Southern Medical Program, Faculty of Medicine, University of British Columbia Okanagan Campus, 1088 Discovery Avenue, Kelowna, BC, V1V 1V7, Canada.
Department of Biology, Irving K. Barber Faculty of Science, University of British Columbia Okanagan Campus, 3187 University Way, ASC 413, Kelowna, BC, V1V 1V7, Canada.
BMC Complement Med Ther. 2023 Jun 9;23(1):190. doi: 10.1186/s12906-023-03997-8.
Emblica officinalis (EO) fruit consumption has been found to have a beneficial effect on cardiovascular disease (CVD) physiological risk factors in preliminary clinical intervention trials; however, questions remain regarding the overall effectiveness of EO on CVD risk. The purpose of this systematic review and meta-analysis is to: 1) systematically describe the clinical research examining EO; and 2) quantitatively assess the effects of EO on CVD physiological risk factors.
The Pubmed, Embase, Web of Science, and Google Scholar electronic platforms were searched for relevant randomized controlled trials (RCTs) published until April 7, 2021. Studies were included if they involved adults (age ≥ 18 years) ingesting a form of EO fruit; included blood lipids, blood pressure, and/or inflammatory biomarkers as outcomes; had clearly defined intervention and control treatments with pre- and post-intervention data; were peer-reviewed; and were written in English. Studies were excluded if they compared EO with another risk reduction intervention without a usual care control group. RCTs were assessed for methodological quality using the Cochrane risk-of-bias version 2 (ROB2) tool, qualitatively described, and quantitatively evaluated using random and fixed effect meta-analysis models.
A total of nine RCTs (n = 535 participants) were included for review. Included studies followed parallel-group (n = 6) and crossover (n = 3) designs, with EO dosage ranging from 500 mg/day to 1500 mg/day, and treatment duration ranging from 14 to 84 days. Meta-analyses revealed EO to have a significant composite effect at lowering low-density lipoprotein cholesterol (LDL-C; Mean difference (MD) = -15.08 mg/dL [95% Confidence interval (CI) = -25.43 to -4.73], I = 77%, prediction interval = -48.29 to 18.13), very low-density lipoprotein cholesterol (VLDL-C; MD = -5.43 mg/dL [95% CI = -8.37 to -2.49], I = 44%), triglycerides (TG; MD = -22.35 mg/dL [95% CI = -39.71 to -4.99], I = 62%, prediction interval = -73.47 to 28.77), and high-sensitivity C-reactive protein (hsCRP; MD = -1.70 mg/L [95% CI = -2.06 to -1.33], I = 0%) compared with placebo.
Due to statistical and clinical heterogeneity in the limited number of clinical trials to date, the promising effects of EO on physiologic CVD risk factors in this review should be interpreted with caution. Further research is needed to determine if EO offers an efficacious option for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy.
初步的临床干预试验发现，余甘子（EO）果实的消费对心血管疾病（CVD）的生理风险因素有有益的影响；然而，关于 EO 对 CVD 风险的整体效果仍存在疑问。本系统评价和荟萃分析的目的是：1）系统描述检查 EO 的临床研究；2）定量评估 EO 对 CVD 生理风险因素的影响。
在 2021 年 4 月 7 日之前，在 Pubmed、Embase、Web of Science 和 Google Scholar 电子平台上搜索了相关的随机对照试验（RCT）。如果研究涉及摄入某种形式的 EO 果实的成年人（年龄≥18 岁）；包括血脂、血压和/或炎症生物标志物作为结果；有明确界定的干预和对照治疗，具有干预前后的数据；是同行评审的；并且是用英文写的，则将其纳入研究。如果 EO 与没有常规护理对照组的另一种降低风险的干预措施进行比较，则将研究排除在外。使用 Cochrane 风险偏倚版本 2（ROB2）工具对 RCT 进行方法学质量评估，定性描述，并使用随机和固定效应荟萃分析模型进行定量评估。
共有 9 项 RCT（n=535 名参与者）被纳入审查。纳入的研究采用平行组（n=6）和交叉（n=3）设计，EO 剂量范围为 500mg/天至 1500mg/天，治疗时间范围为 14 至 84 天。荟萃分析显示，EO 在降低低密度脂蛋白胆固醇（LDL-C；平均差异（MD）=-15.08mg/dL [95%置信区间（CI）=-25.43 至-4.73]，I=77%，预测区间=-48.29 至 18.13）、极低密度脂蛋白胆固醇（VLDL-C；MD=-5.43mg/dL [95% CI=-8.37 至-2.49]，I=44%）、甘油三酯（TG；MD=-22.35mg/dL [95% CI=-39.71 至-4.99]，I=62%，预测区间=-73.47 至 28.77）和高敏 C 反应蛋白（hsCRP；MD=-1.70mg/L [95% CI=-2.06 至-1.33]，I=0%）方面与安慰剂相比有显著的综合效果。
由于迄今为止有限数量的临床试验存在统计学和临床异质性，因此应谨慎解释本综述中 EO 对心血管疾病生理风险因素的有希望的影响。需要进一步的研究来确定 EO 是否作为单一疗法或作为基于证据的饮食模式和/或标准药物治疗的辅助疗法，为 CVD 的一级或二级预防提供有效的选择。
