Clinical effects of Emblica officinalis fruit consumption in CVD CVDon cardiovascular disease risk factors: a systematic review and meta-analysi s

 

Background

                     Embelia officinale (Amala or Awala)

Cardiovascular disease (CVD) is the leading cause of death globally, accounting for ~ 17.8 million deaths annually [1]. Mortality associated with CVD is expected to increase to > 22.2 million per year by 2030 [2]. Due to increasing prevalence, further efforts are required for both primary and secondary prevention of CVD. Aging demographics combined with improved survival post-cardiovascular event contribute to the growing pool of individuals living with established CVD [3]. Secondary prevention of subsequent events via improvement in modifiable CVD risk factors can help reduce morbidity and mortality in this growing population [3].

Modifiable risk factors associated with CVD are 

both behavioural and physiological. 

 Research indicates a linear progression of risk factors leading to CVD, beginning with unhealthy lifestyle behaviours (e.g., physical inactivity, poor nutritional intake), leading to uncontrolled physiological risk factors,

 ultimately translating to CVD. Dyslipidemia,

 inflammation, and hypertension are common physiological risk factors for developing CVD via the progression

 of atherosclerosis [1]. Evidence-based dietary 

patterns have been developed to improve

 CVD physiological risk factors, including the Dietary Approaches to Stop Hypertension (DASH) diet [4]

 and the Portfolio diet [5, 6]. Although these dietary interventions have been associated with improvement in physiological CVD risk factors, 

CVD remains a significant global health concern.

 Therefore, the identification of efficacious, safe, affordable, and convenient options for primary or secondary prevention of CVD as either monotherapy or adjunct to evidence-based dietary patterns and/or standard pharmacotherapy is essential [7]. Furthermore, metabolic syndrome is a multicomponent risk factor for CVD and type 2 diabetes mellitus (T2DM) [1]. Metabolic syndrome is diagnosed when any three or more of the following five cardiometabolic risk factors are present: 1) hypertriglyceridemia, 2) decreased high-density lipoprotein cholesterol (HDL-C), 3) hypertension, 4) hyperglycemia, or 5) central adiposity [1]. Metabolic syndrome increases the risk of CVD mortality and all-cause mortality even for those with metabolic syndrome without T2DM [8]. Therefore, a single agent with the ability to produce beneficial changes in multiple cardiometabolic risk factors would be ideal when treating patients living with metabolic syndrome.

Emblica officinalis (EO)—also known as Phyllanthus emblica, Indian gooseberry in English, Amla in Hindi, and Amalaki in Sanskrit [9]—is a 5-25 m tall deciduous tree, native to tropical and subtropical regions of India, Nepal, Sri Lanka, and throughout South-East Asia to southern China [10]. Although many components of the EO plant (e.g., root bark, stem bark, leaves) are traditionally used in Ayurveda, an Indian indigenous system of medicine, the edible fruit is typically used the most for health reasons [7]. EO berries are spherical and smooth, growing to 2-5 cm in diameter [11]. EO berries are initially pale green in colour, changing to yellow when mature [10]. EO fruit, and formulations incorporating EO fruit, have traditionally been used as dietary supplements to treat an abundance of health ailments, including fever, jaundice, anemia, cough, asthma, headache, dyspepsia, ophthalmic disorders, vomiting, leprosy, diabetes, and menorrhagia [9].

The phytoconstituents of EO fruit include many bioactive compounds including hydrolysable tannins (e.g., chebulinic acid, chebulagic acid, corilagin, punigluconin, pedunculagin, emblicanin A and B), alkaloids, phenols (e.g., gallic acid, ellagic acid, pyrogallol), amino acids, carbohydrates (e.g., pectin), vitamins (e.g., ascorbic acid), flavonoids (e.g., quercetin, kaempferol, rutin), and organic acids (e.g., citric acid) [12]. EO fruit is a rich source of ascorbic acid (vitamin C), with 470-680 mg per 100 g [9]. Vitamin C accounts for ~ 45–70% of the total antioxidant activity of the EO fruit, along with tannins (particularly punigluconin, pedunculagin, emblicanin A and B), flavonoids, and ellagic acid [11]. Furthermore, experimental research indicates the EO fruit to have antibacterial [13], antidiabetic [14], antidiarrheal [15], antihyperlipidemic [16, 17], antioxidant [18], antipyretic [19], anti-hyperthyroid [20], antitussive [21], antiulcer [22], chemopreventive [23], cognitive enhancing [24], gastroprotective [25], hepatoprotective [26], nephroprotective [27], skin antiaging [28], and wound healing [29] properties, among many others.

Preliminary clinical interventional trials have also shown promising results of EO fruit consumption on a variety of health conditions, including cardiovascular disease [9, 12, 30, 31]. Specifically, significant improvements in participant blood lipids and/or biomarkers of inflammation following consumption of EO fruit in various forms [32–49]. These initial studies have subsequently led to randomized controlled trials (RCTs) investigating the effects of EO on CVD physiological risk factors [50–58]. Thus, a body of evidence now exists on the effects of EO on physiological risk, however, these effects have not been systematically reviewed or meta-analyzed. 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, including blood lipids, blood pressure, and biomarkers of inflammation.

Ref

. 2023 Jun 9;23:190. doi: 10.1186/s12906-023-03997-8

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

Paul D S Brown ¹, Nicole Ketter ^2,3, Mathew Vis-Dunbar ¹, Brodie M Sakakibara