Onakpoya Igho J, Heneghan Carl J
Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, UK.
Eur J Prev Cardiol. 2015 Dec;22(12):1575-87. doi: 10.1177/2047487314560663. Epub 2014 Nov 20.
Many different dietary supplements are currently marketed for the management of hypertension and diabetes, but the evidence for effectiveness is mixed. The objective of this systematic review was to critically appraise and evaluate the evidence for effectiveness of steviol glycosides (stevioside and rebaudioside A) on cardiovascular risk factors, using data from randomised clinical trials (RCTs).
Electronic searches were conducted in Medline, Embase, Amed, Cinahl and The Cochrane Library. We also searched Google Scholar, and hand searched the bibliography of retrieved full texts. The reporting quality of included studies was assessed using the Cochrane criteria. Two reviewers independently determined the eligibility, assessed the reporting quality, and extracted the data.
Nine studies with a total of 756 participants were included. There was a variation in the reporting quality of included studies. Meta-analysis revealed a non-significant difference in systolic blood pressure between steviol glycoside and placebo, mean difference (MD): -2.98 mm Hg (-6.23 to 0.27). Significant reductions in diastolic blood pressure and fasting blood glucose were observed. There was no significant effect on blood lipid profile. Heterogeneity was significant. Adverse events included abdominal fullness, epigastric pain, and dizziness.
The evidence from published RCTs suggests that stevioside may generate reductions in blood pressure and fasting blood glucose. The sizes of the effects are small, and the substantial heterogeneity limits the robustness of any conclusions. Rebaudioside A does not appear to have any significant effects on blood pressure or cardiovascular risk factors. Available clinical trials vary in design and reporting quality, and some are characterised by inadequate sample sizes. In addition, the participants in most of the trials have high cardiovascular risk. Further clinical trials and regulatory assessments are warranted.
目前有许多不同的膳食补充剂在市场上销售，用于管理高血压和糖尿病，但关于其有效性的证据参差不齐。本系统评价的目的是利用随机临床试验（RCT）的数据，严格评估和评价甜菊糖苷（甜菊苷和莱鲍迪苷A）对心血管危险因素有效性的证据。
在Medline、Embase、Amed、Cinahl和Cochrane图书馆进行电子检索。我们还搜索了谷歌学术，并手动检索了检索到的全文的参考文献。使用Cochrane标准评估纳入研究的报告质量。两名评价者独立确定纳入标准、评估报告质量并提取数据。
纳入了9项研究，共756名参与者。纳入研究的报告质量存在差异。荟萃分析显示，甜菊糖苷与安慰剂之间收缩压无显著差异，平均差（MD）：-2.98 mmHg（-6.23至0.27）。观察到舒张压和空腹血糖显著降低。对血脂谱无显著影响。异质性显著。不良事件包括腹胀、上腹部疼痛和头晕。
已发表的随机对照试验证据表明，甜菊苷可能会降低血压和空腹血糖。效果大小较小，且显著的异质性限制了任何结论的稳健性。莱鲍迪苷A似乎对血压或心血管危险因素没有任何显著影响。现有的临床试验在设计和报告质量上各不相同，有些试验的样本量不足。此外，大多数试验的参与者心血管风险较高。有必要进行进一步的临床试验和监管评估。
