The Effects of Fenugreek on Cardiometabolic Risk Factors in Adults: A Systematic Review and Meta-analysis

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Highlights

Abstract

Cardiovascular disease (CVD) is the leading causes of mortality across the world. Some earlier studies have revealed the beneficial effects of fenugreek on the risk factors for CVDs. However, a systematic review and meta-analysis is needed to clarify its effectiveness. Accordingly, the purpose of this study was to assess the impacts of fenugreek on several cardiometabolic risk factors in adult populations. Four electronic databases including PubMed/Medline, Scopus, Embase and Cochrane Library were searched from 2000 to 31 July 2019 to identify studies with English language. Controlled clinical trials on fenugreek reported at least one of cardiometabolic risk factors was included. Pooled effect sizes were reported as Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs). Trials were pooled using a random effect model with DerSimonian and Laird method. Finally, out of 2738 publications, 12 articles were included in the meta-analysis. We found that fenugreek seed vs. placebo can reduce FBS (WMD: -12.94 mg/dL, 95%CI: -21.39 mg/dL, -4.49; I2: 85.0%, p heterogeneity = 0.0001), HbA1c (WMD: -0.58%%, 95% CI: -0.99, -0.17%; I2:0%, p heterogeneity =0.61), total cholesterol (WMD:-9.13 mg/dL, 95% CI: -13.83, -4.43; I2:0, p heterogeneity = 0.48), and low-density lipoprotein cholesterol (WMD:-11.11 mg/dL, 95% CI: -20.32, -1.90; I2:1.41%, p heterogeneity = 0.36). However, no significant changes were observed in other cardiometabolic parameters. Fenugreek seed as an adjuvant therapy may reduce serum levels of FBS, LDL-C and HbA1c. However, due to high heterogeneity in glycemic status, findings must be interpreted with great caution. More placebo-controlled clinical trials are warranted to further assess the effectiveness of fenugreek as a complementary therapy to control cardio-metabolic risk factors.

Introduction

Cardiovascular disease (CVD) is the leading cause of mortality across the world.1 Based on the report from World Health Organization (WHO), around 31% of all deaths each year occurred due to CVD worldwide.2 Cardiometabolic risk factors are a combination of vascular and metabolic factors including glycemic and lipid profile parameters, anthropometric indices and blood pressure that are likely to enhance the risk of CVDs and diabetes.3

The first-line treatment of cardiometabolic risk factors are lifestyle modifications. 4,5 However, pharmacotherapy along with primary approaches is commonly required to prevent complications and to treat metabolic disorders.6 Potential therapeutic benefits of medicinal herbs and other types of complementary therapies for the management of cariometabolic risk factors have attracted considerable attentions over the last several decades. 7 WHO recommends that more research on medicinal herbs should be conducted to clarify the efficacy and adverse events of medicinal herbs. 8 Early evidence demonstrates that some herbs such as Urtica dioica, 9 Nigella sativa, 10 Cinnamomum verum 11 and Trigonella foenum 12,13 may exert positive effects on cardiometabolic parameters.

Fenugreek (Trigonella foenum-graecum L.) is a medicinal herb from the Fabaceae family and is cultivated mostly in India and North African countries. 14 Fenugreek seeds have been used both as spice and therapeutic materials in traditional medicine. 15 Fenugreek seeds contain soluble and insoluble dietary fiber, alkaloids, steroidal saponins and flavenoids. 16 Anti-inflammatory and anti-oxidant components of fenugreek are key factors for therapeutic effects of this plant. 17,18 Evidence showed diverse beneficial effects of fenugreek such as anti-diabetic, digestive stimulant, cardioprotective and gastroprotective properties. 19 Several animal studies 20, 21, 22, 23 and clinical trials 24, 25, 26 showed beneficial effects of fenugreek on metabolic parameters. However, findings are conflicting.

To the best of our knowledge, two meta-analyses have been published so far. Gong et al (2016) assessed the effects of fenugreek on hyperglycemia and hyperlipidemia, 27 while another earlier meta-analysis only evaluated anti-hyperglycemic impact of fenugreek. 28 However, limitations exist in these two meta-analyses: (i) in both, search was not performed systematically and (ii) other cardiometabolic effects of fenugreek were not examined. In addition, the meta-analysis by Gong et al. limited to patients with pre-diabetes and diabetes and did not cover other CVD risk factors. 27 Thus, in the current systematic review and meta-analysis we aim to assess the effectiveness and safety of fenugreek on key cardiometabolic risk factors in adult populations.

Section snippets

Methods

The present meta-analysis was designed in accordance to the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) statement guideline. 29 Participants, intervention, comparison and outcomes were defined in Table 1 according to PICO criteria 30 and a comprehensive search was conducted.

Four electronic databases including PubMed/Medline, Scopus, Embase and Cochrane Library were searched by two independent investigators (N.N and M.KH) from 2000 to 31 July 2019 to identify

Study Selection

In total, 2,738 publications were identified from PubMed (n = 533), Scopus (n = 985), Embase (n = 1,063) and Cochrane library (n = 157). Of which, 1,206 were duplicates. As depicted in Fig. 1, initial screening based on titles and abstracts was performed and 24 publications were considered potentially relevant. Six additional publications were found after hand-search. Out of these, 16 studies were excluded and the reasons of exclusions were as follows: bioactive components (not whole plant) (n

Discussion

The current systematic review and meta-analysis indicates that fenugreek seed can reduce serum levels of FBS, LDL-C and HbA1c compared to placebo. Furthermore, reduction in FBS concentrations in patients with T2DM following fenugreek treatment was -22.80 mg/dL compare to control treatment. Due to high level of heterogeneity in glycemic parameters, findings must be interpreted with great caution.

To the best of our knowledge, only two meta-analysis were previously conducted to evaluate effects of

Conclusion

Based on the current systematic review and meta-analysis, fenugreek seed as an adjutant therapy may reduce serum levels of FBS, LDL-C and HbA1c. Taking into account the high heterogeneity in glycemic status, findings must be interpreted with great caution. More placebo-controlled clinical trials with larger sample size are warranted to further assess the effectiveness of fenugreek as a complementary therapy for both diabetic and non-diabetic patients to control cardio-metabolic risk factors.

Conflict of interest

Authors declared no conflict of interest.

Acknowledgment

We would like to thank Endocrinology & Metabolism Research Institute, Tehran University of Medical Sciences for financial support (grant number is 1398-2-97-913).

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