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Evaluating the effects of dietary patterns on circulating C-reactive protein levels in the general adult population: an umbrella review of meta-analyses of interventional and observational studies

Published online by Cambridge University Press:  04 October 2024

Duc Quang Tran Open the ORCID record for Duc Quang Tran [Opens in a new window] ,
Khanh Nguyen Di Open the ORCID record for Khanh Nguyen Di [Opens in a new window] ,
Vu Thi Quynh Chi  and
Huyen Thi Hoa Nguyen
Duc Quang Tran
Affiliation:
Faculty of Technology, Dong Nai Technology University, Bien Hoa City, Vietnam
Khanh Nguyen Di*
Affiliation:
Faculty of Technology, Dong Nai Technology University, Bien Hoa City, Vietnam
Vu Thi Quynh Chi
Affiliation:
The University of Danang – School of Medicine and Pharmacy, Danang 550000, Vietnam
Huyen Thi Hoa Nguyen
Affiliation:
College of Health Sciences, VinUniveristy, Hanoi, Vietnam
*
*Corresponding author: Khanh Nguyen Di, email [email protected]
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Abstract

Adopting a healthy dietary pattern may be an initial step in combating inflammation-related chronic diseases; however, a comprehensive synthesis evaluating current evidence is lacking. This umbrella review aimed to summarise the current evidence on the effects of dietary patterns on circulating C-reactive protein (CRP) levels in adults. We conducted an exhaustive search of the Pubmed, Scopus and Epistemonikos databases, spanning from their inception to November 2023, to identify systematic reviews and meta-analyses across all study designs. Subsequently, we employed a random-effects model to recompute the pooled mean difference. Methodological quality was assessed using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) checklist, and evidence certainty was categorised as non-significant, weak, suggestive, highly suggestive or convincing (PROSPERO: CRD42023484917). We included twenty-seven articles with thirty meta-analyses of seven dietary patterns, fifteen of which (50 %) exhibited high methodological quality. The summary effects of randomised controlled trials (RCT) found that the Mediterranean diet was the most effective in reducing circulating CRP levels, followed by Vegetarian/Vegan and Energy-restricted diets, though the evidence was of weak quality. In contrast, Intermittent Fasting, Ketogenic, Nordic and Paleolithic diets did not show an inverse correlation with circulating CRP levels. Some results from combined interventional and observational studies, as well as solely observational studies, also agreed with these findings. These dietary patterns show the potential in reducing CRP levels in adults, yet the lack of high-quality evidence suggests future studies may alter the summary estimates. Therefore, further well-conducted studies are warranted.

Keywords

Umbrella reviewDietary patternsC-reactive proteinInflammationChronic diseases
Type
Systematic Review and Meta-Analysis
Information
British Journal of Nutrition , Volume 132 , Issue 6 , 28 September 2024 , pp. 783 - 793
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

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References

Calder, PC, Ahluwalia, N, Albers, R, et al. (2013) A consideration of biomarkers to be used for evaluation of inflammation in human nutritional studies. Br J Nutr 109, S1–S34.CrossRefGoogle Scholar
Schmidt, MI, Duncan, BB, Sharrett, AR, et al. (1999) Markers of inflammation, prediction of diabetes mellitus in adults (atherosclerosis risk in communities study): a cohort study. Lancet 353, 1649–1652.CrossRefGoogle Scholar
Dongway, AC, Faggad, AS, Zaki, HY, et al. (2015) C-reactive protein is associated with low-density lipoprotein cholesterol, obesity in type 2 diabetic Sudanese. Diabetes Metab Syndr Obes 8, 427–435.Google ScholarPubMed
Elkind, MS, Tai, W, Coates, K, et al. (2006) High-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, outcome after ischemic stroke. Arch Intern Med 166, 2073–2080.CrossRefGoogle ScholarPubMed
Ridker, PM (2009) C-reactive protein: eighty years from discovery to emergence as a major risk marker for cardiovascular disease. Clin Chem 55, 209–215.CrossRefGoogle Scholar
Ridker, PM, Rifai, N, Rose, L, et al. (2002) Comparison of C-reactive protein, low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 347, 1557–1565 CrossRefGoogle ScholarPubMed
Zong, G, Gao, A, Hu, FB, et al. (2016) Whole grain intake, mortality from all causes, cardiovascular disease, cancer: a meta-analysis of prospective cohort studies. Adv Nutr 7, 1052–1065.Google Scholar
Shang, X, Liu, J, Zhu, Z, et al. (2023) Healthy dietary patterns and the risk of individual chronic diseases in community-dwelling adults. Nat Commun 14, 6704.CrossRefGoogle ScholarPubMed
Allison, DB, Bassaganya-Riera, J, Burlingame, B, et al. (2015) Goals in Nutrition Science 2015–2020. Lausanne, Switzerland: Frontiers Media SA. p. 26.Google ScholarPubMed
Tosti, V, Bertozzi, B & Fontana, L (2018) Health benefits of the Mediterranean diet: metabolic and molecular mechanisms. J Gerontol: Series A 73, 318–326.CrossRefGoogle ScholarPubMed
Cryan, JF, O’Riordan, KJ, Cowan, CSM, et al. (2019) The microbiota-gut-brain axis. Physiol Rev 99, 1877–2013.CrossRefGoogle ScholarPubMed
Bonaccio, M, Cerletti, C, Cerletti, C, et al. (2015) Mediterranean diet, low-grade subclinical inflammation: the Moli-Sani study. Endocr Metab Immune Disord Drug Targets 15, 18–24.CrossRefGoogle ScholarPubMed
Estruch, R (2010) Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc 69, 333–340.CrossRefGoogle ScholarPubMed
Lopez-Garcia, E, Schulze, MB, Fung, TT, et al. (2004) Major dietary patterns are related to plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr 80, 1029–1035.CrossRefGoogle Scholar
Ghaedi, E, Mohammadi, M, Mohammadi, H, et al. (2019) Effects of a paleolithic diet on cardiovascular disease risk factors: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr 10, 634–646.CrossRefGoogle ScholarPubMed
Menzel, J, Jabakhanji, A, Biemann, R, et al. (2020) Systematic review and meta-analysis of the associations of vegan and vegetarian diets with inflammatory biomarkers. Sci Rep 10, 21736.CrossRefGoogle ScholarPubMed
Haghighatdoost, F, Bellissimo, N, Totosy De Zepetnek, JO, et al. (2017) Association of vegetarian diet with inflammatory biomarkers: a systematic review and meta-analysis of observational studies. Public Health Nutr 20, 2713–2721.CrossRefGoogle ScholarPubMed
Shea, BJ, Reeves, BC, Wells, G, et al. (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358, j4008.CrossRefGoogle ScholarPubMed
Fusar-Poli, P & Radua, J (2018) Ten simple rules for conducting umbrella reviews. Evid Based Ment Health 21, 95–100.CrossRefGoogle ScholarPubMed
Veettil, SK, Wong, TY, Loo, YS, et al. (2021) Role of diet in colorectal cancer incidence: umbrella review of meta-analyses of prospective observational studies. JAMA Netw Open 4, e2037341.CrossRefGoogle ScholarPubMed
DerSimonian, R, Laird, N (1986) Meta-analysis in clinical trials. Control Clin Trials 7, 177–188.CrossRefGoogle ScholarPubMed
Egger, M, Davey Smith, G, Schneider, M, et al. (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634.CrossRefGoogle ScholarPubMed
Park, J, Seo, YG, Paek, YJ, et al. (2020) Effect of alternate-day fasting on obesity and cardiometabolic risk: a systematic review and meta-analysis. Metab Clin Exp 111, 154336.CrossRefGoogle Scholar
Chiavaroli, L, Nishi, SK, Khan, TA, et al. (2018) Portfolio dietary pattern and cardiovascular disease: a systematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis 61, 43–53.CrossRefGoogle ScholarPubMed
Kemalasari, I, Fitri, NA, Sinto, R, et al. (2022) Effect of calorie restriction diet on levels of C reactive protein (CRP) in obesity: a systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndrome: Clin Res Rev 16, 102388.CrossRefGoogle ScholarPubMed
Amanollahi, A, Khazdouz, M, Malekahmadi, M, et al. (2023) Effect of ketogenic diets on cardio-metabolic outcomes in cancer patients: a systematic review and meta-analysis of controlled clinical trials. Nutr Cancer 75, 95–111.CrossRefGoogle ScholarPubMed
Schwingshackl, L & Hoffmann, G (2014) Mediterranean dietary pattern, inflammation and endothelial function: a systematic review and meta-analysis of intervention trials. Nutr Metab Cardiovasc Dis 24, 929–939.CrossRefGoogle ScholarPubMed
Mayr, HL, Tierney, AC, Thomas, CJ, et al. (2018) Mediterranean-type diets and inflammatory markers in patients with coronary heart disease: a systematic review and meta-analysis. Nutr Res 50, 10–24.CrossRefGoogle ScholarPubMed
Sohouli, MH, Fatahi, S, Lari, A, et al. (2022) The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 62, 4551–4562.CrossRefGoogle ScholarPubMed
Craddock, JC, Neale, EP, Peoples, GE, et al. (2019) Vegetarian-based dietary patterns and their relation with inflammatory and immune biomarkers: a systematic review and meta-analysis. Adv Nutr 10, 433–451.CrossRefGoogle ScholarPubMed
Jiao, J, Xu, JY, Zhang, W, et al. (2015) Effect of dietary fiber on circulating C-reactive protein in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Food Sci Nutr 66, 114–119.CrossRefGoogle ScholarPubMed
Reynolds, AN, Akerman, AP & Mann, J (2020) Dietary fibre and whole grains in diabetes management: systematic review and meta-analyses. PLoS Med 17, e1003053.CrossRefGoogle ScholarPubMed
Santesso, N, Akl, EA, Bianchi, M, et al. (2012) Effects of higher- v. lower-protein diets on health outcomes: a systematic review and meta-analysis. Eur J Clin Nutr 66, 780–788.CrossRefGoogle Scholar
Wang, X, Yan, Q, Liao, Q, et al. (2020) Effects of intermittent fasting diets on plasma concentrations of inflammatory biomarkers: a systematic review and meta-analysis of randomized controlled trials. Nutrition 79–80, 110974.CrossRefGoogle ScholarPubMed
Bonnet, JP, Cardel, MI, Cellini, J, et al. (2020) Body composition, and cardiometabolic risk: a systematic review and meta-analysis of randomized trials. Obesity (Silver Spring) 28, 1098–1109.CrossRefGoogle Scholar
Turner, L, Charrouf, R, Martínez-Vizcaíno, V, et al. (2024) The effects of time-restricted eating v. habitual diet on inflammatory cytokines and adipokines in the general adult population: a systematic review with meta-analysis. Am J Clin Nutr 119, 206–220.CrossRefGoogle Scholar
Kamarul Zaman, M, Teng, N, Kasim, SS, et al. (2023) Effects of time-restricted eating with different eating duration on anthropometrics and cardiometabolic health: a systematic review and meta-analysis. World J Cardiol 15, 354–374.CrossRefGoogle Scholar
Wu, PY, Chen, KM & Tsai, WC (2021) The Mediterranean dietary pattern and inflammation in older adults: a systematic review and meta-analysis. Adv Nutr 12, 363–373.CrossRefGoogle ScholarPubMed
Nordmann, AJ, Suter-Zimmermann, K, Bucher, HC, et al. (2011) Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 124, 841–851.e2.CrossRefGoogle ScholarPubMed
Koelman, L, Egea Rodrigues, C & Aleksandrova, K (2022) Effects of dietary patterns on biomarkers of inflammation and immune responses: a systematic review and meta-analysis of randomized controlled trials. Adv Nutr 13, 101–115.CrossRefGoogle Scholar
Papadaki, A, Nolen-Doerr, E & Mantzoros, CS (2020) The effect of the Mediterranean diet on metabolic health: a systematic review and meta-analysis of controlled trials in adults. Nutrients 12, 1–21.CrossRefGoogle Scholar
Sakhaei, R, Ramezani-Jolfaie, N, Mohammadi, M, et al. (2019) The healthy Nordic dietary pattern has no effect on inflammatory markers: a systematic review and meta-analysis of randomized controlled clinical trials. Nutrition 58, 140–148.CrossRefGoogle ScholarPubMed
Massara, P, Zurbau, A, Glenn, AJ, et al. (2022) Nordic dietary patterns and cardiometabolic outcomes: a systematic review and meta-analysis of prospective cohort studies and randomised controlled trials. Diabetologia 65, 2011–2031.CrossRefGoogle ScholarPubMed
Steckhan, N, Hohmann, CD, Kessler, C, et al. (2016) Effects of different dietary approaches on inflammatory markers in patients with metabolic syndrome: a systematic review and meta-analysis. Nutrition 32, 338–348.CrossRefGoogle ScholarPubMed
Bueno, NB, de Melo, IS, de Oliveira, SL, et al. (2013) Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr 110, 1178–1187.CrossRefGoogle ScholarPubMed
Santos, FL, Esteves, SS, da Costa Pereira, A, et al. (2012) Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obes Rev 13, 1048–1066.CrossRefGoogle ScholarPubMed
Bach-Faig, A, Berry, EM, Lairon, D, et al. (2011) Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr 14, 2274–2284.CrossRefGoogle ScholarPubMed
Guasch-Ferré, M & Willett, WC (2021) The Mediterranean diet and health: a comprehensive overview. J Intern Med 290, 549–566.CrossRefGoogle ScholarPubMed
Serhan, CN (2014) Pro-resolving lipid mediators are leads for resolution physiology. Nature 510, 92–101.CrossRefGoogle ScholarPubMed
Bowie, AG & O’Neill, LAJ (2000) Vitamin C inhibits NF-κB activation by TNF via the activation of p38 mitogen-activated protein kinase. J Immunol 165, 7180–7188.CrossRefGoogle ScholarPubMed
Maslowski, KM, Vieira, AT, Ng, A, et al. (2009) Regulation of inflammatory responses by gut microbiota, chemoattractant receptor GPR43. Nature 461, 1282–1286.CrossRefGoogle ScholarPubMed
Scoditti, E, Calabriso, N, Massaro, M, et al. (2012) Mediterranean diet polyphenols reduce inflammatory angiogenesis through MMP-9 and COX-2 inhibition in human vascular endothelial cells: a potentially protective mechanism in atherosclerotic vascular disease and cancer. Arch Biochem Biophys 527, 81–89.CrossRefGoogle ScholarPubMed
Łuszczki, E, Boakye, F, Zielińska, M, et al. (2023) Vegan diet: nutritional components, implementation, effects on adults’ health. Front Nutr. 10, 1294497 CrossRefGoogle ScholarPubMed
Yilmaz, MI, Romano, M, Basarali, MK, et al. (2020) The effect of corrected inflammation, oxidative stress and endothelial dysfunction on FMD levels in patients with selected chronic diseases: a quasi-experimental study. Sci Rep 10, 9018.CrossRefGoogle ScholarPubMed
Tomova, A, Bukovsky, I, Rembert, E, et al. (2019) The effects of vegetarian, vegan diets on gut microbiota. Front Nutr. 6, 47.CrossRefGoogle ScholarPubMed
Kahleova, H, Levin, S & Barnard, ND (2018) Vegetarian dietary patterns and cardiovascular disease. Prog Cardiovasc Dis 61, 54–61.CrossRefGoogle ScholarPubMed
Turner-McGrievy, GM, Davidson, CR, Wingard, EE, et al. (2015) Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. Nutrition 31, 350–358.CrossRefGoogle ScholarPubMed
Natto, ZS, Yaghmoor, W, Alshaeri, HK, et al. (2019) n-3 fatty acids effects on inflammatory biomarkers and lipid profiles among diabetic and cardiovascular disease patients: a systematic review and meta-analysis. Sci Rep 9, 18867.CrossRefGoogle ScholarPubMed
Samraj, AN, Pearce, OM, Läubli, H, et al. (2015) A red meat-derived glycan promotes inflammation, cancer progression. Proc Natl Acad Sci U S A 112, 542–547.CrossRefGoogle ScholarPubMed
Kahleova, H, Matoulek, M, Malinska, H, et al. (2011) Vegetarian diet improves insulin resistance, oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabet Med 28, 549–59.CrossRefGoogle ScholarPubMed
Gilchrist, M, Winyard, PG, Fulford, J, et al. (2014) Dietary nitrate supplementation improves reaction time in type 2 diabetes: development and application of a novel nitrate-depleted beetroot juice placebo. Nitric Oxide 40, 67–74.CrossRefGoogle ScholarPubMed
Raskin, I, Ribnicky, DM, Komarnytsky, S, et al. (2002) Plants and human health in the twenty-first century. Trends Biotechnol 20, 522–531.CrossRefGoogle ScholarPubMed
Heilbronn, LK, Noakes, M & Clifton, PM (2001) Energy restriction and weight loss on very-low-fat diets reduce C-reactive protein concentrations in obese, healthy women. Arterioscler Thromb Vasc Biol 21, 968–970.CrossRefGoogle ScholarPubMed
Fontana, L, Nehme, J & Demaria, M (2018) Caloric restriction and cellular senescence. Mech Ageing Dev 176, 19–23.CrossRefGoogle ScholarPubMed
Patry, RT & Nagler, CR (2021) Fiber-poor Western diets fuel inflammation. Nat Immunol 22, 266–268.CrossRefGoogle ScholarPubMed
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