Nutritional advice

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 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 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:
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:
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:
Do melatonin supplements improve sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adults with various diseases?

Study design:
This review article included a total of 23 RCTs.

Results and conclusions:
The investigators found that melatonin supplements had significant effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) [WMD = -1.24, 95% CI = -1.77 to -0.71, p = 0.000, I2 = 80.7%, p = 0.000].

The investigators found subgroup analysis based on health status revealed melatonin supplements in subjects with respiratory diseases [WMD = -2.20, 95% CI = -2.97 to -1.44, p = 0.000], metabolic disorders [WMD = -2.74, 95% CI = -3.48 to -2.00, p = 0.000] and sleep disorders [WMD = -0.67, 95% CI = -0.98 to -0.37, p = 0.000] had significant effects on sleep quality.

The investigators concluded the treatment with exogenous melatonin (melatonin supplements) has positive effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adults, particularly with respiratory diseases, metabolic disorders, primary sleep disorders; however, not with mental disorders, neurodegenerative diseases and other diseases.

Original title:
Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials by Fatemeh G, Sajjad M, […], Khadijeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33417003/

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Objectives:
A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) actually benefit from a DPI of ≤ 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1-3 has not been consistent. Therefore, this review article has been conducted.

Do patients with diabetic kidney disease benefit from a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day)?

Study design:
This review article included 9 RCTs with a total of 506 participants and follow-up periods varying from 4.5 to 60 months.

Results and conclusions:
The investigators found that patients with diabetic kidney disease who consumed 0.8 g protein/kg/day had a significantly reduced decline in glomerular filtration rate (GFR) [MD = 22.31 mL/min/1.73 m², 95% CI = 17.19 to 27.42, p 0.01] and a significant decrease in proteinuria [SMD = -2.26 units, 95% CI = -2.99 to -1.52, p 0.001] versus those on the control diet.

The investigators found the benefits of a low-protein diet to patients with diabetic kidney disease at chronic kidney disease stages 1-3 were a markedly decreased proteinuria [SMD - 0.96 units, 95% CI = -1.81 to -0.11, p = 0.03] and slight but significant decreases in glycated hemoglobin [-0.42%] and cholesterol levels [-0.22 mmol/L].

The investigators concluded that a dietary protein intake of 0.8 g/kg/day is strongly associated with a slow decline in glomerular filtration rate (GFR) and decreases proteinuria in the patients with diabetic kidney disease. Patients with chronic kidney disease (CKD) stages chronic kidney disease 1-3 benefit from a low-protein diet in terms of a marked decrease of proteinuria and slight but significant improvements in lipid and glucose control.  

Original title:
Diabetic Kidney Disease Benefits from Intensive Low-Protein Diet: Updated Systematic Review and Meta-analysis by Li Q, Wen F, [...], Wang W.

Link:
https://pubmed.ncbi.nlm.nih.gov/33150563/

Additional information of El Mondo:
Find here more information/studies about protein consumption and kidney disease.

For example: you are a patient with diabetic kidney disease, you weigh 70 kg and you want to eat 2200 kcal every day. How should you meet a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day) in daily life?
Every day you should take maximal 0.8 g protein x 70 kg = 56 g protein. 56 g protein give 56x4 kcal = 224 kcal. 224 kcal is around 10% of 2200 kcal. Thus, you should eat products whose protein content contributes maximum 10% to the total kcal of the product in question, meaning you should eat products with 10 En% protein. These products in the supermarket contain maximum 10 En% protein.

Thus, a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day) for a person weighing 70 kg on a diet of 2200 kcal, means he/she should eat products with maximum 10 En% protein in daily life.
 

Objectives:
Soy products contain several compounds with anti-inflammatory properties like genistein and daidzein which reported to act through different pathways. However, there are inconsistent results and lack of any comprehensive review regarding randomized controlled trials which assess the effect of soy products on inflammatory markers. Therefore, this review article has been conducted.

Does soy product supplementation reduce levels of inflammatory markers, like CRP, IL-6?

Study design:
This review article included 51 RCTs.

Results and conclusions:
The investigators found soy product supplementation significantly reduced CRP levels [MD = -0.27 mg/L, 95% CI = -0.51 to -0.02, p = 0.028] but it did not affect IL-6 [MD = 0.0 pg/mL, 95% CI = -0.06 to 0.06, p = 0.970] and TNF-α [MD = -0.04 pg/mL, 95% CI = -0.11 to 0.03, p = 0.252].

The investigators found subgroup analysis showed that soy supplementation had a significant impact on decreasing IL-6 and TNF-α levels when studies had a long-term intervention (≥12 weeks) and used low dose isoflavone (100 mg/day).

The investigators concluded there is a significant reduction in CRP levels after soy product supplementation.

Original title:
The effects of soy supplementation on inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials by Asbaghi O, Yaghubi E, […], Ghaedi E.

Link:
https://pubmed.ncbi.nlm.nih.gov/32979840/

Additional information of El Mondo:
Find here more information/studies about soy consumption and chronic disease.

Objectives:
There is some inconclusive evidence for the role of fish consumption in susceptibility to multiple sclerosis (MS). Therefore, this review article has been conducted.

Does fish consumption reduce multiple sclerosis (MS)?

Study design:
This review article included 6 observational studies.

Results and conclusions:
The investigators found that the consumption of fish (at least 0.5 servings of fish per week) significantly decreased the risk of multiple sclerosis with 23% [OR = 0.77, 95% CI = 0.64 to 0.92, p-value = 0.004, I2 = 54.7%] compared with controls.

The investigators concluded that dietary intake of at least 0.5 servings of fish per week during adolescence and after reduce the risk of multiple sclerosis; however, further studies are required to prove this preventive effect.

Original title:
Dietary fish intake and the risk of multiple sclerosis: a systematic review and meta-analysis of observational studies by Rezaeizadeh H, Mohammadpour Z, […], Homayon IA.

Link:
https://pubmed.ncbi.nlm.nih.gov/32787642/

Additional information of El Mondo:
Find here more information/studies about fish consumption.

Objectives:
The relationship between dietary pattern and the risk of chronic obstructive pulmonary disease (COPD) has been described; however, the exclusive role of dietary factors remains controversial. Therefore, this review article has been conducted.

Does a dietary intake of fruits and vegetables, dietary fiber, fish, n-3 or n-6 fatty acids and antioxidant vitamins reduce risk of COPD in adults?

Study design:
This review article included 10 cohort, 6 case-control and 20 cross-sectional studies.

To assess usual dietary intake, 28 studies had used food frequency questionnaires (FFQ), of which 2 studies had used FFQ and a 24-hour recall, 3 studies had used the crosscheck dietary method, 1 study had assessed with only 24-hour recall and 1 study had used weighted household food records.

Results and conclusions:
The investigators found a significantly reduced risk of 26% [relative risk = 0.74, 95% CI = 0.65 to 0.85] for COPD for the highest fruit intake group compared with the lowest intake group.
This significantly reduced risk was 29% in cohort studies [RR = 0.71, 95% CI = 0.63 to 0.79, I2 = 0.0%].

The investigators found a significantly reduced risk of 47% [relative risk = 0.53, 95% CI = 0.39 to 0.74, I2 = 0.0%, p = 0.65] for COPD mortality for the highest fruit intake group compared with the lowest intake group.

The investigators found a significantly reduced risk of 35% [relative risk = 0.65, 95% CI = 0.55 to 0.78] for COPD for the highest dietary fiber intake group compared with the lowest intake group.
This significantly reduced risk was 39% in cohort studies [RR = 0.61, 95% CI = 0.54 to 0.68, I2 = 0.0%, p = 0.9].

The investigators found a significantly reduced risk of 29% [relative risk = 0.71, 95% CI = 0.58 to 0.85] for COPD for the highest fish intake group compared with the lowest intake group.

The investigators found a significantly reduced risk of 11% [relative risk = 0.89, 95% CI = 0.76 to 0.99] for COPD for the highest vitamin C dietary intake group compared with the lowest intake group.

The investigators found no association between the risk of COPD and the intake of vegetables, n-3 fatty acids, vitamin E and β-carotene.

The investigators concluded that a higher dietary intake of fruit, dietary fiber, fish and vitamine C reduce the risk of COPD in adults.

Original title:
Dietary Factors and Risk of Chronic Obstructive Pulmonary Disease: A Systemic Review and Meta-Analysis by Seyedrezazadeh E, Moghaddam MP, […], Kolahdooz F.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309892/

Additional information of El Mondo:
Find here more information/studies about fruit, dietary fiber, fish and vitamine C.

Objectives:
Vitamin D deficiency has been related to the risk of sepsis. However, previous studies showed inconsistent results regarding the association between serum 25-hydroxyvitamin D (25 (OH)D) and mortality risk in septic patients. Therefore, this review article has been conducted.

Does a low serum 25-hydroxyvitamin D (vitamin D level in blood) increase mortality risk in septic patients?

Study design:
This review article included 8 follow-up studies (4 were prospective and the other 4 were retrospective) with 1,736 septic patients.

The sample sizes of the included studies varied from 57 to 610.
The mean ages of the patients included in each study ranged from 57 to 75 years and the proportions of male patients varied from 43% to 71%.

Optimal vitamin D level, vitamin D insufficiency, vitamin D deficiency and severe vitamin D deficiency are defined as serum 25 (OH)D > 30 ng/mL, 21-29 ng/mL and  20 ng/mL, 10 ng/mL, respectively.

There was no publication bias.

Results and conclusions:
The investigators found meta-analysis with a random-effect model showed that septic patients with lower serum 25 (OH)D ( 30 ng/ml) at admission was associated with a significantly increased mortality risk of 93% [adjusted RR = 1.93, 95% CI = 1.41 to 2.63, p  0.001, I2 = 63%, p = 0.003].
Sensitivity analysis by excluding one study at a time did not significantly change the results.

The investigators found subgroup analyses according to the severity of vitamin D deficiency showed that patients with severe vitamin D deficiency ( 10 ng/mL) was significantly associated with a 92% higher mortality risk [adjusted RR = 1.92, 95% CI = 1.09 to 2.55, p  0.001].
But the associations were not significant for vitamin D insufficiency (25 (OH)D = 20-30 ng/mL) or deficiency (25 (OH)D = 10-20 ng/mL).

The investigators found further analyses showed that the association between lower serum 25(OH) D and higher mortality risk were consistent in studies applied different diagnostic criteria for sepsis (SIRS, Sepsis-2.0 or Sepsis-3.0), short-term (within 1 month) and long-term studies (3-12 months) and in prospective and retrospective studies.

The investigators concluded that severe vitamin D deficiency ( 10 ng/mL) is independently associated with increased mortality in patients with sepsis. Large-scale prospective studies are needed to validate these findings.

Original title:
Serum 25-Hydroxyvitamin D and the risk of mortality in adult patients with Sepsis: a meta-analysis by Li Y and Ding S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057612/

Additional information of El Mondo:
Find here more information/studies about vitamin D.

Objectives:
Multiple sclerosis (MS) is a demyelinating and disabling inflammatory disease of the central nervous system. Multiple sclerosis is triggered by complex environmental factors which mostly affect genetically the susceptible young people. Emerging data has suggested that changes of homocysteine (Hcy), vitamin B12 and folate serum levels may be associated with multiple sclerosis. However, previous findings are not always consistent. Therefore, this review aricle has been conducted.

Does a low serum homocysteine, vitamin B12 or folate level increase risk of multiple sclerosis?

Study design:
This review article included 21 original studies with 1,738 multiple sclerosis patients and 1,424 controls (patients without multiple sclerosis). There were 17 studies for measuring homocysteine, 16 studies for measuring vitamin B12 and 13 studies for measuring folate in patients with multiple sclerosis, respectively.

Results and conclusions:
The investigators found patients with multiple sclerosis (MS) had higher serum levels of homocysteine [SMD = 0.64, 95% CI = 0.33 to 0.95, p 0.0001] compared with control groups.

The investigators found no significant differences of SMD for vitamin B12 [SMD = -0.08, 95% CI = -0.35 to 0.20, p = 0.58] or folate [SMD = 0.07, 95% CI = -0.14 to 0.28, p = 0.52] between MS and controls.

The investigators found subgroup analysis demonstrated that there was statistically significant difference for homocysteine between relapsing-remitting MS (RRMS) patients and controls with a SMD of 0.67 [95% CI = 0.21 to 1.13, p = 0.004].

However, no significant difference of homocysteine serum levels between secondary progressive MS patients or primary progressive MS patients and controls.

The investigators found no significant difference of homocysteine levels in females [SMD = 0.22, 95% CI = -0.16 to 0.60, p = 0.25] or males [SMD = 0.56, 95% CI = -0.13 to 1.26, p = 0.11] between MS patients and controls.

The investigators concluded higher serum levels of homocysteine increase risk of multiple sclerosis (MS), especially for relapsing-remitting MS (RRMS) patients. Functional studies are required to assess the effects of homocysteine on patients with MS at the molecular level.

Original title:
Serum levels of Homocysteine, Vitamin B12 and Folate in Patients with Multiple Sclerosis: an Updated Meta-Analysis by Li X, Yuan J, [...], Hu W.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085269/

Additional information of El Mondo:
Find here more information/studies about lowering serum levels of homocysteine.

Objectives:
Physical exercise may offer multiple benefits to patients with chronic kidney disease (CKD). However, it was not traditionally recommended because of the possibility of impairing renal function and increasing proteinuria. Therefore, this review aricle has been conducted.

Does low-intensity physical exercise offer benefits to patients with chronic kidney disease?

Study design:
This review article included 21 RCTs with a intervention of at least 12 weeks and 927 patients.

The frequency of low-intensity physical exercise in 14 studies was 3 times per week during 30 minutes.

Results and conclusions:
The investigators found no differences in glomerular filtration rate or proteinuria between the intervention group (group with low-intensity physical exercise) and the control group (group without low-intensity physical exercise) [SMD = -0.3, p = 0.81 and SMD = 26.6, p = 0.82].

The investigators found positive effects on peak oxygen consumption [SMD = 2.5, p 0.001], functional capacity [SMD = 56.6, p 0.001], upper limb strength [SMD = 6.8, p 0.001] and haemoglobin [SMD = 0.3, p = 0.003] for the intervention group.

The investigators found an improvement on the quality of life, using the KDQOL-36 survey [SMD = 3.56, p = 0.02] and the SF-36 survey [SMD = 6.66, p = 0.02] for the intervention group.

The investigators concluded low-intensity physical exercise routinely has no negative impact on renal function. On the contrary, it improves aerobic and functional capacity, impacting positively on the quality of life.

Original title:
Impact of physical exercise in patients with chronic kidney disease: Sistematic review and meta-analysis by Villanego F, Naranjo J, […], Mazuecos A.

Link:
https://reader.elsevier.com/reader/sd/pii/S0211699520300266?token=62CEB2BCF50CE23B396565B5DC989F795AEEB75C666C74AA410FD2172DB39F90DBBB5D72BF3B4347C0C8AD2FEF8B0110

Additional information of El Mondo:
Find here more information/studies about kidney disease and sport nutrition.

Low-intensity physical exercises are a casual walk, a stretch session, a beginners' yoga class or tai chi.

Objectives:
Is there a causal relationship between dietary anthocyanins and reduced levels of systemic and vascular inflammation?

Study design:
This review article included 32 RCTs.

Results and conclusions:
The investigators found that dietary anthocyanins significantly decreased levels of C-reactive protein (CRP) [-0.33 mg/L, 95% CI = -0.55 to -0.11, p = 0.00], interleukin-6 (IL-6) [-0.41 ρg/mL, 95% CI = -0.70 to -0.13, p = 0.004], tumor necrosis factor-alpha (TNF-α) [-0.64 ρg/mL, 95% CI = -1.18 to -0.09, p = 0.023], intercellular adhesion molecule-1 [-52.4 ng/mL, 95% CI = -85.7 to -19.1, p = 0.002] and vascular adhesion molecule-1 (VCAM-1)  [-49.6 ng/mL, 95% CI = -72.7 to -26.5, p  0.001]. 

The investigators found that dietary anthocyanins significantly increased adiponectin level [0.75 μg/mL, 95% CI = 0.23 to 1.26, p = 0.004].

The investigators found subgroup analyses showed that administration of higher doses of anthocyanins (>300 mg/day) significantly decreased levels of CRP, IL-6, TNF-α and VCAM-1.

The investigators concluded that >300 mg/day dietary anthocyanins reduce the levels of systemic and vascular inflammation in the subjects.

Original title:
Impact of dietary anthocyanins on systemic and vascular inflammation: Systematic review and meta-analysis on randomised clinical trials by Fallah AA, Sarmast E, […], Jafari T.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31669599

Additional information of El Mondo:
Find here more information/studies about inflammation and anthocyanins.

Inflammation in the body can be measured by the following biomarker; the pro-inflammatory cytokines. The pro-inflammatory cytokines are the C-reactive protein (CRP), IL-1, interleukin-6 (IL-6), IL-8, MCP-1, the vascular adhesion molecule-1 (VCAM-1) and tumor necrosis factor alpha (TNF-α).

Objectives:
Is there a causal relationship between intake of pomegranate and decreased risk of getting inflammation in adults?

Study design:
This review article included 16 randomized controlled trials (RCTs) involving 572 subjects.

Results and conclusions:
The investigators found when compared to placebo, that pomegranate supplementation significantly reduced hs-CRP levels [WMD = -6.57 mg/L, 95% CI = -10.04 to -3.10, p = 0.000].

The investigators found when compared to placebo, that pomegranate supplementation significantly reduced IL-6 levels [WMD = -1.68 pg/mL, 95% CI = -3.52 to -0.157, p = 0.000].

The investigators found when compared to placebo, that pomegranate supplementation significantly reduced TNF-α levels [WMD = -2.37 pg/mL, 95% CI = -3.67 to -1.07, p = 0.00].

The investigators found no association between pomegranate supplementation and CRP levels [WMD = 2.19 mg/dL, 95% CI = -3.28 to 7.67, p = 0.61], E-selectin levels [WMD = 8.42 ng/mL, 95% CI = -22.9 to 39.8, p = 0.599], ICAM levels [WMD = -17.38 ng/mL, 95% CI = -53.43 to 18.66, p = 0.107], VCAM levels [WMD = -69.32 ng/mL, 95% CI = -229.26 to 90.61, p = 0.396] or MDA levels [WMD = 0.031 μmol/L, 95% CI = -1.56 to 0.218, p = 0.746].

The investigators concluded pomegranate supplementation reduces hs-CRP levels, IL-6 levels and TNF-α levels in adults.

Original title:
The effects of pomegranate supplementation on biomarkers of inflammation and endothelial dysfunction: A meta-analysis and systematic review by Wang P, Zhang Q, [...], Yao G.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32147056

Additional information of El Mondo:
Find here more information/studies about fruit and chronic diseases.

Inflammation in humans can be measured by biomarkers, such as highly sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and the tumor necrosis factor alpha (TNF-α).

Inflammation in humans can lower the resistance. A low resistance makes the body susceptible to diseases.
 

Objectives:
The activity of hepatitis B virus (HBV) as a risk factor for the incidence and progression of chronic kidney disease (CKD) has not been clarified. Therefore, this review article has been conducted.

Does hepatitis B virus infection increase risk of chronic kidney disease?

Study design:
This review article included 33 studies with a total of 7,849,849 patients.

Results and conclusions:
The investigators found in 11 cohort studies with 1,056,645 patients, that a positive HBV serologic status (hepatitis B virus infection) significantly increased risk of incidence of chronic kidney disease with 40% [adjusted HR = 1.40, 95% CI = 1.16 to 1.69, p 0.001, I2 = 49.5%, p 0.0001].

The investigators found in 10 cross-sectional studies with 3,222,545 patients, no relationship between hepatitis B virus infection and prevalence of chronic kidney disease [adjusted OR = 1.04, 95% CI = 0.90 to 1.218, p = 0.5].

The investigators found meta-regression analysis reported a relationship between positive HBsAg status and incidence of chronic kidney disease in the general population [p 0.015].

The investigators concluded hepatitis B virus infection increases risk of developing of chronic kidney disease in the adult general population. Studies aimed to understand the mechanisms responsible of such association are underway.

Original title:
HBV infection is a risk factor for chronic kidney disease: Systematic review and meta-analysis by Fabrizi F, Cerutti R, […], Messa P.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32037008

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Find here more information/studies about kidney disease.
 

Objectives:
Lead is a known risk factor for amyotrophic lateral sclerosis (ALS). However, the results of studies exploring the relationship between lead exposure and the occurrence of ALS are inconsistent. Therefore, this review article has been conducted.

Does a high lead exposure increase risk of ALS?

Study design:
This review article included 11 case-control studies.

Results and conclusions:
The investigators found a high lead exposure significantly increased risk of ALS with 28% [OR = 1.28, 95% CI = 1.02 to 1.63].
Subgroup and sensitivity analyses showed stable results.

The investigators concluded a high lead exposure increases risk of ALS.

Original title:
Population-based study of environmental/occupational lead exposure and amyotrophic lateral sclerosis: a systematic review and meta-analysis by Meng E, Mao Y, […], Jin W.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31578652

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