Effect of Chia Seed (Salvia Hispanica

PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1909 other parameters.Intheacute trials, post-prandial blood sapentaenoic acid(EPA), withnosignificant changeto reviewed there wasasignificantspikein ALA andeico mass, lipid profile or bloodsugar. Infour ofthestudies inflammatory markers, yet there was nochangeinbody a significantdrop insystolicbloodpressure (SBP)and mized. Of the chia seed interventions, one study showed Two ofthestudieswere acutetrials,bothofthemrando randomized. Fiveofthestudieswere blindexperiments. not criteria. clinicaltrials,onlyonewas Of thechosen Aceptado: 20-VIII-2015. Recibido: 13-VII-2015. E-mail: [email protected] Cidade Universitária,IlhadoFundão,RiodeJaneiro,Brazil. Instituto deNutriçãoJosuéCastro–DND-sala25. Av. CarlosChagasFilho,373-CCS-blocoJ,2.ºandar. Universidade FederaldoRiodeJaneiro. Correspondence: book for Systematic ReviewsofInterventions Version 5.1. out considering6ofthe8criteriaCochraneHand the lasttenyears. The biasesofriskanalysiswere carried cles aboutclinicaltrialsonhumansandpublishedwithin selection English-,Portuguese-or Spanish-languagearti diovascular gliceridemia” or “ or “chia”, “hypertension”or “ “ mia Science under thekeywords”dyslipidemia”or “ Med version),Cochrane,Scielo,Scopus,and Web of tified intheelectronic databasesLilacs,Medline(Pub with nometa-analysis. The articlesscrutinizedwere iden risk factorsinhumans. whole, hasintheprevention/control ofcardiovascular of chiaseed,eitherthe effectconsumption milledor consistent. of thefewstudiestohavelookedintomatter are in it has notbeenestablishedaseffective and thefindings of chiacanreduce cardiovascular riskfactors;however, have beenmadetoassesswhetherconsumption human acid (ALA), minerals, fibers and antioxidants. Efforts proteins,especially alpha-linolenic n-3fattyacidsand Abstract Postgraduate NutritionProgram, JosuédeCastro InstituteofNutrition, FederalUniversityof RiodeJaneiro, Brazil. Glorimar Rosa Cynthia deSouzaFerreira,LuciliaFátimaSousaFomes, GilzeEspirito SantodaSilvaand risk factorsinhumans:asystematicreview Effect ofchiaseed( Revisión obesidade Findings: Methods: Aim: Introduction: ”, “hyperlipidemia”or “ to systematize the findings of studies assessing ”, “salvia”or” ” or “cardiovascularrisk.” We chosefor our this is a systematic literature review (SLR) sevenstudies(n chia is a seed rich in such nutrients as chiaisaseedrichinsuch Glorimar Rosa. hipertrigliceridemia salviahispanica hiperlipidemia

Salvia hispanicaL. = hipertensão

200) fitour inclusion

”, and “ ”, “Lamiaceae” ”, “Lamiaceae” ”, “obesity”or ”, “hypertry

dislipide riscocar

------) consumptiononcardiovascular fue significativamente menor. Solounestudiomostró de azúcarensayos agudos,elnivelpostprandial ensangre cambio significativo enotrosningún parámetros. Enlos significativo en ALA yácidoeicosapentaenoico(EPA), ni gre. Encuatro delosestudiosrevisados en lamasacorporal, el perfil de lípidosoel azúcar ensan cadorescambios deinflamación;sinembargo,nohubo nificativa de la presión arterial sistólica (PAS) ylosmar semillas de chía,unestudiomostróunadisminuciónsig al azar.asignados ambos dos, Delasintervencionesde de losestudioseranensayosagu perimentos ciegos.Dos solo uno nofue aleatorio. Cinco de los estudios fueron ex De losensayosclínicosseleccionados, terios deinclusión. de Intervenciones Versión 5.1. Cochrane paraRevisionesSistemáticas rios delManual riesgo serealizaron considerandoseisdelosochocrite cados enlosúltimosdiezaños.Lossesgosdeanálisis español sobreclínicos enseres ensayos publi humanos o selección artículoseninglés,portugues para nuestra cocardiovascular” o“cardiovascularrisk”.Elegimos “hypertrygliceridemia” o “hipertrigliceridemia” y “ris “Lamiaceae” o“chia”,“hypertension”“hipertensão”, “obesity” o“obesidade”,“salvia”“salviahispanica”, o “dislipidemia”,“hyperlipidemia”“hiperlipidemia”, y Web ofScience bajo lapalabra clave “dyslipidemia” cos, Medline (PubMed versión),Cochrane,Scielo, Scopus eran identificados en lasbasesdedatosLilacs electróni ratura (SLR),sinmetaanálisis.Losartículosescrutados factores deriesgo cardiovascular enlosseres humanos. sea molida o entera, tiene en la prevención/control de los evaluaronde lasemillachía,ya elefecto delconsumo como eficaz y losresultados delospocosestudiosquehan riesgo cardiovascular; sin embargo, no sehaestablecido consumo humanodechía puede reducir losfactores de antioxidantes. Sehanhechoesfuerzosparaevaluar siel mente ácidoalfa-linolénico (ALA); minerales; fibras y tales comoproteínas;omega 3,especial ácidosgrasos Resumen examinado lacuestiónsonincompatibles. FACTORES DE RIESGO CARDIOVASCULAR EN Resultados: Métodos: Introducción: Objetivo: EFECTOS DEL CONSUMO DE LA SEMILLA HUMANOS: UNA REVISIÓN SISTEMÁTICA DECHÍA ( sistematizarque loshallazgos delosestudios setratadeunarevisión sistemática de lalite sieteestudios(n=200)encajanconloscri lachíaesunasemilla rica en nutrientes SALVIA HISPANICA L. ISSN 0212-1611 •CODENNUHOEQ Nutr Hosp.2015;32(5):1909-1918 no habíaunpico ) EN LOS S.V.R. 318 1909 ------17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1910 1910 and diabetes mellitus, with approximately 5% of (overweight or obesity), hypertension, dyslipidemia be modified, controlled or treatedare excess weight lian CardiologySociety2010). and socioeconomiccosts(Schmidt of hospitalizations,inhigherhealthcare which results 2012), aswell as being responsible for agreat number In Brazil,CVDcauses21.1%ofalldeaths(Datasus tality, withapproximately 17 million deaths per year. 2013), CVDisthe world’s number one cause of mor blood pressure(HBP)(Vuksan content suggestsitmaybehelpfulincontrollinghigh Caudillo offers significant antioxidant capacity (Lee A.S. 2009; pounds (mainly quercetin and kaempferol), chia seed et al. a role in satiety and proper bowel function (Vázquez (53.45g/100g) comprisesinsolublefiber, whichplays (Ayresa& Coates1999;Craig&Sons2004). of dietary fiber(33.9g/100g)andprotein(17g/100g). chia seed,whatremainsisasignificant concentration son (n-3) and20%composed of linoleic acid (n-6) (Bres 40%, with60%ofthetotal lipids madeupof ALA (Ulbricht foods inthedietofindigenous Aztec civilization a sourceofenergy andincorporated into anumberof and Colombia, chia seed was usedand consumed as Originating insuchcountriesasGuatemala, Mexico an annual plant belonging to the Lamiaceae family. Introduction Further research ishenceneeded. included inthisreview present numerous limitations. diovascular riskfactorsare insufficient,andthestudies the relationshipcar and betweenchiaseedconsumption lar disease(CVD)riskfactors. The evidence regarding statistically significant results inrelation to cardiovascu comes were reported inthefindings. risk of bias because not all the pre-specified primary out unclear or lowriskofbias. Two studiesshowedahigh was mixedwithother foods.Mostofthestudiesshowed flammatory markers; however, the chia seed inthatcase significant dropin and intriglyceridesmass (TG), body sugar wassignificantlylower.a showed Onlyonestudy Hypertriglyceridemia. Cardiovascular risk. via. Salvia hispanica. Lamiaceae. Chia seed. Hypertension. Conclusion: Among thecardiovascular risk factorsthat can According to the World Health Organization (WHO Of totaldietaryfiber, thegreatestfraction The lipidcontentinchiaseedsvariesfrom25%to Salvia hispanica Key words: et al. 2008).Rich in magnesium and phenolic com et al. 2009). When theoil is extracted fromthe et al. Dyslipidemia. Hyperlipidemia. Obesity. Sal mostof the studiesdidnotdemonstrate 2008),while its calcium and potassium , 2009). L.,commonly knownaschia, is DOI:10.3305/nh.2015.32.5.9394 ( Nutr Hosp. Nutr Hosp.2015;32(5):1909-1918 et al. 2015;32:1909-1918) et al. 2007). 2011; Brazi ------the amountofcholesterol found inthemeat and eggs seed boostedthelevels of n-3fatty acids and reduced Heart Federation2012). worldwide deathsattributed to excessweight(World HDL cholesterol(Ayerza cholesterol and triglycerides while itelevated plasma 2009). Inrats,useoftheseedloweredplasmaLDL (Ayerza pertensión. Hipertrigliceridemia.Riesgocardiovascular. Salvia. Salviahispanica.Lamiaceae.Semillasdechía.Hi limitaciones. Por lotanto,senecesitamásinvestigación. estudios incluidosenestarevisión presentan numerosas factores deriesgocardiovascular soninsuficientes,ylos sobre larelación entre elconsumodesemillaschíaylos los factores de riesgo cardiovascular (ECV). La evidencia resultados estadísticamente significativos en relación con cificados fueron reportados enloshallazgos. sesgo, porque notodoslosresultados primariospreespe o bajosesgo.Dosestudiosmostraron unaltoriesgo de tos. Lamayoría de losestudiosmostraron riesgos claros semilla dechíaenesecasosemezclóconotros alimen corporal ylosmarcadores inflamatorios;sinembargo,la descenso significativodelostriglicéridos (TG), lamasa tuguese: consulting the followingkeywordsinEnglish andPor and Cochrane, Scielo, Scopus, Web ofScienceby in the databases Lilacs, Medline (PubMedversion), tematic reviews(Liberatti2009). Methods diovascular riskfactors. its possible benefits in the prevention/reduction of car dings regarding the human use ofchia seed and assess conducted onanimals. re, mostofthestudiespresentingpositiveresultswere evidence to provechia seed’s efficacy, andfurthermo the fewavailable studiesarecontroversial, with little Vuksan 2007;Nieman 2012). However, the findings of blood sugarandinflammatory markers (Nieman2009; composition andmass,lipidprofile,bloodpressure, vascular riskfactors,byexamining suchdataasbody tion andthepossibleeffect itcouldhaveoncardio seed lookedat the relationship between its consump sistêmica hispanica When added to the diets of pigsandchickens, chia Conclusión: We carriedoutoursearchfromMaytoJuly 2014 For this SLR weusedthe current guidelines for sys Thus, ouraim with thisSLRistosynthesize the fin Most ofthestudiesconducted on humansusingchia Palabras clave: et al. dislipidemias (systemic arterial hypertension), , obesidade 2002; Azeona lamayoríadelosestudiosnodemostraron Dislipidemia.Hiperlipidemia.Obesidad. (dyslipidemias), (obesity), DOI:10.3305/nh.2015.32.5.9394 ( Nutr Hosp. et al. Cynthia de Souza Ferreira et al. et al. 2007)levels. hipertensão arterial 2008;Coates 2015;32:1909-1918) salvia hipertrigli , salvia et al. ------

17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1911 Hipertrigliceridemia Hiperlipidemia Dislipidemia Risco cardiovascular Lamiaceae Salvia Chia Hipertensão SalviaHispanica Obesidade cardiovascular risk factors in humans Effects ofchia consumption on total cholesterol, high-density lipoprotein (HDL-c), Assessing outcomesofinterest (Fig. low risk of bias, high risk of bias or unclear risk of bias mains appraisedcanbeclassifiedintothreecategories: reporting, and other sources ofbias. Each of the do assessment, incomplete outcomes, selective outcome of participants andpersonnel,blindingofoutcome quence generation, allocation concealment, blinding assesses biasaccordingtosevendomains:randomse appraisal ofeach aspectoftheriskseparately. The tool lected typesofstudyforthispaper. based ontheapplicability the 6criteria was to these risk”, “highrisk”and“unclear risk”. The selection of (Higgins 2011), which has areaswith ratings “low for Systematic Reviews of Interventions Version 5.1 Assessment ofriskbias weren’t clinicaltrials,andduplicatearticles. ture reviews. We excludedanimal studies,studiesthat or Portuguese,clinical trials onhumans,andnotlitera be lessthan10yearsold,written inEnglish,Spanish independently ofeachother. and LFSG)analyzedthearticles yielded by thesearch, criptor ofobject]” (Table [des [descriptor of subject] and DYSLIPIDEMIAS cardiovascular risk factors,forexample“SALVIA the conjunction “And” to associate the use ofchia with lar ceridemia The outcomesweassessedfromthestudieswere Collaboration’s tool thereby performing a critical Torisk ofbiasweusedCochraneHandbook assess inclusion criteria Our werethatthearticleshadto (cardiovascularrisk),chiaandLamiaceae. We used

1). in português Concepts (hypertrigliceridemia),

Cardiovascular Risk

I). Tworesearchers (CSF Hypertension Lamiaceae in english Concepts Salvia - - risco cardiovascu

Descriptors andconceptsusedinLRS Hipertrigliceridemia Nutr Hosp.2015;32(5):1909-1918 in portuguese Descriptors Hipertensão Lamiaceae ------Table I Salvia - - - - cess. Fig. 1.—Flowchartillustrating studysearch andselection pro

Scopus Scielo ( by keywordonLilacs 7 n=98 Potentially relevantstudiesidentified Estudos selecionadosparaleiturado

Scopus reading ofabstractsonLilacs Scopus texto completonoPubmed estudos selecionadosparaleiturado Original publicationsselectedfor Pubmed texto completo:Pubmed 7 estudosincluídosnarevisãosistemáticadeliteratura (n=0) ); Cochrane( (n=41) (n=3) (n=1) (n=12) ; in english(mesh) Scopus(n=5) Hyperlipidemias ; e Webof Science ( Dyslipidemias e Web ofscience Hypertension ; Web oScience Descriptors N=200 N=17 N=21 Obesity ; Cochrane n=6) Salvia - (n=13) ;

Scielo ;

Web (n=3) ; Pubmed (n=11) (n=0)

(n=0) (n=17) on animals, about (n=3) (n=3) Exclusão deartigosduplicados 179 studiesexcludedforbeing n=25 (n=4) Studies excludedforbeing systematic revision ; ; ; ; salvia hispânicaL ; ) duplicates Dislipoproteinemias Hyperlipemia in vitro ( n= 10 Synonyms (n=2) ) - - - - ornotbeing (n=4) . or chia ; 1911 - 17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1912 1912

Table II General characteristics of clinical trials included in the selected studies

Clinical Population profile trial Chia dosage Design∕ Population (Metabolic∕ Duration Diet∕Medications Statistics Outcomes of interest Principal findings (author, reported follow-up sex/age pathological) year)

Vuksan 37 g/d ± 4 g Randomized, 20 Type-2 controlled 12 weeks Diet: Recommended NCSS 2000 -Fasting blood glucose Compared with

Nutr Hosp.2015;32(5):1909-1918 et al. of milled chia placebo- teenagers, diabetics by Canadian Diabetes (NCSS and insulin control group, chia 2007. seed added to controlled, adults and Association statistical -Blood pressure (systolic treatment lowered white bread single-blind senior Medication: Software and diastolic) SBP 6.3 ± 4.2 mmHg clinical citizens Individuals Kaysville, UT) -Lipids (Total, LDL, (P < 0.001); CRP (mg/l) crossover trial of both maintained usual HDL, TG) 40 ± 1.6% (P < 0.04); sexes. treatment (type Significance Inflammatory markers Von Willebrand Factor Age: and dosage) of oral p < 0.05 (CRP, fibrinogen, 21 ± 0.3% (P < 0.03), 18-75 hypoglycemic, Von Willebrand Factor ALA and EPA increased antihypertensive VIII). with chia consumption and antilipidemic (P < 0.05) medication.

Vuksan 0, 7, 15 or Acute, 11 adults Healthy, eutrophic 120 Diet and medication NCSS 2000 Post-prandial blood Significant reduction et al. 24 g/d of chia randomized, of both individuals minutes. not reported (NCSS sugar in post-prandial blood 2010 seed added to placebo- sexes Capillary statistical sugar with all doses white bread controlled, blood Software (P = 0.002, r2 = 0.203) double-blind collection Kaysville, UT) clinical Age? 15, 30, 60, Significance crossover 90 and 120 p < 0.05 min. after ingestion

Nieman 25 g/d of chia Randomized, 76 adults Healthy 12 weeks Diet: individuals T-Student test- Body composition and Compared to control

Cynthia de Souza Ferreira et al. et al. seed mixed placebo- of both individuals with oriented to maintain Significance mass, inflammatory group, plasma ALA 2009 with 0.25 L of controlled, sexes excess body fat standard diet p < 0.05 markers (CRP, increased 24.4% water – twice single-blind Age: 20- (≥ 25 Kg∕m2). Interleukin-6, Monocyte- (67.3 ± 5.6 to 83.7 ± 8.5 daily (50 g/d) clinical trial 70 years Medications: none Chemotactic Protein, µg∕Ml) reported TNF Alpha); Oxidative P = 0.012 Stress Markers, PA; No significant difference Lipid Profile; Blood between groups in glucose, analysis of fatty reduction of body mass acid in plasma or composition, blood sugar, lipid profile, PA or inflammatory markers 17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1913 cardiovascular risk factors in humans Effects ofchia consumption on

Table II (cont.) General characteristics of clinical trials included in the selected studies

Nieman 25 g/d of Randomized, 56 adult Healthy with 10 weeks Diet: individuals Anova Body mass and Significant increases in et al. milled or double-blind, and excess body fat oriented to maintain T-Student test composition, serum concentrations 2012 whole chia placebo- elderly (≥ 25 Kg∕m2), standard diet Mann-Whitney inflammatory markers of ALA (58.4% seed controlled women; post-menopausal, Medications: none test and (PCR, Interleucine-6, p = 0.002) and EPA clinical trial Age 49- non-smokers reported Wilcoxon test Monocyte (38.6% p = 0.016) in 79 years Chemoattractive Protein, the group given milled MATLAB TNF Alpha); Oxidative chia compared to that

Nutr Hosp.2015;32(5):1909-1918 R2010a Stress Markers, PA; given whole chia or (MathWorks, Lipid Profile; Blood placebo. No significant Inc., Natick, glucose, analysis of fatty difference in body mass MA) acid in plasma or composition, blood Significance pressure, lipid profile or p < 0.05 inflammatory markers between whole-seed, milled or placebo groups.

Jin 25 g/day of Individual, self- 10 women Post-menopausal, 7 weeks Diet: individuals Anova Plasma concentrations of No significant change et al. milled chia reported clinical Age 52-60 healthy. BMI-17 to oriented to maintain T-tests- ALA , EPA and DHA in body mass.(Pre-study 2012 trial. Six blood years 29 Kg/m standard diet Bonferroni 69.4 ± 13.8 Kg; three extractions Medications: none Significance weeks 69.3 ± 13.7 Kg; reported p < 0.05 seven weeks 60.1 ± 13.4 Kg) - p value not mentioned

ALA - 138% increase (p < 0.001) EPA - 30% increase (p = 0.019) DHA-decrease (p=0.030) 1913 17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1914 1914

Table II (cont.) General characteristics of clinical trials included in the selected studies

Clinical Population profile trial Chia dosage Design∕ Population (Metabolic∕ Duration Diet∕Medications Statistics Outcomes of interest Principal findings (author, reported follow-up sex/age

Nutr Hosp.2015;32(5):1909-1918 pathological) year)

Guevara- 4 g of chia Randomized, 67 adults Individuals with 2 months Diet: 500 kcal Kolmogorov- Body mass, waist Significant decrease Cruz et seed mixed double-blind, of both excess body mass reduction from usual Smirnov Z test perimeter, body in body mass and al. 2012 with palm, placebo- sexes and metabolic diet, reduction in Anova composition, PA, composition, BMI and oats and controlled Age 20-60 syndrome saturated fat and T-Student blood sugar, insulin, waist circumference in soy powder clinical trial years cholesterol for Significance lipid profile, leptin, both groups (p < 0.0001). diluted in 2 weeks before p < 0.05 adiponectin, CRP Significant decrease 250 mL of randomization, and in TG (p = 0.05), CRP water/2 per after randomization (0.01) and insulin day reduction of resistance (0.001) only 500 kcal in diet and in group with diet further 235 kcal in + complement. No complement significant difference Medications: none found in blood sugar reported or total plasma insulin, cholesterol, HDL-c or LDL-c in either group (p > 0.05) No change in leptin or adiponectin.

Ho 0, 7, 15 or Acute, 13 Eutrophic, healthy Capillary Diet: not reported Anova Post-prandial blood Decrease in post-prandial

Cynthia de Souza Ferreira et al. et al. 24 g of whole randomized, individuals individuals blood Medications: NCSS 2000 sugar represented blood sugar significantly 2013 or milled chia crossover of both collection individuals using (NCSS by area under curve related to dosage of chia added to white clinical trial sexes 15, 30, 45, blood sugar- statistical (IAUC)) (p = 0.004); however, not bread 60, 90 and metabolization- Software related to form—milled/ 120 min altering medications Kaysville, UT) whole seed (p = 0.74) following excluded from study Significance when compared to ingestion p < 0.05 placebo group

PAS = systolic blood pressure, EPA = eicosapentaenoic acid, DHA = docosahexaenoic acid, BMI = body mass index, TG = triglycerides; CRP = C-reactive protein 17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1915 cardiovascular risk factors in humans Effects ofchia consumption on whole ormilledform,was added tobread(Vuksan Ho 2013).Insomeofthestudies, thechia,ineither 2009; Guevara-Cruz2012)orboth(Nieman2012; others usedwholechiaseed(Vuksan 2010;Nieman using milledchia(Vuksan 2007; Jin2012),while studies variedfrom4to50g,withsomeofthetrials 2012). chia seedwasaddedtootherfoods(Guevara-Cruz trials (Vuksan 2010;HO2013).In one ofthestudies Vuksan 2010;Ho2013). Two ofthe studies are acute gle-blind, andthreearecrossovertrials(Vuksan 2007; 2007; Nieman 2012; Guevara-Cruz 2012), twoare sin the articlescoverdouble-blind clinical trials (Vuksan 2009, Nieman 2012, Guevara-Cruz 2012). Three of bo controlled (Vuksan 2007, Vuksan 2010,Nieman 2013), andfiveareplace Guevara-Cruz 2012;HO 2007; Vuksan 2010;Nieman2009; 2012; studies areclinical trials, six arerandomized (Vuksan clusion criteria and wereselected fortheLRS. All the met thein blished betweentheyears2007and2013 the studiesincludedinourreview. Severarticles pu Description ofstudiesinsystematicreview seven studieswereincludedintheLRS. Upon analyzingtheinclusionandexclusioncriteria, in selecting the studieswereresolvedbyconsensus. ly of each other. Divergences between the reviewers tract, which wereread by tworeviewers independent from Scopus,and25 Web ofScience. Pubmed, sixfromCochrane library, 17fromScielo, 41 cles, ofwhich13references were fromLilags, 98 from selecting the studies. The search turned up 200arti Study selection Findings (Table statistics, outcomes ofinterest, and principal findings. pathological); exposure\duration; diet\medications; population (sex\age); population profile(metabolic\ was administered and dose; design\follow-up; study were: authorandyearofpublication; howchiaseed Data extraction and EPA concentrations. pressure (SBP, DBP),inflammatory markers, and ALA blood sugar, body mass, systolic and diastolic blood low-density lipoprotein (LDL-c), triglycerides (TG), The amountofthechiaseedusedindifferent Table We made our initial selection based on title and abs Figure The data we extracted from the articles in ourLRS

II).

II highlightstheprincipalcharacteristics of

1 is a flowchart that describes the process of Nutr Hosp.2015;32(5):1909-1918 ------cles assessed. selection. Graph 1showsthe bias riskforall the arti to theauthorsregardingeach of thearticles in thisLRS ly. Chart3showsthesummarized biasriskaccording design, datacollection and analysisweredonecorrect study to be valid one needs to determine whether the was executed properly, that is, without bias. For a ror-assessment toolaimstodetermine whether astudy Cochrane Collaborationbiasassessment at post-prandialbloodsugar. ALA orEPA (Vuksan 2012, Jin (Vuksan the increase in ALA andEPA seen with chia ingestion pid profile (Chart 2),therewasconsensusinregardto position, inflammatory markers, blood sugar, andli not significant for suchdata as bodymass,com studies varied. Although mostoftheoutcomeswere in relationtochiaseedconsumption. sought toassessonlypost-prandial blood sugarlevels outcomes. The acutetrials(Vuksan 2010;Ho2013) participants, did notobtain results significant for said and didmaintain thedietaryprofileofindividual ker (Vuksan relating to CVDrisk,suchasSBP, inflammation mar The findings fromthese are significant for outcomes tion (Vuksan ght (Nieman et al. ns ofdisease,all of them being either healthy (Vuksan rest ofthestudiesselected individuals showingnosig metabolic syndrome (Guevara-Cruz betes (Vuksan well, withonestudyinvolvingpeopletype2dia ing approximately10weeks. 2009). Study duration varied as well, the average be individuals (Jin 2012), andthelargest 76(Nieman deal, with thesmallest sample group composedof10 of age.Sample size was afactor that varied a great Ho 2013). tion with lowered blood sugar levels(Vuksan 2010; the mostpositiveresults,asthesefoundanassocia san 2007;Nieman2012;Jin2012)wasusedobtained diluted inwater. The studieswheremilledchia(Vuk the chia,alongwithpalm,oatsandsoyprotein,were (Nieman 2009).InGuevara-Cruz 2007; Vuksan 2010;Ho2013)ordilutedinwater man studies that did notinvolve dietary intervention (Nie (CRP) (Guevara-Cruz rence, body composition, TG andC-reactive protein Cochrane Collaboration’s bias-orsystematic er The CVD-riskoutcomes of interest assessedinthe Only twoofthe studies involved dietary interven The studypopulations’ metabolic profiles variedas Study-participant age variesfrom18to79years 2010;Jin et al. et al. et al. 2009; Nieman et al. et al. 2007,Nieman et al. 2012). The acutestudiesdidnotlookat et al. et al. 2009;Nieman 2007), body mass, waist circumfe 2007;Guevara-Cruz 2012;Ho 2007),andanother dealing with et al. et al. et al. 2010,Ho 2012;Jin et al. et al. 2012; Jin et al. 2009,Nieman et al. 2013)oroverwei et al. et al. et al. 2012). ’s 2012study, et al. 2013);only 2012). The et al. 2012). The 2012). 2012) et al. 1915 ------

17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1916 1916 Key: effect on cardiovascular risk factors, excess bodymass sumption, bothbyanimalsandhumans,lookedatthe Discussion to havealowriskofbias. the study. Inthisrespect the otherstudieswerefound were reported,whichmaycompromise the quality of because in these studies not all the primary outcomes al. the results described in both the studies by Nieman this riskseemsinflated. at were of unclear risk of bias for lack of information, (de Carvalho2013). As mostofthe studies welooked sions that systematically tend to depart from the truth tion, publication orreview of data, leading to conclu represents aflawinthecollection, analysis,interpreta tained. It must be stressed that bias or systematic error that therewasnoreportastohowtheblindingob in thestudies(Fig. neous percentage between low and unclear risk of bias and outcome evaluators, there was a more homoge mize theriskofbias. been anycriteria forrandomization that would mini refore, we wereunable to ascertainwhether there had data as tohowtherandomization was conducted. The sessed tohaveanunclearriskofbiasfornotproviding have included randomization, most ofthem were as relationship betweentwoevents(deCarvalho2013). bability of error and thus shed light on a cause-effect to produce direct scientific evidence with a low pro among allclinicalas theyareable researchmethods, zed clinical trials, widelyregardedasthegoldstandard Ho 2013 Guevar 2012 Jin 2012 Nieman 2012 Nieman 2009 Vuksan 2010 Vuksan 2007 Most of thestudiesinvestigating chia seedcon Most In regardtothereportingofselective outcomes, As far as blinding of study participants, personnel Though almost all the studiesselected are saidto Six ofthearticles included (2009and2012)showedhighriskofbias. This is Articles

? unclear risk - highrisk + low risk Summary ofriskbias.Reviewjudgmentbyauthorsoneachbias-riskitemforstudyinselection Other sources of bias

1). Onereasonforthisisthefact + + ? ? ? ? ? Nutr Hosp.2015;32(5):1909-1918 ( Table Selective reported outcome + ? ? ? ? ? ?

II ) arerandomi Incomplete outcome + + + ? ? ? ? et Table III ------Researcher their study(76individualsofbothsexes),butse had onthestudyoutcomes. account the positive effect the nutritional intervention However, itwasoneofthefewstudiesthat took into ficant difference found inlipidprofileorbodymass. ditions may have affected the results, with no signi having individuals insuchdistinct physiological con from teenage to oldage(1875yearsold).Hence, small (20individuals)andtheparticipants’ agesvaried sure andinflammatory markers) thesample size was the fewwithsignificant findings (loweredbloodpres rent studies. le-seed, baked inbread—weredifferent in the diffe quantities and forms ofchiaseed—ie,milled, who created a discrepancy in thefindings.Furthermore, the the individuals in the sample group, whichmay have a greatdealinbothsamplesizeandtheprofilesof positive effect on health. However, these studies vary research points totheconsumptionofchia having a quercetin andkaempeferolacids)(Norlaily2012). and potassium)antioxidants (chlorogenic, caffeic, ALA, fiber, proteins, minerals (calcium, magnesium rest inthisseedarose,mainly, duetoitshighlevelsof and serumconcentrations of ALA andEPA. The inte per day. They noted a significant increase in serum smokers andwhoconsumed25gofmilled chia seed were healthy, post-menopausal (49-79 yearsold),non- rences between individuals, selected 56 womenwho inflammatory markers. plasma lipoprotein concentrations, blood pressureor fference in reduction of body mass or composition, amount ofchia(50g). There wasnosignificant di seed diluted in water, and their study had the largest and seniorcitizens (20-70yearsold);theyusedchia lection also hadabroadagerange,withbothadults blinding

Nieman In Viksan Although not common in studies on humans, some Nieman + + + ? ? ? ? et al. et al. et al. Participant blinding (2009)had the largest sample size in (2012),soastominimize the diffe ’s 2007study, although it was oneof + + + + + ? ? Cynthia de Souza Ferreira et al. concealment Allocation + + + + + - - generation sequence Random- + + ? ? ? ? ? ------17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1917 cardiovascular risk factors in humans Effects ofchia consumption on the researchconsistsintwoauthors, independently of we selected, the strength of thisLRSisthe fact that is concerned. consuming chia to prevent/control cardiovascular risk producing inconclusive results where the efficacy of dies on human chia consumption was compromised, the study. Hence the quality of methodology in the stu and oftenthedescriptionofoutcomesproffered in sign, howtherandomization and blindingwasdone, Mainly for the omission ofdetails regarding study de respect, according to CochraneCollaboration’s tool. fatty acids(Ayerza 2007). centrations and a spike in HDL and polyunsaturated seed, asignificant drop wasfoundin TG andLDL con Chicco 2008). Inanother study onratsingesting chia lipid concentrations or bloodpressure(Poudyal2012, liver inflammation. No changewasfoundinplasma and areduction in visceral fat, fatty liver and heart and improved insulinsensitivity and glucosetolerance, carbohydrates overaneight-week period. They noted terations in ratssubjected to adiet heavy infat and attenuated metabolic, cardiovascular and hepatic al waist circumference, TG, CRP andinsulinresistance. monstrated asignificant decrease inbodymass,BMI, of water inconjunction with adietary intervention, de ture of palm, oats and soypowderdiluted in 250mL by Guevara-Cruz serum ALA and EPA concentrations. Now, the study ven-week period,andfoundasignificant increase in women using25gofmilled chia perdayoverase blood sugar. vels. Both studies demonstrated chia seed to lower chia to investigate only post-prandial blood sugar le 13 respectively, andusedmilled and/or whole-seed (2013) involvedasmall number ofindividuals, 11 and but nochangewasfoundintheotherstudyparameters. ALA andEPA levelsinthegroupgivenmilled chia, In spiteofthemanyshortcomingsstudies All the studies showacertain risk ofbiasinsome In experimental studies, chia seed supplementation Jin The acutetrialsof Vuksan Blinding ofoutcomeassessors et al. Random sequencegeneration Reports ofselectiveoutcome Blinding ofparticipantsand Allocation concealment (2012)assessed 10 post-menopausal Incomplete outcomes Other sourcesofbias et al. (2012),wheretheyusedamix et al. 0% (2010)andHo 20% 40% Nutr Hosp.2015;32(5):1909-1918 60% et al. ------

80% Conclusion comings identifiedintheselectedstudies. tradictory, probably due to the methodological short included inthereview. However, thefindingsarecon publications relating to the subject were identified and This means there is a good likelihood that the all the each other, thoroughly searched six distinct databases. References help inthebibliographicsearch. Acknowledgements terest. Conflict ofinterest order toobtainresultsthataremorereliable. zed, double-blind, placebo-controlled clinical trials in clusive results. We underscoretheneedforrandomi of chiaseedhasoncardiovascular risk presentincon 3. 1. 2. 100% The authors thank the Eliana Rosa library for their The authorsdeclarethatthereisnoconflictofin The studiesinvestigating the effect theconsumption

Science and meat fatty acid composition. ce oflinolenic n-3fatty acid sources ongrowth,performance JR, Coates W. Omega 3enriched broiler meat: The influen Azeona JO,Schang M.J,Garcia PT, Gallinger C, Ayerza R Annals of Nutrition andMetabolism oil onlipid content andfatty acid composition ofrat plasma acid derived from chia whenfed as groundseed, whole seed and Ayerza RJR,Coates W. Effect ofdietary alpha-linolenic fatty Poultry Science dark meats, growth performance and sensory characteristics. fatty acid composition, cholesterol and fat content of white and L Ayerza R,Coates W, Lauria M.Chia seed ( ) as anômega-3 fatty acid source forbroilers: influence on , v.88, p.257-269,2008. High risk Unclear risk Low risk , v.81, p.826-837,2002. bias instudiesassessed. Fig. 2.—Frequency ofrisk Canadian Journal of Animal , v.51(1), p.27-34,2007. Salvia hispanica 1917 ------. 17/10/15 7:16 PDF DE CLIENTE CHEQUEADO POR 006_9394 Effect ofchiaseed.indd 1918 1918 10. 14. 13. 12. 15. 11. 5. 4. 6. 9. 8. 7.

Caudillo ty Journal seeds asafoodingredient. of “Chia seeds ( Bresson JL,Flynn A, Heinonen M Chicco mistry sent in Mexican chia ( content and antioxidant activity ofphenolic compounds pre Guevara-Cruz M, TovarGuevara-Cruz p. 38-44,2013. laboração Cochrane. viés de ensaios clínicos randomizados pela ferramenta deco De Carvalho David ArmstrongCompany Advisory committee fornovel foodsandprocesses. nica L. Craig R. Application forapproval ofwhole chia ( mal Science performance, and meat sensorycharacteristics. composition andfat stability ofthe meat and internal fat, growth ga-3 fatty acid source for finishing pigs: effects on fatty acid Coates W, Ayerza R.Chia ( Journal of Nutrition, cerolaemia and insulin resistance in dyslipaemic rats lenic acid improves adiposity and normaliseshypertriacylgly with soybean, chia, linseed, and folic acid asa functional food Justo MB, Alfaro AD, Aguilar E.C. Integral bread development v.67(2), p.105-10,2012. postmenopausal women tation ofmilled chia seeds increases plasma ALA and EPA in Jin F, Nieman cal Nutrition, zed controlled, dose-responsetrial L. V. Effect ofwhole and groundSalba seeds ( Ho H,Lee tion; 2011. Disponívelem: http://www.cochrane-handbook.org. views ofinterventions. Version 5.1.0. The Cochrane Collabora Higgins JPT, Green S.Cochrane handbook forsystematic re v.142(1), p.64-69,2012. in patients with metabolic syndrome. and oat reduces serum triglycerides and glucose intolerance N. A dietary pattern including nopal, chia seed, soyprotein, daz-Nava G,Canizales-Quinteros S,Guillen Pineda rai, Gil-Zenteno L,Hernández-Viveros I,López-Romero P, Or tritional Sciences University of Toronto with the requirements for the degree of Master’s ofScience Nu glicemia eapetitesubjetivo. Lee Amy Sanda.OsEfeitos da Salvia hispanica L (Salba) na p. 78-84,2007. for women. YB ) onpostprandial glycemia inhealthy volunteers: arandomi . Dietary chia seed ( , v.107, p.656-663,2008. ) seed andgroundwhole chia asnovel foodingredients. AG ER , v.996, p.1-26,2009. AS , D’Alessandro . v.87(11), p.3798-3804,2009. Archivos Latino Americanos de Nutrición , Tecante A, Valdivia-LopezM APV v.67(7), p.786-788,2013. , Jovanovski E,Jenkins DC Salvia hispanica L , Silva V, Grande AJ. Avaliação dorisco de , Sha W, Xie G,Qiu Y, Jia W. Supplemen v.101(1), p.41-50,2009. Revista Diagnóstico eTratamento Salvia hispanica L Salvia hispanica L. . Plant Foods for HumanNutrition. AR The European FoodSafety Authori ME Salvia hispanica L , p.1-29,2004. , Aguilar-Salinas Nutr Hosp.2015;32(5):1909-1918 A thesis submitted in conformity , Hein . European Journal of Clini et al. ) and ground whole Chia GJ AL , 2009. , Oliva Opinion onthe safety Journal ofNutrition , Desouza R, Vuksan .) seeds. ) rich inalpha-lino .A Salvia Hispanica ) seed as anôme CA ME Journal of Ani Journal . Dietary fibre , Medina-Ve Salvia hispa- , Lombardo Food Che LE Ireland: , v.57(1), . British , Torres , v.18, ------, 23. 22. 19. 27. 25. 24. 21. 20. 26. 18. 17. 16.

hispanica Ulbricht C,Chao W, Nummy K,Rusie E, Colucci ra de Hipertensão Diretrizes Brasileiras deHipertensão Arterial. sileira de Cardiologia, Sociedade Brasileira de Nefrologia. VI Sociedade Brasileira de Hipertensão Arterial, Sociedade Bra v.377(9781), p.1949-1961,2011. ble diseases inBrazil: burden and current challenges nely Nieman v.29(6), p.414-418,2009. disease risk factors in overweight adults. ty in February 2014. vascular-health/cardiovascular-disease-risk-factors/ Accessed Disponível em: http://www.world-heart-federation.org/cardio World Heart Federation em: 12/ JUL./ 2014. who.int/mediacentre/factsheets/fs317/en/index.html. Acesso Vuksan V,Sievenpiper D, Whitman ca L. mical properties ofafibrous fraction from chia ( Vázquez OA,Rosado RR,Chel GL,Betancur AF. Physioche p. 168-174, 2009. search Collaboration. Schmidt mistry tion in diet-induced obeserats royl-CoA desaturase-1 and induces cardiac andhepatic protec redistribution by Poudyal H,Panchal dicine investigation. and disease riskfactors in overweight women: a metabolomics (CVDs). World Health Organization - WHO. 2809, 2007. Factors in Type 2Diabetes. nica L. ventional Therapy With the Novel Grain Salba ( Nieman D. medicine andBiotechnology, promising future ofchia, YeapN, Mohd Ali 2009). velemhttp://dx.doi.org/10.1136/bmj.b2700 (Published 21July explanation and elaboration. meta-analyses ofstudies that evaluate healthcare interventions: The PRISMA statement forreporting systematic reviews and Liberati A,Altman CM AM AL SR , Bazinet , Plammoottil , Monteiro RA ). , Jin F. Chia seed does notpromote weight lossoralter , v.18 (7),p.700-708,2012. , v.23(2), p.153-62,2012. FoodScience Technology ) ImprovesMajor and Emerging Cardiovascular Risk , OreB,SuM,Schwartz S.Chia seed supplementation DC FactSheet ): A Systematic Review bythe Natural Standard Re MI C , Gillitt N,Jin F, Henson , Cayea E. , Duncan RP Journal of Alternative andComplementary Me , Vidgen E, Amir H.Supplementation ofCon CA α , v.17(1), p.1-64,2010. JB SK -linolenic acid-rich chia seed inhibits stea nº317; 2013.Disponível em: http://www. , Barreto SM. Chronic non-communica DG SK , Varghese,M, Weissner W.( Chia Review onRecent Clinical Trials , Ho J , Waanders J, Ward L, BrownL.Lipid . Cardiovascular disease.Riskfactors BB , Tetzlaff J,Mulrow C,G!Ptzschepc. , Austin M. , Austin Salvia hispanica L.Journal ofBio WY Cynthia de Souza Ferreira et al. , Azevedo E, Silva G, Menezes Diabetes Care British Medical Journal v.2012, Article ID171956,2012. . , Beh

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