Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis

In vitro testing of honey quality and biological functionality: underestimated elements in the clinical testing of honey

Honey is an attractive functional food that often becomes a subject of clinical studies on the treatment of diverse diseases. However, the clinical efficacy of honey is rather controversial due, at least in part, to its variable composition and botanical origin as well as thermal processing or improper storage conditions. This review addresses the importance of honey quality standards and in vitro testing of the biological properties of honey prior to performing clinical studies, which can have a great impact on clinical outcomes. It focused on recently performed meta-analyses and systematic reviews where honey was used in the management of various disorders including respiratory tract infections, and metabolic and cardiometabolic diseases, with the goal of characterising the honeys used in clinical studies. In addition, it provides recommendations for the use and storage of honey for clinical testing. The vast majority of clinical studies included in meta-analyses do not provide any information about honey quality parameters. In fact, indicators of thermal damage or prolonged storage of honey were analysed only in one clinical study. This observation highlights on the alarming status of honey quality in clinical studies. Furthermore, in vitro biological properties of the analysed honeys were assessed in two clinical studies. Therefore, this review strongly advocates the clinical use of only fully characterised honey samples of known botanical origin with proven in vitro biological functionality and no or minimal thermal processing.

Are all sugars equal? Role of the food source in physiological responses to sugars with an emphasis on fruit and fruit juice

High (free) sugar intakes can increase self-reported energy intake and are associated with unfavourable cardiometabolic health. However, sugar source may modulate the effects of sugars due to several mechanisms including the food matrix. The aim of this review was to assess the current state of evidence in relation to food source effects on the physiological responses to dietary sugars in humans relevant to cardiometabolic health. An additional aim was to review potential mechanisms by which food sources may influence such responses. Evidence from meta-analyses of controlled intervention trials was used to establish the balance of evidence relating to the addition of sugars to the diet from sugar-sweetened beverages, fruit juice, honey and whole fruit on cardiometabolic outcomes. Subsequently, studies which have directly compared whole fruit with fruit juices, or variants of fruit juices, were discussed. In summary, the sources of sugars can impact physiological responses, with differences in glycaemic control, blood pressure, inflammation, and acute appetite. Longer-term effects and mechanisms require further work, but initial evidence implicates physical structure, energy density, fibre, potassium and polyphenol content, as explanations for some of the observed responses.