Nutritional advice

Objectives:
Is there a causal relationship between psyllium (a dietary fiber) consumption and improvements of risk factors of diabetes?

Study design:
This review article included 9 RCTs with 395 participants.

Results and conclusions:
The investigators found psyllium consumption significantly reduced triglycerides levels with 19.18 mg/dL [WMD = -19.18 mg/dL, 95% CI = -31.76 to -6.60, I2 = 98%].

The investigators found psyllium consumption significantly reduced low-density lipoprotein cholesterol levels with 8.96 mg/dL [WMD = -8.96 mg/dL, 95% CI = -13.39 to -4.52, I2 = 97%].

The investigators found psyllium consumption significantly reduced fasting blood sugar levels with 8.96 mg/dL [WMD = -31.71 mg/dL, 95% CI = -50.04 to -13.38, I2 = 97%].

The investigators found psyllium consumption significantly reduced hemoglobin A1c levels with 0.91% [WMD = -0.91%, 95% CI = -1.31 to -0.51, I2 = 99%].

The investigators found no significant change in high-density lipoprotein, body mass index, cholesterol and weight following psyllium consumption.

The investigators concluded there is a significant reduction in triglycerides, low-density lipoprotein cholesterol (bad cholesterol), fasting blood sugar and hemoglobin A1c levels following psyllium consumption among diabetic patients.

Original title:
The effect of psyllium consumption on weight, body mass index, lipid profile, and glucose metabolism in diabetic patients: A systematic review and dose-response meta-analysis of randomized controlled trials by Xiao Z, Chen H, [...], Wei Y.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31919936

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Psyllium is a form of fiber made from the husks of the Plantago ovata plant’s seeds. The psyllium husk is a naturally occurring source of soluble fiber.
Psyllium is commonly found in cereals, dietary supplements and is also added to some foods including baked products such as breads, cereal bars and rice/grain cakes.
 

Objectives:
The activity of hepatitis B virus (HBV) as a risk factor for the incidence and progression of chronic kidney disease (CKD) has not been clarified. Therefore, this review article has been conducted.

Does hepatitis B virus infection increase risk of chronic kidney disease?

Study design:
This review article included 33 studies with a total of 7,849,849 patients.

Results and conclusions:
The investigators found in 11 cohort studies with 1,056,645 patients, that a positive HBV serologic status (hepatitis B virus infection) significantly increased risk of incidence of chronic kidney disease with 40% [adjusted HR = 1.40, 95% CI = 1.16 to 1.69, p 0.001, I2 = 49.5%, p 0.0001].

The investigators found in 10 cross-sectional studies with 3,222,545 patients, no relationship between hepatitis B virus infection and prevalence of chronic kidney disease [adjusted OR = 1.04, 95% CI = 0.90 to 1.218, p = 0.5].

The investigators found meta-regression analysis reported a relationship between positive HBsAg status and incidence of chronic kidney disease in the general population [p 0.015].

The investigators concluded hepatitis B virus infection increases risk of developing of chronic kidney disease in the adult general population. Studies aimed to understand the mechanisms responsible of such association are underway.

Original title:
HBV infection is a risk factor for chronic kidney disease: Systematic review and meta-analysis by Fabrizi F, Cerutti R, […], Messa P.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/32037008

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Find here more information/studies about kidney disease.
 

Objectives:
Lead is a known risk factor for amyotrophic lateral sclerosis (ALS). However, the results of studies exploring the relationship between lead exposure and the occurrence of ALS are inconsistent. Therefore, this review article has been conducted.

Does a high lead exposure increase risk of ALS?

Study design:
This review article included 11 case-control studies.

Results and conclusions:
The investigators found a high lead exposure significantly increased risk of ALS with 28% [OR = 1.28, 95% CI = 1.02 to 1.63].
Subgroup and sensitivity analyses showed stable results.

The investigators concluded a high lead exposure increases risk of ALS.

Original title:
Population-based study of environmental/occupational lead exposure and amyotrophic lateral sclerosis: a systematic review and meta-analysis by Meng E, Mao Y, […], Jin W.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31578652

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Objectives:
Previous findings on the associations of legume and soy intake with the risk of type 2 diabetes are conflicting. Therefore, this review article (meta-analysis) has been conducted.

Does legume or soy dietary intake reduce risk of type 2 diabetes?

Study design:
This review article included 15 unique cohort studies with a total of 565,810 individuals and 32,093 incident cases (persons with type 2 diabetes).

Overall quality of evidence was rated as moderate for total legumes and low for total soy and soy subtypes.

Results and conclusions:
The investigators found no association between total legumes dietary intake and risk of type 2 diabetes [summary RR = 0.95, 95% CI = 0.79 to 1.14, I2 = 84.8%].
No association because RR of 1 was found in the 95% CI of 0.79 to 1.14. RR of 1 means no risk/association.

The investigators found no association between total soy dietary intake and risk of type 2 diabetes [summary RR = 0.83, 95% CI = 0.68 to 1.01, I2 = 90.8%].

The investigators found no association between soy milk dietary intake and risk of type 2 diabetes [summary RR = 0.89, 95% CI = 0.71 to 1.11, I2 = 91.7%].

The investigators found tofu dietary intake significantly reduced risk of type 2 diabetes with 8% [summary RR = 0.92, 95% CI = 0.84 to 0.99].
Significantly because RR of 1 was not found in the 95% CI of 0.84 to 0.99. RR of 1 means no risk/association.

The investigators found soy protein dietary intake significantly reduced risk of type 2 diabetes with 16% [summary RR = 0.84, 95% CI = 0.75 to 0.95].

The investigators found soy isoflavones dietary intake significantly reduced risk of type 2 diabetes with 12% [summary RR = 0.88, 95% CI = 0.81 to 0.96].

The investigators found in dose-response analysis, significant linear inverse associations for tofu, soy protein and soy isoflavones [all p 0.05].

The investigators concluded dietary intakes of tofu, soy protein and soy isoflavones reduce incident type 2 diabetes. These findings support recommendations to increase intakes of certain soy products for the prevention of type 2 diabetes. However, the overall quality of evidence was low and more high-quality evidence from prospective studies is needed.

Original title:
Legume and soy intake and risk of type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies by Tang J, Wan Y, […], Feng F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31915830

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Objectives:
Many studies have been reported that dietary meat intake may be associated with the risk of asthma in children, but the results are inconsistent. Therefore, this review article has been conducted.

Does dietary meat intake increase asthma in children?

Study design:
This review article included a total of 9 articles.

No publication bias was detected.

Results and conclusions:
The investigators found dietary meat intake 3 or more times per week compared with never/occasionally intake had no significant association with asthma risk among children [OR = 1.27, 95% CI  =  0.80-2.01, p =  0.308].
Not significant because OR of 1 was found in the 95% CI of 0.80 to 2.01. OR of 1 means no risk/association.

The investigators found, similarly, daily dietary intake of meat did not affect the risk of asthma in children when compared with never/occasionally intake [OR  =  1.13, 95% CI  =  0.93-1.37, p  =  0.234].

The investigators concluded dietary meat intake is not a risk factor for asthma in children. Due to some limitations that exist in this review article, more studies are needed to further assess the association between dietary meat intake and asthma risk in children.

Original title:
Dietary meat intake and risk of asthma in children: evidence from a meta-analysis by Zhang D, Cao L, [...], Wang Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31895767

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Objectives:
The morbidity of eczema has increased in the recent years and the methods to prevent or ameliorate its effects are becoming more important. Therefore, this review article has been conducted.

Do vitamin supplements reduce risk of eczema?

Study design:
This review article included 10 RCTs with a total of 456 patients.
The sample sizes ranged from 5 to 57. The studies were published from 2008 to 2018.
5 studies were conducted on atopic dermatitis, 3 studies were conducted on pediatric atopic dermatitis and 2 studies were conducted on winter-related atopic dermatitis.

Results and conclusions:
The investigators found that the SCORAD index or EASI scores significantly decreased in patients given vitamin D3 (cholecalciferol) supplements [mean difference = -5.96, 95% CI = -7.69 to -4.23, I2 = 33%].

The investigators found that the SCORAD index significantly decreased after the topical application of vitamin B12-containing cream [mean difference = -3.19, 95% CI = -4.27 to -2.10, I2 = 0%]. 

The investigators found that the SCORAD index significantly improved after vitamin E supplementation [mean difference = -5.72, 95% CI = -11.41 to -0.03, I2 = 0%]. 

The investigators concluded vitamin D3, B12 and E supplements could be important therapeutics to help manage eczema patients.

Original title:
Assessment of the Effectiveness of Vitamin Supplement in Treating Eczema: A Systematic Review and Meta-Analysis by Zhu Z, Yang Z, [...], Liu H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875217/

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Find here more information/studies about vitamin B12, D and E and chronic disease.

Objectives:
The role of zinc in the etiology of type 2 diabetes has been widely reported in recent decades. However, much remains uncertain concerning the effect of zinc on the risk of developing type 2 diabetes. Therefore, this review article has been conducted.

Does zinc reduce risk of type 2 diabetes?

Study design:
This review article included 16 studies.
There was no publication bias.

Results and conclusions:
The investigators found in 7 prospective cohort studies and 1 cross-sectional study (146,027 participants aged between 18 and 84 years and of both genders, belonging to different ethnic groups. Of which, 11,511 type 2 diabetes cases) when comparing the highest versus lowest dietary zinc intakes, a significantly reduced risk of 13% [OR = 0.87, 95% CI = 0.78-0.98, I2 = 64.5%, p = 0.003] for type 2 diabetes.
This relationship was stronger and more evident in rural compared to urban areas [rural areas: OR = 0.59, 95% CI = 0.48-0.73, I2 = 0.0%, p = 0.843 versus urban areas: OR = 0.94, 95% CI = 0.86-1.02, I2 = 43.9%, p = 0.113].

The investigators found no association between supplementary [OR = 0.94, 95% CI = 0.75-1.19, I2 = 85.4%, p = 0.009] or total zinc intake from both diet and supplementation [OR = 0.95, 95% CI = 0.82-1.11, I2 = 56.5%, p = 0.129] and type 2 diabetes risk.

The investigators found in population-based studies that high serum/plasma zinc levels significantly increased risk of type 2 diabetes with 64% [OR = 1.64, 95% CI = 1.25-2.14, I2 > 22.5%, p = 0.275].

The investigators concluded high dietary zinc intake reduces risk of type 2 diabetes. This relationship is stronger and more evident in rural compared to urban areas. However, an elevated serum/plasma zinc concentration is associated with an increased risk of type 2 diabetes in the general population.

Link:
Zinc Intake and Status and Risk of Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis by Fernández-Cao JC, Warthon-Medina M, […], Lowe NM.

Link:
https://www.mdpi.com/2072-6643/11/5/1027/htm

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Serum/plasma zinc levels can be increased by eating products that contain a lot of zinc and/or taking zinc supplements.
 

Objectives:
Does magnesium reduce risk of type 2 diabetes?

Study design:
This review article included 35 cohort studies and 26 RCTs (1,168 participants).

Results and conclusions:
The investigators found compared to the lowest magnesium dietary intake, the highest level was associated with a 22% lower risk for type 2 diabetes.

The investigators found the risk for type 2 diabetes was reduced by 6% for each 100mg increment in daily magnesium dietary intake.

The investigators found in 26 RCTs (1,168 participants) that magnesium supplementation significantly reduced:
-the fasting plasma glucose (FPG) level [SMD = -0.32, 95% CI = -0.59 to -0.05];
-2-h oral glucose tolerance test (2-h OGTT) result [SMD = -0.30, 95% CI = -0.58 to -0.02];
-fasting insulin level [SMD = -0.17, 95% CI = -0.30 to -0.04];
-homeostatic model assessment-insulin resistance (HOMA-IR) score [SMD = -0.41, 95% CI = -0.71 to -0.11];
-triglyceride (TG) level;
-systolic blood pressure (SBP) and;
-diastolic blood pressure (DBP).

The investigators found trial sequential analysis (TSA) showed an inverse association, with most benefits of magnesium supplementation on glucose metabolism being stable.

The investigators concluded magnesium dietary intake has an inverse dose-response association with type 2 diabetes incidence and supplementation appears to be advisable in terms of glucose parameters in type 2 diabetes/high-risk individuals.

Original title:
Association of Magnesium Consumption with Type 2 Diabetes and Glucose Metabolism: a Systematic Literature Review and Pooled Study with Trial Sequential Analysis by Zhao B, Deng H, [...], Zhang W.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31758631

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Objectives:
Low-potassium diets are recommended to reduce serum potassium (Sk) and prevent complications of chronic kidney disease (CKD), but evidence underpinning this recommendation has not been systematically reviewed and synthesized. Therefore, this review article has been conducted.

Do patients with chronic kidney disease benefit from low-potassium diets?

Study design:
This review article included 7 studies  with 3,489 participants.

Results and conclusions:
The investigators found in very-low-quality studies that restricted (1,295 mg/d) versus unrestricted (1,570 mg/d) dietary potassium lowered serum potassium by 0.22 mEq/L [95% CI = -0.33 to -0.10, I2 = 0%].

The investigators found in very-low-quality studies that lower (1,725 mg/d) versus higher (4,558 mg/d) dietary potassium was not significantly associated with disease progression [HR = 1.14, 95% CI = 0.77 to 1.70, I2 = 57%].

The investigators found in very-low-quality studies that lower (1,670 mg/d), compared with higher (4,414 mg/d) dietary potassium intake was associated with a 40% reduction in mortality hazard [HR = 0.60, 95% CI = 0.40 to 0.89, I2 = 56%].

The investigators concluded very-low-quality evidence supports consensus that dietary potassium restriction reduces serum potassium in normokalemia and is associated with a reduced risk of death in those with chronic kidney disease. However, high-quality randomized controlled trials are needed to confirm these findings.

Original title:
Effect of Dietary Potassium Restriction on Serum Potassium, Disease Progression, and Mortality in Chronic Kidney Disease: A Systematic Review and Meta-Analysis by Morris A, Krishnan N, […], Lycett D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31734057

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Objectives:
Observational evidence suggests higher nut consumption is associated with better glycemic control. However, it is unclear if this association is causal. Therefore, this review article has been conducted.

Is there a causal relationship between consumption of tree nuts or peanuts and reduced risk of type 2 diabetes?

Study design:
This review article included a total of 40 RCTs with 2,832 unique participants, with a median duration of 3 months (range: 1-12 months).

Results and conclusions:
The investigators found overall consumption of tree nuts or peanuts had a favourable effect on HOMA-IR values [WMD = -0.23, 95% CI = -0.40 to -0.06, I2 = 51.7%] and fasting insulin levels [WMD = -0.40 μIU/mL, 95% CI = -0.73 to -0.07 μIU/mL, I2 = 49.4%].

The investigators found, however, there was no significant effect of nut consumption on fasting blood glucose levels [WMD = -0.52 mg/dL, 95% CI = -1.43 to 0.38 mg/dL, I2 = 53.4%] or HbA1c [WMD = 0.02%, 95% CI = -0.01% to 0.04%, I2 = 51.0%].

The investigators concluded consumption of peanuts or tree nuts decreases HOMA-IR and fasting insulin levels. These findings suggest that nut consumption may improve insulin sensitivity. In the future, well-designed clinical trials are required to elucidate the mechanisms that account for these observed effects.

Original title:
The effect of nuts on markers of glycemic control: a systematic review and meta-analysis of randomized controlled trials by Tindall AM, Johnston EA, […], Petersen KS.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30722007

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Objectives:
Parkinson's disease (PD) is the most common neurodegenerative disease after Alzheimer's dementia. Whereas the exact etiology of Parkinson's disease remains unknown, risk of developing Parkinson's disease seems to be related to a combination of genetic and environmental factors. This also includes abnormal exposure to trace elements of nutritional and toxicological interest. Therefore, this review article has been conducted.

Is there a relationship between exposure to trace elements and Parkinson’s disease risk?

Study design:
This review article included 56 case-control studies reporting data for selenium (cases/controls: 588/721), copper (2,190/2,522), iron (2,956/3,469) and zinc (1,798/1,913) contents in cerebrospinal fluid (CSF) and blood.

Results and conclusions:
The investigators found patients with Parkinson's disease had significantly higher levels of selenium in cerebrospinal fluid compared with controls [+51.6%, WMD = 5.49, 95% CI = 2.82 to 8.15], while levels in serum were similar [-0.2%, WMD = -0.22, 95% CI = -8.05 to 7.62].

The investigators found patients with Parkinson's disease had non-significantly higher levels of copper in cerebrospinal fluid compared with controls [+4.5%, WMD = 1.87, 95% CI = -3.59 to 7.33] and non-significantly lower levels of copper in serum [WMD = -42.79, 95% CI = -134.35 to 48.76].

The investigators found patients with Parkinson's disease had significantly higher levels of iron in cerebrospinal fluid compared with controls [+9.5%, WMD = 9.92, 1.23 to 18.61] and significantly lower levels of iron both in serum/plasma [-5.7%, WMD = -58.19, 95% CI = -106.49 to -9.89] and whole blood [-10.8%, WMD = -95.69, 95% CI = -157.73 to -33.65].

The investigators found patients with Parkinson's disease had significantly lower levels of zinc in cerebrospinal fluid compared with controls [-10.8%, WMD = -7.34, 95% CI = -14.82 to -0.14] and significantly lower levels of zinc in serum/plasma [-7.5%, WMD = -79.93, 95% CI = -143.80 to -16.06].

The investigators found a longer duration of the disease tends to be associated with overall lower trace element levels in either cerebrospinal fluid or blood.

The investigators concluded higher levels of both selenium and iron in cerebrospinal fluid increase Parkinson's disease, while higher levels of zinc in cerebrospinal fluid decrease Parkinson's disease.

Original title:
Selenium and Other Trace Elements in the Etiology of Parkinson's Disease: A Systematic Review and Meta-Analysis of Case-Control Studies by Adani G, Filippini T, […], Vinceti M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31454800

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Objectives:
Does omega-3 fatty acids supplementation improve serum levels of inflammatory biomarkers (C-reactive protein [CRP], high-sensitivity CRP [hs-CRP], tumor necrosis factor-alpha, interleukin-6) and albumin in patients on hemodialysis?

Study design:
This review article included 8 RCTs comprising 371 patients on hemodialysis.

Results and conclusions:
The investigators found omega-3 supplementation significantly decreased serum levels of CRP in patients on hemodialysis [SMD = -1.95 mg/dL, 95% CI = -3.09 to -0.80] and hs-CRP [SMD = -2.09, 95% CI = -3.62 to -0.56].

The investigators found, however, omega-3 supplementation did not significantly improved albumin [SMD = 0.91, 95% CI = -0.78 to 2.59], tumor necrosis factor-alpha [SMD = -1.51, 95% CI = -3.24 to 0.22] and interleukin-6 levels [SMD = 0.72, 95% CI = -0.56 to 1.99] in patients on hemodialysis.

The investigators concluded omega-3 supplementation leads to a significant decrease in serum levels of CRP and hs-CRP in patients on hemodialysis.

Original title:
The Effect of Omega-3 Supplementation on Serum Levels of Inflammatory Biomarkers and Albumin in Hemodialysis Patients: A Systematic Review and Meta-analysis by Dezfouli M, Moeinzadeh F, [...], Feizi A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31420233

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Objectives:
The incidence of type 2 diabetes mellitus (DM) has increased in the US over the last several years. The consumption of low-fat dairy foods has been linked with decreasing the risk of diabetes mellitus but studies have yet to show a clear correlation. Therefore, this review article has been conducted.

Is there a causal relationship between consumption of low-fat dairy foods and reduced risk of type 2 diabetes?

Study design:
This review article included 30 RCTs.
The total sample size was 2,900 with >50% female participants, but the distribution varied greatly across different studies.
The mean age of subjects ranged from 18-63 years.
The funnel plots for all 3 outcomes (HOMA-IR, waist circumference and body weight) did not suggest significant publication bias.

Results and conclusions:
The investigators found (794 individuals) comparing high intake to the control group, consumption of low-fat dairy foods significantly reduced the HOMA-IR values [MD = -1.21, 95% CI = -1.74 to -0.67, p 0.00001, I2 = 92%].

The investigators found (1,348 individuals) comparing high intake to the control group, consumption of low-fat dairy foods significantly reduced waist circumference [MD = -1.09 cm, 95% CI = -1.68 to -0.58, p 0.00001, I2 = 94%].

The investigators found for body weight (2,362 individuals), the low-fat dairy foods intervention group weighed 0.42 kg less than the control group [p 0.00001, I2 = 92%].

The investigators found limiting to studies that were assessed to have low risk of bias did not significantly change the point estimates or heterogeneity statistics (Q or I2) for all 3 outcomes.
Similarly excluding studies with a physical activity component did not significantly alter point estimates or heterogeneity statistics for all 3 outcomes.

The investigators concluded low-fat dairy products have a beneficial effect on HOMA-IR, waist circumference and body weight. This could impact dietary recommendations to reduce type 2 diabetes risk.

Original title:
The Effects of Dairy Intake on Insulin Resistance: A Systematic Review and Meta-Analysis of Randomized Clinical Trials by Sochol KM, Johns TS, […], Melamed ML.

Link:
https://www.mdpi.com/2072-6643/11/9/2237/htm

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Objectives:
In recent years, cardiovascular diseases (CVDs) have become a focus topic and global concern. There have been mixed reports on the relationship between whole grain or cereal fiber intake and the risk of type 2 diabetes. Therefore, this review article has been conducted.

Does grain or cereal fiber dietary intake reduce risk of type 2 diabetes?

Study design:
This review article included 7 cohort studies and 1 case-control study with a total of 434,903 participants and 14,728 cases of type 2 diabetes.
The average follow-up was 12.6 years.
There was no publication bias.

Results and conclusions:
The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 26% [combined RR = 0.74, 95% CI = 0.67 to 0.82, I2 = 56.8%, p = 0.06] for type 2 diabetes.
This reduced risk was 38% [pooled RR = 0.68, 95% CI = 0.64-0.73, I2 = 0.0%, p = 0.452] in sensitivity analysis.

The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 32% [combined RR = 0.68, 95% CI = 0.49 to 0.88] for type 2 diabetes among males.

The investigators found whole grain or cereal fiber dietary intake was associated with a reduced risk of 26% [combined RR = 0.74, 95% CI = 0.64 to 0.77] for type 2 diabetes among females.

The investigators concluded that increased whole grain and cereal fiber dietary intake reduce risk of type 2 diabetes.

Original title:
Whole grain and cereal fiber intake and the risk of type 2 diabetes: a meta-analysis by Wang Y, Duan Y, […], Jin Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6627783/

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Objectives:
Environmental risk factors regrading rheumatoid arthritis (RA) have not been explored extensively. Selenium (Se), zinc (Zn) and copper (Cu) nutrients were reported to associate with rheumatoid arthritis, but the results were inconsistent. Therefore, this review article has been conducted.

Is there a relationship between serum selenium, zinc and copper levels and rheumatoid arthritis risk?

Study design:
This review article included 41 studies.

Results and conclusions:
The investigators found meta-analysis of 16 studies involving 806 rheumatoid arthritis patients and 959 health controls showed that serum selenium levels [SMD = -1.04, 95% CI = -1.58 to -0.50] were significantly decreased in rheumatoid arthritis patients.

The investigators found meta-analysis of 23 studies involving 1,398 rheumatoid arthritis patients and 1,299 health controls showed that serum zinc levels [SMD = -1.20, 95% CI = -1.74 to -0.67] were significantly decreased in rheumatoid arthritis patients.

The investigators found meta-analysis of 26 studies involving 1,723 rheumatoid arthritis patients and 1,451 health controls showed that serum copper levels [SMD = 1.26, 95% CI = 0.63 to 1.89] were significantly increased in rheumatoid arthritis patients.

The investigators found meta-regression reported that steroid use was positively related to serum level of selenium in rheumatoid arthritis [β = 0.041, 95% CI = 0.002 to 0.079].

The investigators found differences in serum selenium, zinc and copper between rheumatoid arthritis patients and controls were all related with the geographical distribution.

The investigators concluded patients with rheumatoid arthritis have significant decreased serum selenium and zinc levels and increased serum copper levels than health controls, suggesting potential roles of selenium, zinc and copper in the pathogenesis of rheumatoid arthritis. Patients and rheumatologist should give enough attention to the monitor of these elements during follow up.

Original title:
Common trace metals in rheumatoid arthritis: A systematic review and meta-analysis by Ma Y, Zhang X, […], Pan F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31442958

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Objectives:
Systematic inflammation plays a major role in all stages of chronic diseases. Recent evidence suggests that coenzyme Q10 (CoQ10), as an anti-inflammatory agent, has shown beneficial effects on the inflammatory process of various human diseases. However, several trials have examined the effects of coenzyme Q10 on pro-inflammatory cytokines with contrasting results. Therefore, this review article has been conducted.

Does coenzyme Q10 supplementation reduce inflammation in humans?

Study design:
This review article included 9 RCTs with a total of 509 patients (269 in the coenzyme Q10 arm and 240 in the control arm).

Results and conclusions:
The investigators found that oral coenzyme Q10 supplementation (60-500 mg/day for 8-12 weeks) resulted in significant reduction of TNF-α [SMD = -0.44, 95% CI = -0.81 to -0.07 mg/dL, I2 = 66.1%, p  = 0.00] and IL-6 levels [SMD = -0.37, 95% CI = -0.65 to -0.09, I2 = 57.2%, p  = 0.01], respectively.

The investigators found subgroup analyses represented a significant reduction of TNF-α and IL-6 levels in patients with BMI  26.
Due to the small number of studies and patients included in each subgroup, these subgroup analyses need to be interpreted cautiously.

The investigators concluded there is a significant effect of 60-500 mg/day coenzyme Q10 supplements for 8-12 weeks on some of the inflammatory markers among patients with chronic diseases which could attenuate the inflammatory state. However, well-designed studies with a larger sample size are required. Note that the results should be interpreted with caution because of the evidence of heterogeneity and limited number of studies.

Original title:
Can coenzyme Q10 supplementation effectively reduce human tumor necrosis factor-α and interleukin-6 levels in chronic inflammatory diseases? A systematic review and meta-analysis of randomized controlled trials by Vafa M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31185284

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Objectives:
There is little evidence whether eggs affect inflammation. Therefore, this review article has been conducted.

Does egg consumption increase risk of inflammation?

Study design:
This review article included 8 RCTs assessed high sensitivity c-reactive protein (hs-CRP), 4 RCTs assessed interleukin-6 (IL-6) and 5 RCTs assessed tumor necrosis factor alpha (TNF-α).

Results and conclusions:
The investigators found egg consumption did not affect hs-CRP [WMD = 0.24 mg/L, 95% CI = -0.43 to 0.90, I2 = 53.8%, p = 0.48], IL-6 [WMD = 0.20 pg/mL, 95% CI =  -0.71 to 1.11, I2 = 69.3%, p = 0.50] and TNF-α [WMD = -0.38 pg/mL, 95% CI = -0.87 to 0.10, I2 = 0.00%, p = 0.12] relative to controls.

The investigators concluded that egg consumption has no effect on serum biomarkers of inflammation in adults.

Original title:
Effect of Egg Consumption on Inflammatory Markers: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials by Sajadi Hezaveh Z, Khalighi Sikaroudi M, […], Soltani S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31259415

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Inflammation in human body can be measured by means of biomarkers. These biomarkers are hs-CRP, IL-6 and TNF-α.
 

Objectives:
The prevalence of overweight/obesity in adults is raised to 39%, which is nearly tripled more than 1975. The alteration of the gut microbiome has been widely accepted as one of the main causal factors. Therefore, this review article has been conducted.

Does probiotics supplementation prevent overweight/obesity in adults?

Study design:
This review article included 12 RCTs (11 randomized, double-blinded, controlled trials and 1 randomized, single-blinded, controlled trial) with a total of 821 participants (416 participants were given placebo and 405 participants were given probiotics).

7 RCTs included participants who consumed two or multiple strains of probiotics and 5 RCTs included participants who consumed a single strain of probiotics.
7 RCTs investigated a high dosage of probiotics (>1010 CFU) and 5 RCTs investigated lower dosage of probiotics (1010 CFU).
Probiotics were administered in different forms, including sachet, capsule, powder, kefir, yogurt and fermented milk.
Duration of the probiotics supplementation ranged from 8 to 24 weeks.

There was no significant publication bias.

Results and conclusions:
The investigators found compared with control groups, probiotics supplementation resulted in a significantly reduction in body weight [WMD = -0.55, 95% CI = -0.91 to -0.19 kg, I2 = 64%, p = 0.003].
Subgroup analyses stratified by probiotics dosage, the number of probiotics strains or forms of probiotics showed the effects of probiotics supplementation on body weight were significantly reduced in trials with high dose of probiotics [WMD = -0.58, 95% CI = -0.92 to 0.23 kg], a single strain of probiotics [WMD = -0.49, 95% CI = -0.92 to -0.07 kg] and the capsule or powder of probiotics [WMD = -0.55, 95% CI = -0.84 to -0.26 kg].
Sensitivity analyses revealed that no particular studies significantly affected the summary effects of body weight.

The investigators found compared with control groups, probiotics supplementation resulted in a significantly reduction in BMI [WMD = -0.30, 95% CI = -0.43 to -0.18 kg/m², I2 = 59%, p = 0.006].
Subgroup analyses stratified by probiotics dosage, the number of probiotics strains or forms of probiotics showed the effects of probiotics supplementation on BMI were significantly reduced with the high dose [WMD = -0.29, 95% CI = -0.46 to -0.12 kg/m²] and single strain of probiotics [WMD = -0.36, 95% CI = -0.52 to -0.20 kg/m²].
Sensitivity analyses revealed that no particular studies significantly affected the summary effects of BMI.

The investigators found compared with control groups, probiotics supplementation resulted in a significantly reduction in waist circumference [WMD = -1.20, 95% CI = -2.21 to -0.19 cm, p = 0.02, I2 = 90%, p 0.00001].
Subgroup analyses stratified by probiotics dosage, the number of probiotics strains or forms of probiotics indicated the effects of probiotics supplementation on waist circumference were significantly reduced in trials with high dose of probiotics [WMD = -1.53, 95% CI = -2.64 to -0.41 cm], a single strain of probiotics [WMD = -1.69, 95% CI = -3.04 to -0.33 cm] and the food form of probiotics [WMD = -1.11, 95% CI = -1.64 to -0.59 cm].
Sensitivity analyses revealed that no particular studies significantly affected the summary effects of waist circumference.

The investigators found compared with control groups, probiotics supplementation resulted in a significantly reduction in fat mass [WMD = -0.91, 95% CI = -1.19 to -0.63 kg, p 0.00001, I2 = 43%, p = 0.08] and fat percentage [WMD = -0.92, 95% CI = -1.27 to -0.56%, p 0.00001, I2 = 57%, p = 0.04].
Subgroup analyses stratified by probiotics dosage, the number of probiotics strains and forms of probiotics indicated that the effect of probiotics supplementation on fat mass was significantly reduced, showing a greater decrease in fat mass with high dosage probiotics WMD -1.08, 95% CI = -1.21 to -0.95 kg] compared to low dosage probiotics [WMD = -1.00, 95% CI = -1.59 to -0.42 kg], a greater decrease with single strain probiotics [WMD = -1.15, 95% CI = -1.28 to -1.02 kg] compared to multiple strain probiotics [WMD = -0.60, 95% CI = -0.94 to -0.26] kg] and a greater decrease with administration probiotics in the form of food [WMD = -1.13, 95% CI = -1.58 to -0.67 kg] compared to in the forms of capsule or powder [WMD = -1.07, 95% CI = -1.20 to -0.94 kg].
No particular study significantly affected the pooled effect of probiotics on fat mass and fat percentage by sensitivity analyses.

The investigators found compared with control groups, probiotics supplementation significantly improved total cholesterol levels [SMD = -0.43, 95% CI = -0.80 to -0.07, p = 0.02, I2 = 73%, p = 0.001].
Subgroup analyses only stratified by probiotics dosage and the number of probiotics strains indicated the effects of probiotics supplementation on total cholesterol were significantly reduced in trials with single strain probiotics [WMD = -0.61, 95% CI = -1.54 to -0.32], compared to multiple strain probiotics [WMD = -0.39, 95% CI = -0.66 to -0.13].
Sensitivity analyses revealed that no particular studies significantly affected the summary effects of total cholesterol.

The investigators found compared with control groups, probiotics supplementation significantly improved LDL-cholesterol levels [SMD = -0.41, 95% CI = -0.77 to -0.04, p = 0.03, I2 = 73%, p = 0.001].
Subgroup analyses stratified by probiotics dosage and the number of probiotics strains indicated the effects of probiotics supplementation on LDL-cholesterol were significantly reduced in trials with multiple strain probiotics [WMD = -0.33, 95% CI = -0.57 to -0.09]. Sensitivity analyses revealed that no particular studies significantly affected the summary effects of LDL-cholesterol.

The investigators found compared with control groups, probiotics supplementation significantly improved fasting plasma glucose (FPG) [SMD = -0.35, 95% CI = -0.67 to -0.02, p = 0.04, I2 = 64%, p = 0.02].

The investigators found compared with control groups, probiotics supplementation significantly improved insulin [SMD = -0.44, 95% CI = -0.84 to -0.03, p = 0.03, I2 = 76%, p = 0.0008].

The investigators found compared with control groups, probiotics supplementation significantly improved HOMA-IR [SMD = -0.51, 95% CI = -0.96 to -0.05, p = 0.03, I2 = 76%, p = 0.003].

The investigators concluded probiotics supplementation during 8 to 24 weeks reduces the body weight and fat mass and improves some of the lipid and glucose metabolism parameters, although some of the effects were small. Probiotics may become a new potential strategy for the prevention and treatment of overweight/obesity in adult individuals.

Original title:
The Potential Role of Probiotics in Controlling Overweight/Obesity and Associated Metabolic Parameters in Adults: A Systematic Review and Meta-Analysis by Wang ZB, Xin SS, [...], Zhang XD.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500612/

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Objectives:
Previous studies reported that magnesium deficiency was associated with vascular calcifications, atherosclerosis and cardiovascular disease, which might play an independent pathogenic role in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. However, the results of these studies were somewhat underpowered and inconclusive. Therefore, this review article has been conducted.

Does hypomagnesemia (a low blood magnesium concentration) increase risk of mortality in patients with chronic kidney disease and end-stage renal disease?

Study design:
This review article included 20 studies involving 200,934 participants.

Results and conclusions:
The investigators found hypomagnesemia significantly increased risk of all-cause mortality in patients with chronic kidney disease and end-stage renal disease with 32% [multivariable adjusted HR = 1.32, 95% CI = 1.19-1.47, p 0.00001]. 

The investigators found, on the contrary, hypermagnesemia (a high blood magnesium concentration) significantly decreased risk of all-cause mortality in patients with chronic kidney disease and end-stage renal disease with 14% [HR = 0.86, 95% CI = 0.79-0.94, p = 0.001] (per unit increase).

The investigators found, moreover, hypermagnesemia significantly decreased risk of cardiovascular mortality in patients with chronic kidney disease and end-stage renal disease with 29% [adjusted HR = 0.71, 95% CI = 0.53-0.97, p = 0.03]. 

The investigators found subgroup analysis showed that hypomagnesemia significantly increased all-cause mortality in hemodialysis patients with 29% [HR = 1.29, 95% CI = 1.12-1.50, p = 0.0005].

The investigators concluded hypomagnesemia (a low blood magnesium concentration) increases cardiovascular and all-cause mortality in patients with chronic kidney disease and end-stage renal disease. Further studies evaluating benefits of magnesium correction in chronic kidney disease and dialysis patients with hypomagnesemia should be performed.

Original title:
Serum magnesium, mortality, and cardiovascular disease in chronic kidney disease and end-stage renal disease patients: a systematic review and meta-analysis by Xiong J, He T, […], Zhao J.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30888644

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Normal values of serum magnesium are considered those between 0.7 and 1.0 mmol/L.
Hypomagnesemia has a serum magnesium concentration of 0.7 mmol/L.
Blood magnesium concentration can be increased by eating magnesium-rich foods and/or taking magnesium supplements.

Objectives:
Insulin resistance, dyslipidemia and increased systemic inflammation are important risk factors for chronic kidney disease (CKD). Hence, vitamin D administration might be an appropriate approach to decrease the complications of chronic kidney disease. Therefore, this review article has been conducted.

Have vitamin D supplements beneficial effects on people with chronic kidney disease?

Study design:
This review article included 17 RCTs.

Results and conclusions:
The investigators found pooling findings from 5 RCTs revealed a significant reduction in fasting glucose among people with chronic kidney disease [WMD = -18.87, 95% CI = -23.16 to -14.58] following the administration of vitamin D.

The investigators found pooling findings from 3 RCTs revealed a significant reduction in homeostatic model assessment of insulin resistance (HOMA-IR) among people with chronic kidney disease [WMD = -2.30, 95% CI = -2.88 to -1.72] following the administration of vitamin D.

The investigators found pooling findings from 6 RCTs revealed a significant reduction in triglycerides among people with chronic kidney disease [WMD = -32.52, 95% CI = -57.57 to -7.47] following the administration of vitamin D or treatment.

The investigators found pooling findings from 5 RCTs revealed a significant reduction in total cholesterol concentrations among people with chronic kidney disease [WMD = -7.93, 95% CI = -13.03 to -2.83] following the administration of vitamin D or treatment.

The investigators found there was no effect on insulin, HbA1c, LDL and HDL cholesterol and CRP levels among people with chronic kidney disease following the administration of vitamin D or treatment.

The investigators concluded there are beneficial effects of vitamin D supplementation or treatment on improving fasting glucose, HOMA-IR, triglycerides and total cholesterol levels among patients with chronic kidney disease.

Original title:
The effects of vitamin D treatment on glycemic control, serum lipid profiles, and C-reactive protein in patients with chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials by Milajerdi A, Ostadmohammadi V, […], Asemi Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31338797

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Objectives:
Does dietary intake of n-3 PUFAs (such as DHA, EPA, DPA and ALA) or fish consumption improve lung function?

Study design:
This review article included 9 cohort studies from the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium (n = 37,077 black and white participants).

In each cohort and each ancestry, separately, associations of dietary n-3 PUFA/fish intake with lung function were estimated in linear regression models.
Fixed-effects meta-analysis was used to generate summarized effect estimates across the cohorts and ancestries.

The lung function was measured by the forced expiratory volume in 1 second (FEV1) and the forced vital capacity (FVC).

Results and conclusions:
The investigators found dietary DPA, DHA, EPA and fish intake significantly improved forced expiratory volume in one second (FEV1) and forced vital capacity (FVC).
However, dietary α-linolenic acid (ALA) had little to no association with these lung function parameters.

The investigators found associations were similar for black and white participants and consistent in direction and magnitude across most cohort studies.

The investigators found for all participants, 1 standard deviation (SD) higher dietary intake of DPA (∼30 mg/d), DHA (∼200 mg/d) and EPA (∼150 mg/d) were associated with 12-16 mL higher FEV1 and 10-15 mL higher FVC.
The effect estimates for fish consumption were in the same direction but smaller in magnitude.

The investigators found ∼200 mg/d DHA and ∼150 mg/d EPA were associated with 28-32 mL higher FEV1 and 24-25 mL higher FVC in current smokers.

The investigators found ∼200 mg/d DHA and ∼150 mg/d EPA were associated with 17-21 mL higher FEV1 and 7-12 mL higher FVC in former smokers.

The investigators found ∼200 mg/d DHA and ∼150 mg/d EPA had little to no association with FEV1 and FVC in never smokers.

The investigators concluded that dietary ∼200 mg/d DHA, ∼30 mg/d DPA and ∼150 mg/d EPA and fish intake are associated with higher lung function, especially among current and former smokers.

Original title:
Positive Associations of Dietary Marine Omega-3 Polyunsaturated Fatty Acids with Lung Function: A Meta-analysis (P18-087-19) by Patchen B, Xu J, […], Cassano P.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6579416/  

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DHA, DPA and EPA are found in fish.

 

Objectives:
Whether exercise can improve cardiovascular health in kidney transplant recipients (KTRs) is unclear. Therefore, this review article (meta-analysis) has been conducted.

Does exercise improve cardiovascular health in kidney transplant recipients?

Study design:
This review article included 12 RCTs (trials) in the review and 11 RCTs for further qualitative analysis.
Most trials provided a 30-60 minutes exercise session for 2-4 times per week.
In terms of the total intervention period, most trials ranged from 10 weeks to 6 months.

Results and conclusions:
The investigators found in 5 trials with a total of 199 participants that exercise had no effects on either systolic [MD = 1.67, 95% CI = -2.17 to 5.51, p = 0.39] or diastolic blood pressure [MD = 0.65, 95% CI = -4.02 to 5.32, p = 0.78].

The investigators found in 3 trials with a total of 261 participants that exercise had no significant benefits in overall lipid profile [MD = 0.03, 95% CI = -0.09 to 0.15, p = 0.62].
In subgroup analysis, total cholesterol [p = 0.15], LDL cholesterol [p = 0.83] and triglyceride [p = 0.82] were not ameliorated by exercise.

The investigators found in 2 trials with 22 subjects in the exercise group and 28 controls that a 12 months of resistance training or regimens of aerobic or resistance training for 12 weeks was not associated with an improvement in kidney function [MD = 2.60, 95% CI = -12.88 to 13.09, p = 0.74].

The investigators found that aerobic training, resistance training or the combination during 12 weeks to 12 months was not associated with an improvement on body weight [MD = -2.02, 95% CI = -8.24 to 4.20, p = 0.52, n = 3] or BMI [MD = 0.12, 95% CI = -1.52 to 1.77, p = 0.88, n = 4].

The investigators found in 2 trials with a total of 64 participants that a 12-week exercise showed a consistent improvement in small arterial stiffness [MD = -1.14, 95% CI = -2.19 to -0.08, p = 0.03].

The investigators found in 5 trials with a total of 202 participants that aerobic training, resistance training or combined method over the course of 12 weeks to 12 months had a significant improvement in exercise capacity (VO₂ peak) [MD = 2.25, 95% CI = 0.54 to 3.69, p = 0.01]. 

The investigators found exercise improved quality of life in different aspects, with significant enhancement in social functioning [MD = 16.76, 95% CI = 2.16 to 31.37, p = 0.02] and overall QOL scores [MD = 12.87, 95% CI = 6.80 to 18.94, p 0.01].

The investigators concluded exercise intervention in kidney transplant recipients improves arterial stiffness and it also improves exercise tolerance and quality of life. Additional long-term RCTs examining a greater number of patients are needed to understand the effects of exercise on cardiovascular health in kidney transplant recipients.

Original title:
Effects of exercise training on cardiovascular risk factors in kidney transplant recipients: a systematic review and meta-analysis by Chen G, Liu Gao L and Li X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534232/

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Objectives:
The role of fruit and vegetables (FVs) consumption in decreasing gallstone disease risk remains contradictory.Therefore, this review article has been conducted.

Does fruit or vegetables consumption reduce risk of gallstone disease?

Study design:
This review article included 1 cross-sectional study, 1 case-control studie and 9 cohort studies, covering approximately 33,983 patients with gallstone disease and 1,53,3752 participants.

Results and conclusions:
The investigators found in a pooled analysis, vegetables consumption was significantly related to a decreased gallstone disease risk of 17% [RR  =  0.83, 95% CI = 0.74-0.94, I2  =  91.1%]. This reduced gallstone disease risk was solid in most subgroup analysis.

The investigators found in a pooled analysis, fruits consumption was significantly related to a decreased gallstone disease risk of 12% [RR  =  0.88, 95% CI = 0.83-0.92, I2  =  0.01%].  
This reduced gallstone disease risk was solid in most subgroup analysis.

The investigators found nonlinear dose-response analysis indicated that gallstone risk was reduced by 4% [RR  =  0.96, 95% CI = 0.93-0.98, p =0.001] for every 200 g per day increment in vegetables consumption.

The investigators found nonlinear dose-response analysis indicated that gallstone risk was reduced by 3% [RR  =  0.97, 95% CI = 0.96-0.98, p =0.001] for every 200 g per day increment in fruits consumption.

The investigators concluded that vegetables and fruits consumption, particularly 200g fruits or 200g vegetables per day is correlated with a reduced risk of gallstone disease.

Original title:
Fruits and vegetables consumption and the risk of gallstone diasease: A systematic review and meta-analysis by Zhang JW, Xiong JP, [...], Zhao HT.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31305451

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Objectives:
Has L-carnitine supplementation positive effects on inflammatory mediators including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)?

Study design:
This review article included 13 RCTs.

Results and conclusions:
The investigators found L-carnitine supplementation was significantly associated with lower levels of CRP in comparison to controls [WMD = -1.23 mg/L, 95% CI = -1.73 to -0.72 mg/dL, p  0.0001].
This reduced effect was greatest during an intervention of more than 12 weeks.

The investigators found L-carnitine supplementation was also significantly associated with lower levels of IL-6 in comparison to controls [WMD = -0.85 pg/dL, 95% CI = -1.38 to -0.32 pg/dL, p = 0.002].
This reduced effect was greatest during an intervention of more than 12 weeks.

The investigators found L-carnitine supplementation was also significantly associated with lower levels of TNF-α in comparison to controls [WMD = -0.37 pg/dL, 95% CI = -0.68 to -0.06 pg/dL, p = 0.018].
This reduced effect was greatest during an intervention of more than 12 weeks.

The investigators concluded that L-carnitine supplementation reduces levels of inflammatory mediators, especially in studies with a duration of more than 12 weeks. Further studies with different doses and intervention durations and separately in men and women are necessary.

Original title:
The effect of L-carnitine on inflammatory mediators: a systematic review and meta-analysis of randomized clinical trials by Haghighatdoost F, Jabbari M and Hariri M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/30915521 

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Objectives:
Although many studies have shown that low zinc status is associated with diabetes, the putative effects of zinc supplementation on glycemic control are inconclusive. Therefore, this review article (meta-analysis) has been conducted.

Does zinc supplementation reduce risk of diabetes mellitus?

Study design:
This review article included 32 RCTs, involving a total of 1,700 participants in 14 countries.

Results and conclusions:
The investigators found overall, compared with their respective control groups, the subjects in the zinc supplementation group had a statistically significant reduction in concentrations of :
-fasting glucose [WMD = -14.15 mg/dL, 95% CI = -17.36 to -10.93 mg/dL];
-2-h postprandial glucose [WMD = -36.85 mg/dL, 95% CI = -62.05 to -11.65 mg/dL];
-fasting insulin [WMD = -1.82 mU/L, 95% CI = -3.10 to -0.54 mU/L];
-homeostasis model assessment for insulin resistance [WMD = -0.73, 95% CI = -1.22 to -0.24]:
-glycated hemoglobin [WMD = -0.55%, 95% CI = -0.84 to -0.27%] and;
-high-sensitivity C-reactive protein [WMD = -1.31 mg/L, 95% CI = -2.05 to -0.56 mg/L].

The investigators found, moreover, subgroup analyses revealed that the effects of zinc supplementation on fasting glucose were significantly influenced by diabetic status and the formulation of the zinc supplement.

The investigators concluded several key glycemic indicators are significantly reduced by zinc supplementation, particularly the fasting glucose in subjects with diabetes and in subjects who received an inorganic zinc supplement. Together, these findings support the notion that zinc supplementation may have clinical potential as an adjunct therapy for preventing or managing diabetes.

Original title:
Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials by Wang X, Wu W, [...], Wang F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/31161192

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