Nutrition and health

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:
Do high maternal or neonatal DHA and/or EPA levels increase offspring birth weight and weight in childhood?

Study design:
This review article included 27 RCTs with 6,408 infants and 14 observational studies.

Results and conclusions:
The investigators found in RCTs that >650 mg/day DHA and/or EPA supplementation significantly increased birth weight [MD = 87.5g, 95% CI = 52.3 to 122.6, n = 3,831 participants, moderate quality].

The investigators found in RCTs that >650 mg/day DHA and/or EPA supplementation significantly increased combined BMI and BMI z score at 5-10 years [SMD = 0.11, 95% CI = 0.04 to 0.18, n = 3,220 participant, moderate quality].

The investigators found results from the observational studies were generally inconsistent. High trans fatty acids levels during pregnancy seemed to be associated with lower birth weight.

The investigators concluded this review and meta-analysis support a relationship between high maternal or neonatal DHA and/or EPA levels and higher offspring birth weight and weight in childhood. More high-quality long-term studies are still needed.

Original title:
Systematic Literature Review and Meta-Analysis of the Relationship Between Polyunsaturated and Trans Fatty Acids During Pregnancy and Offspring Weight Development by Ren X, Vilhjálmsdóttir BL, […], Specht  IO.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027310/

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Objectives:
Does intake of folic acid during pregnancy reduce risk of offspring's autism spectrum disorders?

Study design:
This review article included 10 studies with 23 sub-studies (9,795 autism spectrum disorders cases).

Results and conclusions:
The investigators found folic acid supplementation during early pregnancy significantly reduced risk of offspring's autism spectrum disorders with 43% [OR = 0.57, 95% CI = 0.41 to 0.78].

The investigators found the consumption of a daily amount of at least 400 μg folic acid from dietary sources and supplements significantly reduced risk of offspring's autism spectrum disorders with 45% [OR = 0.55, 95% CI = 0.36 to 0.83].

The investigators concluded that the consumption of a daily amount of at least 400 μg (400 mcg) folic acid from dietary sources and supplements during pregnancy reduces risk of offspring's autism spectrum disorders.

Original title:
Prenatal Folic Acid Supplements and Offspring's Autism Spectrum Disorder: A Meta-analysis and Meta-regression by Liu X, Zou M, [...], Chen WX.

Link:
https://pubmed.ncbi.nlm.nih.gov/33743119/

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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:
Does vitamin A supplementation reduce risk of bronchopulmonary dysplasia (BPD) in premature infants?

Study design:
This review article included 9 RCTs with 709 infants received vitamin A treatment (intervention group) and 700 infants did not receive vitamin A treatment (control group).
The dose of vitamin A regimens varied from 1500 to 10,000 IU (450 to 3,003 micrograms) and the treatment durations generally lasted for 4 weeks.

The funnel plots for all synthesized outcomes remained symmetrical, indicating that there was no significant publication bias.

Results and conclusions:
The investigators found when compared to the control group, vitamin A supplementation significantly reduced the incidence of bronchopulmonary dysplasia in premature infants with 33% [OR  =  0.67, 95% CI = 0.52 to 0.88].
The sensitivity analyses were performed by excluding single RCT one by one. The results of sensitivity analysis of all outcomes had indicated no substantial result changes among the overall estimates.

The investigators concluded that vitamin A supplementation is beneficial to reduce bronchopulmonary dysplasia in premature infants.  

Original title:
Vitamin A supplementation prevents the bronchopulmonary dysplasia in premature infants: A systematic review and meta-analysis by Ding Y, Chen Z and Lu Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837939/

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Bronchopulmonary dysplasia is a form of chronic lung disease that develops in preterm neonates treated with oxygen and positive-pressure ventilation.
 

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.
 

Objectives:
Does a high dietary cholesterol intake increase risk of gestational diabetes mellitus?

Study design:
This review article included 3 cohort studies, 4 cross-sectional studies and 2 case-control studies involving 30,123 participants and 3,237 women with gestational diabetes mellitus (diabetes mellitus in pregnancy).

Results and conclusions:
The investigators found comparing highest versus lowest category of dietary cholesterol intake, that the highest dietary cholesterol intake significantly increased risk of gestational diabetes mellitus with 49% [pooled RR = 1.49, 95% CI = 1.18 to 1.88].

The investigators found in dose-response analysis that the risk of gestational diabetes mellitus significantly increased by 32% [RR = 1.32, 95% CI = 1.20 to 1.45] for every increase of 100 mg per day in dietary cholesterol intake.

The investigators concluded a high dietary cholesterol intake (at least 100 mg per day) increases risk of gestational diabetes mellitus.

Original title:
Dietary Cholesterol Intake and Risk of Gestational Diabetes Mellitus: A Meta-Analysis of Observational Studies by Gao F and Cui CY.

Link:
https://pubmed.ncbi.nlm.nih.gov/33416437/

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Objectives:
Are serum albumin concentrations lower in patients with stable COPD compared to non-COPD controls?  

Study design:
This review article included 26 studies with a total of 2,554 COPD patients (74% males) and 2,055 non-COPD controls (63% males).
Overall, the mean age of participants across all studies was 61.7 years in COPD patients and 64.6 years in controls (patients without COPD).
Almost all (24 out of 26) were prospective cohort studies.

The Begg’s [p = 0.04] and Egger’s tests [p = 0.01] showed a significant publication bias; however, the trim-and-fill analysis found that no study was missing or should be added.

Results and conclusions:
The investigators found pooled results showed that serum albumin concentrations were significantly lower in COPD patients [SMD = -0.50, 95% CI = -0.67 to -0.32, p 0.001, I2 = 85.7%, p 0.001] .
Sensitivity analysis showed that the effect size was not modified when any single study was in turn removed [effect size ranged between -0.44 and -0.52].

The investigators found no significant differences in SMD of serum albumin concentrations between COPD patients with forced expiratory volume in the 1st second (FEV1) 50% and those with FEV1 > 50%.

The investigators concluded that serum albumin concentrations are lower in patients with stable COPD compared to non-COPD controls. This supports the presence of a deficit in systemic anti-inflammatory and antioxidant defense mechanisms in COPD.

Original title:
Serum Albumin Concentrations in Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis by Zinellu E, Fois AG, […], Pirina P.

Link:
https://www.mdpi.com/2077-0383/10/2/269/htm

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Objectives:
Taurine plays a pivotal role in regulating glucose and lipid metabolism, blood pressure homeostasis and obesity largely due to its cytoprotective, antioxidant and anti-inflammatory actions. Despite promising data from animal studies in this scenario, the efficacy of taurine supplementation in human studies has been inconsistent. Therefore, this review article has been conducted.

Does taurine supplementation lower blood pressure and improve the lipid profile in patients with liver dysregulation?

Study design:
This review article included 12 RCTs.
Most studies were conducted in patients with liver or metabolic dysregulation (diabetes, hepatitis, fatty liver, obesity, cystic fibrosis, chronic alcoholism and cardiac surgery).
The taurine dosage varied from 0.5 to 6 g/d for 15 days to 6 months.

Results and conclusions:
The investigators found that taurine administration (supplementation) had a significant effect of on systolic blood pressure [WMD = -4.67 mm Hg, 95% CI = -9.10 to -0.25], diastolic blood pressure [WMD = -2.90 mm Hg, 95% CI = -4.29 to -1.52], total cholesterol levels [WMD = -10.87 mg/dL, 95% CI = -16.96 to -4.79] and triglycerides levels [WMD = -13.05 mg/dL, 95% CI = -25.88 to -0.22]. 

The investigators found, however, that taurine administration had no effect on fasting blood glucose [WMD = 0.06 mg/dL], HDL cholesterol [WMD = 0.90 mg/dL], LDL cholesterol [WMD = -6.17 mg/dL], as well as on body mass index [WMD = -0.46 kg/m²] and body weight [WMD = -0.47 kg] as the anthropometric measures.

The investigators concluded that, in patients with liver dysregulation, taurine supplements (0.5 to 6 g/d for 15 days to 6 months) reduce blood pressure and improve the lipid profile by reducing total cholesterol and triglyceride levels.

Original title:
The effects of taurine supplementation on obesity, blood pressure and lipid profile: A meta-analysis of randomized controlled trials by Guan L and Miao P.

Link:
https://pubmed.ncbi.nlm.nih.gov/32871172/

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The main sources of taurine are animal foods, such as meat, fish and dairy products.

Objectives:
Do melatonin supplements improve sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adults with various diseases?

Study design:
This review article included a total of 23 RCTs.

Results and conclusions:
The investigators found that melatonin supplements had significant effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) [WMD = -1.24, 95% CI = -1.77 to -0.71, p = 0.000, I2 = 80.7%, p = 0.000].

The investigators found subgroup analysis based on health status revealed melatonin supplements in subjects with respiratory diseases [WMD = -2.20, 95% CI = -2.97 to -1.44, p = 0.000], metabolic disorders [WMD = -2.74, 95% CI = -3.48 to -2.00, p = 0.000] and sleep disorders [WMD = -0.67, 95% CI = -0.98 to -0.37, p = 0.000] had significant effects on sleep quality.

The investigators concluded the treatment with exogenous melatonin (melatonin supplements) has positive effects on sleep quality as assessed by the Pittsburgh Sleep Quality Index (PSQI) in adults, particularly with respiratory diseases, metabolic disorders, primary sleep disorders; however, not with mental disorders, neurodegenerative diseases and other diseases.

Original title:
Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials by Fatemeh G, Sajjad M, […], Khadijeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33417003/

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Objectives:
A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) actually benefit from a DPI of ≤ 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1-3 has not been consistent. Therefore, this review article has been conducted.

Do patients with diabetic kidney disease benefit from a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day)?

Study design:
This review article included 9 RCTs with a total of 506 participants and follow-up periods varying from 4.5 to 60 months.

Results and conclusions:
The investigators found that patients with diabetic kidney disease who consumed 0.8 g protein/kg/day had a significantly reduced decline in glomerular filtration rate (GFR) [MD = 22.31 mL/min/1.73 m², 95% CI = 17.19 to 27.42, p 0.01] and a significant decrease in proteinuria [SMD = -2.26 units, 95% CI = -2.99 to -1.52, p 0.001] versus those on the control diet.

The investigators found the benefits of a low-protein diet to patients with diabetic kidney disease at chronic kidney disease stages 1-3 were a markedly decreased proteinuria [SMD - 0.96 units, 95% CI = -1.81 to -0.11, p = 0.03] and slight but significant decreases in glycated hemoglobin [-0.42%] and cholesterol levels [-0.22 mmol/L].

The investigators concluded that a dietary protein intake of 0.8 g/kg/day is strongly associated with a slow decline in glomerular filtration rate (GFR) and decreases proteinuria in the patients with diabetic kidney disease. Patients with chronic kidney disease (CKD) stages chronic kidney disease 1-3 benefit from a low-protein diet in terms of a marked decrease of proteinuria and slight but significant improvements in lipid and glucose control.  

Original title:
Diabetic Kidney Disease Benefits from Intensive Low-Protein Diet: Updated Systematic Review and Meta-analysis by Li Q, Wen F, [...], Wang W.

Link:
https://pubmed.ncbi.nlm.nih.gov/33150563/

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For example: you are a patient with diabetic kidney disease, you weigh 70 kg and you want to eat 2200 kcal every day. How should you meet a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day) in daily life?
Every day you should take maximal 0.8 g protein x 70 kg = 56 g protein. 56 g protein give 56x4 kcal = 224 kcal. 224 kcal is around 10% of 2200 kcal. Thus, you should eat products whose protein content contributes maximum 10% to the total kcal of the product in question, meaning you should eat products with 10 En% protein. These products in the supermarket contain maximum 10 En% protein.

Thus, a dietary protein intake of 0.8 g protein per kilogram body weight per day (g/kg/day) for a person weighing 70 kg on a diet of 2200 kcal, means he/she should eat products with maximum 10 En% protein in daily life.