Meta-analysesThe effects of cranberry on cardiovascular metabolic risk factors: A systematic review and meta-analysis
Introduction
Cardiovascular disease (CVD) is the leading cause of death among non-communicable diseases, and affects millions of people in both developed and developing countries [1]. Despite the reducing CVD mortality rate, it is still one of the main problems faced by healthcare systems, and can lead to serious social distress, as well as imposing substantial health economic burdens on a global scale over the past few decades [2], [3]. For this reason, healthcare service studies should try to find better solution for the prevention and/or treatment of CVD [4], [5]. Multiple factors and diseases have been suggested as being associated with CVD development. Certain associations between CVD and many diseases are well-documented [6], [7], [8], and several metabolic risk factors including hyperglycemia and dyslipidemia have been suggested as playing substantial roles in the onset and progression of CVD [9], [10], [11]. Cardio-metabolic risk factors are modifiable, and CVD can be prevented through strategies which can beneficially amend them. In this regard, many strategies are recommended in terms of focusing on CVD risk factor management, such as diet modification, physical activity, and pharmacological therapy [12], [13]. Current drug therapy, including blood pressure-lowering agents and lipid profiles-modulators, are frequently and effectively used for CVD risk factor management [14], [15]. However, there is a concern about their undesirable side-effects [16], [17], [18]. Beside the pharmacological approach, complementary medicine can offer novel, safe and cost-effective options. It is thus not surprising that many researchers are exploring substitution or adjutant therapy for CVD metabolic risk factor management in parallel with pharmacological agents [19], [20], [21].
Cranberry (Vaccinium macrocarpon Ait Ericaceae), belonging to the Ericaceae family, is widely consumed in many countries in the forms of fresh and dry fruits, juice and encapsulated powders [22]. Cranberries have been highly ranked in terms of their antioxidant capacity, and are known as a rich source of phenolic compounds. It has been used for a long time in traditional folk medicine, especially for the treatment of bladder and kidney ailments [23]. Cranberry also has several putative health benefits for the prevention and/or treatment of cardiovascular disease [24], urinary tract infections [25] and cancer [26]. The CVD protective properties of cranberry have been investigated in animal [27], [28] and human studies [29], [30]. However, results from human studies have remained inconclusive. To summarize the evidence and clarify these inconsistencies in the results of human trials, the current systematic review and meta-analysis was conducted to systematically identify and quantitatively assess the efficacy of cranberry supplementation on CVD metabolic risk factors in adult populations.
Section snippets
Materials and methods
The present systematic review and meta-analysis was reported in accordance with the PRISMA guidelines [31].
Results
Figure 1 shows a flowchart of the study selection process and reasons for excluding articles. The primary literature search yielded 1892 publications from the aforementioned electronic databases. After excluding duplicate studies, a total of 1619 publications were reviewed by title/abstract, and 1603 were excluded which did not meet the inclusion criteria. 16 articles were retrieved and scrutinized by full-text. Of those, 4 studies were discarded for the following reasons: cranberry was
Discussion
The results of the present systematic review and meta-analysis suggested that cranberry supplementation might have favorable effects on blood pressure and weight loss. However, the results did not support any benefit from cranberry on lipid profiles, glycemic status markers, and inflammatory markers. The stratified analysis indicated that cranberry increased TG in the subgroup in which cranberry was administrated in the form of juice. While no significant change was observed in serum TG levels
Conclusion
In conclusion, the current meta-analysis on available trials suggested that cranberry may have beneficial effects on reducing SBP and BMI. This SBP-lowering effect is robust in people >50 years old. Also, the results showed that cranberry might be effective in terms of increasing HDL levels in adults <50 years old. However, these findings are incomplete due to the paucity of studies, and more studies are needed in this field to confirm these results, as well as to clarify other aspects of the
Authorship
M.P. and A.H. carried out the concept, design and drafting of this study. A.N., A.H., and F.J. searched databases, screened articles and extracted data. M.P. performed the acquisition, analysis, and interpretation of data. F.M-G. critically revised the manuscript. All authors approved the final version of the manuscript. F.M-G. and F.J. are the guarantors of this study.
Funding
None.
Conflicts of interest
None.
References (88)
- et al.
Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015
J Am Coll Cardiol
(2017) - et al.
Cardiovascular risk factor management performance in Canada and the United States: a systematic review
Can J Cardiol
(2017) - et al.
The effect of ginger supplementation on lipid profile: a systematic review and meta-analysis of clinical trials
Phytomedicine
(2018) - et al.
Royal jelly is an effective and relatively safe alternative approach to blood lipid modulation: a meta-analysis
J Funct Foods
(2018) - et al.
Low-energy cranberry juice decreases lipid oxidation and increases plasma antioxidant capacity in women with metabolic syndrome
Nutr Res
(2011) - et al.
Effects of cranberry juice consumption on vascular function in patients with coronary artery disease
Am J Clin Nutr
(2011) - et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986) - et al.
Cranberry juice consumption lowers markers of cardiometabolic risk, including blood pressure and circulating C-reactive protein, triglyceride, and glucose concentrations in adults
J Nutr
(2015) - et al.
Evidence that cranberry juice may improve augmentation index in overweight men
Nutr Res
(2013) - et al.
Age-related impairment of HDL-mediated cholesterol efflux
J Lipid Res
(2007)
Age-related decrease in high-density lipoproteins antioxidant activity is due to an alteration in the PON1's free sulfhydyl groups
Atherosclerosis
Effect of PON1 polymorphism on HDL antioxidant potential is blunted with aging
Exp Gerontol
Anthocyanins are bioavailable in humans following an acute dose of cranberry juice
J Nutr
Age-specific relevance of usual blood pressure to vascular mortality
Lancet
Acute, quercetin-induced reductions in blood pressure in hypertensive individuals are not secondary to lower plasma angiotensin-converting enzyme activity or endothelin-1: nitric oxide
Nutr Res
Angiotensin converting enzyme (ACE) inhibitory flavonoids from Erythroxylum laurifolium
Phytomedicine
Quercetin, inflammation and immunity
Nutrients
Association between prehypertension status and inflammatory markers related to atherosclerotic disease: the ATTICA study
Am J Hypertens
Effect of wine phenolics on cytokine-induced C-reactive protein expression
J Thromb Haemost
The anti-inflammatory flavones quercetin and kaempferol cause inhibition of inducible nitric oxide synthase, cyclooxygenase-2 and reactive C-protein, and down-regulation of the nuclear factor kappaB pathway in Chang Liver cells
Eur J Pharmacol
A polyphenol-rich cranberry extract reverses insulin resistance and hepatic steatosis independently of body weight loss
Mol Metab
Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association
Circulation
Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease
Am J Public Health
Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases
Cochrane Database Syst Rev
An update on aspirin in the primary prevention of cardiovascular disease
Arch Intern Med
Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus
Circulation
Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies
J Am Soc Nephrol
Depression and the risk for cardiovascular diseases: systematic review and meta analysis
Int J Geriatr Psychiatry
Dyslipidemia and cardiovascular disease. Dyslipidemia-from prevention to treatment
Is nondiabetic hyperglycemia a risk factor for cardiovascular disease?: A meta-analysis of prospective studies
Arch Intern Med
Screening for high blood pressure in adults: US Preventive Services Task Force recommendation statement
Ann Intern Med
Lifestyle medicine and the management of cardiovascular disease
Curr Cardiol Rep
Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients)
Am J Cardiovasc Drugs
Screening methods for antihyperlipidemic activity: a review
Drug Invent Today
Self-reported side-effects of antihypertensive drugs: an epidemiological study on prevalence and impact on health-state utility
Blood Press
Recent advancements in the cardiovascular drug carriers
Artif Cells Nanomed Biotechnol
Sharing physician notes through an electronic portal is associated with improved medication adherence: quasi-experimental study
J Med Internet Res
Cardiovascular benefits of probiotics: a review of experimental and clinical studies
Food Funct
Cranberry polyphenols: potential benefits for dental caries and periodontal disease
J Can Dent Assoc
Safety and efficacy of cranberry (Vaccinium macrocarpon) during pregnancy and lactation
Can J Clin Pharmacol
Evidences of the cardioprotective potential of fruits: the case of cranberries
Mol Nutr Food Res
Cranberry for prevention of urinary tract infections
Am Fam Physician
Anticancer activities of cranberry phytochemicals: an update
Mol Nutr Food Res
Cranberry juice induces nitric oxide-dependent vasodilation in vitro and its infusion transiently reduces blood pressure in anesthetized rats
J Med Food
Cited by (27)
Polyphenols and atherosclerosis: A critical review of clinical effects on LDL oxidation
2022, Pharmacological ResearchCitation Excerpt :The genus Vaccinium comprises various species of berries including blueberries and cranberries. Consumption of these fruits has been associated with numerous advantages for subjects with MetS [69,70]. They have also shown the ability to modify LDL oxidation.
Effects of blueberry and cranberry on type 2 diabetes parameters in individuals with or without diabetes: A systematic review and meta-analysis of randomized clinical trials
2022, Nutrition, Metabolism and Cardiovascular DiseasesCitation Excerpt :Another review about blueberry and cranberry on diabetes concluded that there is a beneficial effect on glucose control in response to consumption of blueberry (extract or supplementation) and cranberry (juice), demonstrating promising results from the consumption of berries in the management of type 2 diabetes [17]. A previous meta-analysis that evaluated the effects of cranberry on cardiovascular outcomes showed null results for fasting blood glucose and insulin resistance [48]. However, only seven studies for fasting blood glucose and four for insulin resistance were included [48].
Targeting dyslipidemia by herbal medicines: A systematic review of meta-analyses
2021, Journal of EthnopharmacologyCitation Excerpt :Although the effects on other contents of lipid profile were not significant, this change was remarkable in population under 50 years old. A part of favorable effects of cranberry on lipid profile depends on the activity of HDL-C, as by decreasing HDL-C through aging process, adequate distribution of cholesterols and metabolism of LDL-C are disturbed (Pourmasoumi et al., 2020). Hibiscus Sabdariffa L. (sour tea) improves lipid profile by its polyphenol, anthocyanins, flavonoid, etc. contents.
Cranberry (Vacinium macrocarpon) phytochemicals inhibit hepatic stellate cell activation and liver fibrosis
2021, Food BioscienceCitation Excerpt :Cranberry has shown vigorous antimicrobial activities in urinary tract infection of Escherichia coli, stomach ulcers, and oral diseases (Burger et al., 2000; Foo et al., 2000; Jepson et al., 2012; Steinberg et al., 2005; Weiss et al., 2005); exhibited an anticancer activity (Prasain et al., 2016), anti-inflammation effects via against oxidative stress in intestinal Caco-2/15 cells in vitro (Denis et al., 2015). It can also reduce cholesterol and protect against lipoprotein oxidation in vivo, suggesting an essential role in cardiovascular health (Pourmasoumi et al., 2020; Rodriguez-Mateos et al., 2016). Liver fibrosis is a disease that needs to be focused on and eventually can leads to cirrhosis and cancer (Seki & Brenner, 2015).