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The Cochrane Database of Systematic... Aug 2022Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium... (Review)
Review
BACKGROUND
Elevated blood pressure, or hypertension, is the leading cause of preventable deaths globally. Diets high in sodium (predominantly sodium chloride) and low in potassium contribute to elevated blood pressure. The WHO recommends decreasing mean population sodium intake through effective and safe strategies to reduce hypertension and its associated disease burden. Incorporating low-sodium salt substitutes (LSSS) into population strategies has increasingly been recognised as a possible sodium reduction strategy, particularly in populations where a substantial proportion of overall sodium intake comes from discretionary salt. The LSSS contain lower concentrations of sodium through its displacement with potassium predominantly, or other minerals. Potassium-containing LSSS can potentially simultaneously decrease sodium intake and increase potassium intake. Benefits of LSSS include their potential blood pressure-lowering effect and relatively low cost. However, there are concerns about potential adverse effects of LSSS, such as hyperkalaemia, particularly in people at risk, for example, those with chronic kidney disease (CKD) or taking medications that impair potassium excretion.
OBJECTIVES
To assess the effects and safety of replacing salt with LSSS to reduce sodium intake on cardiovascular health in adults, pregnant women and children.
SEARCH METHODS
We searched MEDLINE (PubMed), Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCOhost), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 18 August 2021, and screened reference lists of included trials and relevant systematic reviews. No language or publication restrictions were applied.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and prospective analytical cohort studies in participants of any age in the general population, from any setting in any country. This included participants with non-communicable diseases and those taking medications that impair potassium excretion. Studies had to compare any type and method of implementation of LSSS with the use of regular salt, or no active intervention, at an individual, household or community level, for any duration.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened titles, abstracts and full-text articles to determine eligibility; and extracted data, assessed risk of bias (RoB) using the Cochrane RoB tool, and assessed the certainty of the evidence using GRADE. We stratified analyses by adults, children (≤ 18 years) and pregnant women. Primary effectiveness outcomes were change in diastolic and systolic blood pressure (DBP and SBP), hypertension and blood pressure control; cardiovascular events and cardiovascular mortality were additionally assessed as primary effectiveness outcomes in adults. Primary safety outcomes were change in blood potassium, hyperkalaemia and hypokalaemia.
MAIN RESULTS
We included 26 RCTs, 16 randomising individual participants and 10 randomising clusters (families, households or villages). A total of 34,961 adult participants and 92 children were randomised to either LSSS or regular salt, with the smallest trial including 10 and the largest including 20,995 participants. No studies in pregnant women were identified. Studies included only participants with hypertension (11/26), normal blood pressure (1/26), pre-hypertension (1/26), or participants with and without hypertension (11/26). This was unknown in the remaining studies. The largest study included only participants with an elevated risk of stroke at baseline. Seven studies included adult participants possibly at risk of hyperkalaemia. All 26 trials specifically excluded participants in whom an increased potassium intake is known to be potentially harmful. The majority of trials were conducted in rural or suburban settings, with more than half (14/26) conducted in low- and middle-income countries. The proportion of sodium chloride replacement in the LSSS interventions varied from approximately 3% to 77%. The majority of trials (23/26) investigated LSSS where potassium-containing salts were used to substitute sodium. In most trials, LSSS implementation was discretionary (22/26). Trial duration ranged from two months to nearly five years. We assessed the overall risk of bias as high in six trials and unclear in 12 trials. LSSS compared to regular salt in adults: LSSS compared to regular salt probably reduce DBP on average (mean difference (MD) -2.43 mmHg, 95% confidence interval (CI) -3.50 to -1.36; 20,830 participants, 19 RCTs, moderate-certainty evidence) and SBP (MD -4.76 mmHg, 95% CI -6.01 to -3.50; 21,414 participants, 20 RCTs, moderate-certainty evidence) slightly. On average, LSSS probably reduce non-fatal stroke (absolute effect (AE) 20 fewer/100,000 person-years, 95% CI -40 to 2; 21,250 participants, 3 RCTs, moderate-certainty evidence), non-fatal acute coronary syndrome (AE 150 fewer/100,000 person-years, 95% CI -250 to -30; 20,995 participants, 1 RCT, moderate-certainty evidence) and cardiovascular mortality (AE 180 fewer/100,000 person-years, 95% CI -310 to 0; 23,200 participants, 3 RCTs, moderate-certainty evidence) slightly, and probably increase blood potassium slightly (MD 0.12 mmol/L, 95% CI 0.07 to 0.18; 784 participants, 6 RCTs, moderate-certainty evidence), compared to regular salt. LSSS may result in little to no difference, on average, in hypertension (AE 17 fewer/1000, 95% CI -58 to 17; 2566 participants, 1 RCT, low-certainty evidence) and hyperkalaemia (AE 4 more/100,000, 95% CI -47 to 121; 22,849 participants, 5 RCTs, moderate-certainty evidence) compared to regular salt. The evidence is very uncertain about the effects of LSSS on blood pressure control, various cardiovascular events, stroke mortality, hypokalaemia, and other adverse events (very-low certainty evidence). LSSS compared to regular salt in children: The evidence is very uncertain about the effects of LSSS on DBP and SBP in children. We found no evidence about the effects of LSSS on hypertension, blood pressure control, blood potassium, hyperkalaemia and hypokalaemia in children.
AUTHORS' CONCLUSIONS
When compared to regular salt, LSSS probably reduce blood pressure, non-fatal cardiovascular events and cardiovascular mortality slightly in adults. However, LSSS also probably increase blood potassium slightly in adults. These small effects may be important when LSSS interventions are implemented at the population level. Evidence is limited for adults without elevated blood pressure, and there is a lack of evidence in pregnant women and people in whom an increased potassium intake is known to be potentially harmful, limiting conclusions on the safety of LSSS in the general population. We also cannot draw firm conclusions about effects of non-discretionary LSSS implementations. The evidence is very uncertain about the effects of LSSS on blood pressure in children.
Topics: Adult; Child; Female; Humans; Hyperkalemia; Hypertension; Hypokalemia; Potassium; Pregnancy; Pregnant Women; Randomized Controlled Trials as Topic; Sodium; Sodium Chloride; Sodium Chloride, Dietary; Stroke
PubMed: 35944931
DOI: 10.1002/14651858.CD015207 -
Environmental Science and Pollution... Oct 2021The interaction and the interplay of climate change with oil palm production in the Southeast Asia region are of serious concern. This particularly applies in Malaysia... (Review)
Review
The interaction and the interplay of climate change with oil palm production in the Southeast Asia region are of serious concern. This particularly applies in Malaysia due to its rank as the second largest palm oil producer in the world. The anthropogenic activities and the agroecological practices in oil palm plantation, including excessive use of fertilisers, bush fire due to land clearing, and cultivation on peatland, have exacerbated the effects of climate change featuring extreme events, drought, flooding, heatwave, as well as infestation of pest and diseases. These adverse impacts on oil palm production highlight the significance of deploying effective adaptation strategies. The study aims to examine the impact of climate change on oil palm production and identify the farmers' adaptation strategies to the impacts of climate change in Malaysia. This study was conducted a comprehensive review of the articles published from 2000 to 2021 in the contexts of climate change and oil palm production in Malaysia. The review shows that climate change has a range of impacts on the oil palm production in Malaysia. As a result, several adaptation options were identified, such as breeding of hybrid varieties that are tolerant and resistant to heat; sustainable management of soil; pit and tranches to enhance water management in plantation areas; minimal use of fertilisers, herbicides, and pesticides; zero burning; and minimum tillage. The reviewed studies recommended the following to mitigate the adverse impacts of climate change: sustainable national policy on climate change, conservation of the existing carbon stock, effective management of tropical rainforest biodiversity, afforestation for carbon sequestration, and reduction in greenhouse gas (GHG) emission.
Topics: Climate Change; Malaysia
PubMed: 34402002
DOI: 10.1007/s11356-021-15890-3 -
The International Journal of... Oct 2019The palm oil industry is the largest contributor to global production of oils and fats. Indonesia and Malaysia are the largest producers of palm oil. More than a million...
BACKGROUND
The palm oil industry is the largest contributor to global production of oils and fats. Indonesia and Malaysia are the largest producers of palm oil. More than a million workers are employed in this industry, yet there is a lack of information on their occupational health and safety.
OBJECTIVE
To identify and summarize occupational hazards among oil palm plantation workers.
METHODS
A search was carried out in June 2018 in PubMed, Web of Science, Scopus, and Ovid. Relevant publications were identified by a systematic search of four databases and relevant journals. Publications were included if they examined occupational hazards in oil palm plantation workers.
RESULTS
941 publications were identified; of these, 25 studies were found eligible to be included in the final review. Of the 25 studies examined, 19 were conducted in Malaysia, 2 in Costa Rica, and one each in Ghana, Indonesia, Myanmar, Papua New Guinea, and Cameroon. Oil palm plantation workers were found to be at risk of musculoskeletal conditions, injuries, psychosocial disorders, and infectious diseases such as malaria and leptospirosis. In addition, they have potential exposure to paraquat and other pesticides.
CONCLUSION
In light of the potential of palm oil for use as a biofuel, this is an industry with strong growth potential. The workers are exposed to various occupational hazards. Further research and interventions are necessary to improve the working conditions of this already vast and growing workforce.
Topics: Agricultural Workers' Diseases; Cameroon; Comorbidity; Costa Rica; Food Industry; Food Safety; Ghana; Humans; Indonesia; Malaysia; Myanmar; Occupational Exposure; Occupational Health; Palm Oil; Papua New Guinea; Pesticides; Plant Oils
PubMed: 31586381
DOI: 10.15171/ijoem.2019.1576 -
TheScientificWorldJournal 2022Palm oil production has increased significantly, specifically in Indonesia and Malaysia. However, this growth has raised environmental concerns due to the high discharge... (Review)
Review
Palm oil production has increased significantly, specifically in Indonesia and Malaysia. However, this growth has raised environmental concerns due to the high discharge of empty fruit bunches, palm oil mill effluents, and other solid wastes. Therefore, this study aims to examine the treatment of palm oil waste by composting and systematically review insights into its application through a systematic literature review approach. Among the 1155 articles, a total of 135 were selected for a systematic review of palm oil waste management developments and their applications, while 14 were used for determining compost quality according to the criteria and requirements established in the systematic literature review. Moreover, using Egger's test, JAMOVI 1.6.23 software was used to analyze random effects models with 95% confidence intervals and publication bias. The results showed that palm oil waste was optimally treated by composting, which is considered as a sustainable technology for protecting the environment, human safety, and economic value. The in-vessel method with a controlled composting chamber is the best system with a minimum time of 14 days. However, it requires tight control and provides a final product with a high microbial colony form outdoors and indoors compared to the windrow system. This study is useful to see the bias of research results and helps to find new studies that need to be developed, especially in this case related to the management of palm oil waste into organic compost fertilizer and its application methods in the field. It is suggested that applying palm oil waste or compost is mainly performed by mulching. In contrast, new challenges for better processing to produce organic fertilizers and applicable technologies for sustainable waste management are recommended. The method must be affordable, efficient, and practical, combining compost quality with maximum nutrient recovery.
Topics: Humans; Composting; Palm Oil; Soil; Waste Management; Fertilizers
PubMed: 36408196
DOI: 10.1155/2022/5073059 -
Heliyon Oct 2022This paper reviews previous research on the sustainability and policies of palm oil-based bioenergy in Indonesia and Malaysia. A systematic literature review with a...
This paper reviews previous research on the sustainability and policies of palm oil-based bioenergy in Indonesia and Malaysia. A systematic literature review with a meta-analysis (PRISMA) methodology was performed to evaluate the related articles discussing sustainability and bioenergy policies. This study found 96 articles that mapped the sustainability and policies of bioenergy in Indonesia and Malaysia over the last decade. The sustainability studies were divided into two areas: the environment and socioeconomics. Researchers were more likely to examine environmental factors than socioeconomic factors, specifically focusing on the following environmental indicators: land use conversion, deforestation, and CO emissions. Most policy studies concentrated on sustainability and energy security. Over the last two decades, the development of bioenergy policies in Indonesia and Malaysia has been comparable in terms of geographical position and palm oil production. However, Indonesia's bioenergy policy has tended to be more vigorous and dynamic than Malaysia.
PubMed: 36247150
DOI: 10.1016/j.heliyon.2022.e10919 -
Asia Pacific Journal of Clinical... 2020Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Current guidelines recommend reducing intake of diets rich in saturated fats and replacing it with diets rich in unsaturated fats. Palm oil contains a high amount of saturated fatty acids, but its effect on serum lipid levels is unclear. The study aimed to compare the effects of palm oil consumption with other edible oils rich in monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) on serum lipid profiles.
METHODS AND STUDY DESIGN
We searched Medline, Embase, Cochrane Central Registry of Controlled Trials and CINAHL. Clinical trials were eligible if they compared palm oil-rich diets with diets rich in MUFAs or PUFAs. We pooled results of included studies using a random effects model and assessed the quality of the evidence and certainty of conclusions using the GRADE approach.
RESULTS
Intake of palm oil intake compared to oils rich in MUFA was associated with increased levels of total cholesterol (TC) [mean difference (MD)=0.27 mmol/L; 95% CI 0.08 to 0.45], LDL-C (MD=0.20 mmol/L; 95% CI 0.02 to 0.37) and HDL-C (MD=0.06 mmol/L; 95% CI 0.02 to 0.10). Similarly, for comparison with oils rich in PUFAs, palm oil showed increased in TC (MD=0.38 mmol/L; 95% CI 0.14 to 0.62), LDL-C (MD= 0.44 mmol/L; 95% CI 0.01 to 0.88) and HDL-C (MD=0.08 mmol/L; 95% CI 0.03 to 0.13). For both comparisons, there were no significant effects on triglycerides.
CONCLUSIONS
Even though palm oil increases marginally the level of serum lipids, the evidence is mostly of low to moderate quality.
Topics: Diet; Dietary Fats; Humans; Lipids; Palm Oil
PubMed: 32990612
DOI: 10.6133/apjcn.202009_29(3).0011 -
Diabetes & Metabolic Syndrome 2020High total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) could be major risk factors for cardiovascular disease burden among high risk populations... (Review)
Review Meta-Analysis
BACKGROUND AND AIMS
High total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) could be major risk factors for cardiovascular disease burden among high risk populations especially in South Asians. This systematic review and meta-analysis aimed to quantify the effects of coconut oil compared with other oils and fats on cardio-metabolic parameters.
METHODS
PubMed, Scopus and Web of Science were systematically searched. The main outcomes included are lipid and glycemic parameters. Subgroup analyses were performed to evaluate individual comparisons of vegetable oils and animal fat with coconut oil. Data were pooled using random-effects meta-analysis.
RESULTS
Coconut oil consumption significantly increased TC by 15.42 mg/dL (95% CI, 8.96-21.88, p < 0.001), LDL-C by 10.14 mg/dL (95% CI, 4.44-15.84, p < 0.001) and high density lipoprorein cholesterol (HDL-C) by 2.61 mg/dL (95% CI, 0.95-4.26, p = 0.002), and significantly decreased glycosylated hemoglobin (HbA1c) by 0.39 mg/dL (95% CI, -0.50 to -0.27, p < 0.001) but, it had no effects on triglycerides (TG), (4.25 mg/dL; 95% CI, -0.49-8.99, p = 0.08) when compared with the control group. Sub-group analysis demonstrated that coconut oil significantly increased TC and LDL-C over corn, palm, soybean and safflower oils and not over olive oil. Compared with butter, coconut oil showed a better pattern in cardio-metabolic markers by significantly increasing HDL-C (4.38 mg/dL, 95% CI, 0.40 to 8.36, p = 0.03) and decreasing LDL-C (-14.90 mg/dL, 95% CI, -23.02 to-6.77, p < 0.001).
CONCLUSIONS
Our results suggest that coconut oil consumption results in significantly higher TC, LDL-C and HDL-C than other oils. Consumption of coconut oil can be one of the risk factors for CVDs in South Asians.
Topics: Animals; Cardiovascular Diseases; Coconut Oil; Humans; Risk Factors
PubMed: 33096510
DOI: 10.1016/j.dsx.2020.09.033 -
Pharmaceuticals (Basel, Switzerland) Sep 2021The oil palm tree ( Jacq.) originates from West and Central Africa, and it is cultivated in Malaysia for its oil-producing fruits. Malaysia is the world's second largest... (Review)
Review
The oil palm tree ( Jacq.) originates from West and Central Africa, and it is cultivated in Malaysia for its oil-producing fruits. Malaysia is the world's second largest palm oil producer and the world's largest exporter to date. Consequently, the Malaysian oil palm industry constantly generates a huge amount of biomass with the major contributor being the leaves. A large percentage of these leaves remain underutilized, making them a promising source of raw materials that can be converted into value-added products. The present review summarizes and discusses the flavonoid composition, total phenolic and flavonoid content, and the in vitro and in vivo pharmacological properties exhibited by the extracts of the leaves of . The purpose of this systematic review is to highlight the potential of valorizing the leaf extracts of the oil palm tree as pharmaceutical and cosmeceutical agents.
PubMed: 34681185
DOI: 10.3390/ph14100961 -
Frontiers in Veterinary Science 2020Accumulative evidences on the beneficial effects of palm oil are progressively reported; however, there are still several controversies related to their effects on the...
Accumulative evidences on the beneficial effects of palm oil are progressively reported; however, there are still several controversies related to their effects on the risks of cardiovascular disease (CVD). This review explores the effects of palm oil and its liquid fraction namely palm olein, which is commonly used as cooking oil on four lipid parameters; total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C), which play an important role as CVD-related biomarkers. A systematic review of the literature was conducted to identify the relevant studies on palm oil and the lipid parameters specifically focusing on the animal model. A comprehensive search was conducted in Medline EBSCOhost, Medline OVID and Scopus. Studies were limited to the English language published between the years of 2000 and 2019. The main inclusion criteria were as follows: (1) Study with animal experiments [the animal should be limited to mammals] (2) Study should have evaluated the effects of palm oil or palm olein on plasma or serum lipid parameter (3) Study should have used palm oil or palm olein in the form of pure or refined oil (4) The treatment of palm oil or palm olein was assessed using the following outcomes: plasma or serum TC, TG, HDL-C, and LDL-C concentration (5) Study should have control group and (6) studies on specific fatty acid, fraction enriched tocotrienol and tocopherol, crude palm oil, kernel oil, red palm oil, thermally oxidized palm oil, hydrogenated palm oil, and palm oil or palm olein based products namely margarine, palm milk, butter and cream were excluded. The quality and the risk of bias on the selected studies were assessed using the ARRIVE Guideline and SYRCLE's Risk of Bias tools, respectively. The literature search successfully identified 17 potentially relevant articles, whereby nine of them met the inclusion criteria. All research articles included in this review were studies comprising seven rats, one hamster and one mice model. Significant positive outcomes were observed in several lipid parameters such as TC and LDL-C. The evidence from this review supported that palm oil and palm olein possess high potential as lipid-lowering agents.
PubMed: 32775343
DOI: 10.3389/fvets.2020.00303 -
PloS One 2019Vegetable oil is an important source of fatty acids, and as palm oil being the highest consumed vegetable oil in many countries, its high saturated fatty acid content...
INTRODUCTION
Vegetable oil is an important source of fatty acids, and as palm oil being the highest consumed vegetable oil in many countries, its high saturated fatty acid content has led many concerns on cardiometabolic health. Dietary fatty acids has also been linked to affect glucose metabolism and insulin sensitivity. This systematic review is aimed at critically evaluating the available evidence on the association of palm oil with the biomarkers of glucose metabolism as compared to other vegetable oils.
METHODS
We systemically searched PubMed, CENTRAL and Scopus up to June 2018. We searched for published interventional studies on biomarkers of glucose metabolism (defined as fasting glucose, fasting insulin, HOMA, 2-hour post prandial glucose and HbA1C) that compared palm oil- or palm olein-rich diets with other edible vegetable oils (such as olive oil, canola oil and soybean oil). Two reviewers independently extracted data and assessed study risks of bias. Mean differences of outcomes were pooled for the meta-analysis.
RESULTS
We identified 1921 potentially eligible articles with only eight included studies. Seven randomised cross-over trials and one parallel trial were included. Study population were among young to middle-aged, healthy, non-diabetic, and normal weight participants. Intervention duration ranged from three to seven weeks, and fat substitution ranged from 15% to 20% energy. There were insignificant differences in fasting glucose when compared to partially hydrogenated soybean oil [-0.15mmol/L (-0.46,0.16) P = 0.33, I2 = 48%], soybean oil [0.05mmol/L (-0.09,0.18) P = 0.49, I2 = 0%] and olive oil [0.04mmol/L (-0.09,0.17) P = 0.76, I2 = 0%]. Insignificant effects were also seen on fasting insulin when compared to partially hydrogenated soybean oil [1.72pmol/L (-11.39,14.84) P = 0.80, I2 = 12%] and olive oil diet [-0.14pmol/L (-4.87,4.59) P = 0.95, I2 = 0%].
CONCLUSION
Current evidence on the effects of palm oil consumption on biomarkers of glucose metabolism is poor and limited to only healthy participants. We conclude that little or no additional benefit will be obtained by replacing palm oil with other oils rich in mono or polyunsaturated fatty acids for changes in glucose metabolism.
Topics: Blood Glucose; Carbohydrate Metabolism; Dietary Fats; Humans; Insulin; Insulin Resistance; Palm Oil
PubMed: 31415611
DOI: 10.1371/journal.pone.0220877