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Meta-Analysis
. 2020 Jan 1;11(1):66-76.
doi: 10.1093/advances/nmz064.

The Gut Microbial Metabolite Trimethylamine N-Oxide and Hypertension Risk: A Systematic Review and Dose-Response Meta-analysis

Xinyu Ge  1   2   3   4 , Liang Zheng  1   2   3 , Rulin Zhuang  1   2   3   4 , Ping Yu  5 , Zhican Xu  1   2   3   6 , Guanya Liu  1   2   3   4 , Xiaoling Xi  5 , Xiaohui Zhou  1   2   3 , Huimin Fan  1   2   3   4   5
Affiliations
Meta-Analysis

The Gut Microbial Metabolite Trimethylamine N-Oxide and Hypertension Risk: A Systematic Review and Dose-Response Meta-analysis

Xinyu Ge et al. Adv Nutr. .

Abstract

The gut microbial metabolite trimethylamine N-oxide (TMAO) is increasingly regarded as a novel risk factor for cardiovascular events and mortality. However, little is known about the association between TMAO and hypertension. This meta-analysis was conducted to quantitatively assess the relation between the circulating TMAO concentration and hypertension prevalence. The PubMed, Cochrane Library, and Embase databases were systematically searched up to 17 June 2018. Studies recording the hypertension prevalence in members of a given population and their circulating TMAO concentrations were included. A total of 8 studies with 11,750 individuals and 6176 hypertensive cases were included in the analytic synthesis. Compared with low circulating TMAO concentrations, high TMAO concentrations were correlated with a higher prevalence of hypertension (RR: 1.12; 95% CI: 1.06, 1.17; P < 0.0001; I2 = 64%; P-heterogeneity = 0.007; random-effects model). Consistent results were obtained in all examined subgroups as well as in the sensitivity analysis. The RR for hypertension prevalence increased by 9% per 5-μmol/L increment (RR: 1.09; 95% CI: 1.05, 1.14; P < 0.0001) and 20% per 10-μmol/L increment of circulating TMAO concentration (RR: 1.20; 95% CI: 1.11, 1.30; P < 0.0001) according to the dose-response meta-analysis. To our knowledge, this is the first systematic review and meta-analysis demonstrating a significant positive dose-dependent association between circulating TMAO concentrations and hypertension risk.

Keywords: hypertension; microbial metabolite; risk factor, meta-analysis; trimethylamine N-oxide (TMAO).

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Figures

FIGURE 1
FIGURE 1
Flowchart of study selection for the meta-analysis.
FIGURE 2
FIGURE 2
Pooled RR of high circulating trimethylamine N-oxide (TMAO) concentrations for the risk of hypertension prevalence. I2 represents the degree of heterogeneity.
FIGURE 3
FIGURE 3
Dose–response association between the circulating trimethylamine N-oxide (TMAO) concentration and hypertension prevalence. Linear relation (solid line) and 95% CI (dashed lines) of pooled RR of hypertension prevalence by 1 μmol/L increment of circulating TMAO.
See this image and copyright information in PMC

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