Meta-analysis Of Intervention Studies Research Articles

Impact of institutional quality improvement initiatives on metabolic monitoring in mental disorder in patients treated with antipsychotics: A meta-analysis of intervention studies.

Compliance with guidelines regarding monitoring of metabolic adverse effects induced by antipsychotics has been consistently low. We characterised and evaluated the quality of institutional quality improvement (QI) interventions designed to address disparities between guidelines and real-world practices. Furthermore, we assessed the impact of these interventions on the screening and management of metabolic risks for inpatients receiving treatment with antipsychotic medications. We conducted a meta-analysis of institutional QI intervention studies aimed at improving antipsychotic-associated metabolic risk monitoring in hospitalised mental disease patients. Relevant studies were identified through searches conducted in the Embase and PubMed databases, as well as by reviewing previous reviews and meta-analyses. Quantitative analyses were performed, calculating odds ratios (ORs) and 95% confidence intervals (CIs) to assess the impact of QI programmes on guideline adherence in clinical practice. We identified 12 intervention studies (n = 10 128 and n = 2667 patients in the pre-and post-intervention groups, respectively) and included them in our meta-analysis. QI interventions demonstrated effectiveness in bridging the guideline-practice gap in monitoring antipsychotic-induced metabolic adverse effects, as supported by the ORs and 95% CIs for post-intervention monitoring of plasma glucose, lipids, and blood pressure (BP) vs the pre-intervention period being OR = 6.90 (95% CI = 1.51-31.48), OR = 5.39 (95% CI = 4.01-7.24), and OR = 4.81 (95% CI = 1.23-18.79), respectively. Only 33.3% (4/12) of studies reported screening rates for all four metabolic parameters (plasma glucose, lipids, weight/body mass index (BMI), and BP). The median rates for metabolic screening of plasma glucose, lipids, and BP increased from 51.0-80.0%, 28.7-66.7%, and 91.7-95.8%, respectively. Up to 66.7% (8/12) of intervention studies lacked follow-up measures to treat or manage identified risks in hospitalised psychiatric patients, such as patient referrals, prescription of medications, and switching of antipsychotics. The odds of monitoring weight/BMI and glucose were greatest when QI programmes involved the participation of multidisciplinary health care professionals and patients, yielding OR = 3.35 (95% CI = 2.45-4.59) and OR = 57.51 (95% CI = 24.11-137.21), respectively. Institutional QI interventions were effective in enhancing monitoring practices in alignment with established guidelines for metabolic risk screening among hospitalised patients with mental disorders maintained on antipsychotic medications. Future institutional QI programmes should incorporate multidisciplinary strategies involving patient engagement and extend their focus beyond screening to incorporate follow-up risk management strategies once risks have been identified. PROSPERO CRD42023452138.

The effect of niacin on inflammatory markers and adipokines: a systematic review and meta-analysis of interventional studies.

Niacin (nicotinic acid), known for its lipid-modifying effects, has been explored for its potential anti-inflammatory properties and potential to affect adipokines secretion from adipose tissue. The aim of this systematic review and meta-analysis was to assess the effects of niacin on inflammatory markers and adipokines. A comprehensive search was conducted across five databases: PubMed, Scopus, Cochrane Library, Embase, and ISI Web of Science. Randomized controlled trials exploring the effects of niacin on inflammatory markers (CRP, IL-6, TNF-α) and adipokines (Adiponectin, Leptin) were included. Pooled effect sizes were analysed using a random-effects model, and additional procedures including subgroup analyses, sensitivity analysis and dose-response analysis were also performed. From an initial 1279 articles, fifteen randomized controlled trials (RCTs) were included. Niacin administration demonstrated a notable reduction in CRP levels (SMD: -0.88, 95% CI: -1.46 to -0.30, p = 0.003). Subgroup analyses confirmed CRP reductions in trials with intervention durations ≤ 24 weeks, doses ≤ 1000mg/day, and elevated baseline CRP levels (> 3mg/l). The meta-analysis of IL-6 and TNF-α revealed significant TNF-α reductions, while IL-6 reduction did not reach statistical significance. Niacin administration also substantially elevated Adiponectin (SMD: 3.52, 95% CI: 0.95 to 6.1, p = 0.007) and Leptin (SMD: 1.90, 95% CI: 0.03 to 3.77, p = 0.04) levels. Niacin treatment is associated with significant reductions in CRP and TNF-α levels, suggesting potential anti-inflammatory effects. Additionally, niacin positively influences adipokines, increasing Adiponectin and Leptin levels. These findings provide insights for future research and clinical applications targeting inflammation and metabolic dysregulation.

Frilufts-therapy can improve adolescents’ mental health. A systematic review and meta-analysis of intervention studies

ABSTRACT This study aims to investigate the impact of frilufts-therapy (Nordic inspired therapeutic interventions in nature) on adolescents’ mental health through a systematic literature review following PRISMA 2020 guidelines. Inclusion criteria encompassed peer-reviewed intervention studies in English, Danish, or Norwegian, quantitatively evaluated with pre- and post-measurements on outcomes pertaining to salutogenesis. Papers published between 2010–2021 were selected from PubMed and PsycInfo in November 2021. Risk of bias was assessed using Cochrane RoB 2, ROBINS-I, and NIH tools synthesized into a six-domain assessment. Ten papers evaluating 12 studies (1711 adolescents) were selected. Meta-analysis of effect estimates on controlled studies (7) revealed a medium to large effect (ES = 0.70; CI = 0.41–0.98) favouring frilufts-therapy. Meta-analysis without control (11 studies) showed a medium effect (ES = 0.52; CI = 0.34–0.70) favouring post-test measurements. This support evidence that frilufts-therapy can improve the mental health of adolescents, but caution is advised due to potential study limitations, necessitating further research.

Telemedicine for obesity management among United States adults: A systematic and meta-analysis of intervention studies.

Obesity is projected to affect 86% of United States adults by 2030. Recent data show a surge to 41.9%, with the highest proportion in the 40-59 age group (44.3%). Obesity is linked to various health issues and preventable deaths. Telemedicine has emerged as a promising avenue for addressing obesity. This systematic review and meta-analysis examine the effectiveness of telemedicine interventions for managing obesity in US adults aged 40 and above. Through a thorough Preferred Reporting Items for Systematic Reviews and Meta-Analysis-guided search, 16 studies meeting inclusion criteria were identified. These studies employed diverse telemedicine technologies, including video-based and telephone sessions or a mixture of technologies. The analysis reveals a statistically significant mean difference of 0.93 in favor of telemedicine interventions for weight loss. Subgroup analysis suggests that intervention durations of 6-12 months and telephone-based sessions correlate with more substantial mean differences. This study provides valuable insights into the effectiveness of telemedicine in managing obesity, emphasizing the importance of intervention type and duration. Study limitations include variability and potential biases. Customized telemedicine strategies have the potential to combat the obesity epidemic among older adults in the United States, offering guidance to healthcare professionals aiming to reduce health risks and enhance overall well-being.

The Efficacy of Dietary Interventions in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Intervention Studies.

International guidelines recommend dietary interventions as one of the most important treatments for patients with gastroesophageal reflux disease (GERD). Evidence to confirm the efficacy of these treatment modalities is lacking. The present study aims to evaluate the efficacy of dietary interventions on GERD-related outcomes evaluated in intervention studies on GERD patients. A systematic review and meta-analysis was performed according to PRISMA. The PubMed/MEDLINE, Web of Sciences, and Scopus databases were utilized for the literature search. Two independent researchers searched for relevant publications published up until June 2023. Intervention studies evaluating the efficacy of dietary interventions in patients with GERD were included. A total of 577 articles were identified during the initial literature search. After reviewing, 21 studies with 16 different types of dietary interventions were included in the analysis. The interventions were divided into low-carbohydrate diets (3 studies), high-fat diets (2 studies), speed of eating studies (3 studies), low-FODMAP diets (2 studies), and other interventions (12 studies). A meta-analysis could be performed for low-carbohydrate diets and speed of eating interventions. Low-carbohydrate diets resulted in a significant reduction in esophageal acid exposure time (mean difference = -2.834%, 95% confidence interval (CI): -4.554 to -1.114), while a slow speed of eating did not lead to a lower percentage of reflux events compared to fast eating (risk ratio = 1.044, 95% CI: 0.543-2.004). Most other interventions showed positive effects in only a single study. Low-carbohydrate diets showed a significant improvement in GERD-related outcomes, while a slow eating speed did not result in a reduction in reflux events. The overall evidence regarding dietary interventions in GERD remains scarce. High-quality, long-term RCTs are still required to confirm the effects of dietary interventions in GERD patients.

Effectiveness of yogic exercise on respiratory health indices: A systematic review and meta-analysis of intervention studies

Effectiveness of yogic exercise on respiratory health indices: A systematic review and meta-analysis of intervention studies

The effect of a low-calorie diet on depressive symptoms in individuals with overweight or obesity: a systematic review and meta-analysis of interventional studies.

Individuals with overweight or obesity are at a high risk for so-called 'atypical' or immunometabolic depression, with associated neurovegetative symptoms including overeating, fatigue, weight gain, and a poor metabolic profile evidenced e.g. by dyslipidemia or hyperglycemia. Research has generated preliminary evidence for a low-calorie diet (LCD) in reducing depressive symptoms. The aim of the current systematic review and meta-analysis is to examine this evidence to determine whether a LCD reduces depressive symptoms in people with overweight or obesity. Eligible studies were identified through PubMed, ISI Web of Science, and PsycINFO until August 2023. Standardized mean differences (SMDs) were derived using random-effects meta-analyses for (1) pre-post LCD comparisons of depression outcomes, and (2) LCD v. no-diet-control group comparisons of depression outcomes. A total of 25 studies were included in the pre-post meta-analysis, finding that depression scores were significantly lower following a LCD (SMD = -0.47), which was not significantly moderated by the addition of exercise or behavioral therapy as a non-diet adjunct. Meta-regressions indicated that a higher baseline BMI and greater weight reduction were associated with a greater reduction in depression scores. The intervention-control meta-analysis (n = 4) found that overweight or obese participants adhering to a LCD showed a nominally lower depression score compared with those given no intervention (SMD = -0.29). There is evidence that LCDs may reduce depressive symptoms in people with overweight or obesity in the short term. Future well-controlled intervention studies, including a non-active control group, and longer-term follow-ups, are warranted in order to make more definitive conclusions.

The effects of cash transfer programmes on HIV/AIDS prevention and care outcomes: a systematic review and meta-analysis of intervention studies

Poverty and social inequality are risk factors for poor health outcomes in patients with HIV/AIDS. In addition to eligibility, cash transfer programmes can be divided into two categories: those with specific requirements (conditional cash transfers [CCTs]) and those without specific requirements (unconditional cash transfers). Common CCT requirements include health care (eg, undergoing an HIV test) and education (eg, children attending school). Trials assessing the effect of cash transfer programmes on HIV/AIDS outcomes have yielded divergent findings. This review aimed to summarise evidence to evaluate the effects of cash transfer programmes on HIV/AIDS prevention and care outcomes. For this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane Library, LILACS, WHO IRIS, PAHO-IRIS, BDENF, Secretaria Estadual de Saúde SP, Localizador de Informação em Saúde, Coleciona SUS, BINACIS, IBECS, CUMED, SciELO, and Web of Science up to Nov 28, 2022. We included randomised controlled trials (RCTs) that evaluated the effects of cash transfer programmes on HIV incidence, HIV testing, retention in HIV care, and antiretroviral therapy adherence, and conducted risk of bias and quality of evidence assessments using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations approach. A random-effects meta-analysis model was used to combine studies and calculate risk ratios (RRs). Subgroup analyses were performed using conditionality types (ie, school attendance or health care). The protocol was registered with PROSPERO, CRD42021274452. 16 RCTs, which included 5241 individuals, fulfilled the inclusion criteria. Of these, 13 studies included conditionalities for receiving cash transfer programmes. The results showed that receiving a cash transfer was associated with lowered HIV incidence among individuals who had to meet health-care conditionalities (RR 0·74, 95% CI 0·56-0·98) and with increased retention in HIV care for pregnant women (1·14, 95% CI 1·03-1·27). No significant effect was observed for HIV testing (RR 0·45, 95% CI 0·18-1·12) or antiretroviral therapy adherence (1·13, 0·73-1·75). Lower risk of bias was observed for HIV incidence and having an HIV test. The strength of available evidence can be classified as moderate. Cash transfer programmes have a positive effect on mitigating HIV incidence for individuals who have to meet health-care conditionalities and on increasing retention in HIV care for pregnant women. These results show the potential of cash transfer programmes for HIV prevention and care, especially among people in extreme poverty, and highlight that cash transfer programmes must be considered when developing policies for HIV/AIDS control, as indicated by the UNAIDS 95-95-95 target of the HIV care continuum. National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.

Effectiveness of Positive Deviance Approach to Reduce Malnutrition among under Five Children: A Systematic Review and Meta-Analysis of Interventional Studies.

The high malnutrition rate in children under five makes this problem one of the public health problems. Various efforts have been made to reduce malnutrition in children under five, one of which is the implementation of community programs with a positive deviance approach which is considered an effective way because the solution to the problem comes from the local community. Thus, we conducted a systematic review and meta-analysis to determine the effect of interventions with a positive deviance approach to reducing under-five children's malnutrition. Systematic searches were conducted using the following journal databases: Science Direct, Pubmed, Proquest, SAGE journal, Web of Science, and Scopus. The article was included if using an intervention design. Data analysis used Review Manager 5.4 software, random effect model, outcome mean of difference, and 95% confidence interval. There were no significant differences between the intervention and control groups on the length for age z-scores (LAZ), weight for age z-scores (WAZ), and weight for height z-scores (WHZ) indicators. There was an increase in LAZ, WAZ, and WHZ scores in the intervention group, with a greater z-score than in the control group. In conclusion, interventions with the positive deviance approach can be used as an alternative to improving the nutritional status of under-five children. However, further research is needed to determine the effective duration of interventions in improving the nutritional status of children.

Effect of Potassium Supplementation on Endothelial Function: A Systematic Review and Meta-Analysis of Intervention Studies

(1) Background: Endothelial dysfunction is an early predictor of cardiovascular diseases. Although a large body of evidence shows an inverse association between potassium intake and cardiovascular risk, the studies on endothelial function provided contrasting results. Thus, we carried out a systematic review and a meta-analysis of the available intervention studies of the potassium supplementation on endothelial function. (2) Methods: A systematic search of the online databases available (up to December 2022) was conducted including the intervention trials that reported flow-mediated dilation (FMD) changes-a non-invasive method of assessing endothelial function-after two different potassium intake regimens. For each study, the mean difference (MD) and 95% confidence intervals were pooled using a random effect model. (3) Results: Five studies met the pre-defined inclusion criteria and provided eight cohorts with 332 participants. In the pooled analysis, potassium supplementation was associated with a significant increase in FMD (MD: 0.74%), with a higher effect for a urinary potassium excretion higher than 90 mmol/day. There was a moderate heterogeneity among studies (I2 = 59%), explained by the different amount of potassium supplementation. (4) Conclusions: The results of our meta-analysis indicate that dietary potassium supplement improves endothelial function. This effect is directly associated with the amount of potassium supplement. The findings support the campaigns in favour of an increase in dietary potassium intake to reduce cardiovascular risk.

Comparison of the effect of oral and vaginal misoprostol on labor induction: updating a systematic review and meta-analysis of interventional studies

ObjectivesThis study is aimed to compare the effect of oral misoprostol with vaginal misoprostol to induce labor as a systematic review and meta-analysis.MethodsElectronic databases including PubMed [Medline], Scopus, Web of science, Embase, Ovid, Cochrane library, and ClinicalTrials.gov were searched using the relevant keywords. All RCTs comparing the effect of oral vs vaginal misoprostol on labor induction were considered. The Cochrane Risk of Bias checklist was used for assessing quality of included RCTs. All statistical analyses were completed using STATA (Version 16) and Revman (Version 5).ResultsThirty-three RCTs with 5162 patients (1560 in oral and 2602 in vaginal groups) were included in this meta-analysis. Labor induction length did differ significantly between the two routes of misoprostol administration [Standardized Mean Difference: 0.40 h, 95% confidence interval (CI) 0.34, 0.46; I2: 66.35%; P = 0.04]. In addition, the risk of neonatal death, tachysystole, uterine hyperstimulation, preeclampsia, non-FHR and abortion was lower in the oral misoprostol group and the risk of hypertonus, PROM, oxytocin need and cesarean fever was higher in this group than the vaginal misoprostol group.ConclusionsBased on results of this meta-analysis, it can be inferred that currently, clinical specialists can decide to use this drug orally or vaginally on a case-by-case basis, depending on the condition of the pregnant mother and the baby.

Diet, nutrition and cognitive health in older adults: Shedding new light through systematic review and meta-analysis of intervention studies

Diet, nutrition and cognitive health in older adults: Shedding new light through systematic review and meta-analysis of intervention studies

Effect of Intermittent Fasting on Glycaemic Control in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Background: Type 2 diabetes mellitus (T2DM) is a severe public health issue notably impacting human life and health expenditure. It has been observed in literature that intermittent fasting (IF) addresses diabetes and its underlying cause, which benefits people with diabetes. Therefore, this study aimed to evaluate the effectiveness of IF treatment on glycaemic control in people with T2DM compared with control group. Methods: Systematic review and meta-analysis of interventional studies among patients with T2DM with glycated haemoglobin (HbA1c) as an outcome was performed. A comprehensive search of electronic databases, including PubMed, Embase and Google Scholar, for articles published before 24 April 2022, was done. Studies reporting 24 hours of complete fasting or intermittent restricted energy intake (feeding permitted for only 4-8 hours daily, with 16-20 hours of fasting) and reporting changes in HbA1c and fasting glucose levels were eligible. Meta-analysis was performed using Cochrane's Q statistic and the I2 statistical approach. Results: Eleven studies (13 arms) measuring the effect of IF on patients' HbA1c level were analysed. There was no statistically significant difference between IF and control groups (Standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.20 to 0.04;p=0.19, I2=22%). Overall, seven studies on patients' fasting blood glucose were analysed, and the meta-analysis revealed no significant difference between the two groups i.e. IF and control groups (SMD 0.06, 95% CI -0.25 to 0.38;p=0.69, I2=76%). Conclusion: IF and usual diet pattern have no difference in terms of glycaemic control. Although, IF may be used as a preventative diet pattern in the pre-diabetic population, as it works well in the long-term to achieve controlled sugar levels. Study registration: The protocol of this study was registered in The International Prospective Register of Systematic Reviews (PROSPERO) with a registration number CRD42022328528.

The effect of obstructive sleep apnea therapy on cardiovascular autonomic function: a systematic review and meta-analysis.

Autonomic function is impaired in obstructive sleep apnea (OSA) and may mediate the association between OSA and cardiovascular risk. We investigated the effect of OSA therapy on autonomic function through a systematic review and meta-analysis of intervention studies. A systematic search using three databases (Medline, Embase, and Scopus) was performed up to December 9, 2020. Studies of OSA patients ≥ 18 years with autonomic function assessed before and after treatment with positive airway pressure, oral appliance, positional therapy, weight loss, or surgical intervention were included for review. Random effects meta-analysis was carried out for five groups of autonomic function indices. Risk of bias was assessed using the Cochrane Collaboration tool. Forty-three eligible studies were reviewed with 39 included in the meta-analysis. OSA treatment led to large decreases in muscle sympathetic nerve activity (Hedges' g = -1.08; 95% CI -1.50, -0.65, n = 8) and moderate decreases in catecholamines (-0.60; -0.94, -0.27, n = 3) and radio nucleotide imaging (-0.61; -0.99, -0.24, n = 2). OSA therapy had no significant effect on baroreflex function (Hedges' g = 0.15; 95% CI -0.09, 0.39, n = 6) or heart rate variability (0.02; -0.32, 0.36, n = 14). There was a significant risk of bias due to studies being primarily non-randomized trials. OSA therapy selectively improves autonomic function measures. The strongest evidence for the effect of OSA therapy on autonomic function was seen in reduced sympathetic activity as assessed by microneurography, but without increased improvement in parasympathetic function. OSA therapy may reduce the risk of cardiovascular disease in OSA through reduced sympathetic activity.

Efficacy and safety of saroglitazar for the management of dyslipidemia: A systematic review and meta-analysis of interventional studies.

Saroglitazar is a newer antidiabetic agent approved to manage dyslipidemia. The objective is tevaluate the efficacy and safety profiles of saroglitazar in patients with dyslipidemia. A systematic search was conducted using PubMed, Cochrane Library, Scopus, and Google Scholar from the inception until January 2022. Interventional studies comparing the anti-hyperlipidaemic effect and safety of saroglitazar with or without a control group(s) were included. The efficacy of saroglitazar was assessed concerning its effect on total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL)-cholesterol, triglycerides, fasting plasma glucose, and non-HDL cholesterol. The effects on serum creatinine levels, bodyweight reduction, alanine aminotransferase and aspartate aminotransferase were considered to be safety endpoint.The Cochrane risk of bias assessment tool was used to assess the methodological quality of the included studies. A total of six studies with 581 adults with a mean age ranging from 40.2 to 62.6 years were included in this study. A significant decrease in low-density lipoprotein cholesterol was observed with saroglitazar 4 mg therapy compared to saroglitazar 2 mg [standardized mean difference (SMD): -0.23 mg/dL, 95% CI: -0.47 to 0.00; p = 0.05; 2 studies], and control [SMD: -0.36 mg/dL, 95% CI -0.59 to -0.12; p = 0.0026; 3 studies]. Also, a significant decrease in the total cholesterol was observed with saroglitazar 4 mg therapy compared to saroglitazar 2 mg [SMD - 0.28 mg/dL, 95% CI: - 0.52 to -0.04; p < 0.01; 2 studies], and control [SMD - 0.49 mg/dL, 95% CI: - 0.72 to -0.26; p < 0.0001; 3 studies]. Saroglitazar was not associated with adverse effects such as increase in serum creatinine levels, alanine aminotransferase and aspartate aminotransferase and bodyweight reduction. Saroglitazar appeared to be an effective and safer therapeutic option for improving dyslipidemia in patients. However, comparative studies of saroglitazar with the other pharmacological agents are warranted.

The professional network underlying cerebral palsy intervention research based on systematic reviews and meta-analyses published in international journals: authors’ communities, institutional networks, and international collaboration

Cerebral palsy (CP) is a well-researched area of medical science, health science and special education. The growing number of publications every year makes difficult to monitor the progress of this research domain, therefore there is a broad interest for conducting systematic reviews and meta-analyses of interventions in international peer-reviewed scientific journals.Our goal is to analyze the scientific activity of authors who published systematic reviews and meta-analyses of CP intervention studies. To identify the active researchers, institutions, and countries, we used scientometric and bibliometric indicators that assess their productivity, collaborations, and the citations (utilization/usefulness of their studies), also paying attention to the institutional background and the network structure of national and international collaboration.We used Scopus to search for articles and included systematic reviews and meta-analyses of intervention studies, a total of 180 works, in our sample.Our results showed active and large communities of prolific authors and groups of authors with diverse institutional background. Most institutions are universities, hospitals, but we found various other organizations among them. Most of the universities are leading educational institutions according to international rankings; some of them are among the top-ranking ones. In geographical terms, the North American, Australian, and European regions are the most active and most interconnected ones. We assume organizations other than scientific collaboration networks also play a major role in the productivity and dissemination of scientific knowledge in this research area. As an example, we could mention the network, including the US, Australian and European registers. Authors living and working in the Far East, the Middle East or in South America also started to publish relevant articles in the 2010s. The research network structuring scientific knowledge in this area is flourishing.

The Effect of Bread Consumption on Glycemic Control – A Systematic Review and Meta-Analysis of Intervention Studies

ObjectivesBread is a main carbohydrate sources in most diets and may hence be relevant for several health outcomes. This systematic review evaluated the effect of bread consumption on glycemic control in adults with and without type 2 diabetes mellitus (T2DM). MethodsA systematic literature search was performed in September 2020 using Medline, Embase, Web of Science and the Cochrane Library. Eligible studies had to employ different types of bread in adults with or without T2DM and report glycemic outcomes (primary outcome: mean difference (MD) in fasting blood glucose between intervention and control groups; secondary outcomes: MD in fasting insulin, HOMA-IR, and glycated hemoglobin (HbA1c)). Data were pooled using generic inverse-variance with random effects model and presented as mean MD between treatments with 95% confidence intervals (95% CIs). ResultsTwenty-one studies met the inclusion criteria, providing data on 966 participants. Compared to control breads, the consumption of the intervention breads resulted in lower values of fasting blood glucose (MD –0.21 mmol/L, 95% CI –0.39 to –0.03, I2 = 89%), yet no differences in fasting insulin (MD –1.60 pmol/L, 95% CI –6.10 to 2.91, I2 = 42%), HOMA-IR (MD –0.08, 95% CI –0.39 to 0.23, I2 = 63%) or HbA1c (MD –0.12%, 95% CI –0.40 to 0.17, I2 = 60%). The included studies showed a great degree of heterogeneity. ConclusionsThe type of bread influences fasting blood glucose in adults with and without T2DM. This argues for a mechanistic role of bread quality in metabolic health and calls for its consideration in future health policies. Funding SourcesThe project has received funding from the German and Norwegian Research Council under the umbrella of European Joint programming Initiative “A healthy diet for a health life” (JPI-HDHL) and of the ERA-NET Cofund HDHL INTIMIC (GA N 727,565 of the EU Horizon 2020 Research and Innovation Programme).

Relationship Between Periodontal Disease and Glycemic Control in Pediatric Patients with Type 2 Diabetes Mellitus

IntroductionType 2 Diabetes Mellitus (T2DM) is a disease of heterogeneous etiology, in which the patient presents alterations in metabolism, which are associated with a total or relative deficiency in insulin production and variable degrees of resistance to it1,2.T2DM and periodontal disease are chronic diseases, the evidence suggests an association between the two. Studies report that T2DM worsens the periodontal disease and glycemic control plays a fundamental role in this3.4.ObjectiveTo determine the relationship between periodontal disease and glycemic control in pediatric patients with T2DM.MethodologyAn observational, descriptive, cross‐sectional, prospective, homodemic and single‐center study was carried out in the pediatric stomatology service of the “Hospital para el Niño Poblano” (Puebla city, Mexico) in the period January‐July 2019 with 20 patients (between 6 to 18 years old) diagnosed with T2DM and were under treatment for their glycemic control.ResultsThe population was classified into patients with glycemic control based on glycated hemoglobin (HbA1c ≤ 7.5%) and patients without glycemic control (HbA1c&gt; 7.5%).The prevalence of periodontal disease for patients diagnosed with T2DM was higher in uncontrolled patients who were classified within high Community Periodontal Index (CPI) codes between 3 (71.4%) and 4 (28.6%)5(Table 1).Similarly, it was observed that in the group of patients without glycemic control presented averages of Simplified Oral Hygiene Index (OHI‐S) cataloged between fair (57.1%) and poor (42.9%) (Table 2).DiscussionSimilar results were obtained by Janket (2005)6and Carneiro (2015)7, who relate a higher rate of periodontal disease in patients with higher HbA1c values.ConclusionIt was determined a relationship between glycemic control and periodontal disease in children, because patients with poor glycemic control (HbA1c&gt; 7.5%) presented CPI with degrees of inflammation and presence of periodontal pockets and poor OHI‐S.References Islas S, Revilla MC. Diabetes Mellitus: Actualizaciones. IMSS. México, D.F.: Editorial Alfil. 2013. Menon S, Francis J, Zdraveska N, Dusabimana A &amp; Bhattacharyya S. La epidemiología de la hiperglucemia inducida por TB intransitoria en individuos con diabetes mellitus 2 no diagnosticada previamente: un protocolo para una revisión sistemática y un metanálisis. Revisiones sistemáticas. 2019; 8 (1): 1‐5. Britos MR, Sin CS, &amp; Ortega SM. Enfermedad periodontal y su implicancia en la diabetes mellitus: revisión de la literatura. Rev. Ateneo Argent. Odontol. 2019: 33‐40. Pérez I. Diabetes Mellitus. Gac Med Mex. 2016;152(1):50‐55. IPC. OMS (online, July 2019). URL available at: https://es.scribd.com/doc/84956710/Indice‐Periodontal‐de‐Russell‐forma‐OMS Janket S, Wightman A, Baird AE, Van Dyke T, Jones J. Does periodontal treatment improve glycemic control in diabetic patients? A meta‐analysis of intervention studies. J Dent Res. 2005;84(12):1154‐1159. Carneiro V, Calixto F, Morais F, Pegoretti T, Borges AC, da Silva M. The influence of glycemic control on the oral health of children and adolescents with diabetes mellitus type 1. Arch Endocrinol Metab. 2015;59(6):535‐540.

Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies.

Background: Vitamin D deficiency is associated with sleep disorders and poor sleep quality. Whether vitamin D supplementation (VDS) helps resolve these problems remains unclear. Objective: To systematically review the effect of VDS on sleep quantity, quality, and disorders, and perform a meta-analysis of available data. Methods: The reporting of this review followed the PRISMA statement. VDS human interventions studies that reported on sleep quality, quantity, or disorders were included. Medline, CINAHL, EMBASE, PsycInfo, the Cochrane Library, Clinicaltrials.gov, and the ICTRP were searched, in addition to the references of the included articles and previous relevant reviews, without language or time restrictions. Included studies were critically appraised, findings were narratively synthesized, and a meta-analysis was conducted. Furthermore, the overall certainty of the evidence was assessed. Results: A total of 19 studies were included (13 randomized controlled trials (RCTs), 1 opportunistic addition to an RCT, 4 pre–post studies, and 1 pre–post study analyzed as a case series); 3 RCTs were meta-analyses. The risk of bias was generally low. Pre–post studies showed a significant improvement in sleep quality with VDS. Similarly, the results of the meta-analysis revealed a statistically significant decrease in the Pittsburgh Sleep Quality Index with VDS compared with placebo (mean difference, −2.33 (95% CI, −3.09, −1.57); p < 0.001; I2 = 0%), with a moderate certainty of evidence. The results regarding the effect of VDS on sleep-related impairment, difficulty, and disorders, as well as sleepiness and restless legs syndrome, were not unanimous. Conclusions: VDS is promising in improving sleep quality; however, its effect on sleep quantity and disorders needs to be further investigated.

Cardiovascular Effects of Chocolate and Wine-Narrative Review.

The consumption of food for pleasure is mainly associated with adverse health effects. This review was carried out to verify recent reports on the impact of chocolate and wine consumption on cardiovascular health, with a particular focus on atherosclerosis. On one side, these products have proven adverse effects on the cardiovascular system, but on the other hand, if consumed in optimal amounts, they have cardiovascular benefits. The submitted data suggest that the beneficial doses are 30–50 g and 130/250 mL for chocolate and wine, respectively, for women and men. The accumulated evidence indicates that the active ingredients in the products under consideration in this review are phenolic compounds, characterized by anti-inflammatory, antioxidant, and antiplatelet properties. However, there are also some reports of cardioprotective properties of other compounds such as esters, amines, biogenic amines, amino acids, fatty acids, mineral ingredients, and vitamins. Our narrative review has shown that in meta-analyses of intervention studies, consumption of chocolate and wine was positively associated with the beneficial outcomes associated with the cardiovascular system. In contrast, the assessment with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) scale did not confirm this phenomenon. In addition, mechanisms of action of bioactive compounds present in chocolate and wine depend on some factors, such as age, sex, body weight, and the presence of additional medical conditions. Patients using cardiovascular drugs simultaneously with both products should be alert to the risk of pharmacologically relevant interactions during their use. Our narrative review leads to the conclusion that there is abundant evidence to prove the beneficial impact of consuming both products on cardiovascular health, however some evidence still remains controversial. Many authors of studies included in this review postulated that well-designed, longitudinal studies should be performed to determine the effects of these products and their components on atherosclerosis and other CVD (Cardiovascular Disease) disease.