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Rabe E, Blanc-Guillemaud V, Onselaer MB, Blangero Y, Yaltirik HP, Nicolaides A. Reduction of lower-limb edema in patients with chronic venous disease by micronized purified flavonoid fraction: a systematic literature review and meta-analysis. INT ANGIOL 2023; 42:488-502. [PMID: 38131655 DOI: 10.23736/s0392-9590.23.05084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The prevalence of lower limb edema is high among patients with chronic venous disease (CVD). Several clinical studies with various designs have assessed the effect of micronized purified flavonoid fraction (MPFF) on edema. The aim of this work was to provide a comprehensive and accurate evaluation of the reduction in ankle and calf circumference as an indicator of lower limb edema reduction in patients with CVD treated with MPFF by combining studies that use different designs in a single group meta-analysis. EVIDENCE ACQUISITION We conducted a systematic literature review in April 2022 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria to identify prospective studies investigating the effect of oral MPFF treatment 1000 mg/day on ankle and calf circumference in patients with CVD. Studies with population including at least one patient with an ulcer were excluded. All prospective studies irrespectively of design (i.e., interventional and non-interventional studies, randomized controlled trials (RCTs), non-randomized studies, studies without a control or reference treatment) were eligible. The Medline, Embase and Cochrane databases were searched. Endpoints were ankle and calf circumference measurements and their overall mean change from baseline estimated with random-effects meta-analysis methods. The evaluation criterion feeling of swelling was also analyzed as a standardized mean change (SMC) with 95% confidence intervals after combination of quantitative scales. EVIDENCE SYNTHESIS Among 861 articles identified, eight studies (five RCTs including one placebo-controlled, three non-comparative studies) met the criteria. The overall population consisted of 1635 patients, predominantly female (89% ranging from 64% to 94%) with a mean age of 47 years ranging from 41 to 48 years. Mean reduction in ankle circumference was 6.0 mm (95%CI: 3.6 to 8.4; P<0.001) and 7.0 mm (95%CI: 0.9 to 13.1; P=0.024) after two and at least six months of treatment respectively. The results were similar when considering the study type RCTs and non-RCTs. Mean reduction in calf circumference was 5.7 mm (95%CI: 2.8 to 8.6; P<0.001) and 6.7 mm (95%CI: 5.2 to 8.1; P<0.001), at two months and at the last post-baseline evaluation respectively. Heterogeneity among studies was statistically significant (degree of consistency I2=93.5%; P<0.001 and I2=81.1%, P<0.01 for ankle and calf circumference, respectively). In the three studies reporting the effect on feeling of swelling a significant standardized mean change (SMC) reduction of 2.2 (95%CI: 0.2 to 4.2; P=0.028) on a quantitative scale was observed after two months of treatment with MPFF. CONCLUSIONS MPFF appeared to be effective in reducing ankle and calf circumference as well as feeling of swelling irrespective of study design. The circumference reduction is present at short and long term, suggesting that benefit occurs early and is maintained overtime. Despite the observed heterogeneity among included studies, this meta-analysis supports the significant therapeutic efficacy of MPFF in reducing lower-limb edema in patients with CVD. The complete video presentation of the work is available online at www.minervamedica.it (Supplementary Digital Material 1: Supplementary Video 1, 5 min, 192 MB).
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Affiliation(s)
- Eberharde Rabe
- Department of Dermatology, University of Bonn, Bonn, Germany
| | | | | | | | | | - Andrew Nicolaides
- Vascular Screening and Diagnostic Center, University of Nicosia Medical School, Nicosia, Cyprus -
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Artero NA, Manchope MF, Carvalho TT, Saraiva-Santos T, Bertozzi MM, Carneiro JA, Franciosi A, Dionisio AM, Zaninelli TH, Fattori V, Ferraz CR, Piva M, Mizokami SS, Camilios-Neto D, Casagrande R, Verri WA. Hesperidin Methyl Chalcone Reduces the Arthritis Caused by TiO 2 in Mice: Targeting Inflammation, Oxidative Stress, Cytokine Production, and Nociceptor Sensory Neuron Activation. Molecules 2023; 28:molecules28020872. [PMID: 36677929 PMCID: PMC9864652 DOI: 10.3390/molecules28020872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Arthroplasty is an orthopedic surgical procedure that replaces a dysfunctional joint by an orthopedic prosthesis, thereby restoring joint function. Upon the use of the joint prosthesis, a wearing process begins, which releases components such as titanium dioxide (TiO2) that trigger an immune response in the periprosthetic tissue, leading to arthritis, arthroplasty failure, and the need for revision. Flavonoids belong to a class of natural polyphenolic compounds that possess antioxidant and anti-inflammatory activities. Hesperidin methyl chalcone's (HMC) analgesic, anti-inflammatory, and antioxidant effects have been investigated in some models, but its activity against the arthritis caused by prosthesis-wearing molecules, such as TiO2, has not been investigated. Mice were treated with HMC (100 mg/kg, intraperitoneally (i.p.)) 24 h after intra-articular injection of 3 mg/joint of TiO2, which was used to induce chronic arthritis. HMC inhibited mechanical hyperalgesia, thermal hyperalgesia, joint edema, leukocyte recruitment, and oxidative stress in the knee joint (alterations in gp91phox, GSH, superoxide anion, and lipid peroxidation) and in recruited leukocytes (total reactive oxygen species and GSH); reduced patellar proteoglycan degradation; and decreased pro-inflammatory cytokine production. HMC also reduced the activation of nociceptor-sensory TRPV1+ and TRPA1+ neurons. These effects occurred without renal, hepatic, or gastric damage. Thus, HMC reduces arthritis triggered by TiO2, a component released upon wearing of prosthesis.
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Affiliation(s)
- Nayara A. Artero
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Marília F. Manchope
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Thacyana T. Carvalho
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Telma Saraiva-Santos
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Mariana M. Bertozzi
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Jessica A. Carneiro
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Anelise Franciosi
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Amanda M. Dionisio
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Tiago H. Zaninelli
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Victor Fattori
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Camila R. Ferraz
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Maiara Piva
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Sandra S. Mizokami
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Doumit Camilios-Neto
- Department of Biochemistry and Biotechnology, Centre of Exact Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, Centre of Health Science, Londrina State University, Londrina 86039-440, PR, Brazil
| | - Waldiceu A. Verri
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
- Correspondence: ; Tel.: +55-43-3371-4979
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Jeziorek M, Szuba A, Kujawa K, Regulska-Ilow B. The Effect of a Low-Carbohydrate, High-Fat Diet versus Moderate-Carbohydrate and Fat Diet on Body Composition in Patients with Lipedema. Diabetes Metab Syndr Obes 2022; 15:2545-2561. [PMID: 36035515 PMCID: PMC9415463 DOI: 10.2147/dmso.s377720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/22/2022] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Lipedema is a disorder characterized by an excessive accumulation of subcutaneous body fat, mainly bilateral and symmetrical accumulation of fat deposits, particularly in the lower extremities excluding feet. Pain (spontaneous or with palpation) and increased capillary fragility with bruising are also part of clinical presentation. It is estimated to occur in approximately 11.0% of women worldwide. Management of obesity among patients with lipedema is a key component in its treatment. PURPOSE The aim of this study was to compare effectiveness of two diets: low-carbohydrate-high-fat diet (LCHF) and medium-fat-medium-carbohydrate diet (MFMC) in body weight, body fat and limb circumference reduction in patients with lipedema. MATERIAL AND METHODS The studied women (n = 91) were divided into 2 groups and submitted to 1 of the 2 diets for 16 weeks. Anthropometric measurements such as body height [cm], body weight [kg], body fat percentage [%], body fat [kg], lean body mass [kg], and visceral fat level were collected at the beginning and end of the study. RESULTS We have not found any significant differences in anthropometric measurements at the baseline between groups. Body weight and all anthropometric parameters decreased significantly in both groups after 16 weeks of diets, excluding the circumference above the right ankle for the MFMC diet which did not change. The LCHF diet contributed to reduction of body weight (-8.2 ± 4.1 kg vs -2.1 ± 1.0 kg; p < 0.0001), body fat (-6.4 ± 3.2 kg vs 1.6 ± 0.8 kg; p < 0.0001), waist (-7.8 ± 3.9 cm vs -2.3 ± 1.1 cm; p < 0.0001), hips (-7.4 ± 3.7 cm vs -2.5 ± 1.3 cm; p < 0.0001), thighs and calves' circumferences compared with the MFMC diet. We observed reduction of pain in the extremities and mobility improvement in LCHF group (data not shown). CONCLUSION The LCHF diet was more effective than MFMC in body weight, body fat and lower limb circumferences reduction.
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Affiliation(s)
- Małgorzata Jeziorek
- Department of Dietetics, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
- Correspondence: Małgorzata Jeziorek, Wroclaw Medical University, Borowska 211, Wroclaw, 50-556, Poland, Tel +48 71 784 01 11, Email
| | - Andrzej Szuba
- Department of Angiology, Hypertension & Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Kujawa
- Statistical Analysis Center, Wroclaw Medical University, Wroclaw, Poland
| | - Bożena Regulska-Ilow
- Department of Dietetics, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
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