Tuesday, 1 August 2017

Re: Cinnamon Improves Measures of Metabolic Syndrome in Asian Indians

Cinnamon (Cinnamomum spp., Lauraceae) Metabolic Syndrome Metabolic Profile Date: 07-31-2017 HC# 071751-573 Gupta Jain S, Puri S, Misra A, Gulati S, Mani K. Effect of oral cinnamon intervention on metabolic profile and body composition of Asian Indians with metabolic syndrome: a randomized double-blind control trial. Lipids Health Dis. 2017;16:113. doi: 10.1186/s12944-017-0504-8. Metabolic syndrome (MetS) is characterized by the presence of at least 3 of the following: abdominal obesity, dyslipidemia, hyperglycemia, and hypertension. It is important to treat MetS to prevent the progression to type 2 diabetes and cardiovascular disease (CVD). First-line treatments include diet and exercise. Clinical studies indicate that cinnamon (Cinnamomum spp., Lauraceae) bark and its components may improve insulin sensitivity and serum levels of fasting blood glucose (FBG), postprandial blood glucose, glycosylated hemoglobin (HbA1c), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), and blood antioxidants, as well as systolic blood pressure (SBP) and percent body fat. According to the authors, Asian Indians are at high risk for MetS, type 2 diabetes, and CVD. The purpose of this randomized, double-blind, placebo-controlled study was to evaluate the effects of cinnamon supplementation in Asian Indians with MetS. Patients (n = 116; mean age, 44.8 years) with newly diagnosed MetS who were treatment naïve were recruited from a private hospital and a clinic in South Delhi, India, from October 2011 to September 2012. MetS was defined as the presence of at least 3 of the following: abdominal obesity with waist circumference (WC) > 90 cm for men and > 80 cm for women; serum triglycerides ≥ 150 mg/dL; high-density lipoprotein cholesterol (HDL-C) < 40 mg/dL for men and < 50 mg/dL for women; dysglycemia (FBG ≥ 100 mg/dL); and hypertension (≥ 130/≥ 85 mmHg). Patients on stable medication (defined as no change in the past 3 months) to treat high blood pressure were included. Excluded patients had uncontrolled hypertension (SBP ≥ 140 mmHg or diastolic blood pressure [DBP] ≥ 90 mmHg); severe hypertriglyceridemia (serum triglycerides > 400 mg/dL); hypothyroidism/hyperthyroidism; CVD; diabetes; renal disease; myocardial infarction; endocrine disorders; any debilitating disease such as tuberculosis or HIV; or were taking lipid-lowering or hypoglycemic drugs. Patients were randomly assigned using block randomization with a 1:1 allocation ratio to receive 3 g/day cinnamon or 2.5 g/day placebo for 16 weeks. Raw cinnamon was purchased from K.V. Spices Private Limited (Delhi, India), powdered, and encapsulated. The Cinnamomum species used and the chemical profile of the cinnamon were not reported. The placebo capsules contained roasted wheat (Triticum spp., Poaceae) flour and "a very small quantity" of cinnamon essence. During the 4-week run-in, patients were instructed to follow the diet guidelines of the Dietary Guidelines for Asian Indians, taught about the importance of physical activity, and instructed to initiate physical activity according to Guidelines for Asian Indians. Patients were instructed to continue with the diet and exercise regimen throughout the entire study. The following parameters were assessed at baseline and after 16 weeks: body weight, body mass index (BMI), WC, waist-hip ratio, percentage body fat, FBG, HbA1c, lipid profile, high-sensitivity C-reactive protein (hs-CRP), SBP, and DBP. At baseline, both groups were similar, except the cinnamon group had significantly greater mean weight (P = 0.009) and BMI (P = 0.010) compared with the placebo group. Analysis of covariance was used to adjust the measured values for the differences in body weight and BMI. Six patients in the cinnamon group and 5 patients in the placebo group were excluded from the analysis due to lack of compliance. An additional 2 patients in the placebo group withdrew from the study for personal reasons. After 16 weeks, the cinnamon group compared with the placebo group had a significant decrease of 3.0 kg in weight (P = 0.001), 1.3 kg/m2 decrease in BMI (P = 0.001), 4.8 cm decrease in WC (P = 0.002), 0.03 decrease in waist-hip ratio (P = 0.028), 3% decrease in body fat (P = 0.011), 8.3 mmHg decrease in SBP (P = 0.001), 6.9 mmHg decrease in DBP (P = 0.001), 0.5 mmol/L decrease in FBG (P = 0.001), 2.6 mmol/mol decrease in HbA1c (P = 0.023), 0.6 mmol/L decrease in postprandial blood sugar (P = 0.030), 0.42 mmol/L decrease in total cholesterol (P = 0.006), 0.20 mmol/L decrease in triglycerides (P = 0.010), 0.37 mmol/L decrease in LDL (P = 0.003), and 0.72 decrease in the ratio of LDL to HDL (P = 0.001). The cinnamon group had a significant increase of 0.05 mmol/L in HDL compared with the placebo group (P = 0.035). There was no significant change in hs-CRP in either group. The prevalence of MetS was significantly reduced by 34.5% in the cinnamon group compared to 5.2% in the placebo group. No adverse effects were reported. The authors conclude that there is a beneficial effect of 3 g/day cinnamon for 16 weeks in Asian Indians with MetS. Namely, there was a significant decrease in hyperglycemia, body weight, total adiposity, abdominal adiposity, and serum lipid levels compared to placebo. Future studies should (1) evaluate additional doses of cinnamon to see if the benefits would be greater or more rapid, (2) evaluate a longer duration of treatment to see if the benefits increase over time, and (3) evaluate the effects when cinnamon is stopped (i.e., are the benefits maintained or do they revert to baseline levels or worsen compared to baseline). The authors note that the study population was obese, so the findings cannot be generalized to a leaner population. Additional limitations are the sample size, failure to report the Cinnamomum species used and its chemical composition, and that diet and exercise were not monitored so it is unknown whether those factors may have contributed to the between-group differences. —Heather S. Oliff, PhD

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