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Effects of valsartan combined with α-lipoic acid on renal function in patients with diabetic nephropathy: a systematic review and meta-analysis.
Sun, F, Jiang, D, Cai, J
BMC endocrine disorders. 2021;(1):178
Abstract
BACKGROUND Diabetic nephropathy (DN) is one of the most serious microvascular complications of diabetes, valsartan and α-lipoic acid alone or in combination has been used for the treatment of patients with DN. However, some results in these clinical reports were still controversial. The purpose of this study was to evaluate the efficacy of valsartan combined with α-lipoic acid on renal function in patients with DN. METHODS We searched the electronic databases including PubMed, Sciencedirect, EMBASE, Cochrane library, Chinese national knowledge infrastructure (CNKI) and Wanfang databases, and the publication deadline was limited to January 2020. Randomized controlled trials (RCTs) evaluating the effects of valsartan combined with α-lipoic acid in DN patients were included. Pooled estimates were conducted using a fixed or random effect model. The outcomes included urinary albumin excretion rate (UAER), and the level of urinary albumin, β2-microglobulin (β2-MG), hypersensitive C-reactive protein (hs-CRP) and oxidative stress. RESULTS 11 studies with 1294 participants were included in this study. The pooled analysis indicated that α-lipoic acid combined with valsartan could remarkably reduce UAER (P < 0.00001, SMD = -1.95, 95%CI = -2.55 to - 1.20; P = 0.03, SMD = -0.85, 95%CI = -1.59 to - 0.1) and the level of urinary albumin (P = 0.001, SMD = -1.48, 95%CI = - 2.38 to - 0.58; P = 0.01, SMD = -1.67, 95%CI = -3.00 to - 0.33), β2-MG (P < 0.001,SMD = - 2.59, 95%CI = -3.78 to - 1.40; P = 0.03, SMD = -0.48, 95%CI = -0.93 to - 0.04) when compared with valsartan or lipoic acid monotherapy in patients with DN. However, there was no significant difference in the level of hs-CRP among the three therapies (P = 0.06, SMD = -2.80, 95%CI = -5.67 to 0.07; P = 0.10, SMD = -0.42, 95%CI = - 0.92 to 0.08). In addition, α-lipoic acid combined with valsartan markedly increased the level of SOD (P = 0.03, SMD = 1.24, 95%CI = 0.32 to 1.03; P = 0.0002, SMD = 0.68, 95%CI = 0.32 to 1.03) and T-AOC (P < 0.00001, SMD = 0.89, 95%CI = 0.62 to 1.16; P = 0.02, SMD = 0.58, 95%CI = 0.10 to1.07), and reduced the level of MDA(P = 0.0002, SMD = -1.99, 95%CI = -3.02 to - 0.96; P = 0.0001, SMD = -0.69, 95%CI = -1.04 to - 0.34). CONCLUSIONS α-lipoic acid combined with valsartan could significantly reduce the level of urinary albumin and oxidative stress, increase antioxidant capacity and alleviate renal function damage in patients with DN, and this will provide a reference for the selection of treatment drugs for DN.
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2.
Alpha-lipoic acid supplementation significantly reduces the risk of obesity in an updated systematic review and dose response meta-analysis of randomised placebo-controlled clinical trials.
Vajdi, M, Abbasalizad Farhangi, M
International journal of clinical practice. 2020;(6):e13493
Abstract
BACKGROUND There are numerous trials reported the effect of alpha-lipoic acid (ALA) on obesity measurements; while no summarised dose-response meta-analysis is available to address the effects of dose and duration of ALA supplementation on obesity measurements. We aimed to summarise the results of studies evaluating the effects of ALA supplementation on obesity measurements in a systematic review and dose-response meta-analysis. METHODS AND MATERIALS In a systematic search from Scopus, PubMed, Embase, Proquest electronic databases up to January 2020 relevant studies were retrieved. Randomised, placebo-controlled trials investigating the effect of ALA supplementation on obesity measurements including weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and fat mass (FM) were included. Two class and dose-response meta-analysis were performed to data analysis. RESULTS Totally, 18, 21 and 8 studies were included for the meta-analysis of ALA-weight, ALA-BMI, ALA-WC, respectively. In the two-class meta-analysis, ALA treatment significantly reduced weight (WMD: -2.29 kg, 95% CI: -2.98, 1.60, P < .01) and BMI (WMD: -0.49 kg/m2 , 95% CI:-0.83,-0.15, P = .005) but no effect on WC (WMD: -2.57 cm, 95% CI: -8.91, 3.76; P = .426). While the dose-response meta-analysis revealed that the duration of ALA treatment is a significant factor affecting WC reduction (Pnon-linearity = .047). While no evidence of departure from linearity was observed for other variables; moreover, subgrouping also revealed that gender could be an important factor affecting the ALA impact on WC which was significant among women (WMD: -4.099; CI: -7.837, -0.361; P = .032). CONCLUSION According to our finding, ALA treatment significantly reduced BMI, weight in a two-class meta-analysis without evidence of departure from linearity in terms of dose or duration. While the association of ALA treatment on WC is dependent to the duration of the study. Although further trials evaluating the other obesity measurements specially central obesity will be helpful to infer a more reliable result.
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3.
Alpha-lipoic acid effect on leptin and adiponectin concentrations: a systematic review and meta-analysis of randomized controlled trials.
Haghighatdoost, F, Gholami, A, Hariri, M
European journal of clinical pharmacology. 2020;(5):649-657
Abstract
BACKGROUND New evidence suggests that dysregulation of adipocytokines caused by excess adiposity plays an important role in the pathogenesis of various obesity comorbidities. Our aim in this meta-analysis was to determine the effect of alpha-lipoic acid (ALA) supplementation on serum levels of leptin and adiponectin. METHODS We searched Scopus, PubMed, Google Scholar, and ISI Web of Science from inception up to July 2019. Mean difference for leptin and adiponectin were calculated by subtracting the change from baseline in each study group. Summary estimates for the overall effect of ALA on serum leptin and adiponectin concentrations were calculated using random effects model. Results were presented as weighted mean difference (WMD) and their 95% confidence intervals (CI). Between-study heterogeneity was examined using the I2 statistics. RESULT Eight studies were included in systematic review and seven studies in meta-analysis. The overall effect suggested a significant decrement in serum leptin concentrations (WMD = - 3.63; 95% CI, - 5.63, - 1.64 μg/ml; I2 = 80.7%) and a significant increase in serum levels of adiponectin (WMD = 1.98 μg/ml; 95% CI, 0.92, 3.04; I2 = 95.7%). Subgroup analyses based on age showed a significant reduction in leptin levels only in younger adults, and subgroup analysis based on duration indicated in studies with a duration of more than 8 weeks adiponectin levels increased significantly and leptin levels decreased significantly. CONCLUSION Our results revealed ALA decreased leptin and increased adiponectin especially in studies lasted more than 8 weeks. We still need more studies with different ALA dose, intervention duration, and separately on male and female.
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4.
Does alpha-lipoic acid affect lipid profile? A meta-analysis and systematic review on randomized controlled trials.
Haghighatdoost, F, Hariri, M
European journal of pharmacology. 2019;:1-10
Abstract
Randomized controlled trials (RCTs) have demonstrated that alpha lipoic acid (ALA) may change lipid profile, but their results are contradictory. The aim of this study is to conduct a meta-analysis to assess the effects of ALA on lipid profile. Electronic databases including ISI web of science, Ovid, PubMed/Medline, SCOPUS, and Google Scholar were searched up to February 2018. RCTs which assessed ALA effects on lipid profile were selected. Weighted mean difference (WMD) and 95% confidence intervals (CIs) in serum lipids concentrations were defined as intervention effects. Random effects model was used to estimate the pooled effect. Heterogeneity was measured by using I2 test. The protocol was registered with PROSPERO (No. CRD42017072365). Database search retrieved 12 articles. Serum total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-) levels were significantly lower in subjects supplemented with alpha-lipoic acid compared with controls (WMD=-10.18 mg/dL; 95% CI: -16.16, -4.20 mg/dL; P = 0.001 and WMD=-9.22 mg/dL; 95% CI: -18.28, -0.16 mg/dL; P = 0.001, respectively), but no significant changes were found for high density lipoprotein-cholesterol (HDL-c) (WMD: 3.02 mg/dL; 95% CI: -0.39, 6.43; P = 0.082). The overall effect of ALA on serum triglyceride did not reveal any significant change, but in subgroup analysis based on health status (diabetic vs. non-diabetic), ALA decreased serum triglyceride levels in both diabetic and non-diabetic groups compared with controls. This meta-analysis revealed that ALA might favorably affect lipid profile especially LDL and TC. However, for confirming these results, more studies particularly among hyperlipidemic patients are needed.
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5.
The effect of alpha-lipoic acid on inflammatory mediators: a systematic review and meta-analysis on randomized clinical trials.
Haghighatdoost, F, Hariri, M
European journal of pharmacology. 2019;:115-123
Abstract
Alpha-Lipoic Acid (ALA) is a natural antioxidant compound which is naturally found in plant sources. New evidence revealed that ALA can reduce inflammation. Our objective in this meta-analysis was to conduct a systematic review and meta-analysis on randomized controlled trials to indicate ALA effects on serum inflammatory mediators concentration such as tumor necrosis factor-alpha (TNF-α), c-reactive protein (CRP), and interleukin-6 (IL-6). In order to find relevant articles we performed a systematic research up to June 2018 using EMBASE, ISI web of science, Scopus, PubMed, and Google scholar. The overall treatment effect for each inflammatory marker was calculated as weighted mean differences (WMD) and corresponding 95% of confidence interval (CI) between changes in intervention and control groups. Changes for each parameter were calculated by subtracting baseline values from the final mean values. The I2 statistic was used to examine between-study heterogeneity. When heterogeneity was > 25%, random effect model was run to estimate pooled effect size. There had been nineteen articles in our meta-analysis and twenty-one articles in systematic review. Our meta-analysis results indicated that ALA significantly decreased serum CRP levels (WMD= -0.29, 95% CI: -0.46, -0.12; I2 =97.6%, P < 0.0001), IL-6 (WMD= -3.02, 95% CI: -4.03, -2.01; I2 =99.7%, P < 0.0001) and TNF-α levels (WMD= -1.71, 95% CI: -2.30, -1.13; I2 =99.0%, P < 0.0001). Our results indicated possible decreasing effect of ALA on inflammatory mediators especially in high dose. More randomized clinical trials (RCTs) are necessary with different intervention duration and on women and men separately.
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Alpha-lipoic acid supplement in obesity treatment: A systematic review and meta-analysis of clinical trials.
Namazi, N, Larijani, B, Azadbakht, L
Clinical nutrition (Edinburgh, Scotland). 2018;(2):419-428
Abstract
BACKGROUND & AIMS Previous studies have supported positive roles of antioxidant supplements on weight-loss. One antioxidant supplement is Alpha-lipoic acid. However, recommending ALA as an anti-obesity supplement remains controversial. Accordingly, the purpose of the present study was to perform a meta-analysis on the effects of ALA supplement on anthropometric indices among adult subjects. METHODS We searched five electronic databases till September 2016. Placebo-controlled clinical trials were included. Weighted Mean Difference (WMD) was pooled using a random-effects model. RESULTS Findings of 12 included trials indicated that ALA supplement reduced body weight (WMD: -0.69 kg; 95% CI: -1.27, -0.10; I2 = 0%) and BMI (WMD: -0.38 kg/m2; 95% CI: -0.53, -0.24; I2 = 0%) significantly compared to the placebo group. However, its effects on Waist Circumference (WC) was not significant (WMD: -0.30 cm; 95% CI: -1.18, 0.58; I2 = 17.8%). Stratification by health status indicated that ALA decreased WC in unhealthy subjects (WMD: -2.00 cm; 95% CI: -4.19, 0.19; I2 = 1.3%) more than healthy individuals (0.03 cm; 95% CI: -0.69, 0.75; I2 = 0%). CONCLUSIONS The present study revealed that supplementation with ALA slightly but significantly decreased body weight and BMI. Safe dosage for ALA is up to 1200 mg/day. However, it seems that ALA cannot be cost-effective. Further studies are needed to clarify the effects of ALA on metabolic parameter in unhealthy obese individuals.