No abstract

PURPOSE We wanted to determine the association between consumption of barley and changes in plasma lipids in healthy and hypercholesterolemic men and women.METHODS A systematic literature search was conducted from the earliest possible date through January 2008. Trials were included in the analysis if they were randomized controlled trials of barley that reported effi cacy data on at least 1 lipid endpoint. A DerSimonian and Laird random-effects model was used in calculating the weighted mean difference (WMD) and its 95% confi dence interval (CI). Statistical heterogeneity was addressed using the I 2 statistic. Visual inspection of funnel plots, Egger's weighted regression statistics, and the trim and fi ll method were used to assess for publication bias. RESULTSWe found 8 trials (n = 391 patients) of 4 to 12 weeks' duration evaluating the lipid-reducing effects of barley. The use of barley signifi cantly lowered total cholesterol (weighted mean difference [WMD], -13.38 mg/dL; 95% CI, -18.46 to -8.31 mg/dL), low-density lipoprotein (LDL) cholesterol (WMD, -10.02 mg/dL; 95% CI, -14.03 to -6.00 mg/dL) and triglycerides (WMD, -11.83 mg/dL; 95% CI, -20.12 to -3.55 mg/dL) but did not appear to signifi cantly alter highdensity lipoprotein (HDL) cholesterol (P = .07).CONCLUSION Barley-derived β-glucan appears to benefi cially affect total cholesterol, LDL-cholesterol, and triglycerides, but not HDL-cholesterol.

In order to determine the impact of garlic on total cholesterol (TC), TAG levels, as well as LDL and HDL, and establish if any variables have an impact on the magnitude of this effect, a metaanalysis was conducted. A systematic literature search of MEDLINE, CINAHL and the Cochrane Database from the earliest possible date through to November 2007 was conducted to identify randomised, placebo-controlled trials of garlic that reported effects on TC, TAG concentrations, LDL or HDL. The weighted mean difference of the change from baseline (with 95 % CI) was calculated as the difference between the means in the garlic groups and the control groups using a random-effects model. Subgroup and sensitivity analyses were performed to determine the effects on type, brand and duration of garlic therapy as well as baseline TC and TAG levels, the use of dietary modification, and study quality on the meta-analysis's conclusions. Twenty-nine trials were included in the analysis. Upon meta-analysis garlic was found to significantly reduce TC (2 0·19; 95 % CI 2 0·33, 2 0·06 mmol/l) and TAG (20·11; 95 % CI 2 0·19, 20·06 mmol/l) but exhibited no significant effect on LDL or HDL. There was a moderate degree of statistical heterogeneity for the TC and TAG analyses. Garlic reduces TC to a modest extent, an effect driven mostly by the modest reductions in TAG, without appreciable LDL lowering or HDL elevation. Higher baseline line TC levels and the use of dietary modification may alter the effect of garlic on these parameters. Future studies should be conducted evaluating the impact of adjunctive garlic therapy with fibrates or statins on TAG concentrations.

No abstract

Agency for Healthcare Research and Quality.

CONTEXT: Recombinant human growth hormone (rhGH) improves growth in patients with growth hormone deficiency or idiopathic short stature. Its role in patients with cystic fibrosis (CF) is unclear. OBJECTIVE:To review the effectiveness of rhGH in the treatment of patients with CF. METHODS:Medline and the Cochrane Central Register of Controlled Trials were searched from the earliest date through April 2010. Randomized controlled trials, observational studies, systematic reviews/ meta-analyses, or case reports were included if rhGH therapy was administered to patients with CF and data on prespecified harms, intermediate outcomes, or final health outcomes were reported. When applicable, end points were pooled by using a random-effects model. The overall body of evidence was graded for each outcome as insufficient, low, moderate, or high. RESULTS:Ten unique controlled trials (n ϭ 312) and 8 observational studies (n ϭ 58) were included. On quantitative synthesis of controlled trials, several markers of pulmonary function, anthropometrics, and bone mineralization were significantly improved versus control. Results of single-arm observational studies for the aforementioned outcomes were generally supportive of findings in clinical trials. There is insufficient evidence to determine the effect of rhGH on intravenous antibiotic use during therapy, pulmonary exacerbations, healthrelated quality-of-life, bone consequences, or total mortality, but moderate evidence suggests that rhGH therapy reduces the rate of hospitalization versus control.CONCLUSIONS: rhGH improved almost all intermediate measures of pulmonary function, height, and weight in patients with CF. Improvements in bone mineral content are also promising. However, with the exception of hospitalizations, the benefits on final health outcomes cannot be directly determined at this time.

Based upon the current literature, we can only say that plant sterols/stanols, when administered in addition to statins, favorably affect total and LDL cholesterol with 95% confidence. Randomized trials examining the impact of plant sterols/stanols in combinatation with statins on patient morbidity and mortality are needed.

No abstract