cardiometabolic risk

Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis

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Abstract

Context

Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy.

Objective

The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

Data Sources

MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease.

Data Extraction

Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE.

Data Analysis

A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol.

Conclusion

Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence.

DISCUSSION

This systematic review and meta-analysis of 18 controlled feeding trials involving 33 trial comparisons in 1105 predominantly healthy participants of mixed weight assessed the effect of oral honey intake on cardiometabolic outcomes. The results showed that oral honey intake at a median dose of 40 g over a median period of 8 weeks resulted in beneficial reductions in fasting glucose, ALT, total cholesterol, LDL-C, and fasting triglycerides and a significant increase in HDL-C. There was also a significant increase in markers of inflammation, specifically IL-6 and TNF-α. There was effect modification by both the floral source of honey and the processing of honey. Intake of clover honey and raw honey appeared to have a beneficial effect on fasting glucose, while both clover honey and robinia honey produced beneficial reductions in total cholesterol, LDL-C, and fasting triglycerides. The processing of honey produced a further effect modification on total cholesterol, HDL-C, and fasting triglycerides, with raw honey resulting in a beneficial effect. While there was no significant effect of oral honey intake on SBP, linear dose-response analysis showed that SBP decreased with an increasing dose of honey.

Bariatric surgery improves diabetes remission, reduces cardiometabolic risk

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Compared with conventional treatment, bariatric surgery was superior in achieving remission of prediabetes and type 2 diabetes and reducing cardiometabolic risks for patients with obesity, researchers reported in Obesity Medicine.

According to Antônio Carlos Sobral Sousa, MD, PhD, FACC, head of cardiology at the Federal University of Sergipe in Brazil, and fellow researchers, sparse data in the literature suggest whether bariatric surgery would produce better outcomes relative to long-term diabetes comorbidities among Public Healthcare System users in Brazil. The researchers conducted the study to determine the remission of type 2 diabetes and the reduction of cardiometabolic risk at 5 years among patients with obesity and type 2 diabetes who received bariatric surgery and were followed in the Public Healthcare System.

Bariatric surgery word Adobe

The observational, retrospective, single-center study included 38 patients who received conventional medical treatment and 33 patients who received bariatric surgery. Researchers assessed socioeconomic, lifestyle, anthropometric, biochemical, medication, cardiovascular and glycemic parameters. Baseline characteristics between groups were comparable. Overall, 91.6% of patients were women, and the mean age was 46.1 years. Among those who received bariatric surgery, there was a mean 28.3-month wait to receive surgery, and 93.9% underwent gastric bypass.

Antônio Carlos Sobral Sousa

Results indicated that patients who received bariatric surgery demonstrated a higher level of educational achievement (P = .001), a higher prevalence of social drinking (P = .006) and a higher BMI (P < .001) compared with the conventional approach arm.

At 5 years, 66.7% of patients receiving bariatric surgery had complete remission of type 2 diabetes and 60.6% had remission of cardiometabolic risks, whereas in the conventional treatment arm, 2.6% of patients had remission of type 2 diabetes and 18.4% had remission of cardiometabolic risks (P < .0001 for both).

“Bariatric surgery is superior to conventional treatment in promoting remission of prediabetes/type 2 diabetes, reducing cardiometabolic risk and the number of drugs used, in addition to improving the biochemical and anthropometric markers of patients with obesity and type 2 diabetes,” de Almeida and colleagues concluded. “Future studies might analyze how long after bariatric surgery these benefits achieved in the first 5 years remain in individuals with low socio-educational levels.”

PERSPECTIVE

 Sangeeta Kashyap, MD )

Sangeeta Kashyap, MD

Sousa and colleagues examined the 5-year outcomes of bariatric surgery vs. conventional medical treatment of type 2 diabetes in Brazilian patients with class 3 obesity in an observational, retrospective study. Due to the observational nature of the study, there were significant differences at baseline in that the patients receiving surgery were far heavier than the medical group. Indeed, the BMI at baseline in the surgery group was 50 kg/m2 and that of the medical group was about 42 kg/m2. However, other cardiometabolic factors, including glucose, lipid and blood pressure levels, were similar at baseline, and a majority of participants were female.

At 5 years of follow-up, the primarily gastric bypass surgery group had over 60% of participants achieving full remission of type 2 diabetes and dramatic reduction in cardiovascular disease risk scores as well as the need for diabetes and CV agents. The rates of diabetes remission are far higher than other published randomized controlled studies of bariatric surgery for diabetes and may reflect that these subjects had greater severity of obesity and less severe diabetes and were predominantly female with more preoperative counseling than the conventional medical treatment group. However, this is a small nonrandomized trial that shows greater remission in the Brazilian cohort.

Further studies examining the impact of bariatric surgery with respect to gender and racial differences are needed. The impact of surgery in more severe diabetes with moderate obesity are also warranted. Regardless, bariatric surgery seems to have durable benefits for patients with type 2 diabetes and obesity up to 5 years. Whether these benefits translate to reduction in microvascular and macrovascular events related to diabetes is not known. 

Sangeeta Kashyap, MD

Healio | Endocrine Today Co-Editor

Physician Scientist, Endocrinology Institute

Professor of Medicine

Cleveland Clinic Lerner College of Medicine

Anxiety elevates cardiometabolic risk over time in men

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Higher levels of anxiety were linked to increases in cardiometabolic risk biomarkers over time in men, researchers reported in the Journal of the American Heart Association.

“While the participants were primarily white men, our findings indicate higher levels of anxiousness or worry among men are linked to biological processes that may give rise to heart disease and metabolic conditions, and these associations may be present much earlier in life than is commonly appreciated — potentially during childhood or young adulthood,” Lewina Lee, PhD, assistant professor of psychiatry at Boston University School of Medicine and an investigator and clinical psychologist at the National Center for Posttraumatic Stress Disorder at the U.S. Department of Veterans Affairs in Boston, said in a press release.

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Source: Adobe Stock

The analysis included 1,561 men (mean age, 53 years at baseline; 97% white) from the Normative Aging Study who in 1975 were free from CVD or cancer and completed assessments of neuroticism and worry.

After baseline, participants had physical exams and blood tests every 3 to 5 years until death, dropout or the end of the study in 2015.

Cardiometabolic risks

At each visit, participants had the following cardiometabolic factors measured: systolic BP, diastolic BP, total cholesterol, triglycerides, obesity as determined by BMI, fasting blood glucose levels and erythrocyte sedimentation rate.

High risk for each cardiometabolic factor was defined as exceeding the cut points from national guidelines or taking medication related to that factor. For erythrocyte sedimentation rate, for which there is no universal definition of high risk, those in the top quartile were considered high risk.

In the overall cohort, from age 33 to 65 years, cardiometabolic risk markers increased an average of 0.8 per decade, reaching 3.8 by age 65 years, whereas after age 65 years, risk markers increased an average of 0.5 per decade, Lee and colleagues wrote.

Elevated levels of neuroticism (beta = 0.08; 95% CI, 0.02-0.15) and worry (beta = 0.07; 95% CI, 0.001-0.13) were linked to greater cardiometabolic risk markers over time, according to the researchers.

After adjustment for demographic characteristics and family history of heart disease, those with elevated levels of neuroticism had a 13% greater risk of being high risk on at least six cardiometabolic risk markers (95% CI, 1.03-1.23), and those with elevated levels of worry had a 10% greater risk (95% CI, 1.01-1.2), Lee and colleagues wrote.

‘Pay greater attention’

“We found that cardiometabolic disease risk increased as men aged, from their 30s into their 80s, irrespective of anxiety levels, while men who had higher levels of anxiety and worry consistently had a higher likelihood of developing cardiometabolic disease over time than those with lower levels of anxiety or worry,” Lee said in the release. “While we do not know whether treatment of anxiety and worry may lower one’s cardiometabolic risk, anxious and worry-prone individuals should pay greater attention to their cardiometabolic health. For example, by having routine health checkups and being proactive in managing their cardiometabolic disease risk levels (such as taking medications for high blood pressure and maintaining a healthy weight), they may be able to decrease their likelihood of developing cardiometabolic disease.”

Reference:

Simply standing more daily could reduce cardiometabolic risk

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Standing, stepping, and engaging in other non-sitting activities for 2 hours daily significantly lowered glucose levels and improved total vs high-density lipoprotein (HDL) cholesterol ratios, both important cardiometabolic risk factors, according to a recent study.

Each additional 2 hours a day spent standing was associated with about 2 percent lower fasting plasma glucose, 6 percent lower total/HDL-cholesterol ratio, 14 percent lower triglyceride levels, 3 percent lower 2-hour plasma glucose and about 0.07 mmol/L higher HDL-cholesterol levels. [Eur Heart J 2015; doi:10.1093/eurheartj/ehv308]

Every 2 hours a day spent stepping was significantly linked to about 11 percent lower BMI, 8 cm lower waist circumference, 6 percent lower total/HDL-cholesterol ratio, 20 percent lower triglyceride levels, 14 percent lower 2-hour plasma glucose and about 0.14 mmol/L higher HDL-cholesterol levels. However, neither standing nor stepping was significantly associated with changes in systolic or diastolic blood pressure or HbA1C or LDL-cholesterol levels.

These results contrast with those spent in a sedentary position (sitting), where every additional 2 hours a day spent sitting was linked to about 3 percent higher BMI, 1 percent higher fasting plasma glucose, 5 percent higher total/HDL-cholesterol ratio, 12 percent higher triglyceride levels, 4 percent higher 2-hour plasma glucose levels, and 0.07 mmol/L lower HDL-cholesterol levels.

Every 2 hours spent stepping instead of sitting led to significant reductions in BMI (about 11 percent), waist circumference (7.5 cm) and post-load glucose levels (12 percent). On the other hand, every 2 hours spent standing instead of sitting led to significant reductions in fasting plasma glucose (about 2 percent), total/HDL-cholesterol ratio (6 percent) and triglyceride levels (11 percent), as well as 0.06 mmol/L higher HDL-cholesterol levels.

The study included 782 participants aged 36 to 80 years from the Australian Diabetes, Obesity and Lifestyle Study who were monitored for 24 hours per day for 7 days with an activPAL3TM monitor strapped to the thigh. [J Sci Med Sport 2014;17:293-299]

While the impact of physical activity on cardiometabolic risk factors has been confirmed, the findings suggest simply substituting standing for sitting could exert health benefits.