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Meta-Analysis
. 2017 Feb 9;9(2):117.
doi: 10.3390/nu9020117.

Impact of Flavonols on Cardiometabolic Biomarkers: A Meta-Analysis of Randomized Controlled Human Trials to Explore the Role of Inter-Individual Variability

Regina Menezes  1 , Ana Rodriguez-Mateos  2 , Antonia Kaltsatou  3 , Antonio González-Sarrías  4 , Arno Greyling  5 , Christoforos Giannaki  6 , Cristina Andres-Lacueva  7 , Dragan Milenkovic  8 , Eileen R Gibney  9 , Julie Dumont  10 , Manuel Schär  11 , Mar Garcia-Aloy  7 , Susana Alejandra Palma-Duran  12 , Tatjana Ruskovska  13 , Viktorija Maksimova  13 , Emilie Combet  12 , Paula Pinto  14   15
Affiliations
Meta-Analysis

Impact of Flavonols on Cardiometabolic Biomarkers: A Meta-Analysis of Randomized Controlled Human Trials to Explore the Role of Inter-Individual Variability

Regina Menezes et al. Nutrients. .

Abstract

Several epidemiological studies have linked flavonols with decreased risk of cardiovascular disease (CVD). However, some heterogeneity in the individual physiological responses to the consumption of these compounds has been identified. This meta-analysis aimed to study the effect of flavonol supplementation on biomarkers of CVD risk such as, blood lipids, blood pressure and plasma glucose, as well as factors affecting their inter-individual variability. Data from 18 human randomized controlled trials were pooled and the effect was estimated using fixed or random effects meta-analysis model and reported as difference in means (DM). Variability in the response of blood lipids to supplementation with flavonols was assessed by stratifying various population subgroups: age, sex, country, and health status. Results showed significant reductions in total cholesterol (DM = -0.10 mmol/L; 95% CI: -0.20, -0.01), LDL cholesterol (DM = -0.14 mmol/L; Nutrients 2017, 9, 117 2 of 21 95% CI: -0.21, 0.07), and triacylglycerol (DM = -0.10 mmol/L; 95% CI: -0.18, 0.03), and a significant increase in HDL cholesterol (DM = 0.05 mmol/L; 95% CI: 0.02, 0.07). A significant reduction was also observed in fasting plasma glucose (DM = -0.18 mmol/L; 95%CI: -0.29, -0.08), and in blood pressure (SBP: DM = -4.84 mmHg; 95% CI: -5.64, -4.04; DBP: DM = -3.32 mmHg; 95% CI: -4.09, -2.55). Subgroup analysis showed a more pronounced effect of flavonol intake in participants from Asian countries and in participants with diagnosed disease or dyslipidemia, compared to healthy and normal baseline values. In conclusion, flavonol consumption improved biomarkers of CVD risk, however, country of origin and health status may influence the effect of flavonol intake on blood lipid levels.

Keywords: flavonols; Interindividual variability; cardiovascular  disease; meta‐analysis; quercetin; systematic  review; blood lipids; blood pressure; glucose.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Effect of flavonol supplementation on measures of blood lipids (mmol/L): (a) Triacylglycerols (TAG); (b) Total Cholesterol (TC); (c) LDL Cholesterol (LDL); and (d) HDL Cholesterol (HDL). All studies were used for fixed effect model meta-analysis. The Edwards study consisted of two substudies: hypertensive participants (Edwards 2007a) and pre-hypertensive participants (Edwards 2007b). The Peuffer study also consisted of two substudies: polymorphism ApoE3 (Pfeuffer 2013a) and ApoE4 (Pfeuffer 2013a). DM: difference in means, SE: standard error, CI: confidence interval.
Figure 2
Figure 2
Effect of flavonol supplementation on measures of blood lipids (mmol/L): (a) Triacylglycerols (TAG); (b) Total Cholesterol (TC); (c) LDL Cholesterol (LDL); and (d) HDL Cholesterol (HDL). All studies were used for fixed effect model meta-analysis. The Edwards study consisted of two substudies: hypertensive participants (Edwards 2007a) and pre-hypertensive participants (Edwards 2007b). The Peuffer study also consisted of two substudies: polymorphism ApoE3 (Pfeuffer 2013a) and ApoE4 (Pfeuffer 2013a). DM: difference in means, SE: standard error, CI: confidence interval.
Figure 3
Figure 3
Effect of flavonol supplementation on measures of blood pressure (mmHg): (a) Dyastolic blood pressure (DBP); and (b) Systolic blood pressure (SBP). All studies were used for fixed effect model meta-analysis. The Edwards study consisted of two substudies: hypertensive participants (Edwards 2007a) and pre-hypertensive participants (Edwards 2007b). The Pfeuffer study also consisted of two substudies: polymorphism ApoE3 (Pfeuffer 2013a) and ApoE4 (Pfeuffer 2013b).
Figure 4
Figure 4
Effect of flavonol supplementation on measures of plasma glucose (mmol/L). All studies were used for fixed effect model meta-analysis. The Edwards study consisted of two substudies: hypertensive participants (Edwards 2007a) and pre-hypertensive participants (Edwards 2007b). The Pfeuffer study also consisted of two substudies: polymorphism ApoE3 (Pfeuffer 2013a) and ApoE4 (Pfeuffer 2013b).
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