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BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2023

Open Access 01-12-2023 | Arterial Occlusive Disease | Research

Clinical effects of Emblica officinalis fruit consumption on cardiovascular disease risk factors: a systematic review and meta-analysis

Authors: Paul D. S. Brown, Nicole Ketter, Mathew Vis-Dunbar, Brodie M. Sakakibara

Published in: BMC Complementary Medicine and Therapies | Issue 1/2023

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Abstract

Background

Emblica officinalis (EO) fruit consumption has been found to have a beneficial effect on cardiovascular disease (CVD) physiological risk factors in preliminary clinical intervention trials; however, questions remain regarding the overall effectiveness of EO on CVD risk. The purpose of this systematic review and meta-analysis is to: 1) systematically describe the clinical research examining EO; and 2) quantitatively assess the effects of EO on CVD physiological risk factors.

Methods

The Pubmed, Embase, Web of Science, and Google Scholar electronic platforms were searched for relevant randomized controlled trials (RCTs) published until April 7, 2021. Studies were included if they involved adults (age ≥ 18 years) ingesting a form of EO fruit; included blood lipids, blood pressure, and/or inflammatory biomarkers as outcomes; had clearly defined intervention and control treatments with pre- and post-intervention data; were peer-reviewed; and were written in English. Studies were excluded if they compared EO with another risk reduction intervention without a usual care control group. RCTs were assessed for methodological quality using the Cochrane risk-of-bias version 2 (ROB2) tool, qualitatively described, and quantitatively evaluated using random and fixed effect meta-analysis models.

Results

A total of nine RCTs (n = 535 participants) were included for review. Included studies followed parallel-group (n = 6) and crossover (n = 3) designs, with EO dosage ranging from 500 mg/day to 1500 mg/day, and treatment duration ranging from 14 to 84 days. Meta-analyses revealed EO to have a significant composite effect at lowering low-density lipoprotein cholesterol (LDL-C; Mean difference (MD) = -15.08 mg/dL [95% Confidence interval (CI) = -25.43 to -4.73], I2 = 77%, prediction interval = -48.29 to 18.13), very low-density lipoprotein cholesterol (VLDL-C; MD = -5.43 mg/dL [95% CI = -8.37 to -2.49], I2 = 44%), triglycerides (TG; MD = -22.35 mg/dL [95% CI = -39.71 to -4.99], I2 = 62%, prediction interval = -73.47 to 28.77), and high-sensitivity C-reactive protein (hsCRP; MD = -1.70 mg/L [95% CI = -2.06 to -1.33], I2 = 0%) compared with placebo.

Conclusions

Due to statistical and clinical heterogeneity in the limited number of clinical trials to date, the promising effects of EO on physiologic CVD risk factors in this review should be interpreted with caution. Further research is needed to determine if EO offers an efficacious option for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy.
Appendix
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Literature
1.
Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2020 update: A report from the American Heart Association. Circulation. 2020;141:e139–596.PubMedCrossRef
2.
3.
Bansilal S, Castellano JM, Fuster V. Global burden of CVD: focus on secondary prevention of cardiovascular disease. Int J Cardiol. 2015;201(S1):S1-7.PubMedCrossRef
4.
Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, et al. Dietary approaches to stop hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr. 2020;11(5):1150–60.PubMedPubMedCentralCrossRef
5.
Chiavaroli L, Nishi SK, Khan TA, Braunstein CR, Glenn AJ, Mejia SB, et al. Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018;61(1):43–53.PubMedCrossRef
6.
Jenkins DJA, Jones PJH, Lamarche B, Kendall CWC, Faulkner D, Cermakova L, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. 2011;306(8):831–9.PubMedCrossRef
7.
Khan KH. Roles of Emblica officinalis in medicine - a review. Botany Research International. 2009;2(4):218–28.
8.
Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.PubMedCrossRef
9.
Yadav SS, Singh MK, Singh PK, Kumar V. Traditional knowledge to clinical trials: a review on therapeutic actions of Emblica officinalis. Biomed Pharmacother. 2017;93:1292–302.PubMedCrossRef
10.
Lim TK. Phyllanthus emblica. In: Edible Medicinal and Non-Medicinal Plants: Volume 4, Fruits. Springer; 2012. p. 258–96.
11.
Pareek S, Shikov AN, Pozharitskaya ON, Makarov VG, González-Aguilar GA, Ramalho SA, et al. Indian Gooseberry (Emblica officinalis Gaertn.). In: Yahia EM, editor., et al., Fruit and Vegetable Phytochemicals: Chemistry and Human Health. 2nd ed. Hoboken, NJ: John Wiley & Sons Ltd; 2018. p. 1077–105.
12.
Hashem-Dabaghian F, Ziaee M, Ghaffari S, Nabati F, Kianbakht S. A systematic review on the cardiovascular pharmacology of Emblica officinalis Gaertn. J Cardiovasc Thorac Res. 2018;10(3):118–28.PubMedPubMedCentralCrossRef
13.
Saini A, Sharma S, Chhibber S. Protective efficacy of Emblica officinalis against Klebsiella pneumoniae induced pneumonia in mice. Indian J Med Res. 2008;128(2):188–93.PubMed
14.
Krishnaveni M, Mirunalini S, Karthishwaran K, Dhamodharan G. Antidiabetic and antihyperlipidemic properties of Phyllanthus emblica Linn. (Euphorbiaceae) on streptozotocin induced diabetic rats. Pak J Nutr. 2010;9(1):43–51.CrossRef
15.
Mehmood MH, Siddiqi HS, Gilani AH. The antidiarrheal and spasmolytic activities of Phyllanthus emblica are mediated through dual blockade of muscarinic receptors and Ca2+ channels. J Ethnopharmacol. 2011;133(2):856–65.PubMedCrossRef
16.
Kim HJ, Yokozawa T, Kim HY, Tohda C, Rao TP, Juneja LR. Influence of amla (Emblica officinalis Gaertn.) on hypercholesterolemia and lipid peroxidation in cholesterol-fed rats. J Nutri Sci Vitaminol. 2005;51(6):413–8.CrossRef
17.
Santoshkumar J, Manjunath S, Pranavkumar MS. A study of anti-hyperlipidemia, hypolipidemic and anti-atherogenic activity of fruit of Emblica officinalis (amla) in high fat fed albino rats. Int J Med Res Health Sci. 2013;2(1):70–7.
18.
Prakash D, Upadhyay G, Gupta C, Pushpangadan P, Singh KK. Antioxidant and free radical scavenging activities of some promising wild edible fruits. Int Food Res J. 2012;19(3):1109–16.
19.
Perianayagam JB, Sharma SK, Joseph A, Christina AJM. Evaluation of anti-pyretic and analgesic activity of Emblica officinalis Gaertn. J of Ethnopharmacol. 2004;95(1):83–5.CrossRef
20.
Panda S, Kar A. Fruit extract of Emblica officinalis ameliorates hyperthyroidism and hepatic lipid peroxidation in mice. Pharmazie. 2003;58(10):753–5.PubMed
21.
Nosál’ová G, Mokrý J, Tareq Hassan KM. Antitussive activity of the fruit extract of Emblica officinalis Gaertn. (Euphorbiaceae). Phytomedicine. 2003;10(6–7):583–9.PubMedCrossRef
22.
Chatterjee A, Chattopadhyay S, Bandyopadhyay SK. Biphasic effect of Phyllanthus emblica L. extract on NSAID-induced ulcer: An antioxidative trail weaved with immunomodulatory effect. Evid Based Complement Alternat Med. 2011; https://​doi.​org/​10.​1155/​2011/​146808.
23.
Krishnaveni M, Mirunalini S. Chemopreventive efficacy of Phyllanthus emblica L. (amla) fruit extract on 7,12-dimethylbenz(a)anthracene induced oral carcinogenesis - a dose-response study. Environ Toxicol Pharmacol. 2012;34(3):801–10.PubMedCrossRef
24.
Uddin MS, Mamun A al, Hossain MS, Akter F, Iqbal MA, Asaduzzaman M. Exploring the effect of Phyllanthus emblica L. on cognitive performance, brain antioxidant markers and acetylcholinesterase activity in rats: promising natural gift for the mitigation of Alzheimer’s disease. Ann Neurosci. 2016;23(4):218–29.PubMedPubMedCentralCrossRef
25.
Al-Rehaily AJ, Al-Howiriny TA, Al-Sohaibani MO, Rafatullah S. Gastroprotective effects of “Amla” Emblica officinalis on in vivo test models in rats. Phytomedicine. 2002;9(6):515–22.PubMedCrossRef
26.
Huang CZ, Tung YT, Hsia SM, Wu CH, Yen GC. The hepatoprotective effect of Phyllanthus emblica L. fruit on high fat diet-induced non-alcoholic fatty liver disease (NAFLD) in SD rats. Food Funct. 2017;8(2):842–50.PubMedCrossRef
27.
Yokozawa T, Kim HY, Kim HJ, Tanaka T, Sugino H, Okubo T, et al. Amla (Emblica officinalis Gaertn.) attenuates age-related renal dysfunction by oxidative stress. J Agric Food Chem. 2007;55(19):7744–52.PubMedCrossRef
28.
Fujii T, Wakaizumi M, Ikami T, Saito M. Amla (Emblica officinalis Gaertn.) extract promotes procollagen production and inhibits matrix metalloproteinase-1 in human skin fibroblasts. J Ethnopharmacol. 2008;119(1):53–7.PubMedCrossRef
29.
Sumitra M, Manikandan P, Gayathri VS, Mahendran P, Suguna L. Emblica officinalis exerts wound healing action through up-regulation of collagen and extracellular signal-regulated kinases (ERK1/2). Wound Repair Regen. 2009;17(1):99–107.PubMedCrossRef
30.
Teimouri E, Rainey-Smith SR, Bharadwaj P, Verdile G, Martins RN. Amla therapy as a potential modulator of Alzheimer’s disease risk factors and physiological change. J Alzheimers Dis. 2020;74(3):713–33.PubMedCrossRef
31.
Variya BC, Bakrania AK, Patel SS. Emblica officinalis (Amla): a review for its phytochemistry, ethnomedicinal uses and medicinal potentials with respect to molecular mechanisms. Pharmacol Res. 2016;111:180–200.PubMedCrossRef
32.
Akhtar MS, Ramzan A, Ali A, Ahmad M. Effect of amla fruit (Emblica officinalis Gaertn.) on blood glucose and lipid profile of normal subjects and type 2 diabetic patients. Int J Food Sci Nutr. 2011;62(6):609–16.PubMedCrossRef
33.
34.
Antony B, Benny M, Kaimal TNB. A pilot clinical study to evaluate the effect of Emblica officinalis extract (AmlamaxTM) on markers of systemic inflammation and dyslipidemia. Indian J Clin Biochem. 2008;23(4):378–81.PubMedPubMedCentralCrossRef
35.
Gopa B, Bhatt J, Hemavathi KG. A comparative clinical study of hypolipidemic efficacy of Amla (Emblica officinalis) with 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor simvastatin. Indian J Pharmacol. 2012;44(2):238–42.PubMedPubMedCentralCrossRef
36.
Sinha RR, Sharma N, Advani U, Dadheech G, Kulshreshtha S, Parakh R. Comparative study of hypolipidemic effects of atorvastatin with Emblica officinalis (Amla) in patients of type II hyperlipidemia. World J Pharm Res. 2014;3(2):2799–810.
37.
Fatima N, Usharani P, Muralidhar N. Study of pharmacodynamic interaction of Phyllanthus emblica extract with clopidogrel and ecosprin in patients with type II diabetes mellitus. Phytomedicine. 2014;21(5):579–85.PubMedCrossRef
38.
Khanna S, Das A, Spieldenner J, Rink C, Roy S. Supplementation of a standardized extract from Phyllanthus emblica improves cardiovascular risk factors and platelet aggregation in overweight/class-1 obese adults. J Med Food. 2015;18(4):415–20.PubMedPubMedCentralCrossRef
39.
Gupta M, Mathur KC, Yadav K, Sharma P, Tilwani K, Narnolia PK, et al. Effect of Amla (Emblica officinalis) on various physiological and biochemical parameters of metabolic syndrome. Scholars Journal of Applied Medical Sciences. 2016;4(2C):469–75.
40.
Walia K, Boolchandani R, Dhand S, Antony B. Improving glycemic & lipidemic profile with Amla powder (Emblica officinalis) supplementation in adults with type 2 diabetes mellitus. International Journal of Basic and Applied Medical Sciences. 2015;5(2):251–8.
41.
Usharani P, Kishan PV, Fatima N, Uday KC. A comparative study to evaluate the effect of highly standardised aqueous extracts of Phyllanthus emblica, Withania somnifera and their combination on endothelial dysfunction and biomarkers in patients with type II diabetes mellitus. Int J Pharm Sci Res. 2014;5(7):2687–97.
42.
Tayyab F, Lal SS. Comparative study on supplementation effect of Momordica charantia Linn. and Emblica officinalis Gaertn. on lipid profile of type II diabetic patients in Allahabad, Uttar Pradesh India. Ann Phytomed. 2016;5(1):40–2.
43.
Iyer U, Joshi A, Dhruv S. Impact of Amla (Embilica officinalis) supplementation on the glycemic and lipidemic status of type 2 diabetic subjects. Journal of Herbal Medicine and Toxicology. 2009;3(2):15–21.
44.
Chandra RH, Veeresham C, Asres K. Effects of Emblica officinalis commercial formulation in type 2 diabetic patients. Indian J Pharm Sci. 2004;66(6):735–8.
45.
Kavita MB, Mallika KJ, Poornima B. A clinical study on effect of Amalaki (Indian gooseberry) as food supplement in dyslipidemia. Int J Res Ayurveda Pharm. 2016;7(4):59–64.CrossRef
46.
Sri KVS, Kumari DJ, Sivannarayana G. Effect of Amla, an approach towards the control of diabetes mellitus. Int J Curr Microbiol Appl Sci. 2013;2(9):103–8.
47.
Chen T-S, Liou S-Y, Chang Y-L. Supplementation of Emblica officinalis (Amla) extract reduces oxidative stress in uremic patients. Am J Chin Med. 2009;37(1):19–25.PubMedCrossRef
48.
Nilkanthrao KD, Shandilya MK. Evaluation of rasayana (rejuvenative) effect of Amalaki (Emblica officinalis) in healthy volunteers. Int J Res Ayurveda Pharm. 2015;6(1):18–21.CrossRef
49.
Jacob A, Pandey M, Kapoor S, Saroja R. Effect of the Indian gooseberry (amla) on serum cholesterol levels in men aged 35–55 years. Eur J Clin Nutr. 1988;42(11):939–44.PubMed
50.
Biswas TK, Chakrabarti S, Pandit S, et al. Pilot study evaluating the use of Emblica officinalis standardized fruit extract in cardio-respiratory improvement and antioxidant status of volunteers with smoking history. J Herb Med. 2014;4(4):188–94.CrossRef
51.
Fatima N, Usharani P, Pilli R. Evaluation of Phyllanthus emblica extract on cold pressor induced cardiovascular changes in healthy human subjects. Pharmacognosy Res. 2014;6(1):29–35.PubMedPubMedCentralCrossRef
52.
53.
54.
Shanmugarajan D, Girish C, Harivenkatesh N, Chanaveerappa B, Prasanna Lakshmi NC. Antihypertensive and pleiotropic effects of Phyllanthus emblica extract as an add-on therapy in patients with essential hypertension—a randomized double-blind placebo-controlled trial. Phytother Res. 2021. https://​doi.​org/​10.​1002/​ptr.​7043.CrossRefPubMed
55.
56.
Usharani P, Fatima N, Muralidhar N. Effects of Phyllanthus emblica extract on endothelial dysfunction and biomarkers of oxidative stress in patients with type 2 diabetes mellitus: A randomized, double-blind, controlled study. Diabetes Metab Syndr Obes. 2013;6:275–84.PubMedPubMedCentral
57.
Usharani P, Merugu PL, Nutalapati C. Evaluation of the effects of a standardized aqueous extract of Phyllanthus emblica fruits on endothelial dysfunction, oxidative stress, systemic inflammation and lipid profile in subjects with metabolic syndrome: A randomised, double blind, placebo controlled clinical study. BMC Complement Altern Med. 2019. https://​doi.​org/​10.​1186/​s12906-019-2509-5.CrossRefPubMedPubMedCentral
58.
Usharani P, Sudha Rani E, Kiran Kishore K, Raveendranath P. Evaluation of the effect of a standardized aqueous extract of the fruits of Emblica officinalis on mental stress induced cardiovascular changes in healthy human subjects. Int J Pharm Sci Res. 2017;8(10):4138–46.
59.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372: n71.PubMedPubMedCentralCrossRef
60.
Elbourne DR, Altman DG, Higgins JPT, Curtin F, Worthington HV, Vail A. Meta-analysis involving cross-over trials: methodological issues. Int J Epidemiol. 2002;32(1):140–9.CrossRef
61.
Covidence Systematic Review Software [Computer program]. Melbourne, Australia: Veritas Health Innovation; 2021
62.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ. 2019;366:14898.
63.
64.
65.
66.
67.
Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
68.
Borenstein M, Higgins JP, Hedges LV, Rothstein HR. Basics of meta-analysis: I2 is not an absolute measure of heterogeneity. Res Synth Methods. 2017;8(1):5–18.PubMedCrossRef
69.
Review Manager (RevMan) [Computer program]. Version 5.4. The Cochrane Collaboration. 2020.
70.
Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6:245.PubMedPubMedCentralCrossRef
71.
Srivastava R. Efficacy of amla powder (emblica officinalis) and nutrition counselling on hyperlipidemic and hypertensive subject”. Punjab Agricultural University: Independently Published; 2018. p. 1–119.
72.
Chepulis L, Al-Aubaidy H, Page R. Effects of selected antioxidant food extracts on postprandial glucose responses in healthy individuals. Functional Foods in Health and Disase. 2016;6(8):493–505.CrossRef
73.
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods. 2020.
74.
75.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMedCrossRef
76.
Anderson TJ, Grégoire J, Pearson GJ, Barry AR, Couture P, Dawes M, et al. 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2016;32(11):1263–82.PubMedCrossRef
77.
Mathur R, Sharma A, Dixit VP, Varma M. Hypolipidaemic effect of fruit juice of Emblica officinalis in cholesterol-fed rabbits. J Ethnopharmacol. 1996;50(2):61–8.PubMedCrossRef
78.
Anila L, Vijayalakshmi NR. Flavonoids from Emblica officinalis and Mangifera indica—effectiveness for dyslipidemia. J Ethnopharmacol. 2002;79(1):81–7.PubMedCrossRef
Metadata
Title
Clinical effects of Emblica officinalis fruit consumption on cardiovascular disease risk factors: a systematic review and meta-analysis
Authors
Paul D. S. Brown
Nicole Ketter
Mathew Vis-Dunbar
Brodie M. Sakakibara
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2023
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-023-03997-8

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