Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: a double-blind placebo-controlled randomized clinical trial

The effect of Sumac on cardiometabolic parameters in adults: a systematic review and meta-analysis of randomized controlled trials

Background

The current evidence on the effect of Sumac consumption on cardiovascular parameters has produced controversial findings.

Methods

We systematically searched several databases, including PubMed-Medline, SCOPUS, and ISI Web of Science, to find eligible studies until January 2023. Meta-analysis to calculated the weighted mean difference (WMD) and 95 %CI, Sub-group meta-analysis and meta-regression analysis were conducted throughout the study.

Results

16 randomized controlled trials comprising a total number of 1,225 participants were included. The results of meta-analysis revealed that Sumac significantly affected low-density lipoprotein (WMD: -8.66 mg/dL; 95% CI: -14.2, -3.12), high-density lipoprotein (WMD: 3.15 mg/dL; 1.99,4.31), triglycerides (WMD: -11.96 mg/dL; -19.44, -4.48), fasting blood glucose (WMD: -4.15 mg/dL; -7.31, -0.98), insulin (WMD: -1.72; -3.18, -0.25), homeostasis model assessment of insulin resistance (HOMA-IR; WMD: -0.61; -1.22, -0.01), and anthropometric indices (p < 0.05). Moreover, the results significantly reduced total cholesterol when the intervention duration was ≥12 weeks (WMD: -8.58 mg/dL; -16.8, -0.37).

Conclusion

These findings suggest that Sumac is potentially an effective complementary intervention to improve cardiometabolic parameters. Thus, patients could utilize Sumac as part of their diet to improve their overall cardiometabolic status.

Effects of sumac supplementation on lipid profile: A systematic review and meta-analysis of randomized controlled trials

This systematic review aimed to gather data on the effects of sumac supplementation on lipid profile. A systematic literature search was carried out using electronic databases (PubMed, Scopus, and Web of Science) up to March 2023 to identify eligible randomized controlled trials (RCTs) assessing the effects of sumac intake on lipid profile as an outcome. All participants enrolled in our study were adult individuals who consumed sumac, in various forms, as an intervention. The included articles were assessed using the Cochrane risk of bias assessment tool. Heterogeneity tests of the selected trials were performed using the I2 statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as the weighted mean difference with a 95% confidence interval. In total, seven RCTs with a total sample size of 570 subjects were included. This study found a significant decrease in total cholesterol (TC) (weighted mean difference [WMD]: -10.01 mg/dL; 95% CI: -18.67, -1.34), triglyceride (TG) (WMD: -8.52 mg/dL; 95% CI: -14.79, -2.25), and low-density lipoprotein (LDL)-C levels (WMD: -9.25 mg/dL; 95% CI: -14.56, -3.93); Moreover, a significant increase was observed in high-density lipoprotein (HDL)-C concentration (WMD: 2.97 mg/dL; 95% CI: 0.75, 5.19). The reduction in TG and TC was greater in studies with a duration of ≥12 compared to <12 weeks. The increase in HDL-C was greater in participants with an intervention duration of ≥12 compared to <12 weeks. Moreover, subgroup analysis based on the dose of sumac suggested a significant reduction in TC and LDL, specifically for doses below 3 g. Consumption of sumac significantly decreased serum TC, LDL-C, and TG concentrations. This study suggested significantly positive effects on HDL-C by intake of sumac. Longer interventions (>12 weeks) have a more favorable impact on TC, LDL-C, and HDL-C, while sumac doses below 3 g/day show greater effects on TC and LDL-C. These findings underscore the potential of sumac supplementation as a valuable approach to lipid profile management.

Could Natural Products Help in the Control of Obesity? Current Insights and Future Perspectives

Obesity is a global issue faced by many individuals worldwide. However, no drug has a pronounced effect with few side effects. Green tea, a well-known natural product, shows preventive effects against obesity by decreasing lipogenesis and increasing fat oxidation and antioxidant capacity. In contrast, other natural products are known to contribute to obesity. Relevant articles published on the therapeutic effect of natural products on obesity were retrieved from PubMed, Web of Science, and Scopus. The search was conducted by entering keywords such as "obesity", "natural product", and "clinical trial". The natural products were classified as single compounds, foods, teas, fruits, herbal medicines-single extract, herbal medicines-decoction, and herbal medicines-external preparation. Then, the mechanisms of these medicines were organized into lipid metabolism, anti-inflammation, antioxidation, appetite loss, and thermogenesis. This review aimed to assess the efficacy and mechanisms of effective natural products in managing obesity. Several clinical studies reported that natural products showed antiobesity effects, including Coffea arabica (coffee), Camellia sinensis (green tea), Caulerpa racemosa (green algae), Allium sativum (garlic), combined Ephedra intermedia Schrenk, Thea sinensis L., and Atractylodes lancea DC extract (known as Gambisan), Ephedra sinica Stapf, Angelica Gigantis Radix, Atractylodis Rhizoma Alba, Coicis semen, Cinnamomi cortex, Paeoniae radix alba, and Glycyrrhiza uralensis (known as Euiiyin-tang formula). Further studies are expected to refine the pharmacological effects of natural products for clinical use.

Abnormal Lipid Profiles in Nontraumatic Osteonecrosis of the Femoral Head: A Comparison with Osteoarthritis Using Propensity Score Matching

BACKGROUND

Abnormal lipid metabolism may play an important role in the development of nontraumatic osteonecrosis of the femoral head (ON). By comparing lipid biomarkers in patients with ON and osteoarthritis (OA) after propensity score matching, we sought to reveal (1) common lipid biomarkers that are abnormal in ON regardless of the etiology and (2) specific lipid biomarkers associated with ON according to the etiology.

METHODS

Among 2,268 patients who underwent primary THA, 1,021 patients were eligible for this study. According to the Association Research Circulation Osseous criteria, ON was classified as either idiopathic (n = 230), alcohol-associated (n = 293), or glucocorticoid-associated ON (n = 132). Most common cause of OA was hip dysplasia in 106 patients (47%). We investigated patient lipid profiles by assessing total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TGs), apolipoprotein (Apo) A1 and B, lipoprotein (a) levels and ApoB/A1 ratio. Since age and body mass index affect the lipid profile, we performed propensity score matching to select 304 patients for final analysis and compared lipid profiles between the ON and OA groups. We also compared biomarkers between the ON subgroups and the OA group.

RESULTS

Overall, the ON group showed lower HDL-C (p < 0.001), higher TGs (p = 0.001) levels and higher ApoB/A1 ratio (p = 0.003). Idiopathic ON patients demonstrated lower HDL-C (p = 0.032), higher TGs (p = 0.016), ApoB (p = 0.024) levels and ApoB/A1 ratio (p = 0.008). The alcohol-associated ON subgroup showed lower HDL-C (p < 0.001), higher TGs (p = 0.010) levels and ApoB/A1 ratio (p = 0.030). Finally, the steroid-associated ON subgroup demonstrated lower HDL-C (p = 0.003), higher TGs (p = 0.039), lower TC (p = 0.022), LDL-C (p = 0.021), and ApoA1 (p = 0.004) levels.

CONCLUSIONS

Higher TGs and lower HDL-C levels were associated with nontraumatic ON regardless of the etiology. Additionally, idiopathic ON was associated with higher ApoB levels and ApoB/A1 ratio. Alcohol-associated ON was related to higher ApoB/A1 ratio, and steroid-associated ON paired with decreased TC, LDL-C, and ApoA1 levels. Our findings may support future efforts for prevention and management of nontraumatic ON.

LEVEL OF EVIDENCE

Diagnostic Level III.

Defensive potential and deleterious impact of turmeric (Curcuma longa) L rhizome powder supplemented diet on antioxidant status of indomethacin-induced ulcerated wistar rats

Effects of various concentration of turmeric (Curcuma longa [C longa]) rhizome powder (TRP) supplemented diet on the antioxidant status of selected organs (stomach, liver, kidney, and heart) of indomethacin (Indo)-induced ulcerated wistar rats were investigated in this study. The rats were fed with different percentages of TRP supplemented diet (1% [A], 2% [B], 5% [C], and 10% [D]) for 28 days. It was observed from the results that animals fed on 10% turmeric rhizome supplemented and those in the ulcerogenic group had significant reduction in kidney, cardiac gluthione (GSH), superoxide dismutase (SOD), catalase (CAT), and gastric GSH when compared with normal control animals and other pre-treated groups. However, a significant increase was observed in gastric, hepatic, cardiac, and glutathione peroxidase (GPX); kidney and hepatic SOD; cardiac, kidney, hepatic, and gastric CAT of animals pre- treated with TRP supplemented diet (1%-5%) compared with ulcerogenic group. Also, a significant reduction was observed in GPX of animals fed with 10% TRP supplemented diet in comparison with ulcerogenic group. Consumption of TRP in the diet, therefore, should be lesser than 10% of the whole recipe for it to be potent in enhancing antioxidant defensive mechanism of the aforementioned organs and thereby prevent oxidative stress related diseases. It may reduce antioxidant present in those organs which can lead to increase availability of free radical and expose the organs to oxidative stress-related diseases. PRACTICAL APPLICATIONS: Inclusion of turmeric rhizome powder in daily diet has been globally well accepted due to the knowledge of its medicinal values. Nonetheless, the extent at which it should be consumed has been controversial and unclear. Little or no effort has been put in place to educate the populace on the quantity of concentration of C. longa powder which should be in whole recipe or ingredients. Therefore, if turmeric rhizome powder should be included in diet because of its nutritional and medicinal values, this should be with caution and from the results of this study, the concentration should not be up to 100g/kg w/w of the entire recipe.

Rhus coriaria L., a new candidate for controlling metabolic syndrome: a systematic review

OBJECTIVES

Rhus coriaria L. (RC) is a deciduous shrub with several pharmacological activities. Evidence of the effects of RC on weight, hyperlipidaemia, hypertension and diabetes mellitus have been presented in this study. Books, thesis and internet-based resources such as PubMed, Web of Science, Scopus, EMBASE, Cochrane, Ovid and Google Scholar were searched for the English, Arabic and Persian literature from 1966 to 2020 (December). The keywords were Rhus coriaria L., Sumac, metabolic syndrome and all its medical conditions (hyperlipidaemia, hypertension, obesity and diabetes mellitus). The inclusion criteria were full-text animal and human studies conducted on RC to evaluate its efficacy on any components of metabolic syndrome (MetS). Jadad scale was used to assess the quality of evidence.

KEY FINDINGS

Reviewing 23 relevant studies demonstrated that RC is able to decrease the level of blood glucose, glycated haemoglobin, serum insulin and insulin resistance. Studies on hyperlipidaemia and obesity have very contradicting results, and there is no definite conclusion on the effect of RC on lipid profile. However, the hypotensive and effect of RC was confirmed in the existing studies.

SUMMARY

According to the literature, RC can be considered as a promising curative candidate for MetS. However, further studies with larger sample size and higher methodological quality are needed.

The effects of sumac (Rhus coriaria L.) powder supplementation in patients with non-alcoholic fatty liver disease: A randomized controlled trial

BACKGROUND

In recent years, great attention has been paid to the role of herbal medicine in the management of non-alcoholic fatty liver disease (NAFLD). Sumac (Rhus coriaria L.) is a popular herb which contains major bioactive compounds known for a variety of health benefits. This study aimed to assess the effects of sumac powder supplementation on hepatic fibrosis and some metabolic markers in patients with NAFLD.

METHODS

Eighty-four patients diagnosed with NAFLD were included in this randomized double-blind placebo-controlled clinical trial. They were randomly assigned to receive 2000 mg per day sumac powder (n = 42) or placebo (n = 42) for 12 weeks. Also, both groups received a 500-calories deficit diet plan. Hepatic fibrosis and liver enzymes (ALT and AST) as well as fasting blood sugar (FBS), serum insulin, HbA1c, HOMA-IR (insulin resistance index), QUICKI (insulin sensitivity index), malondialdehyde (MDA), and high sensitivity C-reactive protein (hs-CRP) were measured at baseline and the end of trial.

RESULTS

Eighty patients completed the trial. After 12-weeks of intervention, subjects in the sumac group showed a greater decrease in hepatic fibrosis and liver enzymes as well as FBS, serum insulin, HbA1c, HOMA-IR, MDA, and hs-CRP, compared to the placebo (P-value < 0.05); while the QUICKI was significantly higher in the sumac group at the end of intervention.

CONCLUSION

Daily intake of 2000 mg sumac powder along with a low-calorie diet for 12 weeks was beneficial for the management of NAFLD.

Analysis of the Efficacy of Cinnamon for Patients with Diabetes Mellitus Type II Based on Traditional Persian Medicine Syndrome Differentiation: A Randomized Controlled Trial

Background: Conflicting results have been obtained from the studies on the hypoglycemic effect of cinnamon in patients with diabetes mellitus type II (T2DM). Objectives: This research aimed at assessing the effect of applying the syndrome differentiation model based on traditional Persian medicine (TPM) to identify the patients who benefit more from cinnamon supplementation. Methods: This study was a randomized, triple-blind, placebo-controlled trial based on a parallel design. One hundred and forty eligible patients referring to the Diabetes Clinic of Yazd University of Medical Sciences, who were diagnosed with T2DM, were randomly divided into the cinnamon and placebo groups. Then, 500-mg capsules of cinnamon bark powder or placebo were administered to them twice a day for three months. All the participants completed a standard questionnaire for syndrome diagnosis in traditional Persian medicine (TPM). Fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), fasting insulin (FI), and insulin resistance (IR), calorie intake, and physical activity were measured before and after the interventions. The glycemic outcomes were analyzed according to the TPM syndrome. Results: There was no statistically significant difference between the patients’ demographic and clinical features in the two groups. Glycemic indices were improved in patients receiving cinnamon supplementation compared to placebo group (-13.1 ± 1.7, -1.7 ± 1.9, P < 0.001 for change in FPG and -0.27 ± 0.039 vs. 0.001 ± 0.019, P < 0.001 for change in HbA1C respectively). All the outcomes were more improved in the patients with wet syndrome compared to dry ones, which was compatible with Persian syndrome differentiation (P < 0.05). Conclusions: Diabetic patients with wet syndrome based on TPM benefit more form cinnamon supplementation.

Biochemistry, Safety, Pharmacological Activities, and Clinical Applications of Turmeric: A Mechanistic Review

Turmeric (Curcuma longa L.) is a popular natural drug, traditionally used for the treatment of a wide range of diseases. Its root, as its most popular part used for medicinal purposes, contains different types of phytochemicals and minerals. This review summarizes what is currently known on biochemistry, safety, pharmacological activities (mechanistically), and clinical applications of turmeric. In short, curcumin is considered as the fundamental constituent in ground turmeric rhizome. Turmeric possesses several biological activities including anti-inflammatory, antioxidant, anticancer, antimutagenic, antimicrobial, antiobesity, hypolipidemic, cardioprotective, and neuroprotective effects. These reported pharmacologic activities make turmeric an important option for further clinical research. Also, there is a discussion on its safety and toxicity.

Association between MEG3/miR-181b polymorphisms and risk of ischemic stroke

BACKGROUND

Recent evidence suggests that long non-coding RNAs (lncRNAs) are key regulators in the pathological process of ischemic stroke (IS). Maternally expressed gene 3 (MEG3) was observed to be up-regulated in IS, acting as a competing endogenous RNA for miR-181b to regulate ischemic brain injury. The purpose of this study was to evaluate the association of tagSNPs in MEG3 (i.e., rs7158663 and rs4081134) and miR-181b rs322931 with IS risk.

METHODS

Genomic DNA was extracted from blood samples of 509 patients with IS and 668 healthy controls. Genotyping of MEG3 rs7158663, rs4081134, and miR-181b rs322931 was performed by TaqMan assay. The transcriptional activity was measured using the Dual-Luciferase Reporter Assay kit.

RESULTS

Single-site analysis revealed a significantly higher risk of IS being associated with miR-181b rs322931 CT and CT/TT genotypes (CT vs. CC: adjusted OR = 1.48, 95% CI: 1.13-1.95, P = 0.005; CT/TT vs. CC: adjusted OR = 1.52, 95% CI: 1.17-1.97, P = 0.002). Combined analyses revealed that combined genotypes (rs7158663 GG + rs322931 CT/TT and rs7158663 AG/AA + rs322931 CT/TT) increased IS risk compared to genotypes of rs7158663 GG + rs322931 CC. Stratification analyses showed that patients carrying miR-181b rs322931 CT/TT genotypes had higher levels of low-density lipoprotein cholesterol (LDL_C) (P = 0.01). Moreover, results from logistic regression analysis showed that rs322931 CT/TT genotypes were risk factors besides hypertension, total cholesterol, triglyceride, and LDL_C. Further dual-luciferase reporter assay showed that the rs322931 T allele had lower levels of luciferase activity than the rs322931 C allele.

CONCLUSION

These findings indicate that miR-181b rs322931 may singly or jointly contribute to the risk of IS.

The relationship between apolipoprotein genes polymorphisms and susceptibility to osteonecrosis of the femoral head: a meta-analysis

Background

The objective of this study was to evaluate whether apolipoprotein gene polymorphisms confer susceptibility to osteonecrosis of the femoral head (ONFH).

Methods

The relevant literature was screened from databases of Pubmed, Embase, Wanfang, Weipu and China National Knowledge Internet (CNKI) until May, 2017. In addition, odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as a measure of effect size for calculating effect size.

Results

Totally, six case-control studies were included in this meta-analysis. It revealed that ApoB-C7623T polymorphism frequency was increased in ONFH group than in control group under three genetic models, including allele model (T vs. C, OR = 4.5149, 95% CI: 1.6968–12.0134); additive model (TC vs. CC, OR = 6.2515, 95% CI: 2.0939–18.6640); and dominant model (TT + TC vs. CC, OR = 5.4998, 95% CI: 1.9246–15.7163). In addition, the increased risk of ONFH were related to ApoA1-rs1799837 polymorphism under additive model (AA vs. GG, OR = 1.4175, 95% CI: 1.0522–1.9096) and recessive model (AA vs. GG + AG, OR = 1.7727, 95% CI: 1.3399–2.3452). However, four ApoB rs1042031, rs693, 3’-VNTR and G12619A polymorphisms under the all genetic models were not associated with susceptibility to ONFH.

Conclusion

The T allele and TC genotype of ApoB-C7623T and AA genotype of ApoA1-rs1799837 may contribute to increase the risk of ONFH.

Effect of sumac (Rhus Coriaria) on blood lipids: A systematic review and meta-analysis

Cardiovascular diseases (CVD) are the prominent cause of mortality worldwide. Hypercholesterolemia is a chief risk factor for the progress of atherosclerotic vascular disease. Complementary and alternative medicine (CAM) such as herbal interventions has received much attention in literature. Rhus Coriaria (RC) with the general name Sumac is a medicinal spice, especially in Middle Eastern countries which is well known as an anti-lipid spice. This study aimed to summarize the existing findings regarding the effect of RC on the lipid profile. In this review randomized controlled trials (RCTs) assessing the effect of RC on blood lipids were included. Electronic searches using the MeSH terms were conducted in the following databases: Medline, Embase, Scopus, Web of Science and The Cochrane Library. The effect of RC on serum lipid concentration were measured as standardized mean difference (SMD) and 95% confidence intervals (CI) by the random-effects model. The initial search extracted 119 potentially relevant articles. After studying these publications, 4 were potentially eligible and retrieved in full text (four RCTs). Based on the results of the systematic review, RC has positive effects on different indices of the lipid profile including increasing Apo A-I and HDL; decreasing Apo B, Apo B/ Apo A1 ratio, total cholesterol, LDL and triglyceride. However the meta-analysis conducted on three studies on total cholesterol, HDL, LDL and triglyceride individually did not show any significant difference between intervention and control groups. No definite conclusion could be made on the effect of RC on serum blood lipids due to lack of sufficient clinical trials and variable inconsistency. Future trials with desirable designs that would eliminate the limitations in the current evidence are needed before conclusive claims can be made about the effect of RC on the lipid profile.