Nutritional advice

Objectives:
Since WHO recommended introduction of at least a single dose of inactivated poliovirus vaccine (IPV) in routine immunisation schedules, there have been global IPV shortages. Fractional-dose IPV (fIPV) administration is one of the strategies to ensure IPV availability. Therefore, this review article has been conducted.

Is there a difference in seroconversion and antibodies response between fractional-dose IPV (fIPV) and full-dose IPV?

Study design:
This review article included 14 articles: 2 ongoing trials and 12 articles reporting on 10 completed studies.

The seroconversion meta-analysis for the three-dose comparison was homogeneous [p = 0.45, I2 = 0%], whereas heterogeneity was observed in the two-dose [p 0.00001, I2 = 88%] and one-dose [p = 0.0004, I2 = 74%] comparisons.
Heterogeneity was observed in meta-analyses of GMTs for one-dose [p 0.00001, I2 = 92%, two-dose [p = 0.002, I2 = 80%] and three-dose [p 0.00001, I2 = 93%] comparisons. Findings for types 1 and 3 were similar to those for type 2.
The certainty of the evidence was high for the three-dose comparisons and moderate for the rest of the comparisons.

Results and conclusions:
The investigators found for poliovirus type 2, there were no significant differences in the proportions of seroconversions between fractional and full doses of IPV for 2 or 3 doses: the risk ratio for serconversion at 1 dose was 0.61 [95% CI = 0.51 to 0.72], at 2 doses was 0.90 [95% CI = 0.82 to 1.00] and at 3 doses was 0.95 [95% CI = 0.91 to 1.00].

The investigators found geometric mean titres (GMTs) for poliovirus type 2 were lower for fIPV than for full-dose IPV [-0.51, 95% CI = -0.87 to -0.14] at 1 dose [-0.49, 95% CI = -0.70 to -0.28] at 2 doses and [-0.98, 95% CI = -1.46 to -0.51] at 3 doses.

The investigators concluded that there is no substantial difference in seroconversion between 3 doses of fractional-dose IPV (fIPV) and 3 doses of full-dose poliovirus vaccine (IPV), although the full dose gives higher titres of antibodies for poliovirus type 1, 2 and 3. Use of fractional IPV instead of the full dose can stretch supplies and possibly lower the cost of vaccination.

Original title:
Fractional dose compared with standard dose inactivated poliovirus vaccine in children: a systematic review and meta-analysis by Mashunye TR, Ndwandwe DE, [...], Wiysonge CS.

Link:
https://pubmed.ncbi.nlm.nih.gov/33939958/

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Objectives:
It has been theorized that folic acid supplementation improves inflammation. However, its proven effects on inflammatory markers are unclear as clinical studies on this topic have produced inconsistent results. Therefore, this review article has been conducted.

Have folic acid supplements positive effects on inflammatory markers, like CRP, IL-6 and TNF-α?

Study design:
This review article included 12 RCTs with a total of 1,392 participants.
The studies were conducted between 2003 and 2018 and their sample size varied from 19 to 530 participants.
The mean age of the participants ranged from 24.1 to 68.1 years old.
The supplementation period ranged from 2 to 52 weeks.
The daily mentioned dosage of folic acid varied between 0.8 mg and 10 mg/d.

There was no publication bias.

Results and conclusions:
The investigators found a significant effect of folic acid supplementation on serum concentrations of CRP [WMD = -0.59 mg/L, 95% CI = -0.85 to -0.32, p 0.001, I2 = 91.3%, p 0.001].
This significantly reduced effect was also found in the subgroup and sensitivity analysis.
Subgroup analysis showed that baseline serum concentrations of CRP, duration of intervention, dosage and the participants’ age and gender explained this heterogeneity.

The investigators concluded that 0.8-10 mg/d folic acid supplements decrease serum concentrations of CRP.

Original title:
Effects of Folic Acid Supplementation on Inflammatory Markers: A Grade-Assessed Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials by Asbaghi O, Ashtary-Larky D, […], Naeini AA.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308638/

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Objectives:
The association between serum 25-hydroxyvitamin D 25(OH)D level (vitamin D level in blood) and asthma occurrence in children was controversial. Therefore, this review article has been conducted.

Does a low vitamin D level increase risk of asthma occurrence in children?

Study design:
This review article included 35 studies with 5,711 children with asthma and 21,561 children without asthma. Among them, 24 studies were included for analyzing the association between 25(OH)D level and asthma and 12 studies evaluated the treatment effect of vitamin D.

Results and conclusions:
The investigators found that the children with asthma had significant lower 25(OH)D level than children without asthma [21.7 ng/mL versus 26.5 ng/mL, SMD = -1.36, 95% CI = -2.40 to -0.32, p = 0.010].

The investigators found, besides, children with asthma treated with vitamin D supplement had a significantly lower recurrence rate of 65% than the placebo group [18.4% versus 35.9%, RR = 0.35, 95% CI = 0.35 to 0.79, p = 0.002].

The investigators concluded that children with asthma have a lower 25(OH)D level than healthy children. Vitamin D supplement could decrease the asthma recurrence rate in the follow-up years.

Original title:
Vitamin D and asthma occurrence in children: A systematic review and meta-analysis by Wang Q, Ying Q, [...], Chen J.

Link:
https://pubmed.ncbi.nlm.nih.gov/34366195/

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Objectives:
Vitamin D deficiency is frequently associated with several medical conditions. However, a comprehensive meta-analysis assessing the association between vitamin D level and acne is lacking. Therefore, this review article (meta-analysis) has been conducted.

Does a low vitamin D level (expressed as circulating 25(OH)D levels) increase risk of both acne and acne severity?

Study design:
This review article included 13 articles with a total of 1,362 acne patients and 1,081 healthy controls (persons without acne).

Results and conclusions:
The investigators found that the circulating 25(OH)D levels were significantly lower in patients with acne than in healthy controls [pooled MD = -9.02 ng/mL, 95% CI = -13.22 to -4.81, p 0.0001].

The investigators found that vitamin D deficiency was more prevalent in acne patients than in healthy controls [pooled OR = 2.97, 95% CI = 1.68 to 5.23, I2 = 72%].

The investigators found that vitamin D levels were negatively correlated with acne severity.

The investigators concluded that the vitamin D levels are low in acne patients. Also, there is evidence of an inverse association between vitamin D levels and acne severity. Therefore, vitamin D might be involved in the pathogenesis (the manner of development of a disease) of acne.

Original title:
Association between Vitamin D Level and Acne, and Correlation with Disease Severity: A Meta-Analysis by Hasamoh Y, Thadanipon K, […], Juntongjin P.

Link:
https://pubmed.ncbi.nlm.nih.gov/34348293/

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Objectives:
Selenium (Se) is a trace element having significant effects on human metabolism. Recent studies suggest that selenium supplementation have a pivotal effect on the inflammatory markers. Therefore, this review article has been conducted.

Does selenium supplementation reduce plasma inflammatory markers including C-reactive protein (CRP) and high-sensitivity C-reactive protein (hs-CRP) and nitric oxide (NO) as a stress oxidative index, among patients with metabolic diseases?

Study design:
This review article included 7 RCTs.

Results and conclusions:
The investigators found subgroup analysis of CRP type showed that selenium supplementation significantly decreased hs-CRP level [pooled SMD = -0.44, 95% CI = -0.67 to -0.21] among patients with metabolic diseases.

The investigators concluded that selenium supplementation decreases hs-CRP level among patients with metabolic diseases.

Original title:
The effects of dietary selenium supplementation on inflammatory markers among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials by Djalalinia S, Hasani M, […], Qorbani M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34222098/

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Objectives:
Whether N-acetylcysteine (NAC) therapy can promote the improvement of clinical symptoms and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has not been verified by large-scale randomized controlled trials, only a few small sample studies. Therefore, this review article has been conducted.

Does n-acetylcysteine (NAC) supplementation improve clinical symptoms and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?

Study design:
This review article included 12 retrospective analyses and 3 randomized controlled trials (RCTs) with 1,605 patients.
The 15 included studies were small sample studies, with sample sizes ranging from 72 to 146.

9 studies had a Jadad score of 3-5 points and 6 studies had a Jadad score of 1-2 points.

Results and conclusions:
The investigators found the meta-analysis results of 10 studies (525 cases in the n-acetylcysteine group and 524 cases in the control group) showed that the forced expiratory volume in the first second (FEV1) of the n-acetylcysteine group was markedly higher than that of the control group; the mean difference was 30.63 [95% CI = 25.48 to 35.78, I2 = 92%] and the difference was statistically significant [z = 11.65 and p 0.0001].

The investigators found the meta-analysis results of 6 studies (347 cases in the n-acetylcysteine group and 350 cases in the control group) showed that forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) of the n-acetylcysteine group was markedly higher than that of the control group; the mean difference was 30.42 [95% CI = 24.00 to 36.85, I2 = 93%] and the difference was statistically significant [z = 9.28 and p 0.0001].

The investigators found the meta-analysis results of 6 studies (323 cases in the n-acetylcysteine group and 322 cases in the control group) showed that the glutathione sulfur transferase (GSH-ST) activity of the n-acetylcysteine group was notably greater than that of the control group; the mean difference was 3.10 [95% CI = 1.38 to 4.82, I2 = 91%] and the difference was statistically significant [z = 3.63, p = 0.0004].

The investigators found the meta-analysis results of 4 studies (224 cases in the n-acetylcysteine group and 227 cases in the control group) showed that the ability of the n-acetylcysteine group to inhibit hydroxyl free radicals was higher than that of the control group; the mean difference was 77.52 [95% CI = 61.01 to 94.03, I2 = 44%] and the difference was statistically significant [z = 9.20 and p 0.0001]. 

The investigators found the meta-analysis results of 4 studies (224 cases in the n-acetylcysteine group and 227 cases in the control group) showed that the superoxide anion radical resistance ability of the n-acetylcysteine group was greater than the ability of the control group; the mean difference was 47.75 [95% CI = 36.26 to 59.25, I2 = 35%] and the difference was statistically significant [z = 8.14 and p 0.0001]. 

The investigators concluded n-acetylcysteine (NAC) supplementation could promote the symptom improvement rate of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), improve lung function in FEV1 and FEV1/FVC and enhance the body’s antioxidant capacity. Could because the sample size of the literature included in this review article was small. The sample size should be expanded in future randomized controlled trials to verify these findings. All in all, the results of this review article can provide a reliable theoretical basis for the clinical treatment of AECOPD, so that patients can benefit from NAC treatment.

Original title:
Systematic review and meta-analysis of the efficacy of N-acetylcysteine in the treatment of acute exacerbation of chronic obstructive pulmonary disease by Jiang C, Zou J, [...], Yang Y.

Link:
https://apm.amegroups.com/article/view/72787/html

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An acute exacerbation of chronic obstructive pulmonary disease is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.
 

Objectives:
Zinc in one of the most abundant trace minerals in human body which is involved in numerous biological pathways and has variety of roles in the nervous system. It has been assumed that zinc exerts its role in nervous system through increasing brain derived neurotrophic factor (BDNF) concentrations. Therefore, this review article has been conducted.

Does zinc supplementation increase brain derived neurotrophic factor (BDNF) levels?

Study design:
This review article included 5 studies with 238 participants. These studies enrolled subjects with premenstrual syndrome, diabetic retinopathy, major depression disorder, overweight/obese and obese with mild to moderate depressive disorders.

Funnel plot did not suggest publication bias.

Results and conclusions:
The investigators found zinc supplementation failed to increase blood brain derived neurotrophic factor concentrations with effect size of 0.30 [95% CI = -0.08 to 0.67, p = 0.119].

The investigators concluded zinc supplementation does not increase brain derived neurotrophic factor (BDNF) levels. However, the small number of included articles and significant heterogeneity between them can increase the risk of a false negative result; therefore, the results should be interpreted with caution.

Original title:
The effect of zinc supplementation on brain derived neurotrophic factor: A meta-analysis by Jafari F, Mohammadi H and Amani R.

Link:
https://pubmed.ncbi.nlm.nih.gov/33831797/

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Brain Derived Neurotrophic Factor (BDNF) plays an important role in neuronal survival and growth, serves as a neurotransmitter modulator and participates in neuronal plasticity, which is essential for learning and memory.
Decreased levels of BDNF are associated with neurodegenerative diseases with neuronal loss, such as Parkinson's disease, Alzheimer's disease, multiple sclerosis and Huntington's disease.
 

Objectives:
Do patients with knee osteoarthritis benefit from vitamin D supplementation?

Study design:
This review article included 6 articles with a total of 1,599 patients with osteoarthritis of the knee.

Results and conclusions:
The investigators found, the results of the meta-analysis showed that vitamin D supplementation statistically significantly improved WOMAC score [SMD = -0.67, 95% CI = -1.23 to -0.12) in patients with knee osteoarthritis, including WOMAC pain score [SMD = -0.32, 95% CI = -0.63 to -0.02], function score [SMD = -0.34, 95% CI = -0.60 to -0.08] and stiffness score [SMD = -0.13, 95% CI = -0.26 to -0.01].

The investigators found, in subgroup analysis, vitamin D supplementation less than 2000 IU (50 mcg) was statistically significant for the reduction of stiffness score [SMD = -0.22, 95% CI = -0.40 to -0.04].

The investigators found vitamin D supplements significantly reduced synovial fluid volume progression in patients with knee osteoarthritis [SMD = -0.20, 95% CI -0.39 to -0.02].

The investigators concluded vitamin D supplements improve WOMAC pain and function in patients with knee osteoarthritis.

Original title:
Does vitamin D improve symptomatic and structural outcomes in knee osteoarthritis? A systematic review and meta-analysis by Zhao ZX, He Y, […], Chen J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33783714/

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The WOMAC is a validated patient-administered questionnaire that assesses 3 components: pain, stiffness and function, with the score range of 0-20 for pain, 0-8 for stiffness and 0-68 for physical function.
 

Objectives:
Do critically ill patients benefit of thiamine (vitamin B1) supplementation?

Study design:
This review article included 8 RCTs and 10 cohort studies.

Results and conclusions:
The investigators found in the analysis of RCTs, that thiamine supplementation showed a significantly 42% lower odds of developing ICU delirium [OR = 0.58, 95% CI = 0.34 to 0.98].

The investigators found a reduction in mortaliy was observed on performing fixed effect model analysis. However, a level of statistical significance could not be reached on performing randon effect model analysis [OR = 0.78, 95% CI = 0.59 to 1.04].

The investigators found in subgroup analysis of 13 studies in patients with sepsis, there was no difference in mortality between the 2 groups [OR = 0.83, 95% CI = 0.63 to 1.09].

The investigators concluded thiamine (vitamin B1) supplementation in critically ill patients shows a reduction in the incidence of ICU delirium among RCTs. However, there is no significant benefit in terms of overall mortality and mortality in patients with sepsis. Further, large scale randomized prospective studies are warranted to investigate the role of thiamine supplementation in critically ill patients.

Original title:
Effect of thiamine supplementation in critically ill patients: A systematic review and meta-analysis by Sedhai YR, Shrestha DB, […], Kashiouris MG.

Link:
https://pubmed.ncbi.nlm.nih.gov/34118501/

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Intensive Care Unit (ICU) delirium is a nonspecific, potentially preventable and often reversible disorder of impaired cognition, which results from various causes in ICU patients. The term “delirium”is derived from the Latin word “delirare” which literally means “to go out of the furrow” or figuratively “crazy or deranged”.
 

Objectives:
The efficacy of soy diet for nonalcoholic fatty liver disease remains controversial. Therefore, this review article has been conducted.

Does soy supplementation have positive effects on nonalcoholic fatty liver disease?

Study design:
This review article included 5 RCTs.
All of 5 RCTs have a relatively small sample size (n 100).

Jadad scores of the 5 included studies vary from 3 to 5 and all 5 studies were considered to be high-quality ones according to quality assessment.

Results and conclusions:
The investigators found, overall, compared with control group for nonalcoholic fatty liver disease, soy supplementation is associated with significantly reduced HOMA-IR [SMD = -0.42, 95% CI = -0.76 to -0.08, p = 0.01], increased insulin [SMD = -0.64, 95% CI = -0.98 to -0.30, p = 0.0002] and decreased malondialdehyde [SMD = -0.43, 95% CI = -0.74 to -0.13, p = 0.005].

The investigators found, however, compared with control group for nonalcoholic fatty liver disease, soy supplementation demonstrated no substantial impact on body mass index [SMD = 0.17, 95% CI = -0.20 to 0.53, p = 0.37), alanine aminotransferase [SMD = -0.01, 95% CI = -0.61 to 0.60, p = 0.98), aspartate-aminotransferase [SMD = 0.01, 95% CI = -0.47 to 0.49, p = 0.97], total cholesterol [SMD = 0.05, 95% CI = -0.25 to 0.35, p = 0.73] or low density lipoprotein cholesterol (bad cholesterol) [SMD = 0, 95% CI = -0.30 to 0.30, p = 0.99].

The investigators concluded that soy supplementation improves insulin resistance for nonalcoholic fatty liver disease.

Original title:
Soy diet for nonalcoholic fatty liver disease: A meta-analysis of randomized controlled trials by Xiong P and Zhu YF.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183754/

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Nonalcoholic fatty liver disease (NAFLD) is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. Non-alcoholic fatty liver disease is a disorder, caused by a build-up of fat in the liver.
 

Objectives:
Is hypertension a risk factor in adults with cerebral palsy?

Study design:
This review article included data from 11 international cohort studies representing 444 adults with cerebral palsy [median (IQR) age of the sample was 29.0 (23.0-38.0), 51% men, 89% spastic type, Gross Motor Function Classification System levels I-V].

Results and conclusions:
The investigators found overall mean systolic blood pressure was 124.9 mmHg [95% CI = 121.7 to 128.1] and overall mean diastolic blood pressure was 79.9 mmHg [95% CI = 77.2 to 82.5].

The investigators found overall prevalence of hypertension was 28.7% [95% CI = 18.8 to 39.8%].

The investigators found subgroup analysis indicated higher blood pressure levels or higher prevalence of hypertension in adults with cerebral palsy above 40 years of age, men, those with spastic cerebral palsy or those who lived in Africa.

The investigators concluded that the findings in this review article underscore the importance of clinical screening for blood pressure in individuals with cerebral palsy beginning in young adulthood.

Original title:
Blood pressure in adults with cerebral palsy: a systematic review and meta-analysis of individual participant data by Noten S, van den Berg-Emons RJG, [...], Van Der Slot WMA.

Link:
https://pubmed.ncbi.nlm.nih.gov/34102658/

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Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. Cerebral palsy is the most common motor disability in children.
 

Objectives:
Catechins are a part of the chemical family of flavonoids, a naturally occurring antioxidant, and a secondary metabolite in certain plants. Green tea catechins are well recognized for their essential anti-inflammatory, photo-protective, antioxidant and chemo-preventive functions. Ultraviolet radiation is a principal cause of damage to the skin. Studies observed that regular intake of green tea catechins increased the minimal dose of radiation required to induce erythema. However, there is a gap in knowledge regarding the impact of oral supplementation with green tea catechins on ultraviolet radiation-induced skin inflammation in human subjects. Therefore, this review article has been conducted.

Is green tea catechin supplementation associated with protection against UV-induced damage due to erythema inflammation in humans?

Study design:
This review article included 6 randomized controlled studies with a total of 100 healthy volunteers. The intervention duration of administrated green tea catechins orally varied from 6 to 12 weeks.

All studies included in this systematic review and meta-analysis measured the erythema index using solar simulator techniques, wherein the blue-light (mimicking sunlight) solar simulator was used to irradiate the skin and skin color was evaluated by chromameter before and 24 h after irradiation at baseline and post-supplementation of green tea catechins.

Results and conclusions:
The investigators found meta-analysis results confirmed oral supplementation of green tea catechins was highly effective at low-intensity ultraviolet radiation-induced erythema response [MED range = 1.25 to 1.30] compared to placebo, showing a significant pooling difference in erythema index [SMD = -0.35, 95% CI = -0.57 to -0.13, p = 0.002, I2 = 4%, p = 0.40] in the random-effects model.

The investigators concluded that regular green tea catechin supplementation (as low as 540 mg of green tea catechins per day) is associated with protection against UV-induced damage due to erythema inflammation in humans, wherein green tea catechin metabolites are bioavailable at the dermis and epidermis levels of the skin and thus increase the minimal dose of radiation (MED) required to induce erythema. This in turn suggests that green tea catechins can strengthen the skin’s tolerance to ultraviolet radiation-induced skin damage from radiation through the prevention of the ultraviolet radiation-induced perturbation of epidermal barrier functions.

Original title:
Green Tea Catechin Association with Ultraviolet Radiation-Induced Erythema: A Systematic Review and Meta-Analysis by Kapoor MP, Sugita M, [...], Okubo T.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233826/

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Sunburn, also called UV-induced or solar erythema, is characterized by painful blistering and sometimes second degree burn.

Objectives:
Which disease-modifying osteoarthritis drugs improve knee and hip osteoarthritis among adults?

Study design:
This review article included 28 randomized controlled trials (RCTs) with 11,890 patients.

Results and conclusions:
The investigators found glucosamine supplements significantly improved both structure [minimum joint width or cartilage volume: network results: SMD = 0.16, 95% CI = 0.04 to 0.28] and symptoms [pain = -0.15, 95% CI = -0.25 to -0.05 and function = -0.17, 95% CI = -0.28 to -0.07] of knee and hip osteoarthritis among adults.

The investigators found chondroitin supplements significantly improved both structure [minimum joint width or cartilage volume: network results: SMD = 0.21, 95% CI = 0.10 to 0.32] and symptoms [pain = -0.06, 95% CI = -0.15 to -0.03 and function = -0.15, 95% CI = -0.26 to -0.03] of knee and hip osteoarthritis among adults.

The investigators found strontium supplements significantly improved structure [minimum joint width or cartilage volume: SMD = 0.20, 95% CI = 0.20 to 0.38] of knee and hip osteoarthritis among adults.

The investigators found vitamin D supplements significantly improved symptoms [pain = -0.15, 95% CI = -0.27 to -0.03 and function = -0.18, 95% CI = -0.31 to -0.06] of knee and hip osteoarthritis among adults.  

The investigators found, although doxycycline also demonstrated a favorable efficacy ranking, its safety profile was poor [withdrawal: network relative risk = 1.69, 95% CI = 1.03 to 2.75].

The investigators concluded glucosamine and chondroitin supplements yield statistically significant but clinically questionable long-term benefit on structure and symptoms of knee and hip osteoarthritis among adults, though both have favorable safety profiles.
Strontium supplements improve structure and vitamin D supplements improve symptoms of knee and hip osteoarthritis among adults. Although doxycycline has a favorable efficacy ranking, its safety profile is poor.
None of the 12 classes of drugs appears to have long-term clinically significant benefit.

Original title:
The Efficacy and Safety of Disease-Modifying Osteoarthritis Drugs for Knee and Hip Osteoarthritis-a Systematic Review and Network Meta-Analysis by Yang W, Sun C, […], Zhuo Q.

Link:
https://pubmed.ncbi.nlm.nih.gov/33846938/

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Objectives:
Patients with kidney failure often present with reduced cardiovascular functional reserve and exercise tolerance. Previous studies on cardiorespiratory fitness examined with cardiopulmonary-exercise-testing (CPET) in kidney-transplant-recipients (KTR) had variable results. Therefore, this review article has been conducted.

Does cardiovascular functional reserve improve after kidney-transplantation?

Study design:
This review article included 8 studies with 461 participants.

Results and conclusions:
The investigators found kidney-transplant-recipients had significantly higher oxygen consumption at peak/max exercise (VO2 peak/VO2 max) compared to patients with kidney failure [SMD = 0.70, 95% CI = 0.31 to 1.10, I2 = 70%, p = 0.002]. 

The investigators found, in subgroup analyses, similar differences were evident among 7 studies comparing kidney-transplant-recipients and hemodialysis patients [SMD = 0.64, 95% CI = 0.16 to 1.12, I2 = 65%, p = 0.009] and 2 studies comparing kidney-transplant-recipients with peritoneal dialysis subjects [SMD = 1.14, 95% CI = 0.19 to 2.09, I2 = 50%, p = 0.16]. 

The investigators found across 4 studies with relevant data, oxygen consumption during peak/max exercise showed significant improvement after kidney-transplantation compared to pre-transplantation values [WMD = 2.43, 95% CI = 0.01 to 4.85, I2 = 68%, p = 0.02].

The investigators concluded kidney-transplant-recipients exhibit higher cardiovascular functional reserve during cardiopulmonary-exercise-testing compared to patients with kidney failure. Cardiovascular reserve is also improved after kidney-transplantation in relation to pre-surgery levels.

Original title:
Cardiorespiratory fitness in kidney transplant recipients compared to patients with kidney failure: a systematic review and meta-analysis by Theodorakopoulou MP, Boutou AK, […], Sarafidis P.

Link:
https://pubmed.ncbi.nlm.nih.gov/34170572/

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Cardiac reserve or cardiovascular reserve refers to the difference between the rate at which the heart pumps blood and its maximum capacity for pumping blood at any given time. A measurement of the cardiovascular reserve may be a health indicator for some medical conditions, like patients with kidney failure.

Objectives:
Does supplementation of thiamine (vitamin B1) combined vitamin C reduce mortality in patients with sepsis or septic shock?

Study design:
This review article included 7 randomized controlled trials (RCTs) with a total of 868 patients.

Results and conclusions:
The investigators found there was no statistical difference between the thiamine combined vitamin C intervention group and the control group for in-hospital mortality [OR = 1.11, 95% CI = 0.79 to 1.56, p = 0.55].
No statistical because OR of 1 was found in the 95% CI of 0.79 to 1.56. OR of 1 means no risk/association.

The investigators found significant improvements of sequential organ failure assessment (SOFA) score during the first 72 h after enrollment and duration of vasopressor use for the thiamine combined vitamin C intervention group.
However, no other significant associations were found.

The investigators concluded despite widespread enthusiasm for thiamine (vitamin B1) combined with vitamin C for sepsis and septic shock, this meta-analysis only shows an association with reduced sequential organ failure assessment (SOFA) score and time of vasopressor use. There is no association with in-hospital mortality in patients with sepsis or septic shock.

Original title:
Thiamine combined with vitamin C in sepsis or septic shock: a systematic review and meta-analysis by Ge Z, Huang J, [...], Li Y.

Link:
https://pubmed.ncbi.nlm.nih.gov/33709993/

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Vasopressors are a group of medicines that contract (tighten) blood vessels and raise blood pressure.
 

Objectives:
The literature showed that grape products containing polyphenols (GPCP) had anti-oxidant activity. However, the effects of GPCP on different biomarkers of oxidative stress are still controversial. Therefore, this review article (meta-analysis) has been conducted.

Does supplementation of grape products containing polyphenols improve status of oxidative stress (like TAC, ORAC and SOD)?

Study design:
This review article included 17 eligible RCTs with a total of 633 participants.

Results and conclusions:
The investigators found supplementation of grape products containing polyphenols significantly increase total antioxidant capacity (TAC) [WMD = 1.524 mmol/L, 95% CI = 0.83 to 2.21].

The investigators found supplementation of grape products containing polyphenols significantly enhanced superoxide dismutase (SOD) [WMD = 0.450 mmol/L, 95% CI = 0.23 to 0.66], total antioxidant capacity (TAC) [WMD = 2.829 mmol/L, 95% CI = 0.13 to 5.52] and oxygen radical absorbance capacity (ORAC) [WMD = 0.524 μmol/L, 95% CI = 0.42 to 0.62] among healthy participants. 

The investigators found in subgroup analyses, that higher grape products containing polyphenols doses significantly increased SOD [WMD = 0.539 U/mgHb, 95% CI = 0.24 to 0.82] and ORAC [WMD = 0.377 μmol/L, 95% CI = 0.08 to 0.67], whereas longer intervention periods significantly enhanced ORAC [WMD = 0.543 μmol/L, 95% CI = 0.43 to 0.64].

The investigators concluded that supplementation of grape products containing polyphenols partly improves status of oxidative stress, but further well-designed trials are required to confirm these results.

Original title:
The effect of grape products containing polyphenols on oxidative stress: a systematic review and meta-analysis of randomized clinical trials by Sarkhosh-Khorasani S, Sangsefidi ZS, […], Hosseinzadeh M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971097/

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Polyphenols are divived into 2 general classes, one is flavonoids and other is phenolic acids. Flavonoids are divided into flavones, flavononse, flavonols, flavanols, isoflavones, while phenolic acids are generally classified into hydroxybenzoic and hydroxycinnamic acids.

Objectives:
Does vitamin B supplementation have positive effects on patients with mouth ulcers?

Study design:
This review article included 16 RCTs with 1,534 patients (767 in the treatment group and 767 in the control group).
Patients who did not receive treatment were taken as controls, while those who were treated with vitamin B alone or vitamin B combined with pantothenic acid were included in the treatment group.

Results and conclusions:
The investigators found, in comparison with the control group, the effective rate was higher [OR = 5.24, 95% CI = 3.72 to 7.37, p 0.001] while the recurrence rate was lower [OR = 0.194, 95% CI = 0.128 to 0.295, p 0.001] in the treatment group.
Sensitivity analysis revealed that the results did not change significantly after pooling, suggesting that the result was stable and less likely to be affected by heterogeneit

The investigators found, additionally, both the ulcer healing time [SMD = -2.15, 95% CI = -2.80 to -1.50, p 0.001] and treatment time [SMD = -2.31, 95% CI = -2.67 to -1.96, p 0.001] in the treatment group were shorter than those of the control group.  
Additionally, the low sensitivity was also supported by the above results and indicated the robustness of the above results.

The investigators concluded that vitamin B supplementation (both vitamin B alone or vitamin B combined with pantothenic acid) enables a higher effective rate and lower recurrence rate, accelerates ulcer healing and shortens the course of treatment. Collectively, vitamin B has a high clinical value in treating patients with mouth ulcers.

Original title:
Clinical efficacy of vitamin B in the treatment of mouth ulcer: a systematic review and meta-analysis by Shi J, Wang L, [...], Zhi D.

Link:
https://apm.amegroups.com/article/view/72221/html

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Objectives:
L-carnitine is an amino acid derivative that is thought to be helpful for treating renal anemia in hemodialysis patients. However, the mechanism remains to be fully elucidated. Therefore, this review article (meta-analysis) has been conducted.

Does L-carnitine supplementation/therapy have positive effects on renal anemia in hemodialysis patients?

Study design:
This review article included 18 RCTs with 1,090 participants.

Results and conclusions:
The investigators found L-carnitine supplementation significantly increased plasma free L-carnitine levels [MD = 140.53, 95% CI = 102.22 to 178.85, p 0.00001]. 

The investigators found L-carnitine supplementation significantly decreased the erythropoietin responsiveness index (ERI) [MD = -2.72, 95% CI = -3.20 to -2.24, p 0.00001] and the required erythropoiesis-stimulating agent (ESA) doses [MD = -1.70, 95% CI = -2.04 to -1.36, p 0.00001].

The investigators found, however, the use of L-carnitine was not associated with a higher hemoglobin level [MD = 0.18, 95% CI = -0.20 to 0.55, p = 0.35] and hematocrit level [MD = 1.07, 95% CI = -0.73 to 2.87, p = 0.24].

The investigators found, in subgroup analyses, the effects of L-carnitine supplementation on renal anemia in patients on hemodialysis were independent of the treatment duration and intervention routes. 

The investigators concluded that L-carnitine supplementation/therapy increases plasma L-carnitine concentrations, improves the response to erythropoiesis-stimulating agent, decreases the required erythropoiesis-stimulating agent doses in patients receiving hemodialysis and maintains hemoglobin and hematocrit levels. L-carnitine supplementation should be supported in hemodialysis patients. However, the relationship between L-carnitine treatment and long-term outcomes is still unclear. Further high-quality RCTs are needed to verify these findings.

Original title:
Effect of L-carnitine supplementation on renal anemia in patients on hemodialysis: a meta-analysis by Zhu Y, Xue C, […], Deng J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33713287/

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Erythropoietin responsiveness index (ERI) is defined as average weekly erythropoietin (EPO) dose per kg body weight (wt) per average hemoglobin (Hgb), over a 3-month period (ERI = (EPO/wt)/Hgb).

Epoetin alfa and darbepoetin alfa are erythropoiesis-stimulating agents (ESAs), approved for the treatment of anemia (low red blood cells) resulting from chronic kidney disease.
 

Objectives:
Does coenzyme Q10 supplementation improve oxidative stress variables?

Study design:
This review article included 17 RCTs with 972 participants.

Results and conclusions:
The investigators found the pooled analysis of primary studies showed that coenzyme Q10 supplementation increased serum total antioxidant capacity [SMD = 0.62 mmol/L, 95% CI = 0.18 to 1.05, I2 = 76.1%, p ˂ 0.001] and superoxide dismutase [SMD = 0.40 U/mg, 95% CI = 0.12 to 0.67, I2 = 9.6%, p ˂ 0.345] levels and decreased malondialdehyde [SMD = -1.02 mmol/L, 95% CI = -1.60 to -0.44, I2 = 88.2%, p ˂ 0.001] level significantly compared to the placebo group.

The investigators found, however, the effect of coenzyme Q10 supplementation on nitric oxide [SMD = 1.01 µmol/L, 95% CI = -1.53 to 3.54, I2 = 97.8%, p ˂ 0.001] and glutathione peroxidase [SMD -0.01 mmol/L, 95% CI = -0.86 to 0.84, I2 = 88.6%, p ˂ 0.001] was not significant.

The investigators concluded that coenzyme Q10 supplementation improves antioxidant defense status against reactive oxygen species.

Original title:
Diabetes, Age, and Duration of Supplementation Subgroup Analysis for the Effect of Coenzyme Q10 on Oxidative Stress: A Systematic Review and Meta-Analysis by Hajiluian G, Heshmati J, […], Shidfar F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33866314/

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Oxidative stress is an imbalance between the reactive oxygen species and antioxidant system.
Total antioxidant capacity (TAC), superoxide dismutase, malondialdehyde, nitric oxide and glutathione peroxidase are biomarkers of oxidative stress.

Objectives:
Migraine is a common disease worldwide and migraine prevention is primarily currently based on pharmaceuticals. The mechanism of vitamin B2 may positively contribute to migraine. Therefore, this review article has been conducted.

Does vitamin B2 supplementation decrease migraine?

Study design:
This review article included 8 randomized controlled trials and 1 controlled clinical trial with 673 subjects.

Results and conclusions:
The investigators found 400 mg/day vitamin B2 supplementation for 3 months significantly decreased migraine days [p = 0.005, I2 = 89%], duration [p = 0.003, I2 = 0], frequency [p = 0.001, I2 = 65%] and pain score [p = 0.015, I2 = 84%].

The investigators concluded that 400 mg/day vitamin B2 supplementation for 3 months has significant effect on days, duration, frequency and pain score of migraine attacks.

Original title:
Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis by Chen YS, Lee HF, […], Hu FW.

Link:
https://pubmed.ncbi.nlm.nih.gov/33779525/

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Objectives:
What are the blood concentrations of zinc, iron, manganese, magnesium, selenium and copper of patients with multiple sclerosis (MS)?

Study design:
This review article included 32 studies with 1,567 MS patients and 1,328 controls (people without MS).

Results and conclusions:
The investigators found pooled results using random-effects model indicated that the levels of zinc [WMD = -7.83 mcg/dL, 95% CI = -12.78 to -2.87, z = 3.09, p = 0.002] and iron [WMD = -13.66 mcg/dL, 95% CI = -23.13 to -4.19, z = 2.83, p = 0.005] were significantly lower in MS patients than in controls.

The investigators found, however, the levels of manganese [WMD = 0.03 mcg/dL, 95% CI = 0.01 to 0.04, z = 2.89, p = 0.004] were significantly higher in MS patients.

The investigators found no significant differences in the levels of magnesium, selenium and copper between both groups.

The investigators concluded that the circulating levels of zinc and iron are significantly lower in MS patients and that manganese level is significantly higher than those in the control group (people without MS).

Original title:
Blood Trace Element Status in Multiple Sclerosis: a Systematic Review and Meta-analysis by Nirooei E, Kashani SMA, […], Akbari H.

Link:
https://pubmed.ncbi.nlm.nih.gov/33611740/

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Objectives:
Resistant starch type 2 (RS2) has been documented to regulate gut microbiota and to improve the clinical outcomes of several diseases. However, whether RS2 may benefit patients with end-stage renal disease under maintenance hemodialysis (MHD) remains unknown. Therefore, this review article has been conducted.

Do patients with end-stage renal disease under maintenance hemodialysis benefit from resistant starch type 2 supplementation?

Study design:
This review article included 5 RCTs with 179 patients under maintenance hemodialysis.

Resistant starch type 2 was used for 4 weeks to 2 months.

Results and conclusions:
The investigators found a significant decrease of blood urea nitrogen [WMD = -6.91, 95% CI = -11.87 to -1.95, I2 = 0%, p = 0.006], serum creatinine [WMD = -1.11, 95% CI = -2.18 to -0.05, I2 = 44%, p = 0.04] and interleukin (IL)-6 in blood [SMD = -1.08, 95% CI = -1.64 to -0.53, I2 = 35%, p = 0.0001] was revealed in the resistant starch type 2 group.

The investigators found analyses of blood levels of uric acid, p-cresyl sulfate, indoxyl sulfate, high sensitive C-reaction protein, albumin and phosphorus yielded no significant difference.

The investigators concluded that resistant starch type 2 improves the residual renal function of patients under maintenance hemodialysis and mitigate a proinflammatory response. Nevertheless, results should be cautiously interpreted, because of the limited sample size and different treatment dosages. Large and pragmatic multicenter trials are thus necessary to corroborate the beneficial effects of resistant starch type 2 supplementation on end-stage renal disease.

Original title:
Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis by Jia L, Dong X, […], Zhang HL.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797550/

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Resistant starch (RS) is starch, including its degradation products, that escapes from digestion in the small intestine of healthy individuals, but rather turned into short-chain fatty acids (such as acetate, butyrate and propionate) by intestinal bacteria in the colon (large intestine). Short chain fatty acids can be absorbed into the body from the colon or stay put and be used by colonic bacteria for energy.

Different types of resistant starch are RS1, RS2 and RS3. 

Resistant starch is present in whole grains, fruits, vegetables and beans/legumes.

Resistant starch type 2 (resistant granules) is intrinsically resistant to digestion and contains high amounts of amylose. Resistant starch type 2 is found in fruits, potatoes, hi-maize RS products, corn and some legumes.

The more “raw” or “uncooked” a food is, the more resistant starch it tends to have, since heat results in gelatinization of starch - making it more accessible to digestion. Type 3 starch is the exception to this rule.

All starches are composed of 2 types of polysaccharides: amylose and amylopectin.

Amylopectin is highly branched, leaving more surface area available for digestion in the small intestine. Amylopectin is broken down quickly, which means it produces a larger rise in blood sugar (glucose) and subsequently, a large rise in insulin.

Amylose is a straight chain, which limits the amount of surface area exposed for digestion. Amylose predominates in resistant starch. Foods high in amylose are digested more slowly. They’re less likely to spike blood glucose or insulin.

Since resistant starch is incompletely digested, we only extract about 2 calories of energy per gram (versus about 4 calories per gram from other starches).
 

Objectives:
N-acetylcysteine (NAC) is an antioxidant that can regenerate glutathione and is primarily used for acetaminophen overdose. NAC has been tested and used for preventing iatrogenic acute kidney injury or slowing the progression of chronic kidney disease, with mixed results. Therefore, this review article has been conducted.

Has NAC administration a positive effect on the serum creatinine level and the serum cystatin C level?

Study design:
This review article included 6 studies (4 studies were before/after single-arm prospective trials and 2 were parallel randomized controlled trials, comparing NAC against placebo) with a total of 199 participants.

Overall, these studies are small, with a median sample size of 30 (range: 10-60).
The proportion of men ranged from 48% to 83%.
The mean patient age ranged from 33 to 71 years.
The follow-up periods were mostly short.
There was no evidence of publication bias both by visual examination or the Egger test for the analysis of NAC and cystatin C.

Results and conclusions:
The investigators found there was a small but significant decrease in serum creatinine after n-acetylcysteine (NAC) administration overall [WMD = -2.80 μmol/L, 95% CI = -5.6 to 0.0, p = 0.05].

This was greater with non-Jaffe methods [WMD = -3.24 μmol/L, 95% CI = -6.29 to -0.28, p = 0.04] than Jaffe [WMD = -0.51 μmol/L, 95% CI = -7.56 to 6.53, p = 0.89] and in particular with intravenous [WMD = -31.10 μmol/L, 95% CI = -58.37 to -3.83, p = 0.03] compared with oral NAC [WMD = -2.5 μmol/L, 95% CI = -5.32 to 0.32, p = 0.08].

The investigators found there was no change in cystatin C after n-acetylcysteine (NAC) administration [WMD = -0.84 μmol/L, 95% CI = -3.14 to 1.47, p = 0.48, I2 = 0%, p = 0.99].

The investigators concluded there is a small but significant decrease in serum creatinine with n-acetylcysteine (NAC) administration but not in cystatin C. This effect seems to be higher when creatinine is measured with the enzymatic assay (non-Jaffe method) and with intravenous n-acetylcysteine administration.

Original title:
A Systematic Review of the Effect of N-Acetylcysteine on Serum Creatinine and Cystatin C Measurements by Huang JW, Lahey B, […], Hiremath S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879108/

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The Jaffe and enzymatic methods (non-Jaffe methods) are the 2 most common methods for measuring serum creatinine. The Jaffe method is less expensive than the enzymatic method but is also more susceptible to interferences.

Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein.
 

Objectives:
Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. Therefore, this review article has been conducted.

Do probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease?  

Study design:
This review article included 14 RCTs.

Results and conclusions:
The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly reduced:
-total cholesterol [SMD = -0.25, 95% CI = -0.46 to -0.04, I2 = 00.0%];
-fasting blood glucose [SMD = -0.41, 95% CI = -0.65 to -0.17, I2 = 00.0%];
-homeostatic model assessment of insulin resistance [SMD = -0.63, 95% CI = -0.95 to -0.30, I2 = 43.3%];
-insulin levels [SMD = -0.49, 95% CI = -0.90 to -0.08, I2 = 65.2%];
-high-sensitivity C-reactive protein levels [SMD = -0.52, 95% CI = -0.81 to -0.22, I2 = 52.7%] and;
-malondialdehyde levels [SMD = -0.79, 95% CI = -1.22 to -0.37, I2 = 69.8%] compared with control interventions.

The investigators found in patients with chronic kidney disease, probiotic, prebiotic and synbiotic supplementation significantly increased:
-the quantitative insulin sensitivity check index [SMD = 0.78, 95% CI = 0.51 to 1.05, I2 = 00.0%];
-total antioxidant capacity [SMD = 0.42, 95% CI = 0.18 to 0.66, I2 = 00.0%] and;
-glutathione levels [SMD = 0.52, 95% CI = 0.19 to 0.86, I2 = 37.0%].

The investigators concluded probiotic, prebiotic and synbiotic supplementation improve cardiometabolic and oxidative stress parameters in patients with chronic kidney disease.

Original title:
Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients with Chronic Kidney Disease: a Systematic Review and Meta-analysis by Bakhtiary M, Morvaridzadeh M, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33526314/

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Levels of malondialdehyde can be also considered (as a marker of lipid peroxidation) to assess the membrane damage in spermatozoa; this is crucial because oxidative stress affects sperm function by altering membrane fluidity, permeability and impairing sperm functional competence.
Lipid peroxidation is a well-established mechanism of cellular injury and is used as an indicator of oxidative stress in cells and tissues.

Glutathione is one of the body's most important and potent antioxidants. As an antioxidant, glutathione helps neutralize free radicals and reduce oxidative stress that can damage the body’s cells.

Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) have been used to quantify degrees of insulin resistance and β-cell secretory capacity.
 

Objectives:
Is there a causal relationship between ginger intake and improvements of major oxidative stress (OS) parameters, such as glutathione peroxidase activity, total antioxidant capacity, alondialdehyde (MDA) levels and CAT activity?   

Study design:
This review article included 12 RCTs.

Results and conclusions:
The investigators found ginger intake significantly increased glutathione peroxidase (GPx) activity [SMD = 1.64, 95% CI = 0.43 to 2.85, I2 = 86.8%] compared to control group (group without ginger intake). 

The investigators found ginger intake significantly increased total antioxidant capacity (TAC) [SMD = 0.40, 95% CI = 0.06 to 0.73, I2 = 42.8%] compared to control group. 

The investigators found ginger intake significantly decreased alondialdehyde (MDA) levels [SMD = -0.69, 95% CI = -1.26 to -0.12, I2 = 85.8%] compared to control group.

The investigators found ginger supplementation non-significantly increased CAT activity [SMD = 1.09, 95% CI = -0.07 to 2.25, I2 = 87.6%].

The investigators concluded this meta-analysis (review article) presents convincing evidence supporting the efficacy of ginger supplementation on improving oxidative stress (OS) levels.

Original title:
Effect of ginger (Zingiber officinale) supplementation on oxidative stress parameters: A systematic review and meta-analysis by Morvaridzadeh M, Sadeghi E, […], Heshmati J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33458848/

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Oxidative stress is an imbalance between free radicals and antioxidants in your body.