Lack of Efficacy of Pomegranate Supplementation on Insulin Resistance and Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

IF 6.1 2区 医学 Q1 CHEMISTRY, MEDICINAL
Shao Yin, Fengya Zhu, Qian Zhou, Miao Chen, Xia Wang, Qiu Chen
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引用次数: 0

Abstract

The objective of this study is to assess the impact of pomegranate supplements on insulin resistance (IR) and insulin sensitivity through a systematic review and meta-analysis of randomized controlled trials (RCTs). Additionally, we aim to analyze the differences in efficacy among various pomegranate extracts and the sensitivity of different diseases to pomegranate supplementation. We conducted searches in PubMed, Embase, Web of Science, and Cochrane Library up to October 30, 2023, for relevant studies published in English. The treatment group required the intake of pomegranate extract for a minimum of 4 weeks, with no restrictions on the extract type. The control group received a placebo or a treatment excluding pomegranate extract. The primary outcome was homeostatic model assessment for insulin resistance (HOMA-IR) and fasting insulin (FI), and the secondary outcome was quantitative insulin sensitivity check index (QUICKI). RoB 2 was used to assess the risk of bias in the original studies. We pre-specified subgroup analyses based on types of intervention, intervention duration, health condition, and intervention dose. Sensitivity analysis was conducted to validate result stability, utilizing Begg's test and Egger's test for publication bias. Data synthesis and analysis were performed using Stata 15.1 software. This study included a total of 15 RCTs with 673 participants conducted in 7 countries. Risk of bias results indicated an overall low risk of bias of the articles. Participants included healthy individuals, overweight and obese individuals, non-alcoholic fatty liver disease (NAFLD) patients, type 2 diabetes (T2DM) patients, polycystic ovary syndrome (PCOS) patients, metabolic syndrome (MS) patients, and individuals with hyperlipidemia. Pomegranate extract variations included pomegranate juice (PJ), pomegranate seed oil (PSO) capsule, pomegranate/pomegranate peel (PP) extract capsule, and pomegranate peel-added bread. The control groups primarily received placebo treatments with varying dosage and frequency. No adverse reactions were reported in any of the studies. The summary results showed that compared to the control groups, pomegranate extract had no significant impact on improving HOMA-IR levels in participants (WMD = -0.03, 95%CI: -0.37 to 0.31, and p = 0.851) and FI (WMD = -0.03, 95%CI: -0.42 to 0.36, and p = 0.862). Additionally, there was no significant advantage of pomegranate extract on QUICKI changes in T2DM and PCOS patients (WMD = 0.00, 95%CI: 0.00 to 0.01, and p = 0.002). Subgroup analysis results indicated that pomegranate extract could improve HOMA-IR levels in PCOS patients (WMD = -0.42, 95%CI: -0.54 to -0.29, and p < 0.001) and FI levels in T2DM, PCOS, and NAFLD patients. Our results indicate that pomegranate extract only improves HOMA-IR and FI levels in PCOS patients and FI levels in T2DM and NAFLD patients. No significant difference has been found for HOMA-IR, FI, or QUICKI in other metabolic diseases. The current evidence suggests that we should interpret the value of pomegranate extract in regulating IR and sensitivity cautiously. In the future, there is a need for more rigorously designed RCTs to specifically evaluate the impact of pomegranate supplementation on insulin sensitivity in patients with NAFLD, PCOS, and T2DM.

补充石榴对胰岛素抵抗和敏感性缺乏疗效:随机对照试验的系统回顾和元分析》。
本研究旨在通过对随机对照试验(RCT)进行系统回顾和荟萃分析,评估石榴补充剂对胰岛素抵抗(IR)和胰岛素敏感性的影响。此外,我们还旨在分析各种石榴提取物之间的功效差异以及不同疾病对石榴补充剂的敏感性。我们在 PubMed、Embase、Web of Science 和 Cochrane Library 中检索了截至 2023 年 10 月 30 日用英语发表的相关研究。治疗组要求摄入石榴提取物至少 4 周,提取物类型不限。对照组接受安慰剂或不含石榴提取物的治疗。主要结果是胰岛素抵抗静态模型评估(HOMA-IR)和空腹胰岛素(FI),次要结果是胰岛素敏感性定量检查指数(QUICKI)。RoB 2 用于评估原始研究的偏倚风险。我们根据干预类型、干预持续时间、健康状况和干预剂量预先设定了亚组分析。我们进行了敏感性分析,利用 Begg 检验和 Egger 出版偏倚检验来验证结果的稳定性。数据综合与分析使用 Stata 15.1 软件进行。本研究共纳入了 15 项 RCT,共有 673 名参与者,在 7 个国家进行。偏倚风险结果表明,文章的总体偏倚风险较低。参与者包括健康人、超重和肥胖者、非酒精性脂肪肝(NAFLD)患者、2 型糖尿病(T2DM)患者、多囊卵巢综合征(PCOS)患者、代谢综合征(MS)患者和高脂血症患者。石榴提取物的种类包括石榴汁(PJ)、石榴籽油(PSO)胶囊、石榴/石榴皮(PP)提取物胶囊和添加石榴皮的面包。对照组主要接受不同剂量和次数的安慰剂治疗。所有研究均未报告不良反应。总结结果显示,与对照组相比,石榴提取物对改善参与者的 HOMA-IR 水平(WMD = -0.03,95%CI:-0.37 至 0.31,p = 0.851)和 FI 水平(WMD = -0.03,95%CI:-0.42 至 0.36,p = 0.862)没有显著影响。此外,石榴提取物对 T2DM 和 PCOS 患者的 QUICKI 变化没有明显优势(WMD = 0.00,95%CI:0.00 至 0.01,p = 0.002)。亚组分析结果表明,石榴提取物可改善多囊卵巢综合征患者的 HOMA-IR 水平(WMD = -0.42,95%CI:-0.54 至 -0.29,p = 0.002)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Phytotherapy Research
Phytotherapy Research 医学-药学
CiteScore
12.80
自引率
5.60%
发文量
325
审稿时长
2.6 months
期刊介绍: Phytotherapy Research is an internationally recognized pharmacological journal that serves as a trailblazing resource for biochemists, pharmacologists, and toxicologists. We strive to disseminate groundbreaking research on medicinal plants, pushing the boundaries of knowledge and understanding in this field. Our primary focus areas encompass pharmacology, toxicology, and the clinical applications of herbs and natural products in medicine. We actively encourage submissions on the effects of commonly consumed food ingredients and standardized plant extracts. We welcome a range of contributions including original research papers, review articles, and letters. By providing a platform for the latest developments and discoveries in phytotherapy, we aim to support the advancement of scientific knowledge and contribute to the improvement of modern medicine.
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