Integrative Evidence on Sesame Supplementation for Cardiometabolic Risk Factors Relevant to Retinopathy

Abstract

Background: Cardiometabolic disorders, such as diabetes, hypertension, dyslipidemia, retinopathy, and non-alcoholic fatty liver disease, present significant health challenges globally. Recent evidence suggests that sesame (Sesamum indicum L.) supplementation may offer beneficial effects in modulating various cardiometabolic risk factors, although findings from clinical trials have been inconsistent.

Objective: This meta-analysis aims to systematically assess the effects of sesame supplementation on multiple cardiometabolic parameters, including lipid profiles, blood pressure, glycemic control, liver enzyme levels, inflammatory biomarkers, body weight, and body mass index (BMI), with the goal of evaluating its potential as an adjunctive therapy for clinical retinopathy.

Methods: A comprehensive literature search was conducted across multiple databases through July 2025 to identify randomized controlled trials (RCTs) that compared sesame supplementation with placebo or active controls on cardiometabolic outcomes.

Results: Pooled effect sizes were calculated using a random-effects model. A total of 10 studies involving 441 participants were included in the meta-analysis. Sesame supplementation significantly reduced both systolic and diastolic blood pressure. Improvements were also observed in glycemic control, with reductions in fasting blood glucose and HbA1c levels. Further-more, sesame intake was associated with a significant reduction in liver enzyme levels, particularly alanine aminotransferase (ALT). Subgroup analyses revealed that the effects did not increase with longer durations of sesame supplementation.

Conclusions: This meta-analysis provides evidence supporting the beneficial effects of sesame supplementation in improving various cardiometabolic risk factors. Incorporating sesame products into dietary strategies may offer a promising adjunctive intervention for managing cardiometabolic disorders and retinopathy associated with these disorders.

Keywords: dyslipidemia; inflammation; insulin; lipid; non-alcoholic fatty liver; obesity; type 2 diabetes.

Figure 1

A flowchart illustrating the study selection process for the systematic review and meta-analysis on the effects of sesame supplementation in managing cardiometabolic risk factors. Of the 321 records initially identified, 10 studies met the eligibility criteria and were included in the final analysis.

Figure 2

Evaluation of the methodological quality of the included trials. (A) Individual risk of bias assessment for each selected study, based on the Rob 2.0 tool (https://mcguinlu.shinyapps.io/robvis/). (B) Overall risk of bias summarized as a percentage, considering intention-to-treat and perprotocol analyses. The primary sources of high risk of bias across the studies were deviations from intended interventions, followed by issues related to missing outcome data and deficiencies in the randomization process.

Figure 3

Forest plots showing the effects of sesame supplementation on blood pressure. Panel (A) illustrates the effects on systolic blood pressure, and panel (B) presents the effects on diastolic blood pressure. Individual studies are represented by squares, with horizontal lines indicating 95% confidence intervals. Diamonds at the bottom represent the pooled effect sizes for each blood pressure outcome.

Figure 4

Subgroup analyses corresponding to the effects presented in Figure 3A. Panel (A) assesses differences according to the duration of sesame supplementation, and Panel (B) evaluates effects based on sesame component type. Individual effect sizes are shown as squares, with their position indicating the standardized mean difference; squares positioned to the left indicate a reduction in blood pressure. Horizontal lines represent the 95% confidence intervals, and the diamond at the bottom illustrates the pooled effect size for each subgroup analysis.

Figure 5

Forest plots depicting the impact of sesame supplementation on glycemic control outcomes. Panel (A) presents the effects on fasting blood glucose, Panel (B) fasting insulin, Panel (C) HbA1c levels, and Panel (D) HOMA-IR. Each square represents the standardized mean difference of individual studies, accompanied by horizontal lines indicating the 95% confidence intervals. The diamond at the base of each panel shows the pooled effect size, summarizing the overall effect of sesame supplementation on each glycemic marker.

Figure 6

Forest plots demonstrating the effects of sesame supplementation on anthropometric outcomes. Panel (A) illustrates the impact on body weight, Panel (B) shows the effect on body mass index (BMI), and Panel (C) presents the changes in body fat percentage. Individual effect sizes are represented by squares, with horizontal lines indicating the 95% confidence intervals. The diamonds at the bottom of each panel represent the pooled effect sizes, summarizing the overall influence of sesame supplementation on these anthropometric measures.

Figure 7

Forest plots illustrating the impact of sesame supplementation on waist and hip circumference. Panel (A) shows changes in waist circumference, while Panel (B) depicts changes in hip circumference. Squares represent individual study effect sizes, with horizontal lines indicating their respective 95% confidence intervals. The diamonds at the bottom summarize the pooled effect sizes, reflecting the overall effects of sesame supplementation on these anthropometric outcomes.

Figure 8

Forest plots presenting the effects of sesame supplementation on lipid profile parameters. Panel (A) shows the impact on total cholesterol, panel (B) illustrates changes in triglyceride levels, panel (C) depicts effects on LDL cholesterol, and panel (D) examines alterations in HDL cholesterol. Individual study effects are represented by squares, with horizontal lines indicating the corresponding 95% confidence intervals. The diamonds at the bottom of each panel represent the pooled effect sizes, summarizing the overall impact of sesame supplementation on these lipid outcomes.

Figure 9

Forest plots demonstrating the effects of sesame supplementation on liver injury markers. Panel (A) presents the effects on AST levels, and panel (B) shows changes in ALT levels. Individual study results are indicated by squares, accompanied by horizontal lines denoting the 95% confidence intervals. Diamonds at the bottom of each panel summarize the overall pooled effect sizes, representing the cumulative impact of sesame supplementation on liver function parameters.

Figure 10

Forest plots illustrating the effects of sesame supplementation on inflammatory markers. Panel (A) presents the effects on TNF-α levels, Panel (B) depicts changes in IL-6, and Panel (C) summarizes findings for hs-CRP. Squares indicate the standardized mean differences for individual studies, with horizontal lines representing the 95% confidence intervals. Diamonds at the bottom of each panel reflect the overall pooled effect sizes. Panel (D) displays a funnel plot assessing publication bias among studies evaluating systolic blood pressure (as shown in Figure 3A). Each circle represents an individual study, with circle size corresponding to the study's relative weight or sample size. The lines denote confidence intervals around the pooled effect size, while the central diamond illustrates the overall effect estimate and its 95% confidence interval.