Impact of a Chokeberry ( (Michx.) Elliott) Supplementation on Cardiometabolic Outcomes: A Critical Systematic Review and Meta-Analysis of Randomized Controlled Trials.

: Chokeberry ( (Michx.) Elliott) is a (poly)phenol-rich fruit with purported cardiometabolic benefits. However, the evidence from randomized controlled trials (RCTs) remains inconclusive. This systematic review and meta-analysis aimed to assess the effects of chokeberry supplementation on cardiometabolic outcomes, including anthropometric parameters, glycemic control, lipid profile, and blood pressure in adults. : A systematic literature search was conducted in PubMed, Scopus, and Web of Science through January 2025. RCTs investigating chokeberry supplementation (≥2 weeks) in adults (≥18 years) with or without cardiometabolic risk factors were included. A random effects model was used to pool effect sizes, expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the statistic, and risk of bias was evaluated with the Cochrane risk of bias 1 (RoB 1) tool. Trial sequential analysis (TSA) was performed to assess the conclusiveness of the evidence. Certainty of evidence was rated using GRADE. : Ten RCTs ( = 666 participants) met the inclusion criteria. Chokeberry supplementation had no significant effects on cardiometabolic outcomes under evaluation. Subgroup analysis suggested that a chokeberry supplementation could reduce total cholesterol and LDL-C in individuals with a baseline total plasma cholesterol <200 mg/dL, and systolic blood pressure with interventions, containing >50 mg/day anthocyanin, while increasing fasting blood glucose in individuals ≤50 years old. Risk of bias was unclear or high in several studies, TSA indicated inconclusive evidence for most outcomes, and the certainty of evidence was rated as very low across all cardiometabolic markers. : Chokeberry supplementation did not significantly improve cardiometabolic outcomes in the general adult population. Limited evidence is given for potential lipid-lowering and blood pressure effects in specific subgroups. However, a high risk of bias accompanies these results. More robust RCTs with standardized interventions and dietary assessments are needed.