Lack of efficacy of pomegranate supplementation for glucose management, insulin levels and sensitivity: evidence from a systematic review and meta-analysis - PubMed (original) (raw)

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Lack of efficacy of pomegranate supplementation for glucose management, insulin levels and sensitivity: evidence from a systematic review and meta-analysis

Haohai Huang et al. Nutr J. 2017.

Abstract

Background: The potential glucose-lowering effects of pomegranate have been reported in animal and observational studies, but intervention studies in humans have generated mixed results. In this paper, we aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the precise effects of pomegranate supplementation on measures of glucose control, insulin levels and insulin sensitivity in humans.

Methods: Comprehensive electronic searches were conducted in PubMed, Embase, and the Cochrane Library. Studies included were RCTs that evaluated the changes in diabetes biomarkers among adults (≥18 years) following pomegranate interventions. The predefined outcomes included fasting blood glucose (FBG), fasting blood insulin (FBI), glycated haemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR). Endpoints were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs) by using a random-effects model. Publication bias, subgroup analyses, sensitivity analysis and random-effects meta-regression were also performed to explore the influence of covariates on the net changes in fasting glucose and insulin concentrations.

Results: Sixteen eligible trials with 538 subjects were included. The pooled estimates suggested that pomegranate did not significantly affect the measures of FBG (WMD, -0.6 mg/dL; 95% CI, -2.79 to 1.58; P=0.59), FBI (WMD, 0.29 μIU/mL; 95% CI, -1.16 to 1.75; P=0.70), HOMA-IR (WMD, -0.04; 95% CI, -0.53 to 0.46; P=0.88) or HbA1c (WMD, -0.11%; 95% CI, -0.39 to -0.18; P=0.46). Overall, significant heterogeneity was detected for FBI and HOMA-IR, but subgroup analysis could not identify factors significantly influencing these parameters. These results were robust in sensitivity analysis, and no significant publication bias was found in the current meta-analysis.

Conclusion: Pomegranate intake did not show a notably favourable effect on improvements in glucose and insulin metabolism. The current evidence suggests that daily pomegranate supplementation is not recommended as a potential therapeutic strategy in glycemic management. Further large-scale RCTs with longer duration are required to confirm these results.

Keywords: Diabetes mellitus; Glucose; Insulin; Meta-analysis; Pomegranate.

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Figures

Fig. 1

Fig. 1

Flow chart of data base searches and articles included in the present meta-analysis. # The work conducted by Heber et al. was separated into 2 trials; The study conducted by Fuster-Munoz et al. was also separated into 2 trials

Fig. 2

Fig. 2

Results of risk of bias assessment. a Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies. b Risk of bias summary: review authors’ judgments about each risk of bias item for each included study

Fig. 3

Fig. 3

Pooled estimated effect of pomegranate on glucose control and insulin sensitivity as compared with the control arms. a fasting blood glucose; b fasting blood insulin, c homeostatic model assessment of insulin resistance; d glycated hemoglobin. WMD, weighted mean difference; PJ, pomegranate juice; PSO, pomegranate seed oil; PE, pomegranate extract

Fig. 4

Fig. 4

Meta-regression result of the association between mean changes in fasting glucose concentrations with dose and duration of supplementation with pomegranate juice

Fig. 5

Fig. 5

Tests for publication bias of impact of pomegranate consumption on glucose control and insulin sensitivity. a FBG, fasting blood glucose; b FBI, fasting blood insulin; c HOMA-IR, homeostatic model assessment of insulin resistance; d HbA1C, glycated hemoglobin

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