Impact of citrus fruit and hesperidin intake on multiple health outcomes: An umbrella review

Abstract Citrus fruits are rich sources of several biologically active flavonoids such as hesperidin, naringin, and polymethoxylated flavones. We evaluated the evidence of associations between citrus fruit or hesperidin intake and multiple health outcomes. An umbrella review was conducted for studies performed in humans. Overall, 246 articles were initially identified by searching in 4 databases. Twenty-two meta-analyses and systematic reviews with 28 health outcomes met the inclusion criteria. Citrus fruit intake had beneficial effects on all-cause mortality (relative risk [RR]. 0.90; 95% confidence interval [95% CI], 0.86 to 0.94), cardiovascular diseases (RR, 0.78; 95% CI, 0.66 to 0.92), coronary heart disease (RR, 0.91; 95% CI, 0.86 to 0.96), stroke (RR, 0.74; 95% CI, 0.65 to 0.84), type 2 diabetes mellitus (RR, 0.85; 95% CI, 0.78 to 0.92), and several cancers. Dose-response analyses indicated that each 100-g/d increase in citrus fruit intake could reduce the risks of all-cause mortality by 6% (RR, 0.94; 95% CI, 0.88 to 1.00), stroke by 22% (RR, 0.78; 95% CI, 0.69 to 0.90), and cardia gastric cancer by 40% (RR, 0.60; 95% CI, 0.44 to 0.83). Citrus fruit intake also had beneficial effects on the lipid profile and body weight control (weighted mean difference, −1.28; 95% CI, −1.82 to −0.74). Grapefruits could reduce the systolic blood pressure (weighted mean difference, −2.43, 95% CI, −4.77 to −0.09). Hesperidin supplementation significantly improved inflammation. Citrus fruit intake was generally safe and beneficial for multiple health outcomes in humans. However, grapefruit and pomelo juice may affect the bioavailability of various medications, so care should be exercised before increasing the intake of these fruits or their juices.