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Journal of Integrative Medicine ›› 2020, Vol. 18 ›› Issue (4): 284-291.doi: 10.1016/j.joim.2020.05.001

• Systematic Review • Previous Articles     Next Articles

Effects of L-arginine supplementation on glycemic profile: Evidence from a systematic review and meta-analysis of clinical trials

Esmaeil Yousefi Rada, Behzad Nazarianb, Somayeh Sabooria, Ebrahim Falahia, Azita Hekmatdoostc,d   

  1. a. Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad 6813833946, Iran
    b. Student Research Committee, Lorestan University of Medical Sciences, Khorramabad 6813833946, Iran
    c. Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
    d. Division of Gastroenterology, Hepatology and Nutrition, British Columbia’s Children’s Hospital and Child and Family Research Institute, the University of British Columbia, British Columbia 6048752345, Canada
  • Received:2020-01-20 Accepted:2019-05-28 Online:2020-07-10 Published:2020-05-28

This meta-analysis was performed to assess the effects of L-arginine supplementation on indices of glycemic control, including fasting blood glucose (FBG), hemoglobin A1c (HbA1c), serum insulin and homeostatic model assessment of insulin resistance (HOMA-IR) levels in randomized controlled trials (RCTs).

Search strategy
This study conducted a systematic review of RCTs published in PubMed, Scopus, Web of Science, Cochrane Library and Embase, up to 5 May, 2018.

Inclusion criteria
Studies were included in this meta-analysis if they were RCTs with parallel design and reported sufficient data on participants before and after intervention, and outcomes of glycemic profile parameters in both the arginine supplementation and control groups.

Data extraction and analysis
The screening of titles and abstracts was performed independently by two reviewers. Selected articles were considered if they met the study’s inclusion criteria. The quality of included studies was assessed by using the Cochrane Collaboration modified tool. From 710 articles retrieved in the initial search, only 10 trials were suitable for pooling the effects of arginine supplementation on serum glucose, insulin, HOMA-IR and HbA1c levels, with effect sizes of nine, eight, five and five, respectively.

Although the results of this study confirmed that supplementation with L-arginine could have significant effects on some glycemic profile indices of participants in clinical trials, the clinical importance of this reduction may not be meaningful.

Pooled random-effect analysis revealed that L-arginine supplementation could significantly decrease FBG level (weighted mean difference [WMD]: 3.35 mg/dL; 95% confidence interval [CI] = [–06.55, –00.16]; = 0.04) and serum insulin level (WMD: –2.19 μIU/mL; 95% CI = [–3.70, –0.67]; P = 0.005). However, the effects of L-arginine supplementation on HOMA-IR and HbA1c were not significant. Results of subgroup analysis showed that supplementation with L-arginine could significantly decrease serum insulin levels when the dosage of L-arginine is > 6.5 g/d (WMD: –3.49 μIU/mL; 95% CI= [–5.59, –1.38]; P = 0.001), when the duration of supplementation is ≤ 12.8 weeks (WMD: –3.76; 95% CI = [–6.50, –0.98]; P= 0.008), when the participants are not diabetic patients (WMD: –2.54 μIU/mL; 95% CI= [–4.50, –0.50]; P= 0.01) and when the baseline serum level of insulin was > 20 μIU/mL (WMD: –3.98; 95% CI = [–6.31, –1.65]; P = 0.001).

Key words: L-arginine, Fasting blood glucose, Insulin resistance, Hemoglobin A1c, Glycemic profile, Meta-analysis

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