Results from six meta-analyses of ACNs from fruits and vegetables on glycemic indices, insulin resistance, hyperlipidemia, inflammation, and oxidation in patients with T2DM.
| Reference | Number of studies/patients included | Intervention/dosage form/dose | T2DM outcomes | Conclusions | Study limitations |
|---|---|---|---|---|---|
| Tiwari et al. [111] (2024) | 21 RCTs/not stated | ACN-rich foods, various sources/dose not stated | Results of clinical trials showed that ACN-rich foods significantly reduced the FBG, TC, HbA1c, and TG. | Consumption of ACN-rich foods improves blood glucose regulation and lipid levels in diabetic and obese subjects. | A low number of studies were included in the analysis. Many studies had an unclear risk of bias and were from China and the Middle East, suggesting that they may not be generalizable. |
| de Oliveira et al. [112] (2023) | 8 RCTs/n = 390 | Fresh or freeze-dried blueberries/dose not stated | The study showed no differences in BP, FBG, TC, LDL-C, ApoB, or HbA1c. Decreases in hs-CRP, IL-6. ROS and TNF were reported. | Administration of fresh or frozen whole berry products had no significant effect on diabetic parameters, except for reduced inflammation and oxidative stress markers. | Analyses only included papers in English or Spanish. Only included studies of whole fruits. Many studies included a high risk of bias. |
| Mao et al. [113] (2023) | 13 RCTs/n = 703 T2DM | ACN-rich extracts/supplements/ 320 mg/day | A study reported that a median ACN dose of 320 mg/day from concentrated fruit extracts or powders significantly reduced FBG, HbA1c, TG, and LDL-C. No significant difference was seen in insulin levels, HOMA-IR, TC, HDL-C, or BP. | Significant improvements in glycemic parameters and lipid profiles in patients with T2DM. Concluded that ACNs in fruit extracts or powders were useful in T2DM, to reduce lipiddisorders and resultant cardiovascular diseases. | A low number of studies and subjects were included in the analysis. More than half of the studies had an unclear risk of bias for allocation concealment. Many studies from China and the Middle East indicate that the study may not be generalizable. |
| Sandoval-Ramírez et al. [114] (2022) | 5 systematic reviews/meta-analyses/n = 2,314,336 and 8 RCTs/n = 4,984 | Various ACN-rich products/200 and400 mg/day | Supplementation with ACNs at doses between 200 and 400 mg/day significantly reduced both FBG (–5.58 mg/dL) and Hb1Ac (–0.65 units).In T2DM patients, doses of ACNs of 31.45 to 1,050 mg/day reduced the HOMA-IR. | Supplementation with ACNs improved lipid profiles, glycemic indices, and endothelial function, but had no effect on BP. | High heterogeneity between disease states, products, populations, and ACN doses. Umbrella reviews limitations include the restriction of the information, limiting the data that can be analyzed. |
| Fallah et al. [115] (2020) | 37 RCTs/n = 2,068 | Various ACN-rich fruit extracts and purified ACNs | Significant reduction in FBG, the 2-hour level PPG (2h-PPG), HbA1c, HOMA-IR, resistin, and PAI-1. No significant change in the levels of fasting insulin or CRP. | ACN supplementation for longer than 8 weeks at a high dose of > 300 mg/d significantly reduced levels of FBG, 2h-PPG, HbA1c, and HOMA-IR in patients with T2DM. | High heterogeneity as studies included different sources of ACN products, doses, and patient populations. Products also contained other active compounds that may have introduced bias into the study. |
| Araki et al. [116] (2021) | 22 RCTs based on ACN structure type/not stated | Cyanidin-, delphinidin-, or malvidin-based ACNs/wide range of products: juices, fruit, extracts, freeze-dried berries, purified ACNs | Significant reduction in LDL-C cholesterol by delphinidin-based ACNs. Increased HDL-C. No significant effect on fasting glucose levels, insulin levels, HbA1c, or HOMA-IR for any ACN. The insulin resistance index was reduced by cyanidin-based ACNs. | No significant effects on glucose levels, insulin levels, HbA1c, or HOMA-IR. TG, LDL-C, and HDL-C levels were significantly improved by delphinidin-based ACNs.Cyanidin-based ACN products showed improvements in TC and insulin resistance.Malvidin-based ACNs showed improvement only in HDL-C. | The clinical trials included had low to moderate qualities. Small number of participants, particularly for the individual ACNs trials. The effects of malvidin-based ACNs on glucose related parameters and of cyanidin-based ACNs on HbA1c was not determined due to insufficient data. |
ACNs: anthocyanins; BP: blood pressure; CRP: C-reactive protein; FBG: fasting blood glucose; HbA1c: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; HOMA-IR: homeostasis model assessment of insulin resistance; LDL-C: low-density lipoprotein cholesterol; PAI-1: plasminogen activator inhibitor-1; PPG: postprandial glucose; RCTs: randomized controlled trials; T2DM: type 2 diabetes mellitus; TC: total cholesterol; TG: triglycerides.
The supplementary material for this article is available at: https://www.explorationpub.com/uploads/Article/file/101474_sup_1.pdf.
SMW: Investigation, Writing—original draft, Writing—review & editing. TOL: Validation, Writing—review & editing. BAA: Investigation, Validation, Writing—original draft, Writing—review & editing. GPA: Investigation, Writing—review & editing. GBM: Conceptualization, Investigation, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.
The authors declare that they have no conflicts of interest.
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All information and data in this review are in the public domain. The primary data for this systematic review were sourced online from databases listed in the methods. Referenced articles are accessible on Cochrane Library, PubMed Central/Medline, Embase, Google Scholar, and the Scopus electronic databases. Additional supporting data are available from the corresponding author upon request.
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