Effect of Garlic Powder Supplementation on Total Cholesterol and Low Density Lipoprotein Level in Patient with Hypercholesterolemia: A Meta-Analysis

Authors

  • Zuraida Zulkarnain Masters Program in Public Health, Universitas Sebelas Maret
  • Yulia Lanti Retno Dewi Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret

Abstract

Background: Hypercholesterolemia is a risk factor for cardiovascular disease that can cause death and disability, so it must be managed properly. Garlic flour (GP) is one of the dosage forms of garlic that has the potential to reduce cholesterol. This study is a systematic review and meta-analysis that aims to determine the effectiveness of GP in reducing total cholesterol (TC) and low density lipoprotein (LDL).

Subjects and Method: Search articles through the Pubmed database, Google scholar, Proquest, Springer link, and Science direct with the appropriate keywords. Population= patients with hyper­cholesterolemia. Intervention= GP. Comparison= placebo. Outcome= TC and LDL. Inclusion crite­ria included complete articles in English or Indonesian published from 2010-2022, Randomized Con­trolled Trial (RCT) design, subjects >18 years old with hypercholesterolemia, the study had a complete fat profile outcome, duration of intervention 2 weeks-12 months. The flow of article selection is based on the PRISMA flow diagram. Meta-analysis using RevMan 5.3 with effect size standardized mean difference (SMD) and Random Effect Model (REM) analysis model.

Results: A total of 10 articles were eligible for a meta-analysis. The GP group had TC levels 1.49 units lower than the placebo group (SMD = -1.49; 95% CI = -1.95 to -0.55; p = 0.005) and LDL levels 0.68 units lower than the placebo group (SMD= -0.68; CI95). %= -1.08 to -0.27; p=0.001). Subgroup analysis based on the length of the intervention showed that administration of GP <12 weeks only significantly reduced TC while administration > 12 weeks significantly reduced TC and LDL.

Conclusion: GP is effective in lowering TC and LDL especially at 12 weeks or more.

Keywords: garlic powder, hypercholesterolemia, RCT

Correspondence: Zuraida Zulkarnain. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java 57126. Mobile: 081393933862. Email: zuraida.zu@gmail.com.

Indonesian Journal of Medicine (2022), 07(01): 102-114
https://doi.org/10.26911/theijmed.2022.07.01.11

References

AAlamiHarandi R, Karamali M, Asemi Z (2015). The favorable effects of garlic intake on metabolic profiles , hsCRP , biomarkers of oxidative stress and pregnancy outcomes in pregnant women at risk for preeclampsia: randomized, doubleblind, placebo controlled trial, J Matern Fetal Neonatal Med. 28(17): 2020–2027. doi: 10.3109/14767058.2014.977248.

Aljawad F, Hashim M, Al=attar Z, Alani A (2018) Changing the lipid profile and renal functions by allium sativum , nigella sativa and hibiscus sabdariffa in essential hypertensive patients. World J Pharm Pharm Sci. 7(5):125134.

Altman D, Ashby D, Birks J, Borenstein M, Campbell M, Deeks J, Egger M, et al. (2022) Analysing data and undertaking metaanalyses, in Deeks JJ, Higgins JP, Altman DG (eds) Cochrane Handbook for Systematic Reviews of Interventions version 6.3. Cochrane. Available at: www.training.cochrane.org/handbook.

Badan Litbang Kesehatan (2019). Laporan nasional riskesdas 2018. Jakarta.

Bahmani M, Mirhoseini M, Shirzad H, Sedighi M, Shahinfard N, Rafieiankopaei M (2015). A review on promising natural agents effective on hyperlipidemia. J Evid Based Complementary Altern Med. 20(3):228–238. doi: 10.1177/2156587214568457.

Bradley CK, Wang TY, Li S, Robinson JG, Roger VL, Goldberg AC, Virani SS, et al. (2019). Patientreported reasons for declining or discontinuing statin therapy: insights from the PALM registry. J Am Heart Assoc. 8: e011765. doi: 10.1161/JAHA.118.011765.

CASP (2021). CASP RCT Checklist. Available at: https//caspuk.net/casptoolschecklist/.

Center for Evidence Based Management (2014). Critical appraisal checklist for a controlled study. diakses (Maret, 22, 2022) dari https://www.cebma.org.

Galiciagarcia U, Jebari S, Larreasebal A, Uribe KB, Siddiqi H, Ostolaza H, BenitoVicente A, et al. (2020). Statin treatmentinduced development of type 2 diabetes: from clinical evidence to mechanistic insights. Int J Mol Sci. 21(13): 4725. doi: doi:10.3390/ijms21134725.

Hadjiphilippou S, Ray KK (2019). Cholesterollowering agents. Circ Res. 124(3):354–363. doi: 10.1161/CIRCRESAHA.118.313245.

Hasaniranjbar S, Nayebi N, Moradi L, Mehri A, Larijani B, Abdollahi (2010). The efficacy and safety of herbal medicines used in the treatment of hyperlipidemia: a systematic review. Curr Pharm Des.16(26):2935–2947

Kumar R, Chhatwal S, Arora S, Sharma S, Singh J, Singh N, Bhandari V, et al. (2013). Antihyperglycemic, antihyperlipidemic, antiinflammatory and adenosine deaminase– lowering effects of garlic in patients with type 2 diabetes mellitus with obesity. Diabetes Metab Syndr Obes. 6:49–56. doi: 10.2147%2FDMSO.S38888.

Kwak JS, Kim JY, Paek JE, Lee YJ, Kim HR, Park DS, Kwon O (2014). Garlic powder intake and cardiovascular risk factors: a metaanalysis of randomized controlled clinical trials. Nutr Res Pract. 8(6): 644–654. doi: 10.4162/nrp.2014.8.6.644.

Lawson LD, Hunsaker SM (2018). Allicin bioavailability and bioequivalence from garlic supplements and garlic foods. Nutrients. 10(7):812. doi: 10.3390/nu10070812.

Limbu A, Rauniar GP, Sharma SK, Panday DR, Shah BK, Subedi M (2019). Shortterm effect of garlic extract on patients with dyslipidemia. Nepal Med Coll J. 21(4):301–305. doi: 10.3126/nmcj.v21i4.27626.

Mariam BB, Devi U (2020). Effect of Allium sativun on lipid profile in menopausal women with moerate hyperlipidemia: a randomized clinical trial. Int J Adv Res. 8(2):1104–1111. doi: 10.21474/IJAR01/10553.

Murti, B (2018). Prinsip dan metode riset epidemiologi. Colomadu: Bintang Fajar Offside.

Nazir S, Lohani S, Tachamo N, Poudel DR, Donato Anthony (2017). Statinassociated autoimmune myopathy. JRC. 23(3):149–154. doi: 10.1097/RHU.0000000000000497.

Newman CB, Preiss D, Tobert JA, Jacobson T A, Page RL 2nd, Goldstein LB, Chin C, et al. (2019). Statin safety and associated adverse events. Arterioscler Thromb Vasc Biol. 39(2):e38–e81. doi: 10.1161/ATV.0000000000000073.

Prati P, Henrique CM, deSouza AS, daSilva VSN, Pacheco MTB (2014) Evaluation of allicin stability in processed garlic of different cultivars. Food Science and Technology. 34(3): 623628. doi: 10.1590/1678457x.6397.

Ramkumar S, Raghunath A, Raghunath S (2016). Statin therapy: review of safety and potential side effects. Acta Cardiol Sin. 32:631–639. doi: 10.6515/ACS20160611A.

Ried K, Toben C, Fakler P (2013). Effect of garlic on serum lipids: an updated metaanalysis. Nutr Rev. 71(5):282–299. doi: 10.1111/nure.12012.

Sangouni AA, Reza M, Hosseini M, Alizadeh M (2020). Effect of garlic powder supplementation on hepatic steatosis , liver enzymes and lipid profile in patients with nonalcoholic fatty liver disease: a doubleblind randomised controlled clinical trial. Br J Nutr. 124(4):450–456. doi: 10.1017/S0007114520001403.

Sobenin IA, Pryanishnikov VV, Kunnova LM, Rabinovich YA, Martirosyan DM, Orekhov AN (2010). The effects of timereleased garlic powder tablets on multifunctional cardiovascular risk in patients with coronary artery disease. Lipids in Health and Disease.9(1):119. doi: 10.1186/1476511X9119.

Soleimani D, Paknahad Z, Rohani MH (2020). Therapeutic effects of garlic on hepatic steatosis in nonalcoholic fatty liver disease patients: a randomized clinical trial. Diabetes Metab Syndr Obes. 13:2389–2397.

Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, Carpenter J et al. (2011) Recommendations for examining and interpreting funnel plot asymmetry in metaanalyses of randomised controlled trials. BMJ. 343: d4002. doi:10.1136/bmj.d4002.

Subramanian MS, Ms GN, Nordin SA, Thilakavathy K, Joseph N (2020). Prevailing knowledge on the bioavailability and biological activities of sulphur compounds from alliums: a potential drug candidate. Molecules. 25(18): 4111. doi: 10.3390/molecules25184111.

Szulinska M, KregielskaNarozna M, Swiatek J, Stys P, KuznarKaminska B, Jakubowski H, Walkowiak J, et al. (2018). Garlic extract favorably modifies markers of endothelial function in obese patients – randomized double blind placebocontrolled nutritional intervention. Biomed Pharmacother. 102: 792–797. doi: 10.1016/j.biopha.2018.03.131.

Ward NC, Watts GF, Eckel RH (2019). Statin toxicity. Circ Res. 124(2):328–350. doi: 10.1161/CIRCRESAHA.118.312782.

WHO (2022) Raised cholesterol, World Health Organization. Available at: https://www.who.int/data/gho/indicatormetadataregistry/imrdetails/3236.

Zarate A, Manuelapolinar L, Saucedo R, Hern M, Basurto L (2016). Hypercholesterolemia as a risk factor for cardiovascular disease: current controversial therapeutic management. Arch Med Res. 47(7): 491–495. doi: 10.1016/j.arcmed.2016.11.009.

Zeb F, Safdar M, Fatima S, Khan S, Alam S, Muhammad M Syed, A, et al. (2018). Index, lipid profile and blood pressure of hyperlipidemic patients Supplementation of garlic and coriander seed powder: Impact on body mass index, lipid profile and blood pressure of hyperlipidemic patients. Pak J Pharm Sci. 31(5): 1935–1941.

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2022-01-10

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