Anti‐hyperglycemic effect of Abelmoschus culentesus (Okra) on patients with diabetes type 2: a randomized clinical trial

Okra-supplemented diet prevents hypothalamic inflammation in early overfeeding-programmed obese rats

BACKGROUND

Early overnutrition programs long-term metabolic dysfunctions. Owing to their benefits, functional foods have been used to treat metabolic diseases. We aimed to test the hypothesis that a diet supplemented with okra (Abelmoschus esculentus L.) mitigates energy metabolism impairment and glucose dyshomeostasis in early overfeeding-programmed rat offspring.

METHODS

At postnatal Day 3, the litters were adjusted to 3 (small litter, SL) or 8 (normal litter, NL) pups. During lactation, milk collection and milk intake were performed. At 22 days-old, the pups were weaned and fed a standard diet (NL-SD and SL-SD groups) or an okra-supplemented diet (1.5 % A. esculentus; NL-AE and SL-AE groups). Body weight and food and water intake were measured every two days. Intraperitoneal glucose tolerance and intracerebroventricular insulin (10-3 mmol/L) tests were performed, and then the offspring were euthanized. Blood, hypothalamus, and visceral fat pads were collected and lean body mass was measured.

RESULTS

Milk from SL mothers had higher triglyceride and energy contents (P < 0.05), and milk consumption by SL offspring was greater than that by NL rats. SL-SD rats were obese, hyperphagic, hypertriglyceridemic, hyperglycemic and glucose intolerant (P < 0.05) and presented central insulin resistance and increased levels of hypothalamic proinflammatory [tumor necrosis factor alpha (TNF-α), 43.5 %; interleukin 6 (IL-6), 78.5 %; and interleukin 1 beta (IL-1β), 50.1 %, P < 0.05] cytokines. On the other hand, the consumption of an okra-supplemented diet prevented all metabolic impairments.

CONCLUSION

In summary, dietary supplementation with okra prevents obesity and glucose deregulation in early-overfeeding rats, which is associated with improved hypothalamic inflammation and insulin resistance.

In-vitro evaluation of the effect of okra (Abelmoschus esculentus L.) extract on periodontal cells: a comprehensive study of cellular and molecular impacts

BACKGROUND

This research assessed the potential role of okra (Abelmoschus esculentus L.) extract on periodontal tissue wound healing by evaluating its effects on human periodontal ligament fibroblast (hPDLF), human gingival fibroblast (hGF), and human osteoblast (hOB) cells in vitro.

METHODS

The viability effect of okra extract on hPDLF, hGF, and hOB cells was determined using the MTT assay protocol. The highest viability concentrations were applied to hPDLF and hOB cells, and the expression levels of on type 1 collagen (COL1), bone morphogenetic protein 2 (BMP2), axis inhibition protein 2 (AXIN2), and fibroblast growth factor 2 (FGF2) proteins were determined through ELISA. The extract was also tested for antioxidant (CUPRAC, DPPH, FCR, and FRAP tests), acetylcholinesterase (AChE) inhibition, and antimicrobial properties, and its content was determined by HPLC-DAD.

RESULTS

The viability results showed no significant difference between the okra extract-treated and control groups for all cell types. In hPDLF cells, higher expression levels of COL1 and AXIN2 in the okra extract-treated group compared to the control group, while BMP2 expression level was lower. In hOB cells, the extract-treated group had higher levels of COL1, BMP2, and AXIN2 expression than the control group.

CONCLUSION

It can be posited that okra extract may activate the Wnt/β-catenin signalling pathway and may have a beneficial impact on wound healing in periodontal tissues. However, extensive long-term in-vivo research on the activation of signalling pathways by okra extract in periodontal wound healing is required.

An Overview of the Current Scientific Evidence on the Biological Properties of Abelmoschus esculentus (L.) Moench (Okra)

Abelmoschus esculentus (L.) Moench, commonly known as okra or lady's finger, is an annual flowering plant belonging to the Malvaceae family. Okra is a native plant in Africa as well as a traditional medicine in Africa and India for treating different diseases and conditions. Today, okra is widely consumed as a vegetable and is increasingly recognized as a superfood due to its rich nutritional profile and potential pharmacological benefits. Research indicates that okra exhibits a range of biological activities, including antidiabetic, antihyperlipidemic, antifatigue, vasoprotective, hepatoprotective, antitumor, anti-inflammatory, and antimicrobial effects. Despite its promising therapeutic potential, research on the active compounds in okra and evaluating efficacy in clinical settings remains limited. This review aims to consolidate existing scientific knowledge on the biological and pharmacological properties of okra, thereby encouraging further investigation into its health benefits. Ultimately, this could pave the way for the development of functional foods or health supplements that leverage okra as a key ingredient to prevent chronic diseases and enhance overall health outcomes.

The cardiometabolic benefits of okra-based treatment in prediabetes and diabetes: a systematic review and meta-analysis of randomized controlled trials

Background

This systematic review and meta-analysis examine the effects of okra consumption on cardiometabolic risk factors in individuals with prediabetes and diabetes. Okra is a widely consumed vegetable with potential health benefits, and understanding its impact on metabolic parameters in these populations is important.

Methods

A comprehensive search of the literature was conducted up to May 2024 in PubMed/Medline, Scopus, and Web of Science to find relevant randomized clinical trials (RCTs) by using following keyword: ("okra" OR "okras" OR "abelmoschus esculentus") AND ("intervention" OR "controlled trial" OR "randomized" OR "randomized" OR "randomly" OR "clinical trial" OR "trial" OR "randomized controlled trial" OR "randomized clinical trial" OR "RCT" OR "blinded" OR "placebo" OR "Cross-Over" OR "parallel"). The selected trials were subjected to heterogeneity tests using the I2 statistic. Random effects models were examined based on the heterogeneity tests, and the pooled data were calculated as weighted mean differences (WMD) with a 95% confidence interval (CI). In this meta-analysis, all the analyses were performed by using the STATA version 17 software.

Results

Of the 1,339 papers, nine eligible RCTs were included in the present meta-analysis. Our findings indicated that okra consumption significantly reduced total cholesterol (TC) levels (WMD: -14.40 mg/dL; (95% CI: -20.94 to -7.86); p < 0.001), low-density lipoprotein (LDL) (WMD: -7.90 mg/dL; (95% CI: -13.30 to -2.48); p = 0.004), fasting blood glucose (FBG) (WMD: -39.58 mg/dL; (95% CI: -61.60 to -17.56); p < 0.001), and hemoglobin A1C (HbA1c) (WMD: -0.46 mg/dL; (95% CI: -0.79 to -0.13); p = 0.005). Overall effect size showed that okra intake failed to change triglycerides (TG), high-density lipoprotein (HDL), Insulin, homeostatic model assessment for insulin resistance (HOMA-IR), systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, and body Mass Index (BMI) significantly.

Conclusion

Okra decreased TC, LDL, FBG, and HbA1c levels in the intervention compared to the control group. A dose ≤3,000 mg/day caused a significant decrease in TG, TC, LDL, HbA1c, and a significant increase in HDL. More study is needed to determine the optimum dose and duration of intervention.

The Effects of Okra Consumption on Glycemic Parameters and Lipid Profile in Adults: A Systematic Review and Meta-Analysis

The clinical research findings on the effects of okra consumption on blood glucose and lipids are inconsistent. In this study, we aimed to explore the impact of okra consumption on glycemic parameters and lipid profile in adults, including homeostatic model assessment for insulin resistance (HOMA-IR), glycosylated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C). To find relevant randomized controlled trials (RCTs), we systemically searched EMBASE, Web of Science, PubMed, Cochrane Library, and Scopus until April 2024. According to the inclusion and exclusion criteria, eight studies involving 521 participants were ultimately included in the present study. Compared to placebo, okra consumption remarkably decreased FBG (WMD: -32.56 mg/dL; 95% CI: -48.83, -16.28; p < 0.001; I 2 = 84.7%), HbA1c (WMD: -0.48%; 95% CI: -0.81, -0.16; p = 0.004; I 2 = 5.5%), TG (WMD: -13.16 mg/dL; 95% CI: -23.54, -2.77; p = 0.013; I 2 = 0.0%), and TC (WMD: -9.70 mg/dL; 95% CI: -14.95, -4.46; p < 0.001; I 2 = 38.3%) in adults. However, okra showed no notable impact on HOMA-IR, HDL-C, and LDL-C. Okra consumption has an improving effect on adult FBG, HbA1c, TG, and TC levels. More large-scale RCT studies are necessary to validate the beneficial effects of okra on adults due to the limited number of included RCTs. Trial Registration: PROSPERO: CRD42024540121.

Effect of Abelmoschus esculentus L. (Okra) on Dyslipidemia: Systematic Review and Meta-Analysis of Clinical Studies

The global prevalence of cardiovascular diseases (CVDs), including dyslipidemia and atherosclerosis, is rising. While pharmacological treatments for dyslipidemia and associated CVDs exist, not all individuals can afford them, and those who do often experience adverse side effects. Preclinical studies have indicated the potential benefits of Abelmoschus esculentus and its active phytochemicals in addressing dyslipidemia in rodent models of diabetes. However, there is limited clinical evidence on lipid parameters. Thus, this study aimed to assess the potential impact of Abelmoschus esculentus on dyslipidemia. A literature search was performed on PubMed, Scopus, and Cochrane Library for relevant trials published from inception until 11 August 2024. Data analysis was performed using Jamovi software version 2.4.8 and Review Manager (version 5.4), with effect estimates reported as standardized mean differences (SMDs) and 95% confidence intervals (CI). The evidence from eight studies with nine treatment arms showed that Abelmoschus esculentus reduces total cholesterol (TC), SMD = -0.53 (95% CI: -1.00 to -0.07), p = 0.025), compared to placebo. Additionally, triglyceride (TG) was reduced in Abelmoschus esculentus compared to placebo, SMD = -0.24 (95% CI: -0.46 to -0.02), p = 0.035. Furthermore, low-density lipoprotein (LDL) was also reduced, SMD = -0.35 (95% CI: -0.59 to -0.11), p = 0.004 in Abelmoschus esculentus versus placebo. This remedy substantially increased high-density lipoprotein (HDL), SMD = 0.34 (95% CI: 0.07 to 0.61), p = 0.014). Abelmoschus esculentus substantially improved lipid profile in prediabetes, T2D, obesity, and diabetic nephropathy. While the evidence confirms the potential benefits of Abelmoschus esculentus in reducing dyslipidemia, it is important for future clinical studies to standardize the effective dosage for more reliable results. Therefore, future trials should focus on these markers in well-designed trials with sufficient sample sizes. Furthermore, Abelmoschus esculentus can be supplemented to the diet of the relevant populations to alleviate dyslipidemia.

Effects of dried okra extract on lipid profile, renal function and some RAGE-related inflammatory genes expression in patients with diabetic nephropathy: A randomized controlled trial

BACKGROUND

Diabetic nephropathy (DN) is a common complication of type 2 diabetes. Okra (Abelmoschus esculentus L) is reported to have anti-diabetic effects. The present study aimed to investigate the effects of dried okra extract (DOE) supplementation on lipid profile, renal function indices, and expression of inflammatory genes, as well as serum level of soluble Receptor for Advanced glycation end products (sRAGE) in patients with DN.

METHODS

In this triple-blind randomized placebo-controlled clinical trial, 64 eligible patients with DN received either 125 mg of DOE or placebo daily along with DN-related nutritional recommendations for 10 weeks. Changes in kidney indices including proteinuria and estimated glomerular filtration rate (eGFR), lipid profile, serum SRAGE, as well as the expression of RAGE, ICAM-1, and IL-1 genes were measured over 10 weeks.

RESULTS

After adjustment for the potential confounders, between-group analyses showed no significant differences in terms of lipid profile, kidney function indices, sRAGE, and RAGE-related inflammatory genes expression after 10 weeks.

CONCLUSION

Daily 125 mg DOE along with nutritional recommendations on top of usual care did not lead to significant changes in renal function indices, lipid profile, and inflammatory genes expression in patients with DN.

The effect of Abelmoschus esculentus L. (Okra) extract supplementation on glycaemic control, inflammation, kidney function and expression of PPAR-α, PPAR-γ, TGF-β and Nrf-2 genes in patients with diabetic nephropathy: a triple-blind, randomised, placebo-controlled trial

The present study was carried out to evaluate the effects of okra extract supplementation on kidney function, glycaemic control, inflammation and gene expression in patients with diabetic nephropathy (DN). A total of sixty-four DN patients based on the inclusion and exclusion criteria were recruited in this triple-blind placebo-controlled randomised clinical trial. Participants were randomly allocated to receive a 125-mg capsule of dried okra extract (DOE) (n 32) or placebo (n 32) for 10 weeks. At the baseline and endpoint of the trial, kidney function, glycaemic indices, inflammation and gene expression were evaluated. Statistical analysis showed that fasting blood glucose, HbA1c and insulin resistance significantly reduced in the DOE group although between-group analysis did not show any significant difference. Also, no significant difference was observed in urine protein, urine creatinine and high-sensitivity C-reactive protein between the two groups. Furthermore, gene expression of PPAR-α, PPAR-γ, transforming growth factor-beta and Nrf-2 did not affect the end of the trial in comparison with the baseline. According to the present study, DOE did not have impressive effects on kidney function, inflammation, glycaemic management and gene expression in patients with DN.

Effect of Lactiplantibacillus plantarum fermentation on the physicochemical, antioxidant activity and immunomodulatory ability of polysaccharides from Lvjian okra

Okra polysaccharides exhibits a range of biological activities. To date, its processing using microbial fermentation has not been explored. This study investigated the fermentation of okra juice with various lactic acid bacteria, followed by the extraction and characterization of crude polysaccharides (termed OPS-F), in contrast to their non-fermented counterpart (OPS). Changes in physicochemical properties, antioxidant activity and immunomodulatory ability were noted. The results demonstrated that OPS-F had a 7.42-12.53 % increase in total polysaccharides content compared to OPS. However, high-performance size-exclusion chromatography indicated a reduction in the molecular weight of OPS-F (7.9-9.5 × 105 Da) relative to OPS (1.66 × 106 Da). Compared to OPS, OPS-F had reduced levels of mannose, glucose, glucuronic acid and arabinose, but increased rhamnose, galacturonic acid and galactose, exhibiting enhanced solubility and lower apparent viscosity. Fourier transform infrared spectroscopy and nuclear magnetic resonance analysis showed minimal changes in polysaccharide structure post-fermentation. Moreover, despite a decrease in antioxidant activity post-fermentation, OPS-F exhibited superior immunomodulatory potential. In conclusion, fermenting okra juice with lactic acid bacteria alters the physicochemical properties of crude polysaccharides and enhances their immunomodulatory activity, offering a promising approach for developing new functional food resources.

Clinical efficacy and safety of okra (Abelmoschus esculentus (L.) Moench) in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial

AIMS

The recent trend toward the use of natural functional and medical supplements has motivated the focus on the search and revival of traditional medicinal plant applications for many years. As a valuable dietary crop, okra fruit (Abelmoschus esculentus (L.) Moench) has been used for thousands of years as a medicinal food. This clinical trial aimed to assess the efficacy and safety of the okra pod capsule as an adjuvant treatment in controlling type 2 diabetes mellitus and provide clinical trial-based evidence about its anti-inflammatory effects.

METHODS

A total of 100 type II diabetic patients, aged between 40 and 60 years, were randomly assigned into two groups of okra and placebo. The first group was administered 1000 mg of powdered okra fruit three times a day for 3 months, while the other group received a placebo capsule with the same dosage. Both groups continued the standard antidiabetic therapy (consisting of metformin and gliclazide, as well as a nutritional regimen). At the start and three months later, various factors were measured, including FBG, insulin, HbA1c, cholesterol, triglycerides, HDL, LDL, CRP, liver and renal function tests, blood pressure, and BMI changes.

RESULTS

According to the results, patients who received okra treatment exhibited a significant decrease in FBG, HbA1c, total cholesterol, and triglyceride levels when compared to both the baseline and the placebo group. Patients in the okra group have lower levels of hs-CRP compared with the placebo group after 3 months of treatment. No liver, kidney, and blood pressure or other side effects were observed in the groups associated with okra treatment.

CONCLUSIONS

The present study demonstrated that adjunctive consumption of okra, in type 2 diabetic patients with 1000 mg three times a day for three months, improves lipid profile, glycemic control, and chronic inflammation without any tangible adverse effects.

CLINICAL TRIAL REGISTRY

IRCT.Ir (IRCT20120112008712N2). https://www.irct.ir/trial/42042 .

Okra ameliorates hyperglycaemia in pre-diabetic and type 2 diabetic patients: A systematic review and meta-analysis of the clinical evidence

Background: Despite the use of available pharmaceutical drugs, high rates of metabolic diseases and cardiovascular disorders are alarming. This calls for alternative therapies that can attenuate these complications. Therefore, we investigated the beneficial effects of okra on glycaemic control in pre-diabetes and type 2 diabetes mellitus (T2D).

Methods: MEDLINE and Scopus were searched for relevant studies. Collected data were analysed using RevMan and reported as mean difference and 95% confidence intervals (CI). Eight studies, including 331 patients with pre-diabetes or T2D, were eligible.

Results: Our findings showed that okra treatment reduced the levels of fasting blood glucose: mean difference (MD) = −14.63 mg/dL; 95% CI (-25.25, −4.00, p = 0.007); I2 = 33%, p = 0.17 compared to placebo. Glycated haemoglobin, however, did not differ significantly between the groups: MD = 0.01%; 95%CI (-0.51, 0.54, p = 0.96); I2 = 23%, p = 0.28.

Conclusion: this systematic review and meta-analysis found that okra treatment improves glycaemic control in patients with pre-diabetes or T2D. The findings suggest that okra may be used as a supplemental dietary nutrient, especially in pre-diabetic and T2D patients due to its potential to regulate hyperglycaemia.

Structural characterization and anti-lipotoxicity effects of a pectin from okra (Abelmoschus esculentus (L.) Moench)

Okra (Abelmoschus esculentus (L.) Moench) is rich in various bioactive ingredients and used as a medicinal plant in traditional medicine. In the present study, to find the polysaccharide with anti-lipotoxicity effects from okra and clarify its structure, a pectin OP-1 was purified from okra, which had a backbone containing →4)-α-GalpA-(1 → residues, and 1,5-Ara linked the main chain through the O-3 of the residue →3,4)-α-GalpA-(1→, and the C-6 of residue 1, 4-α-GalpA replaced by methyl ester. In vitro experiments showed that OP-1 pretreatment alleviated oleic acid (OA)-induced lipid accumulation, ROS generation, apoptosis, transaminase leakage, and inflammatory cytokine secretion in HepG2 cells, resulting in reduced lipotoxicity. Further molecular results revealed that OP-1 increased Adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK) phosphorylation and affected the expression of AMPK downstream targets, including inhibit SREBP1c and FAS, as well as activate CPT-1A. Impressively, AMPK inhibitor dorsomorphin (Compound C) blocked the effects of OP-1 against lipotoxicity. The effects of OP-1 on lipid metabolism were also diminished by dorsomorphin. Our results demonstrated that OP-1 possesses a potent function in preventing lipotoxicity via regulating AMPK-mediated lipid metabolism and provide a novel insight into the future utilization of okra polysaccharide.

The effect of Abelmoschus esculentus L. (Okra) extract supplementation on dietary intake, appetite, anthropometric measures, and body composition in patients with diabetic nephropathy

Background: Diabetes is a risk factor for chronic kidney disease because it induces nephropathy. Okra is a rich source of antioxidants, vitamins, minerals, and fibers, of which favorable effects in diabetes have been reported in many animal studies. The present trial aimed to investigate the effect of dried okra extract (DOE) supplementation on anthropometric measures, body composition, appetite, and dietary intake in diabetic nephropathy (DN) patients. Methods: In this triple-blind placebo-controlled randomized clinical trial, 64 DN patients were randomly allocated to receive a 125-mg capsule of DOE (n=32) or placebo (n=32) for 10 weeks. At baseline and endpoint of the trial, anthropometric variables, body composition indices, dietary intake, and appetite scores were evaluated. Results: The results showed that energy (P=0.047, CI: -425.87, -3.25, ES: 0.539) and carbohydrate (P=0.038, CI: -85.64, -2.53, ES: 0.555) intake as well as desire to eat salty food (P=0.023) were reduced in DOE group at the endpoint, compared to the baseline values. However, anthropometric measures, body composition, and appetite score were not significantly different between the two study groups. Conclusion: In conclusion, the present clinical trial showed that DOE could significantly decrease energy intake and carbohydrate consumption in the DN patients. Further clinical trials are needed to determine the effects of this supplement.