Nutrition and health

Objectives:
Do diets rich in protein causually reduce body weight of adults with overweight or obesity? 

Study design:
This review article included 37 RCTs.
The diets were included during a mean of 32 weeks interventions, ranging from 8 to 104 weeks.

There was no publication bias.

Results and conclusions:
The investigators found protein intake (ranging from 18-59 energy percentage [En%]) significantly reduced body weight by 1.6 kg [95% CI = 1.2 to 2.0 kg, I2 = 56%] compared to controls (digestible carbohydrate, fiber, fat or no supplementation (no placebo used)).
This result was also found in sensitivity analysis.

The investigators found the effect size of dietary protein in body weight management was dependent on specific phenotypes, where individuals with prediabetes had more benefit compared to individuals with normoglycemia.
Furthermore, individuals without the obesity risk allele (AA genotype) had more benefit compared to individuals with the obesity risk alleles (AG and GG genotypes).

The investigators concluded that diets rich in protein (18-59 energy percentage [En%]) during 32 weeks causally have a moderate beneficial effect on body weight management of adults with overweight or obesity.

Original title:
Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein by Hansen TT, Astrup A and Sjödin A.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468854/

Additional information of El Mondo:
Find more information/studies on protein consumption and overweight right here.

A diet rich in protein with 18-59 energy percentage [E%] or a diet with 18-59 En% protein means that the amounts of protein contribute 18 to 59% to the total calories (kcal) of the diet.
If the diet contains 2000 kcal, 90 grams of protein contribute 18% to this 2000 kcal.
1 gram of protein gives 4 kcal. Thus 90 grams of protein provide 360 kcal (90x4 kcal) and 360 kcal is 18% of 2000 kcal.

The most easy way to follow a diet rich in protein with 18-59 energy percentage is to choose only meals/products with 18-59 En% protein. Check here which products contain 18-59 En% protein.

However, the most practical way to follow a diet with 18-59 En% protein is, all meals/products that you eat on a daily basis should contain on average 18-59 En% protein.

To do this, use the 7-points nutritional profile app to see whether your daily diet contains 18-59 En% protein.

A high-protein diet is a diet with at least 20 En% protein.

 

Objectives:
The association between vitamin C and metabolic syndrome (MetS) has been evaluated in several epidemiological studies with conflicting results. Therefore, this review article has been conducted.

Do dietary vitamin C intake and circulating vitamin C level reduce risk of metabolic syndrome? 

Study design:
This review article included 26 cross-sectional studies and 2 cohort studies with a total number of 110,771 participants. 23 studies were related to the dietary vitamin C level.
The sample size ranged from 143 to 27,656 persons.
The dietary vitamin C level was assessed by food-frequency questionnaire (FFQ) in 4 studies, a 24-h or 3-day recall in 18 studies and a 4-day record in 1 study.

No evidence of publication bias existed according to Begg's rank correlation test [p = 0.495].

Results and conclusions:
The investigators found when compared to the lowest dietary vitamin C intake, that the highest dietary vitamin C intake significantly reduced risk of metabolic syndrome with 7% [overall multivariable-adjusted RR = 0.93, 95% CI = 0.88 to 0.97, p = 0.003, I2 = 54.5%, p = 0.003]. The above findings were confirmed in cross-sectional studies [RR = 0.92, 95% CI = 0.87 to 0.97, p = 0.001] and 24-h or 3-day recall [RR = 0.89, 95% CI = 0.86 to 0.93, p 0.001] studies.

The investigators found when compared to the lowest circulating vitamin C level, that the highest circulating vitamin C level significantly reduced risk of metabolic syndrome with 40% [overall multivariable-adjusted RR = 0.60, 95% CI = 0.49 to 0.74, p 0.001, I2 = 22.7%, p = 0.249].

The investigators concluded that both the dietary and the circulating vitamin C level reduce risk of metabolic syndrome. However, due to the limitation of the available evidence, more well-designed prospective studies are still needed.

Original title:
Vitamin C and Metabolic Syndrome: A Meta-Analysis of Observational Studies by Guo H, Ding J, [...], Zhang Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531097/

Additional information of El Mondo:
Find more information/studies on vitamin C consumption and overweight right here.

In practice, a lot of dietary vitamin C intake amounts to 200 to 300 grams of vegetables and 2-5 pieces of fruit per day. Vitamin C is found in fruit and vegetables.

A high circulating vitamin C level can be obtained through vitamin C-rich food and/or taking vitamin C supplements.

 

Objectives:
The associations between dietary carbohydrate and diverse health outcomes remain controversial and confusing. Therefore, this review article (meta-analyse) has been conducted.

What is the association between dietary carbohydrate intake and diverse health outcomes?

Study design:
This review article included 43 meta-analyses of observational research studies with 23 health outcomes, including cancer (n = 26), mortality (n = 4), metabolic diseases (n = 4), digestive system outcomes (n = 3) and other outcomes [coronary heart disease (n = 2), stroke (n = 1), Parkinson's disease (n = 1) and bone fracture (n = 2)].

This umbrella review summarized 281 individual studies with 13,164,365 participants.

33.3% studies were considered to be of high quality and 66.7% of moderate quality.

Results and conclusions:
The investigators found highly suggestive evidence showed that dietary carbohydrate intake significantly increased risk of metabolic syndrome with 25% [adjusted summary odds ratio = 1.25, 95% CI = 1.15 to 1.37].

The investigators found suggestive evidence showed that dietary carbohydrate intake significantly decreased risk of esophageal adenocarcinoma with 43% [adjusted summary hazard ratio = 0.57, 95% CI = 0.42 to 0.78].

The investigators found suggestive evidence showed that dietary carbohydrate intake significantly increased risk of all-cause mortality with 19% [adjusted summary hazard ratio 1.19, 95% CI = 1.09 to 1.30].

The investigators concluded despite the fact that numerous systematic reviews and meta-analyses have explored the relationship between carbohydrate intake and diverse health outcomes, there is no convincing evidence of a clear role of carbohydrate intake. However, highly suggestive evidence shows carbohydrate intake is associated with higher risk of metabolic syndrome. Suggestive evidence shows carbohydrate intake is associated with higher risk of all-cause mortality and lower risk of esophageal adenocarcinoma.

Original title:
Dietary Carbohydrate and Diverse Health Outcomes: Umbrella Review of 30 Systematic Reviews and Meta-Analyses of 281 Observational Studies by Liu YS, Wu QJ […], Zhao YH.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116488/

Additional information of El Mondo:
Find more information/studies on carbohydrate consumption and obesity/overweight right here.

Objectives:
What is the association between red meat and poultry consumption and the risk of metabolic syndrome?

Study design:
This review article included 9 prospective cohort studies, which involved a total of 21,869 participants.
Among them, 8 studies were identified for red meat consumption.

No publication bias was observed according to the Begg's rank-correlation test and the Egger's test.  

Results and conclusions:
The investigators found that red meat consumption was significantly associated with a higher risk of 35% for metabolic syndrome [multi-variable adjusted RR = 1.35, 95% CI = 1.13 to 1.62, p = 0.001, I2 = 54.4%, p = 0.032].  
The same results were obtained in subgroup analysis for >5 years follow-up [RR = 1.36, 95% CI = 1.09 to 1.7, p = 0.006], non-National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III) [RR = 1.34, 95% CI = 1.12 to 1.62, p = 0.002], Non-Asia [RR = 1.51, 95% CI = 1.29 to 1.77, p 0.001], adjustment of BMI [RR = 1.4, 95% CI = 1.23 to 1.6, p 0.001] and physical activity studies [RR = 1.48, 95% CI = 1.29 to 1.71, p 0.001].

The investigators found that unprocessed red meat consumption was significantly associated with a higher risk of 32% for metabolic syndrome [multi-variable adjusted RR = 1.32, 95% CI = 1.14 to 1.54, p = 0.0003, I2 = 0%, p = 0.397].  

The investigators found that processed red meat consumption was significantly associated with a higher risk of 48% for metabolic syndrome [multi-variable adjusted RR = 1.48, 95% CI = 1.11 to 1.97, p = 0.007, I2 = 64.7%, p = 0.097].  

The investigators found that poultry consumption was significantly associated with a lower risk of 15% for metabolic syndrome [multi-variable adjusted RR = 0.85, 95% CI = 0.75 to 0.97, p = 0.02, I2 = 0%, p = 0.707].  

The investigators concluded that red meat (processed and unprocessed) consumption is associated with a higher risk of metabolic syndrome, whereas, poultry consumption is associated with a lower risk of metabolic syndrome. More well-designed randomized controlled trials are still needed to address the issues further.

Original title:
Association of Red Meat and Poultry Consumption With the Risk of Metabolic Syndrome: A Meta-Analysis of Prospective Cohort Studies by Guo H, Ding J, [...], Zhang Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295459/

Additional information of El Mondo:
Find more information/studies on meat consumption and obesity/overweight right here.

Objectives:
Nuts are recommended for cardiovascular health, yet concerns remain that nuts may contribute to weight gain due to their high energy density. Therefore, this review article has been conducted.

Does nut consumption contribute to an increased adiposity risk?

Study design:
This review article included 6 prospective cohort studies with 569,910 participants and 86 RCTs with 114 comparisons and 5,873 participants.

Results and conclusions:
The investigators found nuts consumption was significantly associated with a lower risk of 7% for incidence of overweight/obesity [RR = 0.93, 95% CI = 0.88 to 0.98, p 0.001, moderate certainty of evidence] in prospective cohort studies.

The investigators found RCTs showed no adverse effect of nuts on body weight [MD = 0.09 kg, 95% CI = -0.09 to 0.27 kg, p 0.001, high certainty of evidence].

The investigators found meta-regression showed that higher nut intake was significantly associated with reductions in body weight and body fat.

The investigators concluded that current evidence demonstrates the concern that nut consumption contributes to increased adiposity appears unwarranted.

Original title:
Are fatty nuts a weighty concern? A systematic review and meta-analysis and dose-response meta-regression of prospective cohorts and randomized controlled trials by Nishi SK, Viguiliouk E, [...], Sievenpiper JL.

Link:
https://pubmed.ncbi.nlm.nih.gov/34494363/

Additional information of El Mondo:
Find more information/studies on nut consumption and obesity/overweight right here.

Objectives:
Diets with high glycemic index (GI) or high glycemic load (GL) have been linked to important risk factors associated with the development of metabolic syndrome (MetS), such as dyslipidemia, higher blood glucose and insulin concentrations. However, the role of GI and GL in relation to metabolic syndrome is still understudied and controversial. Therefore, this review article has been conducted.

Does high dietary GI or GL increase risk of metabolic syndrome?

Study design:
This review article included 1 cohort study and 11 cross-sectional studies with a total sample size of 36,295 subjects.

Results and conclusions:
The investigators found, the pooled effect sizes from the 9 studies indicated high versus low dietary GI was significantly associated with increased risk of 5% for metabolic syndrome [OR = 1.05, 95% CI = 1.01 to 1.09, I2 = 58.1%, p = 0.004].
This finding was supported by all subgroup analyses except where studies used 24-h recalls for dietary assessment.

The investigators found, additionally, a linear dose-response investigation revealed that each 5-point increment in GI was associated with 2% increase in the risk of metabolic syndrome [OR = 1.02, 95% CI = 1.01 to 1.02].
Howver, non-linear pattern was insignificant [p-nonlinearity = 0.63].

The investigators found, moreover, pooled effect sizes from 10 studies suggested that no association was found between the GL and metabolic syndrome with results remaining consistent in all subgroup analyses.

The investigators concluded that high dietary GI increases risk of metabolic syndrome. Nutrition policy and clinical practices should encourage a diet with low GI. Future studies should include both GI and GL and different criteria of metabolic syndrome to provide a better comparison.

Original title:
Glycemic index, but not glycemic load, is associated with an increased risk of metabolic syndrome: Meta-analysis of observational studies by Askari M, Dehghani A, […], Alizadeh S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33928722/

Additional information of El Mondo:
Find more information/studies on GI and overweight right here.

A diet with low GI is a diet with GI of 55 or lower.

Objectives:
Excess body weight, including overweight and obesity, is one of the major factors influencing human health and plays an important role in the global burden of disease. Carotenoids serve as precursors of vitamin A-related retinoids and are considered to have potential effects on many diseases. However, the influence of carotenoids on people with excess body weight is unclear. Therefore, this review article has been conducted.

Does carotenoid supplementation reduce risk of overweight and obesity in overweight or obese subjects?

Study design:
This review article included 7 randomized controlled trials (RCTs) and 8 observational studies with 28,944 subjects and data on multiple carotenoid subgroups, including lycopene, astaxanthin, cryptoxanthin, α-carotene, and β-carotene.

In all included RCTs, the intervention duration was 20 days at the shortest and 16 weeks at the longest and the range of intervention doses was 1.2-60 mg/d.

Results and conclusions:
The investigators found that the insufficiency of serum carotenoids significantly increased risk of overweight and obesity with 73% [OR = 1.73, 95% CI = 1.57 to 1.91, p 0.001].

The investigators found, moreover, carotenoid supplementation was significantly associated with body weight reductions [SMD = -2.34 kg, 95% CI = -3.80 to -0.87 kg, p 0.001], body mass index decrease [SMD = -0.95 kg/cm², 95% CI = -1.88 to -0.01 kg/cm², p 0.001] and waist circumference losses [SMD = -1.84 cm, 95% CI = -3.14 to -0.54 cm, p 0.001].

The investigators concluded that 1.2-60 mg/d carotenoid supplementation reduces risk of overweight and obesity in overweight or obese subjects. Furthermore, an insufficiency of serum carotenoids is a risk factor for overweight and obesity. Additional data from large clinical trials are needed.

Original title:
The association between carotenoids and subjects with overweight or obesity: a systematic review and meta-analysis by Yao N, Yan S, […], Cui W.

Link:
https://pubmed.ncbi.nlm.nih.gov/33977977/

Additional information of El Mondo:
Find more information/studies on carotenoid consumption and obesity/overweight right here.

Am I overweight?
 

Objectives:
The evidence on the association between obesity and atrial fibrillation (AF) recurrence was equivocal. Therefore, this review article (meta-analysis) has been conducted.

Does obesity increase risk of atrial fibrillation recurrence in patients undergoing catheter ablation?

Study design:
This review article included 20 studies with 52,771 patients.

Results and conclusions:
The investigators found that obesity was significantly associated with higher atrial fibrillation recurrence [OR = 1.30, 95% C = 1.16 to 1.47, p 0.001, I2 = 72.7%] and similar rate of adverse events [OR = 1.21, 95% CI = 0.87 to 1.67, p = 0.264, I2 = 23.9%] in patients undergoing catheter ablation.

The investigators found meta-regression showed that the association varied by age [coefficient = -0.03, p = 0.024].

The investigators found meta-analysis of highest versus lowest BMI showed that the highest group had higher atrial fibrillation recurrence [OR = 1.37, 95% CI = 1.18 to 1.58, p 0.001, I2 = 64.9%] and adverse events [OR = 2.02, 95% CI = 1.08 to 3.76, p = 0.028, I2 = 49.5%] in patients undergoing catheter ablation.

The investigators found the dose-response relationship for BMI and atrial fibrillation recurrence was nonlinear [p nonlinearity 0.001], the curve became steeper at 30-35 kg/m².

The investigators found for adverse events, an increase of 1% for every 1 kg/m² increase in BMI [OR = 1.01, 95% CI = 1.00 to 1.02, p = 0.001], the relationship was nonlinear [p nonlinearity = 0.001].

The investigators concluded that obesity is associated with higher atrial fibrillation recurrence in patients undergoing catheter ablation. High BMI is associated with a higher risk for adverse events.

Original title:
BMI and atrial fibrillation recurrence post catheter ablation: A dose-response meta-analysis by Pranata R, Henrina J, […], Munawar M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33544873/

Additional information of El Mondo:
Find more information/studies on cardiovascular diseases and obesity/overweight right here.

Catheter ablation is a procedure that uses radiofrequency energy (similar to microwave heat) to destroy a small area of heart tissue that is causing rapid and irregular heartbeats. Destroying this tissue helps restore your heart’s regular rhythm. Catheter ablation is also called radiofrequency ablation.

Am I overweight?
 

Objectives:
A few randomized controlled trials (RCTs) have assessed the effect of brown rice consumption on metabolic parameters (such as, weight, height, waist circumference, fasting glucose, LDL, HDL, total cholesterol, triglycerides and blood pressure) compared to white rice, with inconsistent findings. Therefore, this review article has been conducted.

Is the effect of brown rice on adiposity indices (such as, weight, height and waist circumference), lipid profile (such as, LDL, HDL, total cholesterol and triglycerides) and glycemic markers (such as, fasting blood glucose) higher compared to white rice in adult subjects?

Study design:
This review article included 13 RCTs.
In accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the certainly of the included evidence was low and very low.

Results and conclusions:
The investigators found brown rice significantly reduced:
weight by -1.63 kg [95% CI = -2.15 to -1.11, I2 = 97%, n = 6];
body mass index (BMI) by -0.58 kg/m² [95% CI = -0.78 to -0.37, I2 = 96%, n = 6] and;
waist circumference by -2.56 cm [95% CI = -4.86 to -0.26, I2 = 88%, n = 5] compared with white rice.

The investigators found, moreover, brown rice had no significant effect on lipid profile and glycemic markers.

The investigators found pre-germinated brown rice significantly declined:
weight by -1.75 kg [95% CI = -2.70 to -0.81, I2 = 99%, n = 4];
total cholesterol by -24.22 mg/dL [95% CI = -33.03 to -15.41, I2 = 78%, n = 5];
triglyceride (TG) by -43.28 mg/dL [95% CI = -74.05 to -12.50, I2 = 90%, n = 5];
low-density lipoprotein (LDL or bad cholesterol) by -20.05 mg/dL [95% CI = -29.57 to -10.52, I2 = 71%, n = 5] and;
fasting blood glucose (FBG) by -15.83 mg/dL [95% CI = -25.20 to -6.46, I2 = 91%, n = 5] compared to white rice.

The investigators concluded brown rice has anti-obesity effects in comparison with white rice. However, it has no beneficial effects on lipid profile and glycemic markers. Furthermore, pre-germinated brown rice has better functional effects on promoting lipid profile and fasting blood glucose compared to brown rice.

Original title:
The effect of brown rice compared to white rice on adiposity indices, lipid profile, and glycemic markers: a systematic review and meta-analysis of randomized controlled trials by Golzarand M, Toolabi K, […], Mirmiran P.

Link:
https://pubmed.ncbi.nlm.nih.gov/33905269

Additional information of El Mondo:
Find more information/studies on rice consumption and obesity/overweight right here.

Objectives:
Several mechanisms have been proposed for the effect of vitamin E on weight loss. Yet various interventional studies with wide ranges of doses and durations have reported contradictory results. Therefore, this review article has been conducted.

Does vitamin E supplementation reduce overweight?

Study design:
This review article included 24 RCTs.

Results and conclusions:
The investigators found there was no significant effect of vitamin E supplements on weight [WMD = 0.15, 95% CI = -1.35 to 1.65, p = 0.847], body mass index (BMI) [WMD = 0.04, 95% CI = -0.29 to 0.37, p = 0.815] and waist circumference (WC) [WMD = -0.19 kg, 95% CI = -2.06 to 1.68, p = 0.842], respectively.

The investigators found, however, subgroup analysis revealed that vitamin E supplementation in studies conducted on participants with normal BMI (18.5-24.9) had increasing impact on BMI [p = 0.047].  

The investigators concluded there is no significant effect of vitamin E supplementation on weight, BMI and waist circumference (WC). However, vitamin E supplementation increases BMI in participants with normal BMI (18.5-24.9).

Original title:
Can vitamin E supplementation affect obesity indices? A systematic review and meta-analysis of twenty-four randomized controlled trials by Emami MR, Jamshidi S, […], Aryaeian N.

Link:
https://pubmed.ncbi.nlm.nih.gov/33632535/

Additional information of El Mondo:
Find more information/studies on vitamin E and obesity/overweight right here.

Objectives:
Recent systematic reviews and meta-analyses of randomized, double-blind, placebo-controlled trials (double-blind, placebo-controlled RCTs) have reported controversial findings regarding the associations between calcium supplements on the risk of cardiovascular disease (CVD). Therefore, this review article has been conducted.

Do calcium supplements increase risk of cardiovascular disease (CVD)?

Study design:
This review article included 13 RCTs with 28,935 participants in an intervention group (group with calcium supplements) and 14,243 in a control group (group without calcium supplements).

The mean age of the study participants was 66.3 years (range: 35 to 97 years) and 92.8% of those were women.
Publication bias was not observed.

Results and conclusions:
The investigators found calcium supplements significantly increased the risk of cardiovascular disease with 15% in healthy postmenopausal women [RR = 1.15, 95% CI = 1.06 to 1.25, I2 = 0.0%, n = 14].

The investigators found calcium supplements significantly increased the risk of coronary heart disease with 16% in healthy postmenopausal women [RR = 1.16, 95% CI = 1.05 to 1.28, I2 = 0.0%, n = 9].

The investigators found in the subgroup meta-analysis, dietary calcium intake of 700-1000 mg per day or supplementary calcium intake of 1000 mg per day significantly increased the risk of cardiovascular disease and coronary heart disease.

The investigators concluded that the use of calcium supplements (1000 mg per day) is significantly associated with the increased risk of cardiovascular disease and coronary heart disease by 15%, specifically in postmenopausal women. These findings should be explicitly confirmed by conducting further RCTs with cardiovascular disease outcome measures as well as the incidence of osteoporosis or fractures as the primary endpoints.

Original title:
Calcium Supplements and Risk of Cardiovascular Disease: A Meta-Analysis of Clinical Trials by Myung SK, Kim HB, […], Oh SW.

Link:
https://pubmed.ncbi.nlm.nih.gov/33530332/

Additional information of El Mondo:
Find more information/studies on calcium consumption, elderly and cardiovascular diseases right here.

Objectives:
Vitamin D deficiency during pregnancy or infancy is associated with adverse growth in children. No systematic review has been conducted to summarize available evidence on the effect of vitamin D supplementation in pregnancy and infancy on growth and body composition in children. Therefore, this review article has been conducted.

Does vitamin D supplementation during pregnancy or infancy increase adiposity (severe or morbid overweight) risk in childhood?

Study design:
This review article included 12 RCTs with a total of 4,583 participants.
The doses of vitamin D in the intervention group (group with vitamin D supplements) were 60,000 IU/4 weeks (1,500 mcg/4 weeks) or 60,000 IU/8 weeks and in the control group (group without vitamin D supplements) was 400 IU/day.

Results and conclusions:
The investigators found vitamin D supplementation during pregnancy was associated with higher triceps skinfold thickness (mm) [MD = 0.33, 95% CI = 0.12 to 0.54, I2 = 34%] in neonates.

The investigators found vitamin D supplementation during pregnancy or infancy was associated with significantly increased length for age z-score in infants at 1 year of age [MD = 0.29, 95% CI = 0.03 to 0.54, I2 = 0%].

The investigators found vitamin D supplementation during pregnancy or infancy was associated with lower body mass index (BMI) (kg/m²) [MD = -0.19, 95% CI = -0.34 to -0.04, I2 = 0%] and body mass index z-score (BMIZ) [MD = -0.12, 95% CI = -0.21 to -0.04, I2 = 0%] in offspring at 3-6 years of age.

The investigators found vitamin D supplementation during early life was not observed to be associated with children’s bone, lean or fat mass.

The investigators concluded vitamin D supplementation during pregnancy or infancy is associated with reduced adiposity (severe or morbid overweight) in childhood. Future large well-designed double blinded RCTs are needed to assess the effectiveness of vitamin D supplementation in early life on children’s bone health, lean mass and adiposity.

Original title:
Effect of Vitamin D Supplementation in Early Life on Children's Growth and Body Composition: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Ma K, Wei SQ, [...], Wen SW.

Link:
https://www.mdpi.com/2072-6643/13/2/524/htm

Additional information of El Mondo:
Find more information/studies on vitamin D and obesity/overweight right here.

Objectives:
Randomised controlled trials comparing low- versus high-fat diets on cardiometabolic risk factors in people with overweight or obesity have shown inconsistent results, which may be due to the mixed metabolic status of people with excess adiposity. The role of dietary fat manipulation in modifying cardiometabolic indicators in people with overweight or obese without metabolic disturbance is unclear. Therefore, this review article (meta-analysis) has been conducted.

Does a low-fat diet modify cardiometabolic indicators in people who are overweight (BMI>25) or obese (BMI>30) without metabolic disturbance?

Study design:
This review article included 20 RCTs with 2,106 participants.

Results and conclusions:
The investigators found total cholesterol levels in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -7.05 mg/dL, 95% CI = -11.30 to -2.80, p = 0.001].  

The investigators found LDL-cholesterol levels (bad cholesterol) in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -4.41 mg/dL, 95% CI = -7.81 to -1.00, p = 0.011].  

The investigators found HDL-cholesterol levels (good cholesterol) in people who are overweight or obese without metabolic disturbance were significantly lower following low-fat diet compared with high-fat diet [WMD = -2.57 mg/dL, 95% CI = -3.85 to -1.28, p 0.001].  

The investigators found TAG levels (blood fat levels) in people who are overweight or obese without metabolic disturbance were significantly higher following low-fat diet compared with high-fat diet [WMD = -11.68 mg/dL, 95% CI = 5.90 to 17.45, p 0.001].  

The investigators concluded a low-fat diet reduces cholesterol and TAG levels in people with overweight or obesity without metabolic disturbances.

Original title:
Effects of low-fat compared with high-fat diet on cardiometabolic indicators in people with overweight and obesity without overt metabolic disturbance: a systematic review and meta-analysis of randomised controlled trials by Lu M, Wan Y, [...], Li D.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29212558

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Find more information/studies on fat, cholesterol and overweight right here.

A triglyceride (TG, triacylglycerol, TAG or triacylglyceride) is an ester derived from glycerol and three fatty acids. Triglycerides are the main constituents of body fat in humans.

Those with overweight or obesity are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
Dietary fiber intake may provide beneficial effects on the components of metabolic syndrome (MetS); however, observational studies reported inconsistent results for the relationship between dietary fiber intake and metabolic syndrome risk. Therefore, this review article (meta-analysis) has been conducted.

Does dietary fiber intake reduce risk of metabolic syndrome?

Study design:
This review article included 11 cross-sectional studies and 3 cohort studies.
There was evidence of publication bias in cross-sectional studies.

Results and conclusions:
The investigators found in cross-sectional studies when comparing the highest with lowest categories of dietary fiber intake, a significantly reduced risk of 33% [OR = 0.67, 95% CI = 0.58-0.78, I2 = 32.4%, p = 0.181] for metabolic syndrome. However, this reduced risk was not significant in cohort studies [pooled RR = 0.86, 95% CI = 0.70-1.06]. Not significant because RR of 1 was found in the 95% CI of 0.70 to 1.06. RR of 1 means no risk/association.

The investigators concluded that a high dietary intake of fiber may reduce risk of metabolic syndrome. May reduce because there was evidence of publication bias in cross-sectional studies and the reduced risk was not significant in cohort studies. Therefore, more prospective cohort studies are needed to further verify the association between dietary fiber intake and the risk of metabolic syndrome.

Original title:
Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-analysis by Tian Y, Su L, [...], Jiang X.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29151369

Additional information of El Mondo:
Find more information/studies on publication bias/cohort studies/significant, fiber consumption and overweight right here.  

Find out whether you are overweight or not right here.

Those with metabolic syndrome are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
Several epidemiological studies have been performed to evaluate the association of fruit and vegetable consumption with risk of the metabolic syndrome (MetS), but the results remain controversial. Therefore, this review article (meta-analysis) has been conducted.

Does consumption of vegetables or fruit reduce risk of metabolic syndrome?

Study design:
This review article included a total of 9 studies for fruit consumption, 9 studies for vegetable consumption and 7 studies for fruit and vegetable consumption.

There was no evidence of small-study effect (publication bias)

Results and conclusions:
The investigators found a significantly reduced risk of 13% [pooled RR = 0.87, 95% CI = 0.82-0.92, I2 = 46.7%] for metabolic syndrome when comparing the highest fruit consumption versus the lowest consumption.

The investigators found a significantly reduced risk of 15% [pooled RR = 0.85, 95% CI = 0.80-0.91, I2 = 0.0%] for metabolic syndrome when comparing the highest vegetable consumption versus the lowest consumption.

The investigators found a significantly reduced risk of 24% [pooled RR = 0.76, 95% CI = 0.62-0.93, I2 = 83.5%] for metabolic syndrome when comparing the highest fruit and vegetable consumption versus the lowest consumption.

The investigators found in subgroup analyses stratified by continent, the inverse association of fruit consumption [RR = 0.86, 95% CI = 0.77-0.96] and vegetable consumption [RR = 0.86, 95% CI = 0.80-0.92] with risk of metabolic syndrome remained significant in Asia.

The investigators concluded that a high fruit or/and vegetable consumption reduce risk of metabolic syndrome, particularly among Asian. Therefore, people should consume more fruits and vegetables to reduce risk of metabolic syndrome.

Original title:
Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-analysis by Tian Y, Su L, [...], Jiang X.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29151369

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Find more information/studies on fruit and vegetables consumption and overweight right here.  

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Those with metabolic syndrome are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Objectives:
The scientific literature shows conflicting evidence about the relationship between adiposity and bone mass in overweight and obese populations. Therefore, this review article (meta-analysis) has been conducted.

Does a high adipose mass reduce bone mineral density in overweight and obese populations?

Study design:
This review article included a total of 16 studies, comprising 2587 participants and 75 correlation coefficients.

Results and conclusions:
The investigators found strong evidence supported a negative relationship between relative (%) adipose mass and bone mineral density (BMD) in men [R = -0.37, 95% CI = -0.57 to -0.12] and in those aged less than 25 years [R = -0.28, 95% CI = -0.45 to -0.08].

The investigators concluded that a high relative (%) adipose mass reduces bone mineral density in overweight (BMI = 25-30) and obese populations (BMI > 30), particularly in men and those aged less than 25 years. Therefore, to prevent bone loss in overweight and obese populations, nutrition- and exercise-based interventions that focus on a controlled reduction of adipose mass with concomitant preservation of lean mass are recommended.

Original title:
Influence of adipose tissue mass on bone mass in an overweight or obese population: systematic review and meta-analysis by Dolan E, Swinton PA, […], O'Reilly J.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29028271

Additional information of El Mondo:
Find more information/studies on overweight right here. 

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Those with overweight (BMI = 25-30) or obesity (BMI > 30) are advised to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
The most easy way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is to choose meals/products with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.
However, the most practical way to follow a diet with maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal is all meals/products that you eat on a daily basis should on average contain maximum 30 En% fat, of which maximum 7 En% saturated fat and minimum 1.5 grams fiber per 100 kcal.

Strength exercise is the best way to reduce adipose mass while preserving lean mass.

Objectives:
The prevalence of metabolic syndrome (MetS) has been greatly increased, worldwide. In recent years, investigators have proposed that sodium might contribute to the development of metabolic syndrome; however, the published data were conflicting. Therefore, this review article (meta-analysis) has been conducted.

Does sodium contribute to the development of metabolic syndrome?

Study design:
This review article included 17 observational studies with 66,274 participants.

Results and conclusions:
The investigators found that subjects with metabolic syndrome had significantly higher levels of sodium compared to healthy controls [Hedges' g = 0.21, 95% CI = 0.12-0.29, I2 = 68.6%]. Subgroup analyses revealed that the difference was significant when the sodium status was assessed using urinary sodium levels.

The investigators found that random effects meta-regression analysis also revealed that body sodium level increases with the number of metabolic syndrome components.

The investigators found that participants with highest dietary/urinary or serum sodium levels had a significantly 37% higher chance of developing metabolic syndrome when compared with participants with the lowest sodium levels [OR = 1.37, 95% CI = 1.31-1.42, I2 = 86.9%].

The investigators concluded that higher sodium input into the body is directly associated with the likelihood of metabolic syndrome. Prospective cohort studies and well-designed randomized clinical trials considering the effect of sodium restricted diets on the risk of metabolic syndrome as an outcome are necessary to represent the causal association.

Original title:
Sodium status and the metabolic syndrome: A systematic review and meta-analysis of observational studies by Soltani S, Kolahdouz Mohammadi R, […], Salehi-Abargouei A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28846446

Additional information of El Mondo:
Find more information/studies on overweight and sodium right here. 

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Those with metabolic syndrome are advised to select the following food items.

Sodium is part of table salt or sodium choride.

High-sodium or high-salt products are products with more than 0.3 gram salt per 100 kcal. These products are rich in salt.
A high-salt diet is a diet with many products with more than 0.3 gram salt per 100 kcal.

Objectives:
The relationships between metabolic syndrome (MetS) and risk of incident stroke are inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Does metabolic syndrome increase risk of stroke?

Study design:
This review article included a total of 16 prospective cohort studies, including 116,496 participants who were initially free of cardiovascular diseases.

Results and conclusions:
The investigators found comparing the persons without metabolic syndrome, those with metabolic syndrome had a significantly higher risk of 70% for incident stroke [pooled relative risk (RR) = 1.70, 95% CI = 1.49-1.95]. Significant means that there is an association with a 95% confidence.

The investigators found in subgroup analyses that women with metabolic syndrome had a significantly higher risk of 83% for incident stroke [pooled relative risk (RR) = 1.83, 95% CI = 1.31-2.56]. Significant because RR of 1 was not found in the 95% CI of 1.31 to 2.56. RR of 1 means no risk/association.

The investigators found in subgroup analyses that men with metabolic syndrome had a significantly higher risk of 47% for incident stroke [pooled relative risk (RR) = 1.47, 95% CI = 1.22-1.78].

The investigators found in subgroup analyses that those with metabolic syndrome had a significantly higher risk of 112% for ischemic stroke [pooled relative risk (RR) = 2.12, 95% CI = 1.46-3.08].

The investigators found in subgroup analyses that those with metabolic syndrome had a non-significantly higher risk of 48% for hemorrhagic stroke [pooled relative risk (RR) = 1.48, 95% CI = 0.98-2.24].

The investigators concluded metabolic syndrome increases risk of stroke, particularly among women and those with ischemic stroke.

Original title:
Metabolic syndrome and stroke: A meta-analysis of prospective cohort studies by Li X, Li X, […], Gao Q.

Link:
http://www.sciencedirect.com/science/article/pii/S0967586816311079

Additional information of El Mondo:
Find more information/studies on overweight and cardiovascular disease right here. 

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Those with metabolic syndrome are advised to select the following food items.

Objectives:
The associations between n-3 polyunsaturated fatty acids (PUFAs) and metabolic syndrome (MetS) risk have demonstrated inconsistent results. Therefore, this review article (meta-analysis) has been conducted.

Do higher circulating n-3 PUFA levels associate with a lower metabolic syndrome risk?

Study design:
This review article included a total of 7 case-control studies and 20 cross-sectional studies.
There was no publication bias.
Results and conclusions:
The investigators found a higher plasma/serum n-3 PUFAs was associated with a lower metabolic syndrome risk of 37% [pooled OR = 0.63, 95% CI = 0.49-0.81, I2 = 72.4%].

The investigators found the plasma/serum n-3 PUFAs in controls was significantly higher than cases [WMD = 0.24, 95% CI = 0.04-0.43], especially docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA).

The investigators found, however, no significant association between dietary intake of n-3 PUFAs or fish and metabolic syndrome risk.

The investigators found in sensitivity analysis by omitting one study at a time and re-calculated the remaining data, that exclusion of anyone study did not substantially influence the pooled effects.

The investigators concluded a higher circulating n-3 PUFAs is associated with a lower metabolic syndrome risk. The circulating n-3 PUFAs can be regarded as biomarkers indicating metabolic syndrome risk, especially DPA and DHA. The evidence of this review article will have important public implications in preventing metabolic syndrome through supplemental long-chain n-3 PUFAs of marine-origin. Furthermore, added RCTs and epidemiological studies with large sample-size are warranted to confirm these findings.

Original title:
n-3 Polyunsaturated Fatty Acids and Metabolic Syndrome Risk: A Meta-Analysis by Guo XF, Li X, […], Li D.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537818/

Additional information of El Mondo:
Find more information/studies on overweight and n-3 PUFA right here.  
Docosapentaenoic acid (DPA) is a dietary omega-3 fatty acid mainly found in fish, fish oil, seal oil and red meat.

Find out whether you are overweight or not right here.

Objectives:
Have flaxseed supplementation positive effects on body composition?

Study design:
This review article included a total of 45 RCTs.

Results and conclusions:
The investigators found a significant reduction in body weight [WMD = -0.99 kg, 95% CI = -1.67 to -0.31, p = 0.004], BMI [WMD = -0.30 kg m², 95% CI = -0.53 to -0.08, p = 0.008] and waist circumference [WMD = -0.80 cm, 95% CI = -1.40 to -0.20, p = 0.008] following flaxseed supplementation.

The investigators found subgroup analyses showed that using whole flaxseed in doses ≥30 g/d, longer-term interventions (≥12 weeks) and studies including participants with higher BMI (≥ 27 kg/m²) had positive effects on body composition.

The investigators concluded whole flaxseed supplementation in doses ≥30 g/d during ≥12 weeks has positive effects on body composition in overweight and obese participants (=participants with BMI ≥ 25 kg/m²).

Original title:
The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta-analysis of 45 randomized placebo-controlled trials by Mohammadi-Sartang M, Mazloom Z, […], Totosy de Zepetnek JO.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28635182

Additional information of El Mondo:
Find more information/studies on overweight right here. 

Find out whether you are overweight or not right here.

Objectives:
Have flaxseed supplementation positive effects on body composition?

Study design:
This review article included a total of 45 RCTs.

Results and conclusions:
The investigators found a significant reduction in body weight [WMD = -0.99 kg, 95% CI = -1.67 to -0.31, p = 0.004], BMI [WMD = -0.30 kg m², 95% CI = -0.53 to -0.08, p = 0.008] and waist circumference [WMD = -0.80 cm, 95% CI = -1.40 to -0.20, p = 0.008] following flaxseed supplementation.

The investigators found subgroup analyses showed that using whole flaxseed in doses ≥30 g/d, longer-term interventions (≥12 weeks) and studies including participants with higher BMI (≥ 27 kg/m²) had positive effects on body composition.

The investigators concluded whole flaxseed supplementation in doses ≥30 g/d during ≥12 weeks has positive effects on body composition in overweight and obese participants (=participants with BMI ≥ 25 kg/m²).

Original title:
The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta-analysis of 45 randomized placebo-controlled trials by Mohammadi-Sartang M, Mazloom Z, […], Totosy de Zepetnek JO.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28635182

Additional information of El Mondo:
Find more information/studies on nuts&seeds and overweight right here. 

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Objectives:
Do overweight and obese adults benefit from n-3 PUFA supplements?

Study design:
This review article included a total of 11 RCTs involving 617 participants.

Results and conclusions:
The investigators found a statistically non-significant difference in weight loss between n-3 PUFA supplements and placebo [WMD = 0.00, 95% CI = -0.42 to 0.43, p = 0.99].

The investigators found n-3 PUFA supplements was superior to placebo in reducing serum triglyceride levels [Std MD = -0.59, 95% CI = -0.93 to -0.25, p = 0.0007].

The investigators found a significant reduction in waist circumference for n-3 PUFA group [WMD = -0.53, 95% CI = -0.90 to -0.16, p = 0.005].

The investigators found no significant differences in body mass index, total serum levels of cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and fasting glucose levels between n-3 PUFA supplements and placebo.

The investigators concluded that n-3 PUFA supplements reduce waist circumference and triglyceride levels in overweight and obese adults. However, large-scale, well-designed RCTs are needed to further address this issue.

Original title:
Efficacy of Omega-3 Polyunsaturated Fatty Acids Supplementation in Managing Overweight and Obesity: A Meta-Analysis of Randomized Clinical Trials by Zhang YY, Liu W, […], Tian HM.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28112774

Additional information of El Mondo:
Find more information/studies on overweight, n-3 PUFA and cholesterol right here.  

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Objectives:
The effects of green tea on lipid metabolism were inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Have tea consumption beneficial effects on lipid metabolism?

Study design:
This review article included 21 RCTs studying 1,704 overweight or obese subjects.

Results and conclusions:
The investigators found that green tea consumption significantly decreased plasma total cholesterol with 3.38 mg/dL [WMD = -3.38 mg/dL, 95% CI = -6.42 to -0.33 mg/dL] in overweight or obese people.

The investigators found that green tea consumption significantly decreased plasma LDL cholesterol (bad cholesterol) with 5.29 mg/dL [WMD = -5.29 mg/dL,95% CI = -7.92 to -2.66 mg/dL] in overweight or obese people.

The investigators found that green tea consumption, however, showed no effect on plasma triglyceride and HDL cholesterol levels (good cholesterol) in overweight or obese people with a relatively high heterogeneity.

The investigators concluded that drinking green tea lowers plasma total cholesterol and LDL cholesterol levels in overweight or obese people. Nevertheless, green tea's effect on plasma triglyceride and HDL cholesterol levels must be further evaluated by additional high-quality and large-scale RCTs.

Original title:
Effects of green tea on lipid metabolism in overweight or obese people: A meta-analysis of randomized controlled trials by Fen Y, Hui D, [...], Fu Er L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28636182

Additional information of El Mondo:
Find more information/studies on overweight, cholesterol and tea consumption right here. 

Objectives:
Epidemiological studies have presented inconsistent evidence of the correlation between a fish-oriented dietary intake (FDI) and the risk of cognitive decline. Therefore, this meta-analysis (review article) has been conducted.

Does a fish-oriented dietary intake reduce risk of cognitive decline?

Study design:
This review article included 9 cohort studies containing 28,754 subjects.
Limited evidence involving heterogeneity was found within subgroups or across studies.

Results and conclusions:
The investigators found when comparing the highest versus lowest categories of fish consumption a significant reduced risk of 20% [RR = 0.80, 95% CI = 0.65-0.97] for dementia of Alzheimer type (DAT).

The investigators found the dose-response synthesized data indicated that a 100-g/week increase in fish intake reduced the risk of dementia of Alzheimer type by an additional 12% [RR = 0.88, 95% CI = 0.79-0.99].

The investigators found that the reduced risk of dementia of all causes (DAC) and mild cognitive impairment (MCI) was non-significant.

The investigators concluded that a higher intake of fish, at least 100-g/week is correlated with a reduced risk of dementia of Alzheimer type.

Original title:
An exploration of the role of a fish-oriented diet in cognitive decline: a systematic review of the literature by Zeng LF, Cao Y, […], Wang NS.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28418899

Additional information of El Mondo:
Find more information/studies on fish consumption and elderly right here.
 

Objectives:
Controversy persists regarding the effect of mixtures of conjugated linoleic acids (c9,t11- and t12,c10-CLA) in fasting blood glucose (FBG) and waist circumference (WC) in humans. Therefore, this review article (meta-analysis) has been conducted.

Does CLA reduce fasting blood glucose (FBG) and waist circumference (WC) in humans?

Study design:
This review article included 32 randomized clinical trials.

Results and conclusions:
The investigators found subgroup analysis showed that taking CLA supplement did not significantly influence fasting blood glucose [SMD = 0.075 mg/dL, 95% CI = -0.099 to 0.249, p = 0.399].

The investigators found subgroup analysis showed that taking CLA supplement reduced non-significantly waist circumference with 0.149cm [SMD = -0.149cm, 95% CI = -0.522 to 0.225, p = 0.435].

The investigators found foods enriched in CLA also showed no significant effect on fasting blood glucose [SMD = 0.126 mg/dL, 95% CI = -0.100 to 0.352, p = 0.274].

The investigators found foods enriched in CLA also showed no significant effect on waist circumference [SMD = -0.233cm, 95% CI = -0.625 to 0.159, p = 0.244].

The investigators concluded that c9,t11- and t12,c10-CLA administered as a supplement or used to enrich foods does not reduce fasting blood glucose (FBG) and waist circumference (WC) in humans.

Original title:
Effect of conjugated linoleic acid as a supplement or enrichment in foods on blood glucose and waist circumference in humans: A meta-analysis by Rahbar AR, Ostvar A, […], Rahbar A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/28176632

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Overweight people often have higher fasting blood glucose (FBG) and greater waist circumference (WC).

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Conjugated linoleic acids (CLA) are a family of isomers of linoleic acid found mostly in meat and dairy products derived from ruminants. An average daily diet supplies 15-174mg of conjugated linoleic acid.

Chemical structures of CLA.