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Published in: Diabetology & Metabolic Syndrome 1/2021

01-12-2021 | Insulins | Research

Combination therapy of flaxseed and hesperidin enhances the effectiveness of lifestyle modification in cardiovascular risk control in prediabetes: a randomized controlled trial

Authors: Zahra Yari, Zahra Naser-Nakhaee, Elahe Karimi‐Shahrbabak, Makan Cheraghpour, Mehdi Hedayati, Seyede Marjan Mohaghegh, Shahrzad Ommi, Azita Hekmatdoost

Published in: Diabetology & Metabolic Syndrome | Issue 1/2021

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Abstract

Background

Regarding the increasing prevalence of cardiometabolic abnormalities, and its association with non-communicable chronic diseases, providing preventive and therapeutic strategies is a priority. A randomized placebo-controlled study was conducted to assess the effects of combination therapy of milled brown flaxseed and hesperidin during lifestyle intervention on controlling cardiovascular risk in prediabetes.

Methods

A total of forty-eight subjects were randomly assigned to receive lifestyle intervention plus combination therapy of brown flaxseed (30 g milled) and hesperidin (two 500 mg capsules) or lifestyle modification alone for 12 weeks. Changes from baseline in anthropometric measures, lipid profile and atherogenic indices, glucose homeostasis parameters, and inflammatory biomarkers was assessed as a primary end point.

Results

Anthropometric data comparison between the two groups showed a significant reduction in weight (p = 0.048). Waist circumference reduction was about twice that of the control group (− 6.75 cm vs − 3.57 cm), but this difference was not statistically significant. Comparison of blood pressure changes throughout the study indicated a greater reduction in blood pressure in the intervention group rather than control group (− 5.66 vs. − 1.56 mmHg, P = 0.049). Improvements of lipid profile and atherogenic indices, glucose homeostasis parameters, and inflammatory biomarkers in flaxseed-hesperidin group was significantly more than the control group after 12 weeks of intervention (p < 0.05).

Conclusion

Our results indicate that co-administration of flaxseed and hesperidin as an adjunct to lifestyle modification program is more effective than lifestyle modification alone in the metabolic abnormalities remission of prediabetic patients.
Trial registration: The trial was registered with ClinicalTrials.gov, number NCT03737422. Registered 11 November 2018. Retrospectively registered, https://​clinicaltrials.​gov/​ct2/​results?​cond=​&​term=​NCT03737422&​cntry=​&​state=​&​city=​&​dist=​.
Literature
1.
go back to reference Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Rev Endocrinol. 2012;8(4):228–36.CrossRef Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Rev Endocrinol. 2012;8(4):228–36.CrossRef
2.
go back to reference Bansal N. Prediabetes diagnosis and treatment: a review. World J Diab. 2015;6(2):296.CrossRef Bansal N. Prediabetes diagnosis and treatment: a review. World J Diab. 2015;6(2):296.CrossRef
3.
go back to reference Daniele G, Abdul-Ghani M, DeFronzo RA. What are the pharmacotherapy options for treating prediabetes? Expert Opin Pharmacother. 2014;15(14):2003–18.PubMedCrossRef Daniele G, Abdul-Ghani M, DeFronzo RA. What are the pharmacotherapy options for treating prediabetes? Expert Opin Pharmacother. 2014;15(14):2003–18.PubMedCrossRef
4.
go back to reference Liu T. A Comparison of Biological, Physical, and Psychological Risk Factors forCardiovascular Disease In Overweight/Obese Individuals With and Without Prediabetes: Emory University; 2015. Liu T. A Comparison of Biological, Physical, and Psychological Risk Factors forCardiovascular Disease In Overweight/Obese Individuals With and Without Prediabetes: Emory University; 2015.
5.
go back to reference Lindström J, Peltonen M, Eriksson J, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56(2):284–93.PubMedCrossRef Lindström J, Peltonen M, Eriksson J, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56(2):284–93.PubMedCrossRef
6.
7.
go back to reference Agrawal YO, Sharma PK, Shrivastava B, Ojha S, Upadhya HM, Arya DS, et al. Hesperidin produces cardioprotective activity via PPAR-gamma pathway in ischemic heart disease model in diabetic rats. PLoS ONE. 2014;9(11):e111212.PubMedPubMedCentralCrossRef Agrawal YO, Sharma PK, Shrivastava B, Ojha S, Upadhya HM, Arya DS, et al. Hesperidin produces cardioprotective activity via PPAR-gamma pathway in ischemic heart disease model in diabetic rats. PLoS ONE. 2014;9(11):e111212.PubMedPubMedCentralCrossRef
8.
go back to reference Cavia-Saiz M, Busto MD, Pilar-Izquierdo MC, Ortega N, Perez-Mateos M, Muñiz P. Antioxidant properties, radical scavenging activity and biomolecule protection capacity of flavonoid naringenin and its glycoside naringin: a comparative study. J Sci Food Agric. 2010;90(7):1238–44.PubMedCrossRef Cavia-Saiz M, Busto MD, Pilar-Izquierdo MC, Ortega N, Perez-Mateos M, Muñiz P. Antioxidant properties, radical scavenging activity and biomolecule protection capacity of flavonoid naringenin and its glycoside naringin: a comparative study. J Sci Food Agric. 2010;90(7):1238–44.PubMedCrossRef
9.
go back to reference Poudyal H, Panchal SK, Diwan V, Brown L. Omega-3 fatty acids and metabolic syndrome: effects and emerging mechanisms of action. Prog Lipid Res. 2011;50(4):372–87.PubMedCrossRef Poudyal H, Panchal SK, Diwan V, Brown L. Omega-3 fatty acids and metabolic syndrome: effects and emerging mechanisms of action. Prog Lipid Res. 2011;50(4):372–87.PubMedCrossRef
10.
go back to reference Oomah BD. Flaxseed as a functional food source. J Sci Food Agric. 2001;81(9):889–94.CrossRef Oomah BD. Flaxseed as a functional food source. J Sci Food Agric. 2001;81(9):889–94.CrossRef
11.
go back to reference Morris DH. Flax: A health and nutrition primer: Flax Council of Canada; 2007. Morris DH. Flax: A health and nutrition primer: Flax Council of Canada; 2007.
12.
go back to reference Munir KM, Chandrasekaran S, Gao F, Quon MJ. Mechanisms for food polyphenols to ameliorate insulin resistance and endothelial dysfunction: therapeutic implications for diabetes and its cardiovascular complications. Am J Physiol Endocrinol Metab. 2013;305(6):E679.PubMedPubMedCentralCrossRef Munir KM, Chandrasekaran S, Gao F, Quon MJ. Mechanisms for food polyphenols to ameliorate insulin resistance and endothelial dysfunction: therapeutic implications for diabetes and its cardiovascular complications. Am J Physiol Endocrinol Metab. 2013;305(6):E679.PubMedPubMedCentralCrossRef
13.
go back to reference Jung UJ, Lee M-K, Jeong K-S, Choi M-S. The hypoglycemic effects of hesperidin and naringin are partly mediated by hepatic glucose-regulating enzymes in C57BL/KsJ-db/db mice. J Nutri. 2004;134(10):2499–503.CrossRef Jung UJ, Lee M-K, Jeong K-S, Choi M-S. The hypoglycemic effects of hesperidin and naringin are partly mediated by hepatic glucose-regulating enzymes in C57BL/KsJ-db/db mice. J Nutri. 2004;134(10):2499–503.CrossRef
14.
go back to reference Rhee Y, Brunt A. Flaxseed supplementation improved insulin resistance in obese glucose intolerant people: a randomized crossover design. Nutr J. 2011;10(1):44.PubMedPubMedCentralCrossRef Rhee Y, Brunt A. Flaxseed supplementation improved insulin resistance in obese glucose intolerant people: a randomized crossover design. Nutr J. 2011;10(1):44.PubMedPubMedCentralCrossRef
15.
go back to reference Hutchins AM, Brown BD, Cunnane SC, Domitrovich SG, Adams ER, Bobowiec CE. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutri Res. 2013;33(5):367–75.CrossRef Hutchins AM, Brown BD, Cunnane SC, Domitrovich SG, Adams ER, Bobowiec CE. Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study. Nutri Res. 2013;33(5):367–75.CrossRef
16.
go back to reference Homayouni F, Haidari F, Hedayati M, Zakerkish M, Ahmadi K. Hesperidin supplementation alleviates oxidative DNA damage and lipid peroxidation in type 2 diabetes: a randomized double-blind placebo-controlled clinical trial. Phytotherapy Res PTR. 2017;31(10):1539–45.CrossRef Homayouni F, Haidari F, Hedayati M, Zakerkish M, Ahmadi K. Hesperidin supplementation alleviates oxidative DNA damage and lipid peroxidation in type 2 diabetes: a randomized double-blind placebo-controlled clinical trial. Phytotherapy Res PTR. 2017;31(10):1539–45.CrossRef
17.
go back to reference Kim JY, Jung KJ, Choi JS, Chung HY. Modulation of the age-related nuclear factor-κB (NF-κB) pathway by hesperetin. Aging Cell. 2006;5(5):401–11.PubMedCrossRef Kim JY, Jung KJ, Choi JS, Chung HY. Modulation of the age-related nuclear factor-κB (NF-κB) pathway by hesperetin. Aging Cell. 2006;5(5):401–11.PubMedCrossRef
18.
go back to reference Sekgala MD, McHiza ZJ, Parker WA, Monyeki KD. Dietary Fiber Intake and Metabolic Syndrome Risk Factors among Young South African Adults. Nutrients. 2018;10(4). Sekgala MD, McHiza ZJ, Parker WA, Monyeki KD. Dietary Fiber Intake and Metabolic Syndrome Risk Factors among Young South African Adults. Nutrients. 2018;10(4).
19.
go back to reference Chen JP, Chen GC, Wang XP, Qin L, Bai Y. Dietary Fiber and Metabolic Syndrome: A Meta-Analysis and Review of Related Mechanisms. Nutrients. 2017;10(1). Chen JP, Chen GC, Wang XP, Qin L, Bai Y. Dietary Fiber and Metabolic Syndrome: A Meta-Analysis and Review of Related Mechanisms. Nutrients. 2017;10(1).
20.
go back to reference Thakur G, Mitra A, Pal K, Rousseau D. Effect of flaxseed gum on reduction of blood glucose and cholesterol in type 2 diabetic patients. Int J Food Sci Nutr. 2009;60(sup6):126–36.PubMedCrossRef Thakur G, Mitra A, Pal K, Rousseau D. Effect of flaxseed gum on reduction of blood glucose and cholesterol in type 2 diabetic patients. Int J Food Sci Nutr. 2009;60(sup6):126–36.PubMedCrossRef
21.
go back to reference Barre D, Mizier-Barre K, Stelmach E, Hobson J, Griscti O, Rudiuk A, et al. Flaxseed lignan complex administration in older human type 2 diabetics manages central obesity and prothrombosis—an invitation to further investigation into polypharmacy reduction. Journal of nutrition and metabolism. 2012;2012. Barre D, Mizier-Barre K, Stelmach E, Hobson J, Griscti O, Rudiuk A, et al. Flaxseed lignan complex administration in older human type 2 diabetics manages central obesity and prothrombosis—an invitation to further investigation into polypharmacy reduction. Journal of nutrition and metabolism. 2012;2012.
22.
go back to reference Cunnane SC, Ganguli S, Menard C, Liede AC, Hamadeh MJ, Chen Z-Y, et al. High α-linolenic acid flaxseed (Linum usitatissimum): some nutritional properties in humans. Br J Nutr. 1993;69(2):443–53.PubMedCrossRef Cunnane SC, Ganguli S, Menard C, Liede AC, Hamadeh MJ, Chen Z-Y, et al. High α-linolenic acid flaxseed (Linum usitatissimum): some nutritional properties in humans. Br J Nutr. 1993;69(2):443–53.PubMedCrossRef
23.
go back to reference Selvamuthukumaran M, Boobalan MS, Shi J. Bioactive Components in Citrus Fruits and Their Health Benefits. Phytochemicals in Citrus: Applications in Functional Foods. 2017. Selvamuthukumaran M, Boobalan MS, Shi J. Bioactive Components in Citrus Fruits and Their Health Benefits. Phytochemicals in Citrus: Applications in Functional Foods. 2017.
24.
go back to reference Rizza S, Muniyappa R, Iantorno M, Kim JA, Chen H, Pullikotil P, et al. Citrus polyphenol hesperidin stimulates production of nitric oxide in endothelial cells while improving endothelial function and reducing inflammatory markers in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(5):E782–92.PubMedPubMedCentralCrossRef Rizza S, Muniyappa R, Iantorno M, Kim JA, Chen H, Pullikotil P, et al. Citrus polyphenol hesperidin stimulates production of nitric oxide in endothelial cells while improving endothelial function and reducing inflammatory markers in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(5):E782–92.PubMedPubMedCentralCrossRef
25.
go back to reference Salden BN, Troost FJ, de Groot E, Stevens YR, Garcés-Rimón M, Possemiers S, et al. Randomized clinical trial on the efficacy of hesperidin 2S on validated cardiovascular biomarkers in healthy overweight individuals. Am J Clin Nutri. 2016;104(6):1523–33.CrossRef Salden BN, Troost FJ, de Groot E, Stevens YR, Garcés-Rimón M, Possemiers S, et al. Randomized clinical trial on the efficacy of hesperidin 2S on validated cardiovascular biomarkers in healthy overweight individuals. Am J Clin Nutri. 2016;104(6):1523–33.CrossRef
26.
go back to reference Constans J, Bennetau-Pelissero C, Martin J-F, Rock E, Mazur A, Bedel A, et al. Marked antioxidant effect of orange juice intake and its phytomicronutrients in a preliminary randomized cross-over trial on mild hypercholesterolemic men. Clin Nutr. 2015;34(6):1093–100.PubMedCrossRef Constans J, Bennetau-Pelissero C, Martin J-F, Rock E, Mazur A, Bedel A, et al. Marked antioxidant effect of orange juice intake and its phytomicronutrients in a preliminary randomized cross-over trial on mild hypercholesterolemic men. Clin Nutr. 2015;34(6):1093–100.PubMedCrossRef
27.
go back to reference Morand C, Dubray C, Milenkovic D, Lioger D, Martin JF, Scalbert A, et al. Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers. Am J Clin Nutri. 2011;93(1):73–80.CrossRef Morand C, Dubray C, Milenkovic D, Lioger D, Martin JF, Scalbert A, et al. Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers. Am J Clin Nutri. 2011;93(1):73–80.CrossRef
28.
go back to reference Rangel-Huerta OD, Aguilera CM, Martin MV, Soto MJ, Rico MC, Vallejo F, et al. Normal or high polyphenol concentration in orange juice affects antioxidant activity, blood pressure, and body weight in obese or overweight adults. J Nutri. 2015;145(8):1808–16.CrossRef Rangel-Huerta OD, Aguilera CM, Martin MV, Soto MJ, Rico MC, Vallejo F, et al. Normal or high polyphenol concentration in orange juice affects antioxidant activity, blood pressure, and body weight in obese or overweight adults. J Nutri. 2015;145(8):1808–16.CrossRef
29.
go back to reference Association AD. 2. Classification and diagnosis of diabetes. Diabetes care. 2017;40(Supplement 1):S11-S24. Association AD. 2. Classification and diagnosis of diabetes. Diabetes care. 2017;40(Supplement 1):S11-S24.
30.
go back to reference 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 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
31.
go back to reference Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMed Matthews D, Hosker J, Rudenski A, Naylor B, Treacher D, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.CrossRefPubMed
32.
go back to reference Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85(7):2402–10.CrossRefPubMed Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000;85(7):2402–10.CrossRefPubMed
33.
go back to reference Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with type 2 diabetes. Clin Chem. 2004;50(7):1184–8.PubMedCrossRef Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with type 2 diabetes. Clin Chem. 2004;50(7):1184–8.PubMedCrossRef
34.
go back to reference Badeli H, Assadi F. Strategies to reduce pitfalls in measuring blood pressure. Int J Preventive Med. 2014;5(Suppl 1):S17. Badeli H, Assadi F. Strategies to reduce pitfalls in measuring blood pressure. Int J Preventive Med. 2014;5(Suppl 1):S17.
35.
go back to reference Miwa Y, Mitsuzumi H, Sunayama T, Yamada M, Okada K, Kubota M, et al. Glucosyl hesperidin lowers serum triglyceride level in hypertriglyceridemic subjects through the improvement of very low-density lipoprotein metabolic abnormality. J Nutr Sci Vitaminol. 2005;51(6):460–70.PubMedCrossRef Miwa Y, Mitsuzumi H, Sunayama T, Yamada M, Okada K, Kubota M, et al. Glucosyl hesperidin lowers serum triglyceride level in hypertriglyceridemic subjects through the improvement of very low-density lipoprotein metabolic abnormality. J Nutr Sci Vitaminol. 2005;51(6):460–70.PubMedCrossRef
36.
go back to reference Demonty I, Lin Y, Zebregs YE, Vermeer MA, van der Knaap HC, Jäkel M, et al. The citrus flavonoids hesperidin and naringin do not affect serum cholesterol in moderately hypercholesterolemic men and women–3. J Nutri. 2010;140(9):1615–20.CrossRef Demonty I, Lin Y, Zebregs YE, Vermeer MA, van der Knaap HC, Jäkel M, et al. The citrus flavonoids hesperidin and naringin do not affect serum cholesterol in moderately hypercholesterolemic men and women–3. J Nutri. 2010;140(9):1615–20.CrossRef
37.
go back to reference Rizza S, Muniyappa R, Iantorno M, Kim J, Chen H, Pullikotil P, et al. Citrus polyphenol hesperidin stimulates production of nitric oxide in endothelial cells while improving endothelial function and reducing inflammatory markers in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(5):E782-E92.CrossRef Rizza S, Muniyappa R, Iantorno M, Kim J, Chen H, Pullikotil P, et al. Citrus polyphenol hesperidin stimulates production of nitric oxide in endothelial cells while improving endothelial function and reducing inflammatory markers in patients with metabolic syndrome. J Clin Endocrinol Metab. 2011;96(5):E782-E92.CrossRef
38.
go back to reference Assini JM, Mulvihill EE, Huff MW. Citrus flavonoids and lipid metabolism. Curr Opin Lipidol. 2013;24(1):34–40.PubMedCrossRef Assini JM, Mulvihill EE, Huff MW. Citrus flavonoids and lipid metabolism. Curr Opin Lipidol. 2013;24(1):34–40.PubMedCrossRef
39.
go back to reference Soltanian N, Janghorbani M. Effect of flaxseed or psyllium vs. placebo on management of constipation, weight, glycemia, and lipids: A randomized trial in constipated patients with type 2 diabetes. Clinical nutrition ESPEN. 2019;29:41-8. Soltanian N, Janghorbani M. Effect of flaxseed or psyllium vs. placebo on management of constipation, weight, glycemia, and lipids: A randomized trial in constipated patients with type 2 diabetes. Clinical nutrition ESPEN. 2019;29:41-8.
40.
go back to reference Hasaniani N, Rahimlou M, Ramezani Ahmadi A, Mehdizadeh Khalifani A, Alizadeh M. The Effect of Flaxseed Enriched Yogurt on the Glycemic Status and Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus: randomized, Open-labeled. Controlled Study Clin Nutr Res. 2019;8(4):284–95.PubMedCrossRef Hasaniani N, Rahimlou M, Ramezani Ahmadi A, Mehdizadeh Khalifani A, Alizadeh M. The Effect of Flaxseed Enriched Yogurt on the Glycemic Status and Cardiovascular Risk Factors in Patients with Type 2 Diabetes Mellitus: randomized, Open-labeled. Controlled Study Clin Nutr Res. 2019;8(4):284–95.PubMedCrossRef
41.
go back to reference Fukumitsu S, Aida K, Ueno N, Ozawa S, Takahashi Y, Kobori M. Flaxseed lignan attenuates high-fat diet-induced fat accumulation and induces adiponectin expression in mice. Br J Nutr. 2008;100(3):669–76.PubMedCrossRef Fukumitsu S, Aida K, Ueno N, Ozawa S, Takahashi Y, Kobori M. Flaxseed lignan attenuates high-fat diet-induced fat accumulation and induces adiponectin expression in mice. Br J Nutr. 2008;100(3):669–76.PubMedCrossRef
42.
go back to reference Bloedon LT, Balikai S, Chittams J, Cunnane SC, Berlin JA, Rader DJ, et al. Flaxseed and cardiovascular risk factors: results from a double blind, randomized, controlled clinical trial. J Am Coll Nutr. 2008;27(1):65–74.PubMedCrossRef Bloedon LT, Balikai S, Chittams J, Cunnane SC, Berlin JA, Rader DJ, et al. Flaxseed and cardiovascular risk factors: results from a double blind, randomized, controlled clinical trial. J Am Coll Nutr. 2008;27(1):65–74.PubMedCrossRef
43.
go back to reference Mirmasoumi G, Fazilati M, Foroozanfard F, Vahedpoor Z, Mahmoodi S, Taghizadeh M, et al. The Effects of Flaxseed Oil Omega-3 Fatty Acids Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Experimental and clinical endocrinology & diabetes: official journal, German Society of Endocrinology [and] German Diabetes Association. 2018;126(4):222-8. Mirmasoumi G, Fazilati M, Foroozanfard F, Vahedpoor Z, Mahmoodi S, Taghizadeh M, et al. The Effects of Flaxseed Oil Omega-3 Fatty Acids Supplementation on Metabolic Status of Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Experimental and clinical endocrinology & diabetes: official journal, German Society of Endocrinology [and] German Diabetes Association. 2018;126(4):222-8.
44.
go back to reference Mirfatahi M, Tabibi H, Nasrollahi A, Hedayati M. Effects of Flaxseed Oil on Serum Lipids and Lipoproteins in Hemodialysis Patients: a Randomized Controlled Trial. Iranian J Kidney Dis. 2016;10(6):405–12. Mirfatahi M, Tabibi H, Nasrollahi A, Hedayati M. Effects of Flaxseed Oil on Serum Lipids and Lipoproteins in Hemodialysis Patients: a Randomized Controlled Trial. Iranian J Kidney Dis. 2016;10(6):405–12.
45.
go back to reference Kontogianni MD, Vlassopoulos A, Gatzieva A, Farmaki AE, Katsiougiannis S, Panagiotakos DB, et al. Flaxseed oil does not affect inflammatory markers and lipid profile compared to olive oil, in young, healthy, normal weight adults. Metabolism: clinical and experimental. 2013;62(5):686-93. Kontogianni MD, Vlassopoulos A, Gatzieva A, Farmaki AE, Katsiougiannis S, Panagiotakos DB, et al. Flaxseed oil does not affect inflammatory markers and lipid profile compared to olive oil, in young, healthy, normal weight adults. Metabolism: clinical and experimental. 2013;62(5):686-93.
46.
go back to reference Edel AL, Patenaude AF, Richard MN, Dibrov E, Austria JA, Aukema HM, et al. The effect of flaxseed dose on circulating concentrations of alpha-linolenic acid and secoisolariciresinol diglucoside derived enterolignans in young, healthy adults. Eur J Nutr. 2016;55(2):651–63.PubMedCrossRef Edel AL, Patenaude AF, Richard MN, Dibrov E, Austria JA, Aukema HM, et al. The effect of flaxseed dose on circulating concentrations of alpha-linolenic acid and secoisolariciresinol diglucoside derived enterolignans in young, healthy adults. Eur J Nutr. 2016;55(2):651–63.PubMedCrossRef
47.
go back to reference Akiyama S, Katsumata S, Suzuki K, Ishimi Y, Wu J, Uehara M. Dietary hesperidin exerts hypoglycemic and hypolipidemic effects in streptozotocin-induced marginal type 1 diabetic rats. J Clin Biochem Nutr. 2010;46(1):87–92.PubMedCrossRef Akiyama S, Katsumata S, Suzuki K, Ishimi Y, Wu J, Uehara M. Dietary hesperidin exerts hypoglycemic and hypolipidemic effects in streptozotocin-induced marginal type 1 diabetic rats. J Clin Biochem Nutr. 2010;46(1):87–92.PubMedCrossRef
48.
go back to reference Li C, Schluesener H. Health-promoting effects of the citrus flavanone hesperidin. Crit Rev Food Sci Nutr. 2017;57(3):613–31.PubMedCrossRef Li C, Schluesener H. Health-promoting effects of the citrus flavanone hesperidin. Crit Rev Food Sci Nutr. 2017;57(3):613–31.PubMedCrossRef
49.
go back to reference Mohammadi-Sartang M, Sohrabi Z, Barati-Boldaji R, Raeisi-Dehkordi H, Mazloom Z. Flaxseed supplementation on glucose control and insulin sensitivity: a systematic review and meta-analysis of 25 randomized, placebo-controlled trials. Nutr Rev. 2018;76(2):125–39.PubMedCrossRef Mohammadi-Sartang M, Sohrabi Z, Barati-Boldaji R, Raeisi-Dehkordi H, Mazloom Z. Flaxseed supplementation on glucose control and insulin sensitivity: a systematic review and meta-analysis of 25 randomized, placebo-controlled trials. Nutr Rev. 2018;76(2):125–39.PubMedCrossRef
50.
go back to reference Albert BB, Derraik JG, Brennan CM, Biggs JB, Smith GC, Garg ML, et al. Higher omega-3 index is associated with increased insulin sensitivity and more favourable metabolic profile in middle-aged overweight men. Scientific Rep. 2014;4:6697.CrossRef Albert BB, Derraik JG, Brennan CM, Biggs JB, Smith GC, Garg ML, et al. Higher omega-3 index is associated with increased insulin sensitivity and more favourable metabolic profile in middle-aged overweight men. Scientific Rep. 2014;4:6697.CrossRef
51.
go back to reference González-Périz A, Horrillo R, Ferré N, Gronert K, Dong B, Morán-Salvador E, et al. Obesity-induced insulin resistance and hepatic steatosis are alleviated by ω-3 fatty acids: a role for resolvins and protectins. FASEB J. 2009;23(6):1946–57.PubMedPubMedCentralCrossRef González-Périz A, Horrillo R, Ferré N, Gronert K, Dong B, Morán-Salvador E, et al. Obesity-induced insulin resistance and hepatic steatosis are alleviated by ω-3 fatty acids: a role for resolvins and protectins. FASEB J. 2009;23(6):1946–57.PubMedPubMedCentralCrossRef
52.
go back to reference Wien M, Rajaram S, Oda K, Sabaté J. Decreasing the linoleic acid to α-linolenic acid diet ratio increases eicosapentaenoic acid in erythrocytes in adults. Lipids. 2010;45(8):683–92.PubMedCrossRef Wien M, Rajaram S, Oda K, Sabaté J. Decreasing the linoleic acid to α-linolenic acid diet ratio increases eicosapentaenoic acid in erythrocytes in adults. Lipids. 2010;45(8):683–92.PubMedCrossRef
53.
go back to reference Kuo S-M. The interplay between fiber and the intestinal microbiome in the inflammatory response. Advances Nutr. 2013;4(1):16–28.CrossRef Kuo S-M. The interplay between fiber and the intestinal microbiome in the inflammatory response. Advances Nutr. 2013;4(1):16–28.CrossRef
54.
go back to reference Karlsson FH, Tremaroli V, Nookaew I, Bergström G, Behre CJ, Fagerberg B, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature. 2013;498(7452):99.PubMedCrossRef Karlsson FH, Tremaroli V, Nookaew I, Bergström G, Behre CJ, Fagerberg B, et al. Gut metagenome in European women with normal, impaired and diabetic glucose control. Nature. 2013;498(7452):99.PubMedCrossRef
55.
go back to reference Sun Q, Wedick NM, Tworoger SS, Pan A, Townsend MK, Cassidy A, et al. Urinary Excretion of Select Dietary Polyphenol Metabolites Is Associated with a Lower Risk of Type 2 Diabetes in Proximate but Not Remote Follow-Up in a Prospective Investigation in 2 Cohorts of US Women–3. J Nutr. 2015;145(6):1280–8.PubMedPubMedCentralCrossRef Sun Q, Wedick NM, Tworoger SS, Pan A, Townsend MK, Cassidy A, et al. Urinary Excretion of Select Dietary Polyphenol Metabolites Is Associated with a Lower Risk of Type 2 Diabetes in Proximate but Not Remote Follow-Up in a Prospective Investigation in 2 Cohorts of US Women–3. J Nutr. 2015;145(6):1280–8.PubMedPubMedCentralCrossRef
56.
go back to reference Mulero J, Bernabé J, Cerdá B, García-Viguera C, Moreno DA, Albaladejo MD, et al. Variations on cardiovascular risk factors in metabolic syndrome after consume of a citrus-based juice. Clin Nutr. 2012;31(3):372–7.PubMedCrossRef Mulero J, Bernabé J, Cerdá B, García-Viguera C, Moreno DA, Albaladejo MD, et al. Variations on cardiovascular risk factors in metabolic syndrome after consume of a citrus-based juice. Clin Nutr. 2012;31(3):372–7.PubMedCrossRef
57.
go back to reference Ghanim H, Sia CL, Upadhyay M, Korzeniewski K, Viswanathan P, Abuaysheh S, et al. Orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase and Toll-like receptor expression–. Am J Clin Nutri. 2010;91(4):940–9.CrossRef Ghanim H, Sia CL, Upadhyay M, Korzeniewski K, Viswanathan P, Abuaysheh S, et al. Orange juice neutralizes the proinflammatory effect of a high-fat, high-carbohydrate meal and prevents endotoxin increase and Toll-like receptor expression–. Am J Clin Nutri. 2010;91(4):940–9.CrossRef
58.
go back to reference Medina-Remón A, Casas R, Tressserra-Rimbau A, Ros E, Martínez-González MA, Fitó M, et al. Polyphenol intake from a Mediterranean diet decreases inflammatory biomarkers related to atherosclerosis: a substudy of the PREDIMED trial. Br J Clin Pharmacol. 2017;83(1):114–28.PubMedCrossRef Medina-Remón A, Casas R, Tressserra-Rimbau A, Ros E, Martínez-González MA, Fitó M, et al. Polyphenol intake from a Mediterranean diet decreases inflammatory biomarkers related to atherosclerosis: a substudy of the PREDIMED trial. Br J Clin Pharmacol. 2017;83(1):114–28.PubMedCrossRef
59.
go back to reference Medina-Remón A, Tresserra-Rimbau A, Pons A, Tur JA, Martorell M, Ros E, et al. Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial. Nutrition, Metabolism and Cardiovascular Diseases. 2015;25(1):60-7. Medina-Remón A, Tresserra-Rimbau A, Pons A, Tur JA, Martorell M, Ros E, et al. Effects of total dietary polyphenols on plasma nitric oxide and blood pressure in a high cardiovascular risk cohort. The PREDIMED randomized trial. Nutrition, Metabolism and Cardiovascular Diseases. 2015;25(1):60-7.
60.
go back to reference Ursoniu S, Sahebkar A, Andrica F, Serban C, Banach M. Effects of flaxseed supplements on blood pressure: a systematic review and meta-analysis of controlled clinical trial. Clin Nutr. 2016;35(3):615–25.PubMedCrossRef Ursoniu S, Sahebkar A, Andrica F, Serban C, Banach M. Effects of flaxseed supplements on blood pressure: a systematic review and meta-analysis of controlled clinical trial. Clin Nutr. 2016;35(3):615–25.PubMedCrossRef
61.
go back to reference Sleight P, Yusuf S, Pogue J, Tsuyuki R, Diaz R, Probstfield J, et al. Blood-pressure reduction and cardiovascular risk in HOPE study. Lancet. 2001;358(9299):2130–1.PubMedCrossRef Sleight P, Yusuf S, Pogue J, Tsuyuki R, Diaz R, Probstfield J, et al. Blood-pressure reduction and cardiovascular risk in HOPE study. Lancet. 2001;358(9299):2130–1.PubMedCrossRef
62.
go back to reference Prasad K. Secoisolariciresinol diglucoside (SDG) isolated from flaxseed, an alternative to ACE inhibitors in the treatment of hypertension. The International journal of angiology: official publication of the International College of Angiology, Inc. 2013;22(4):235. Prasad K. Secoisolariciresinol diglucoside (SDG) isolated from flaxseed, an alternative to ACE inhibitors in the treatment of hypertension. The International journal of angiology: official publication of the International College of Angiology, Inc. 2013;22(4):235.
63.
go back to reference Caligiuri SP, Edel AL, Aliani M, Pierce GN. Flaxseed for hypertension: implications for blood pressure regulation. Curr Hypertens Rep. 2014;16(12):499.PubMedCrossRef Caligiuri SP, Edel AL, Aliani M, Pierce GN. Flaxseed for hypertension: implications for blood pressure regulation. Curr Hypertens Rep. 2014;16(12):499.PubMedCrossRef
64.
go back to reference Austria JA, Richard MN, Chahine MN, Edel AL, Malcolmson LJ, Dupasquier CM, et al. Bioavailability of alpha-linolenic acid in subjects after ingestion of three different forms of flaxseed. J Am Coll Nutr. 2008;27(2):214–21.PubMedCrossRef Austria JA, Richard MN, Chahine MN, Edel AL, Malcolmson LJ, Dupasquier CM, et al. Bioavailability of alpha-linolenic acid in subjects after ingestion of three different forms of flaxseed. J Am Coll Nutr. 2008;27(2):214–21.PubMedCrossRef
65.
go back to reference Kuijsten A, Arts IC, van’t Veer P, Hollman PC. The relative bioavailability of enterolignans in humans is enhanced by milling and crushing of flaxseed. The Journal of nutrition. 2005;135(12):2812-6. Kuijsten A, Arts IC, van’t Veer P, Hollman PC. The relative bioavailability of enterolignans in humans is enhanced by milling and crushing of flaxseed. The Journal of nutrition. 2005;135(12):2812-6.
66.
go back to reference Yari Z, Rahimlou M, Poustchi H, Hekmatdoost A. Flaxseed supplementation in metabolic syndrome management: a pilot randomized, open-labeled, controlled study. Phytotherapy Res. 2016;30(8):1339–44.CrossRef Yari Z, Rahimlou M, Poustchi H, Hekmatdoost A. Flaxseed supplementation in metabolic syndrome management: a pilot randomized, open-labeled, controlled study. Phytotherapy Res. 2016;30(8):1339–44.CrossRef
67.
go back to reference Homayouni F, Haidari F, Hedayati M, Zakerkish M, Ahmadi K. Blood pressure lowering and anti-inflammatory effects of hesperidin in type 2 diabetes; a randomized double-blind controlled clinical trial. Phytotherapy Res. 2018;32(6):1073–9.CrossRef Homayouni F, Haidari F, Hedayati M, Zakerkish M, Ahmadi K. Blood pressure lowering and anti-inflammatory effects of hesperidin in type 2 diabetes; a randomized double-blind controlled clinical trial. Phytotherapy Res. 2018;32(6):1073–9.CrossRef
68.
go back to reference Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity. 2007;15(5):1061–7.PubMedCrossRef Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s health: association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity. 2007;15(5):1061–7.PubMedCrossRef
69.
go back to reference Yari Z, Rahimlou M, Eslamparast T, Ebrahimi-Daryani N, Poustchi H, Hekmatdoost A. Flaxseed supplementation in non-alcoholic fatty liver disease: a pilot randomized, open labeled, controlled study. Int J Food Sci Nutr. 2016;67(4):461–9.PubMedCrossRef Yari Z, Rahimlou M, Eslamparast T, Ebrahimi-Daryani N, Poustchi H, Hekmatdoost A. Flaxseed supplementation in non-alcoholic fatty liver disease: a pilot randomized, open labeled, controlled study. Int J Food Sci Nutr. 2016;67(4):461–9.PubMedCrossRef
70.
go back to reference Mohammadi‐Sartang M, Mazloom Z, Raeisi‐Dehkordi H, Barati‐Boldaji R, Bellissimo N, Totosy de Zepetnek J. The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta‐analysis of 45 randomized placebo‐controlled trials. Obesity Reviews. 2017;18(9):1096-107. Mohammadi‐Sartang M, Mazloom Z, Raeisi‐Dehkordi H, Barati‐Boldaji R, Bellissimo N, Totosy de Zepetnek J. The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta‐analysis of 45 randomized placebo‐controlled trials. Obesity Reviews. 2017;18(9):1096-107.
71.
go back to reference Garaulet M, Hernández-Morante J, Tébar F, Zamora S. Anthropometric indexes for visceral fat estimation in overweight/obese women attending to age and menopausal status. J Physiol Biochemistry. 2006;62(4):245–52.CrossRef Garaulet M, Hernández-Morante J, Tébar F, Zamora S. Anthropometric indexes for visceral fat estimation in overweight/obese women attending to age and menopausal status. J Physiol Biochemistry. 2006;62(4):245–52.CrossRef
72.
go back to reference Buckley JD, Howe P. Anti-obesity effects of long-chain omega-3 polyunsaturated fatty acids. Obes Rev. 2009;10(6):648–59.PubMedCrossRef Buckley JD, Howe P. Anti-obesity effects of long-chain omega-3 polyunsaturated fatty acids. Obes Rev. 2009;10(6):648–59.PubMedCrossRef
73.
go back to reference Buckley JD, Howe PR. Long-chain omega-3 polyunsaturated fatty acids may be beneficial for reducing obesity—a review. Nutrients. 2010;2(12):1212–30.PubMedPubMedCentralCrossRef Buckley JD, Howe PR. Long-chain omega-3 polyunsaturated fatty acids may be beneficial for reducing obesity—a review. Nutrients. 2010;2(12):1212–30.PubMedPubMedCentralCrossRef
74.
go back to reference Setchell K, Adlercreutz H. Mammalian Lignans and Phytooestrogens Recent Studies on their Formation, Metabolism and Biological Role in Health and. Role of the gut flora in toxicity and cancer. 1988;315. Setchell K, Adlercreutz H. Mammalian Lignans and Phytooestrogens Recent Studies on their Formation, Metabolism and Biological Role in Health and. Role of the gut flora in toxicity and cancer. 1988;315.
75.
go back to reference Morisset A-S, Lemieux S, Veilleux A, Bergeron J, Weisnagel SJ, Tchernof A. Impact of a lignan-rich diet on adiposity and insulin sensitivity in post-menopausal women. Br J Nutr. 2009;102(2):195–200.PubMedCrossRef Morisset A-S, Lemieux S, Veilleux A, Bergeron J, Weisnagel SJ, Tchernof A. Impact of a lignan-rich diet on adiposity and insulin sensitivity in post-menopausal women. Br J Nutr. 2009;102(2):195–200.PubMedCrossRef
76.
go back to reference Alam MA, Subhan N, Rahman MM, Uddin SJ, Reza HM, Sarker SD. Effect of citrus flavonoids, naringin and naringenin, on metabolic syndrome and their mechanisms of action. Advances Nutr. 2014;5(4):404–17.CrossRef Alam MA, Subhan N, Rahman MM, Uddin SJ, Reza HM, Sarker SD. Effect of citrus flavonoids, naringin and naringenin, on metabolic syndrome and their mechanisms of action. Advances Nutr. 2014;5(4):404–17.CrossRef
77.
go back to reference Andriantsitohaina R, Auger C, Chataigneau T, Étienne-Selloum N, Li H, Martínez MC, et al. Molecular mechanisms of the cardiovascular protective effects of polyphenols. Br J Nutr. 2012;108(9):1532–49.PubMedCrossRef Andriantsitohaina R, Auger C, Chataigneau T, Étienne-Selloum N, Li H, Martínez MC, et al. Molecular mechanisms of the cardiovascular protective effects of polyphenols. Br J Nutr. 2012;108(9):1532–49.PubMedCrossRef
Metadata
Title
Combination therapy of flaxseed and hesperidin enhances the effectiveness of lifestyle modification in cardiovascular risk control in prediabetes: a randomized controlled trial
Authors
Zahra Yari
Zahra Naser-Nakhaee
Elahe Karimi‐Shahrbabak
Makan Cheraghpour
Mehdi Hedayati
Seyede Marjan Mohaghegh
Shahrzad Ommi
Azita Hekmatdoost
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2021
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/s13098-020-00619-y

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