The effect of cactus pear (Opuntia ficus-indica) on body weight and cardiovascular risk factors: A systematic review and meta-analysis of randomized clinical trials

doi:10.1016/j.nut.2014.11.015

Nutrition

Volume 31, Issue 5, May 2015, Pages 640-646

https://doi.org/10.1016/j.nut.2014.11.015 Get rights and content

Highlights

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The cactus pear, Opuntia ficus-indica (OFI), is marketed under trade names such as Proactol and XLS medical, with “certified” claims of clinical efficacy in obesity management.
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OFI-containing supplements are also being marketed as antidiabetic agents.
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The results from our meta-analysis of published clinical trials do not indicate that OFI supplementation has significant beneficial effects on body weight.
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Our results suggested that OFI intake causes significant reductions in body mass index, percentage body fat and total; however, the effect sizes are small and do not reach clinical significance.
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Few clinical trials evaluating the effects of OFI in obesity management have been conducted; they vary in design and methodology.

Abstract

Objectives

Hundreds of dietary supplements are currently marketed as weight loss supplements. However, the advertised health claims of effectiveness for most of these have not been proven. The aim of this study was to critically appraise and evaluate the evidence for effectiveness of cactus pear, Opuntia ficus-indica (OFI), using data from published randomized clinical trials.

Methods

We conducted electronic searches in Medline, Embase, Amed, Cinahl, and the Cochrane Library. No restrictions on age, time, or language were imposed. The risk for bias in the studies included was assessed using the Cochrane Collaboration criteria. Two reviewers independently determined the eligibility of included studies, assessed reporting quality, and extracted data.

Results

We identified seven eligible studies, of which five were included. The studies varied in design and reporting quality. Meta-analysis revealed a nonsignificant difference in body weight between OFI and controls (mean difference = −0.83 kg; 95% confidence interval, −2.49 to 0.83; I² = 93%). Significant reductions in body mass index, percentage body fat, systolic and diastolic blood pressures, and total cholesterol were observed. Adverse events included gastric intolerance and flu symptoms.

Conclusion

The evidence from randomized clinical trials does not indicate that supplementation with OFI generates statistically significant effects on body weight. Consumption of OFI can cause significant reductions in percentage body fat, blood pressure, and total cholesterol. Few clinical trials evaluating the effects of OFI have been published. They vary in design and methodology, and are characterized by inconsistent quality of reporting. Further clinical trials evaluating the effects of OFI on body composition and metabolic parameters are warranted.

Introduction

The increased prevalence of obesity and overweight has led to the proliferation of various dietary supplements on the market, with varying claims of effectiveness. However, evidence supporting the effectiveness for most of these products is not proven, and clinicians are sometimes uncertain about the therapeutic value of using such agents [1]. One such supplement being touted as having an antiobesity effect is the cactus pear, Opuntia ficus-indica (OFI).

OFI is a domesticated cactus plant that has been an important part of agricultural economies in the arid and semiarid regions of the world [2]. The fruits of the OFI are edible, and can be lime green, orange, red, or purple, depending on the ratios or concentrations of its constituent pigments [3]. Cactus pear is rich in betalains, which are bioactive compounds thought to be responsible for its positive health effects [4]. In addition to its nutritional use, the cactus pear is thought to possess antioxidant and anti-inflammatory properties [5], [6], [7], and has been used as an artificial sweetener in the food industry [8]. In humans, consumption of OFI has been shown to improve platelet function [9] and also to confer protection against peptic ulcer [10].

More recently, there has been increased interest in the possible role of OFI in the management of obesity and body metabolic parameters. Results of animal research have suggested that OFI intake can lead to reductions in body weight via diuresis [11], decrease blood glucose by enhancing basal plasma insulin concentration [12], [13], and improve lipid profile through scavenging of intracellular radicals [14], [15], [16]. Randomized and nonrandomized human studies have shown that OFI could attenuate postprandial hyperglycemia by stimulating glucose uptake in the peripheral tissues [17], [18], [19]. Studies in humans also have demonstrated that consumption of OFI causes marked reductions in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triacylglycerols (TGs) in patients with dyslipidemias by up-regulating binding of LDL receptors in the liver [20], [21].

Clinical trials examining the effect of OFI on body weight and composition and lipid profile have been conducted, but the effectiveness of this supplement as a weight loss aid has not been established. Therefore, the objective of this review was to critically appraise and evaluate the evidence for effectiveness of OFI as a weight loss supplement, using data from published trials in humans.

Section snippets

Methods

Electronic searches were conducted in the following databases: Medline, Embase, Amed, Cinahl, and the Cochrane Library. Each database was searched from inception through April 2014. The search terms used included opuntia, neopuntia, cactus, cactus pear, spineless cactus, prickly pear, nopal, litramine, body weight, overweight, obesity, weight loss, body composition, body fat, waist circumference, cholesterol, triacylglycerols, systolic blood pressure, diastolic blood pressure, blood sugar, and

Results

Our electronic searches identified 76 nonduplicate citations, of which 7 eligible studies were identified (Fig. 1). One RCT was excluded because it did not report relevant outcomes [25], and another because OFI was combined with other weight loss supplements [26]. Thus, five RCTs with a total of 382 participants were included in the review [27], [28], [29], [30], [31].

There were variations in the risk for bias across the included studies (Fig. 2). Only 40% of the RCTs adequately reported

Main findings

The results of this meta-analysis indicated that supplementation with OFI does not generate statistically significant reductions in body weight and waist circumference. The results also suggest that OFI ingestion results in significant reductions in BMI, %BF, SBP and DBP, and TC. The results of the meta-analysis should be interpreted with caution because of the high heterogeneity observed in some of the analyses, and the lack of consistency in the direction of study results between the overall

Conclusions

The evidence from published RCTs does not show that OFI intake has beneficial effects on body weight. Evidence also suggests that OFI generates beneficial effects on %BF, BMI, and TC; the effect sizes are small, and the clinical relevance is doubtful. OFI appears to cause significant reductions in SBP and DBP. Few clinical trials evaluating the effects of OFI have been published; they vary in design and methodology, and the majority are characterized by flaws in reporting quality. Further

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The Role of Diet in the Prevention of Hypertension and Management of Blood Pressure: An Umbrella Review of Meta-Analyses of Interventional and Observational Studies
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High blood pressure (BP) is a major pathological risk factor for the development of several cardiovascular diseases. Diet is a key modifier of BP, but the underlying relationships are not clearly demonstrated. This is an umbrella review of published meta-analyses to critically evaluate the wide range of dietary evidence from bioactive compounds to dietary patterns on BP and risk of hypertension. PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception until October 31, 2021, for relevant meta-analyses of randomized controlled trials or meta-analyses of observational studies. A total of 175 publications reporting 341 meta-analyses of randomized controlled trials (145 publications) and 70 meta-analyses of observational studies (30 publications) were included in the review. The methodological quality of the included publications was assessed using Assessment of Multiple Systematic Reviews 2 and the evidence quality of each selected meta-analysis was assessed using NutriGrade. This umbrella review supports recommended public health guidelines for prevention and control of hypertension. Dietary patterns including the Dietary Approaches to Stop Hypertension and the Mediterranean-type diets that further restrict sodium, and moderate alcohol intake are advised. To produce high-quality evidence and substantiate strong recommendations, future research should address areas where the low quality of evidence was observed (for example, intake of dietary fiber, fish, egg, meat, dairy products, fruit juice, and nuts) and emphasize focus on dietary factors not yet conclusively investigated.
Recent developments on Opuntia spp., their bioactive composition, nutritional values, and health effects
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Citation Excerpt :
Opuntia intake can lead to a decrease in blood pressure, and it should not be recommended as a supplement to current hypertensive treatment because its extracts may interfere with diabetes medications and possibly trigger hypoglycemic episodes in patients with diabetes. ( Onakpoya et al., 2015). Considering all plant remedies include chemical compounds that are highly poisonous and are listed in the Hazardous Substances Data Bank (National Library of Medicine, Bethesda, Maryland), it is necessary to conduct additional research to assess the possible hazards of utilizing Opuntia (Osuna-Martínez et al., 2014).
Opuntia is a plant that grows in wild, arid, and semi-arid regions, and it is a renowned food source that is presently undervalued. The chemical composition and properties of the Opuntia genus have attracted research and commercial interest as its species are rich in phytochemicals, nutrients, and bioactive compounds. Several of these constituents have revealed anti-inflammatory, antioxidant, antibacterial, anti-cancer, anti-atherosclerotic, antidiabetic, neurological, and gut protective characteristics. This review provides an extensive and up-to-date evidence synthesis of the nutrients in the Opuntia genus, its phytochemical composition, health benefits, the influence of the processing technologies on its bioactive components, and the potential for functional food product development. Due to its high nutritional value, Opuntia genus has the potential to contribute to improving food security and contribute to the food industry as food additive or preservative. Accordingly, Opuntia products can be utilized as food substitutes as part of a well-balanced diet and may potentially have pharmacological properties. The Opuntia genus is also used as animal feed, a source of nutraceuticals, an addition to edible packaging materials, wastewater treatment, and land rehabilitation in arid regions. Opuntia is a rich source of minerals, essential amino acids, and vitamins, and is high in antioxidants, making it a promising candidate for the management of non-communicable diseases. The potential health-promoting effects of Opuntia consumption remain relatively unexplored, and further research human trials are required to unravel its mechanisms of action.
Prickly pear juice consumption after fat intake affects postprandial heart rate variability but not traditional risk factors of cardiovascular disease in healthy men
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PP is a sweet and uniquely flavored fruit that grows on a drought-resistant cactus native to the Americas [17–19]. The fruit and the leaf have historically been used in traditional medicines [17–19] and are suggested to have anti-atherosclerotic [11] and anti-hyperglycemic [20–26] properties. Several articles have reviewed the effects of PP consumption (fruit flesh, juice, fruit-based capsules, or powder supplements) on the amounts of body fat (%) [25], BP [25], total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triacylglycerides (TGs), and [11,25,26], heart rate variability (HRV) [27], but not on body weight [25,26].
Prickly Pear (PP) fruit is proposed to have anti-atherosclerotic and anti-hyperglycemic effects. The aim of this study was to examine the effects of a single consumption of PP juice on modifiable blood and physiological markers of cardiovascular disease risk in healthy men using a postprandial hyperlipidemia model.
This was a double-blind, randomized, placebo-controlled, crossover trial with 17 healthy men (body mass index 22.6 ± 2.04 kg/m²; 29.5 ± 7.19 y of age). Participants consumed PP juice (250 mL; 45 mg betalain content; reduced fiber) or a simple placebo drink (water-based), with a high-fat muffin (50 g fat) to determine potential effects on physiologic and biological responses, for up to 3 h post-consumption (hourly, 2 sessions, 7-d washout period). Blood pressure, heart rate variability (HRV), total cholesterol (TC), triacylglycerides (TGs), low-density and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and glucose were measured.
Key findings included a lower HRV measure after PP consumption (main effect for group, P ≤0.001–0.020) but no differences for TC, TG, LDL-C, or HDL-C.
Consumption of PP (with high-fat muffin), did not alter traditional cardiovascular disease risk responses but rather markers of HRV, beyond an expected increase in glucose attributed to the carbohydrate content of the trials foods. Additionally, macronutrient content is important when understanding HRV responses to meals.
Targeting dyslipidemia by herbal medicines: A systematic review of meta-analyses
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The remaining 60 meta-analyses have been categorized as “other herbal medicines” group, as they contained lower number of herbal medicines. This group was included pooled effect of avocado, berberis, cinnamon, cumin, fenugreek, garlic, ginger, ginseng, grape, sour tea, pomegranate, saffron, cayenne pepper, cardamom, purslane, aronia, rhus, tulsi, Artichoke, white mulberry, Spirulina, and other herbs (Mahmassani et al., 2018; Peou et al., 2016; Pourmasoumi et al., 2018, 2019, 2020; Hadi et al., 2019a, 2019b; Zhang et al., 2016b, 2019, 2020; Ju et al., 2018; Phimarn et al., 2017; Huang et al., 2016; Lan et al., 2015; Dong et al., 2013; Heydarpour et al., 2020; Ainehchi et al., 2019; Allen et al., 2013; Jafarnejad et al., 2017, 2018; Askarpour et al., 2020; Heshmat-Ghahdarijani et al., 2020; Khodamoradi et al., 2020; Gong et al., 2016; Shabani et al., 2019; Sun et al., 2018; Ried et al., 2013; Silagy and Neil, 1994; Maharlouei et al., 2019; Mazidi et al., 2016; Ziaei et al., 2020; Hernández-García et al., 2019; Gui et al., 2016; Asbaghi et al., 2019, 2020b; Feringa et al., 2011; Bule et al., 2020; Najafpour Boushehri et al., 2020; Aziz et al., 2013; Jandari et al., 2020; Sahebkar et al., 2016a, 2016c, 2018; Taherifard et al., 2020; Rahmani et al., 2019a, 2019b; Hallajzadeh et al., 2020; Jang et al., 2020; Payab et al., 2020; Shekarchizadeh-Esfahani et al., 2020; Lee et al., 2020; Akbari-Fakhrabadi et al., 2018; Mohammadi et al., 2019a; Jamshidi et al., 2018; Teoh et al., 2018;; Sawangjit et al., 2017; Daryabeygi-Khotbehsara et al., 2017; Serban et al., 2016; Onakpoya et al., 2015; Cheng et al., 2013). Along with healthy subjects, the underlying disorders of participants were DM, HLP, obesity, NAFLD, CAD, MetS, chronic kidney disease (CKD), and HTN.
The worldwide increasing prevalence of dyslipidemia has become a global health concern. Various herbal remedies have been claimed to be effective for the treatment of dyslipidemia in traditional and folkloric medicine of different regions clinical trials have been conducted to investigate their efficacy. The aim of the current systematic review is to critically assess the meta-analyses of controlled trials (CT) evaluated herb medicines for dyslipidemia.
Relevant studies from Web of Science, PubMed, Scopus, and Cochrane Library databases based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist until January 2021 have been searched. All meta-analyses which pooled studies on the effect of herbal medicines on lipid profile including total cholesterol (TC), triglyceride (TG), and low- or high-density lipoprotein cholesterol (LDL-C, HDL-C) were also included. Meta-analyses of in vitro, animal or observational studies were excluded.
The overall of 141 meta-analyses were revealed. Vegetable oils, phytosterols, tea, soy protein, nuts, and curcumin have been studied frequently among the herbal medicines. Among 13 meta-analyses on vegetable oils, the greater reduce of TC (18.95 mg/dl), LDL-C (16.24 mg/dl) and TG (13.69 mg/dl) were exhibited from sunflower oil. Furthermore, rice bran oil (6.65 mg/dl) increased HDL-C significantly. Phytosterols in 12 meta-analyses demonstrated significant improvements in reducing TC, LDL-C and TG as 16.4, 23.7, and 8.85 mg/dl, respectively, and rise in HDL-C as 10.6 mg/dl. The highest reduction in serum level of TC, LDL-C and TG was reported while intake Green tea; 27.57, 24.75, and 31.87 mg/dl, accordingly within 9 meta-analyses. Average improvement of lipid profiles by 6 meta-analyses on plant proteins were 23.2, 21.7, 15.06, and 1.55 mg/dl for TC, LDL-C, TG, and HDL-C, respectively. Among 11 meta-analyses on nuts, almond showed better and significant alleviations in TC (10.69 mg/dl), walnut in LDL-C (9.23 mg/dl), pistachio in TG (22.14 mg/dl), and peanut in HDL-C (2.72 mg/dl). Overall, Curcumin, Curcuminoid, and Turmeric have resulted in the reduction of TC (25.13 mg/dl), LDL-C (39.83 mg/dl), TG (33.65 mg/dl), and an increase in the HDL-C (4.31 mg/dl).
The current systematic review shed light on the use of herbal medicines for the management of dyslipidemia. However, more well-conducted CTs are required to determine effective doses of herbal medicines.
Prebiotic potential and chemical characterization of the poly and oligosaccharides present in the mucilage of Opuntia ficus-indica and Opuntia joconostle
2021, Food Chemistry
The mucilage extracted from the convection-dried cladodes of O. ficus-indica and O. joconostle, two species of economic importance, delivered three fractions after methanol precipitation. Two were composed of high molar mass polysaccharides, and one included water-soluble mono-, di-, and oligosaccharides. The large polysaccharides have a molar mass range of 4.0 × 10³ to 8.0 × 10⁵ g·mol⁻¹ and are consistently composed of galactose, arabinose, xylose, and rhamnose; however, the content of galacturonic acid was different between both fractions and species. Their fermentability by selected probiotics was relatively low, 11–27 % compared to glucose, and decreased with increasing levels of galacturonic acid in the molecules. In the third fraction, previously unreported oligosaccharides were found. These include simple- and complex-structured galactooligosaccharides with arabinosyl-, xylosyl- and galacturonosyl acid residues. Their fermentability by prebiotic species can be ascribed more to their structural characteristics and monosaccharide composition than their molecular dimensions.
The effects of Prickly Pear fruit and cladode (Opuntia spp.) consumption on blood lipids: A systematic review
2020, Complementary Therapies in Medicine
The current dietary recommendations for cardiovascular disease (CVD) risk reduction include increased fruit and vegetable consumption. The Opuntia spp., Prickly Pear (PP) fruit is rich in dietary fiber and may have lipid-lowering effects but it is often confused with the PP stem/leaf (Cladode (CLD)), or not identified. The efficacy of the PP fruit and CLD in reducing CVD risk is a growing area of research.
This systematic review (PROSPERO: CRD42018110643), examined the effects of consuming the Opuntia spp. components (PP or CLD) on CVD risk factors, specifically total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). The review, performed from February through September 2019, used resources available through Food Science and Technology Abstracts (EBSCO), Medline, Scopus, CINAHL, Web of Science and Cochrane databases.
Eleven articles met the inclusion criteria, which characterised Opuntia spp. products as either PP (n = 6), CLD (n = 4) or commercial products’ (n=1). Effects were investigated in healthy and obese populations as well as those with metabolic illnesses, specifically type 2 diabetes and metabolic syndrome. PP consumption was associated with significant reductions in TC (p < 0.05) in all but one included study, whereas in the remaining studies (n=6), LDL-C levels decreased (p < 0.05). Separately, the effect of CLD consumption on lipids was small with one study reporting a significant increase in plasma HDL-C in a subgroup of participants (>45 years of age) following consumption of a patented CLD powder product. It is plausible, that differences in overall effect may be due to compositional distinctions between CLD and PP, such as fiber composition. Care must be taken in future studies to accurately report the identity of the selected components of Opuntia spp.

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: IJO and JOS were involved in the design, data collection, data analysis and interpretation, and drafting of the manuscript. CJH was involved in the design, data analysis, and interpretation of the manuscript. The authors have no conflicts of interest to declare.

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Meta-analysisThe effect of cactus pear (Opuntia ficus-indica) on body weight and cardiovascular risk factors: A systematic review and meta-analysis of randomized clinical trials

Highlights

Abstract

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Methods

Results

Main findings

Conclusions

Prostaglandins Leukot Essent Fatty Acids

Prostaglandins Leukot Essent Fatty Acids

Bioresour Technol

Am J Clin Nutr

J Ethnopharmacol

J Nutr

Nutr Metab Cardiovasc Dis

J Nutr

Am J Clin Nutr

Food supplements for body weight reduction: a systematic review of systematic reviews

Obesity

The origins of an important cactus crop, Opuntia ficus-indica (Cactaceae): new molecular evidence

Am J Bot

Colour inheritance in cactus pear (Opuntia ficus-indica) fruits

Annal Appl Biol

Health benefits and bioactive components of the fruits from Opuntia ficus-indica

J Prof Assoc Cactus Dev

Color, betalain pattern, and antioxidant properties of cactus pear (Opuntia spp.) clones

J Agric Food Chem

Effect of Opuntia ficus indica on symptoms of the alcohol hangover

Arch Intern Med

Cactus pear fruit: a new source for a natural sweetner

Plant Foods Hum Nutr

Chemical characterization and biological effects of Sicilian Opuntia ficus indica (L.) mill. Fruit juice: antioxidant and antiulcerogenic activity

J Agric Food Chem

Diuretic and antioxidant effects of Cacti-Nea, a dehydrated water extract from prickly pear fruit, in rats

Phytother Res

Comparative evaluation of two different Opuntia ficus-indica extracts for blood sugar lowering effects in rats

Phytother Res

[Effect of raw and cooked nopal (Opuntia ficus indica) ingestion on growth and profile of total cholesterol, lipoproteins, and blood glucose in rats]. [Article in Spanish]

Arch Latinoam Nutr

Glycoprotein (90 kDa) isolated from Opuntia ficus-indica var. saboten MAKINO lowers plasma lipid level through scavenging of intracellular radicals in Triton WR-1339-induced mice

Biol Pharm Bull

Pharmaco-toxicologic study of Opuntia ficus indica L. aqueous extract in experimental animals

Int J Med Arom Plants

Opuntia ficus-indica ingestion stimulates peripheral disposal of oral glucose before and after exercise in healthy men

Int J Sport Nutr Exerc Metab

[Effect of a dehydrated extract of nopal (Opuntia ficus indica Mill.) on blood glucose]. [Article in Spanish]

Arch Invest Med (Mex)

Additive insulinogenic action of Opuntia ficus-indica cladode and fruit skin extract and leucine after exercise in healthy males

J Int Soc Sports Nutr

Meta-analysis
The effect of cactus pear (Opuntia ficus-indica) on body weight and cardiovascular risk factors: A systematic review and meta-analysis of randomized clinical trials