = 0%, p = 0.99].

The investigators concluded there is a small but significant decrease in serum creatinine with n-acetylcysteine (NAC) administration but not in cystatin C. This effect seems to be higher when creatinine is measured with the enzymatic assay (non-Jaffe method) and with intravenous n-acetylcysteine administration.

Original title:
A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements by Huang JW, Lahey B, […], Hiremath S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879108/

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The Jaffe and enzymatic methods (non-Jaffe methods) are the 2 most common methods for measuring serum creatinine. The Jaffe method is less expensive than the enzymatic method but is also more susceptible to interferences.

Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein.
 

Objectives:
Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. Therefore, this review article has been conducted.

Do probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease?  

Study design:
This review article included 14 RCTs.

Results and conclusions:
The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly reduced:
-total cholesterol [SMD = -0.25, 95% CI = -0.46 to -0.04, I2 = 00.0%];
-fasting blood glucose [SMD = -0.41, 95% CI = -0.65 to -0.17, I2 = 00.0%];
-homeostatic model assessment of insulin resistance [SMD = -0.63, 95% CI = -0.95 to -0.30, I2 = 43.3%];
-insulin levels [SMD = -0.49, 95% CI = -0.90 to -0.08, I2 = 65.2%];
-high-sensitivity C-reactive protein levels [SMD = -0.52, 95% CI = -0.81 to -0.22, I2 = 52.7%] and;
-malondialdehyde levels [SMD = -0.79, 95% CI = -1.22 to -0.37, I2 = 69.8%] compared with control interventions.

The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly increased:
-the quantitative insulin sensitivity check index [SMD = 0.78, 95% CI = 0.51 to 1.05, I2 = 00.0%];
-total antioxidant capacity [SMD = 0.42, 95% CI = 0.18 to 0.66, I2 = 00.0%] and;
-glutathione levels [SMD = 0.52, 95% CI = 0.19 to 0.86, I2 = 37.0%].

The investigators concluded probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease.

Original title:
Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients with Chronic Kidney Disease: a Systematic Review and Meta-analysis by Bakhtiary M, Morvaridzadeh M, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33526314/

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Levels of malondialdehyde can be also considered (as a marker of lipid peroxidation) to assess the membrane damage in spermatozoa; this is crucial because oxidative stress affects sperm function by altering membrane fluidity, permeability and impairing sperm functional competence.
Lipid peroxidation is a well-established mechanism of cellular injury and is used as an indicator of oxidative stress in cells and tissues.

Glutathione is one of the body's most important and potent antioxidants. As an antioxidant, glutathione helps neutralize free radicals and reduce oxidative stress that can damage the body’s cells.

Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) have been used to quantify degrees of insulin resistance and β-cell secretory capacity.
 

Objectives:
Is there a causal relationship between ginger intake and improvements of major oxidative stress (OS) parameters, such as glutathione peroxidase activity, total antioxidant capacity, alondialdehyde (MDA) levels and CAT activity?   

Study design:
This review article included 12 RCTs.

Results and conclusions:
The investigators found ginger intake significantly increased glutathione peroxidase (GPx) activity [SMD = 1.64, 95% CI = 0.43 to 2.85, I2 = 86.8%] compared to control group (group without ginger intake). 

The investigators found ginger intake significantly increased total antioxidant capacity (TAC) [SMD = 0.40, 95% CI = 0.06 to 0.73, I2 = 42.8%] compared to control group. 

The investigators found ginger intake significantly decreased alondialdehyde (MDA) levels [SMD = -0.69, 95% CI = -1.26 to -0.12, I2 = 85.8%] compared to control group.

The investigators found ginger supplementation non-significantly increased CAT activity [SMD = 1.09, 95% CI = -0.07 to 2.25, I2 = 87.6%].

The investigators concluded this meta-analysis (review article) presents convincing evidence supporting the efficacy of ginger supplementation on improving oxidative stress (OS) levels.

Original title:
Effect of ginger (Zingiber officinale) supplementation on oxidative stress parameters: A systematic review and meta-analysis by Morvaridzadeh M, Sadeghi E, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33458848/

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Oxidative stress is an imbalance between free radicals and antioxidants in your body.
 

Objectives:
Are serum albumin concentrations lower in patients with stable COPD compared to non-COPD controls?  

Study design:
This review article included 26 studies with a total of 2,554 COPD patients (74% males) and 2,055 non-COPD controls (63% males).
Overall, the mean age of participants across all studies was 61.7 years in COPD patients and 64.6 years in controls (patients without COPD).
Almost all (24 out of 26) were prospective cohort studies.

The Begg’s [p = 0.04] and Egger’s tests [p = 0.01] showed a significant publication bias; however, the trim-and-fill analysis found that no study was missing or should be added.

Results and conclusions:
The investigators found pooled results showed that serum albumin concentrations were significantly lower in COPD patients [SMD = -0.50, 95% CI = -0.67 to -0.32, p 0.001, I2 = 85.7%, p 0.001] .
Sensitivity analysis showed that the effect size was not modified when any single study was in turn removed [effect size ranged between -0.44 and -0.52].

The investigators found no significant differences in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) 50% and those with FEV1 > 50%.

The investigators concluded that serum albumin concentrations are lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

Original title:
Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis by Zinellu E, Fois AG, […], Pirina P.

Link:
https://www.mdpi.com/2077-0383/10/2/269/htm

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Objectives:
Evidence suggests that vitamin C supplementation could be a potential therapy in type 2 diabetes. However, its effectiveness and evidence quality require further evaluation. Therefore, this review article has been conducted.

Does oral vitamin C supplementation improve glycemic control, cardiovascular risk factors and oxidative stress in people with type 2 diabetes?

Study design:
This review article included 28 RCTs with in totaal 1,574 participants.
RCTs were predominantly short term (6 months) with a small number of participants (n 100).

Results and conclusions:
The investigators found that oral vitamin C supplementation significantly reduced systolic blood pressure [mean difference = -6.27, 95% CI = -9.60 to -2.96 mmHg, p = 0.0002, with moderate evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced HbA1c levels [mean difference = -0.54%, 95% CI = -0.90 to -0.17, p = 0.004, with very low evidence certainty].

The investigators found that oral vitamin C supplementation significantly reduced diastolic blood pressure [mean difference = -3.77, 95% CI = -6.13 to -1.42 mmHg, p = 0.002, with very low evidence certainty].

The investigators concluded evidence from short-term RCTs suggests that oral vitamin C supplementation may improve glycemic control and blood pressure in people with type 2 diabetes. However, vitamin C supplementation cannot currently be recommended as a therapy until larger, long-term and high-quality trials confirm these findings.

Original title:
Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials by Mason SA, Keske MA and Wadley GD.

Link:
https://pubmed.ncbi.nlm.nih.gov/33472962/

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Objectives:
Taurine plays a pivotal role in regulating glucose and lipid metabolism, blood pressure homeostasis and obesity largely due to its cytoprotective, antioxidant and anti-inflammatory actions. Despite promising data from animal studies in this scenario, the efficacy of taurine supplementation in human studies has been inconsistent. Therefore, this review article has been conducted.

Does taurine supplementation lower blood pressure and improve the lipid profile in patients with liver dysregulation?

Study design:
This review article included 12 RCTs.
Most studies were conducted in patients with liver or metabolic dysregulation (diabetes, hepatitis, fatty liver, obesity, cystic fibrosis, chronic alcoholism and cardiac surgery).
The taurine dosage varied from 0.5 to 6 g/d for 15 days to 6 months.

Results and conclusions:
The investigators found that taurine administration (supplementation) had a significant effect of on systolic blood pressure [WMD = -4.67 mm Hg, 95% CI = -9.10 to -0.25], diastolic blood pressure [WMD = -2.90 mm Hg, 95% CI = -4.29 to -1.52], total cholesterol levels [WMD = -10.87 mg/dL, 95% CI = -16.96 to -4.79] and triglycerides levels [WMD = -13.05 mg/dL, 95% CI = -25.88 to -0.22]. 

The investigators found, however, that taurine administration had no effect on fasting blood glucose [WMD = 0.06 mg/dL], HDL cholesterol [WMD = 0.90 mg/dL], LDL cholesterol [WMD = -6.17 mg/dL], as well as on body mass index [WMD = -0.46 kg/m²] and body weight [WMD = -0.47 kg] as the anthropometric measures.

The investigators concluded that, in patients with liver dysregulation, taurine supplements (0.5 to 6 g/d for 15 days to 6 months) reduce blood pressure and improve the lipid profile by reducing total cholesterol and triglyceride levels.

Original title:
The effects of taurine supplementation on obesity, blood pressure and lipid profile: A meta-analysis of randomized controlled trials by Guan L and Miao P.

Link:
https://pubmed.ncbi.nlm.nih.gov/32871172/

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The main sources of taurine are animal foods, such as meat, fish and dairy products.

Objectives:
Is fish or omega-3 fatty acids consumption associated with a lower risk of venous thromboembolism (VTE)?

Study design:
This review article included 8 prospective cohort studies.
The follow-up duration ranged from 0.5 to 19 years.
The sample size ranged from 595 to 80,263.
The fish and omega-3 fatty acids consumption was assessed by food-frequency questionnaire (FFQ) in all studies.
The diagnosis of venous thromboembolism was obtained in registered medical record (imaging or autopsy) and food was considered as the source of omega-3 fatty acids in all included studies.
Begg's rank-correlation test showed no evidence of publication bias.

Results and conclusions:
The investigators found the overall multi-variable adjusted RR showed no significant relationship between fish consumption and the risk of venous thromboembolism [RR = 1.02, 95% CI = 0.93 to 1.11, p = 0.709, I2 = 33%, p = 0.176].
The sensitivity analysis showed only minimal changes in magnitude of the pooled RR when any study was excluded from the meta-analysis, suggesting that no individual study had excessive influence on these robust aggregate results.

The investigators found the overall multi-variable adjusted RR showed that omega-3 fatty acids consumption was associated with a lower risk of 11% for venous thromboembolism [RR = 0.89, 95% CI = 0.80 to 0.98, p = 0.024, I2 = 0%, p = 0.469].
The sensitivity analysis showed only minimal changes in magnitude of the pooled RR when any study was excluded from the meta-analysis, suggesting that no individual study had excessive influence on these robust aggregate results.

The investigators found the overall multi-variable adjusted RR showed that omega-3 fatty acids consumption was associated with a lower risk of 55% for recurrent venous thromboembolism [RR = 0.45, 95% CI = 0.25 to 0.81, p = 0.008, I2 = 26.4%, p = 0.244].
Significant because RR of 1 was not found in the 95% CI of 0.25 to 0.81. RR of 1 means no risk/association.

The investigators concluded omega-3 fatty acids consumption is associated with a lower risk of both venous thromboembolism and recurrent venous thromboembolism.

Original title:
Associations of Fish and Omega-3 Fatty Acids Consumption With the Risk of Venous Thromboembolism. A Meta-Analysis of Prospective Cohort Studies by Zhang Y, Ding J, [...],Li Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793732/

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Venous thromboembolism (VTE) is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE).