Abstract
Several randomized controlled trials (RCTs) and meta-analyses support the benefits of flavanols on cardiometabolic health, but the factors affecting variability in the responses to these compounds have not been properly assessed. The objectives of this meta-analysis were to systematically collect the RCTs-based-evidence of the effects of flavanol-containing tea, cocoa and apple products on selected biomarkers of cardiometabolic risk and to explore the influence of various factors on the variability in the responses to the consumption of these products. A total of 120 RCTs were selected. Despite a high heterogeneity, the intake of the flavanol-containing products was associated using a random model with changes (reported as standardized difference in means (SDM)) in body mass index (−0.15, p < 0.001), waist circumference (−0.29, p < 0.001), total-cholesterol (−0.21, p < 0.001), LDL-cholesterol (−0.23, p < 0.001), and triacylglycerides (−0.11, p = 0.027), and with an increase of HDL-cholesterol (0.15, p = 0.005). Through subgroup analyses, we showed the influence of baseline-BMI, sex, source/form of administration, medication and country of investigation on some of the outcome measures and suggest that flavanols may be more effective in specific subgroups such as those with a BMI ≥ 25.0 kg/m2, non-medicated individuals or by specifically using tea products. This meta-analysis provides the first robust evidence of the effects induced by the consumption of flavanol-containing tea, cocoa and apple products on weight and lipid biomarkers and shows the influence of various factors that can affect their bioefficacy in humans. Of note, some of these effects are quantitatively comparable to those produced by drugs, life-style changes or other natural products. Further, RCTs in well-characterized populations are required to fully comprehend the factors affecting inter-individual responses to flavanol and thereby improve flavanols efficacy in the prevention of cardiometabolic disorders.
Highlights
Metabolic disorders, principally, abdominal obesity, dyslipidemia (high levels of triacylglycerides (TAGs) and low levels of high-density lipoprotein (HDL)), and insulin resistance have been associated to an increased risk of Type-2 diabetes mellitus (DM) and cardiovascular diseases (CVDs)
Our results show that the use of flavanol-containing products in the absence of medication was significantly associated with the reduction of body mass index (BMI), waist circumference (WC), total and LDL cholesterol, as well as TAGs giving some evidence of their efficacy as therapeutics
Our analysis suggests that the administration of tea as a solid extract might be more efficient than tea beverages at reducing WC and total cholesterol
Summary
Abdominal obesity, dyslipidemia (high levels of triacylglycerides (TAGs) and low levels of high-density lipoprotein (HDL)), and insulin resistance have been associated to an increased risk of Type-2 diabetes mellitus (DM) and cardiovascular diseases (CVDs). In addition to other protective compounds (i.e., fiber and vitamins), plant foods are an exclusive and abundant source of phytochemicals, a large and diverse group of compounds which exhibit an array of biological activities The intake of these bioactive compounds are thought to contribute to the health benefits associated with the consumption of such foods [3]. Polyphenols are some of the most abundant phytochemicals in plant foods and increasing evidence from cohort studies indicate that the intake of some of these compounds such as diverse flavonoids and/or, importantly, some of their derived microbial metabolites (e.g., enterolactone) may help to reduce the development of CVDs and CVDs mortality risk [4,5,6,7]. This evidence is supported by animal and clinical studies reporting beneficial effects of the consumption of some polyphenol-rich foods or pure compounds on CVDs risk factors such as blood cholesterol, blood pressure, endothelial function and arterial stiffness [8]
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