Effects of Pomegranate Extract Supplementation on Cardiovascular Risk Factors and Physical Function in Hemodialysis Patients

Abstract

The purpose of this study was to evaluate the effects of oral supplementation with pomegranate extract on cardiovascular risk, physical function, oxidative stress, and inflammation in hemodialysis (HD) patients. Thirty-three HD subjects were randomized to the pomegranate (POM) or placebo (CON) group. Patients in POM ingested a 1000 mg capsule of a purified pomegranate polyphenol extract 7 days/week for 6 months. Individuals in CON ingested a noncaloric placebo capsule using the same protocol. Measurements were conducted at baseline and repeated 6 months following the start of the intervention. Brachial blood pressure (BP) was obtained using an automatic digital BP monitor. Cardiovascular risk was assessed using ultrasound and arterial tonometry. Blood samples were collected for the measurements of circulating markers of inflammation, oxidative stress, and antioxidant capacity. Muscle strength and physical function were assessed by isokinetic dynamometry, a validated shuttle walk test, and a battery of tests to assess functional fitness. Systolic blood pressure and diastolic blood pressure were reduced by 24 ± 13.7 and 10 ± 5.3 mmHg, respectively, in POM (P < .05). However, the BP differences in POM were no longer significant after controlling for baseline BP. The paraoxonase-1 activity increased by 26.6% (P < .05) in POM, compared to no significant change in CON. However, pomegranate supplementation had no effect on other markers of cardiovascular disease risk, inflammation and oxidative stress, or measures of physical function and muscle strength. While pomegranate extract supplementation may reduce BP and increase the antioxidant activity in HD patients, it does not improve other markers of cardiovascular risk, physical function, or muscle strength.

Pomegranate juice improves cardiometabolic risk factors, biomarkers of oxidative stress and inflammation in hemodialysis patients: a randomized crossover trial

“…In contrast to blood pressure, evidence regarding the effect of pomegranate on blood lipids of hemodialysis patients is rather controversial. Studies confirmed our results for serum triglyceride and HDL cholesterol improvement by pomegranate, but two other investigations reported no effect of either pomegranate polyphenol or PJ on these lipid profiles. Some of the controversy over the results of different studies may be explained by the baseline values of triglycerides and HDL cholesterol which probably should be at unfavorable levels in order for pomegranate to exert its benefit.…”

“…Once again, pomegranate may not exert these effects in non‐oxidative stress conditions or if administered in pre‐dialysis states . Also, such beneficial effects have not been observed in high doses of pomegranate and long interventions . The beneficial effects of pomegranate are attributed to polyphenols .…”

“…A few studies on the effect of pomegranate in hemodialysis patients have found conflicting results for cardiovascular risk factors and no effect for markers of oxidative stress and inflammation . The controversial or negative results may be due to the time of pomegranate administration which has been mostly before dialysis session when polyphenols are quickly excreted during dialysis.…”

The Search for Dietary Supplements to Elevate or Activate Circulating Paraoxonases

“…A higher dose (10 mL/day) pomegranate extract for 12 weeks was found to increase PON1 in patients with active rheumatoid arthritis [48]. In hemodialyzed patients, daily administration of 1000 mg of a purified pomegranate polyphenol extract for six months increased PON1 activity [52]. Pomegranate juice, or its purified phenolic compounds punicalagin, gallic acid, or ellagic acid, promote binding of a labeled recombinant PON1 to HDL in vitro [49].…”

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“…Juice, seeds, leaves, flowers, bark and roots of pomegranate have various effects. Lowering fever, treating diabetes, anthelmintic, anti-diarrhea, blood tonic, stopping the bleeding, and healing ulcers are the most important traditional uses of pomegranate [10][11][12][13][14] .…”