Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: a systematic review and meta-analysis

Authors: CUSTODERO, CARLO - University Of Florida; MANKOWSKI, ROBERT - University Of Florida; LEE, STEPHANIE - University Of Florida; CHEN, ZHIGUO - University Of Florida; WU, SAMUEL SHANGWU - University Of Florida; MANINI, TODD - University Of Florida; HINCAPIE ECHEVERRI, JACOBO - University Of Florida; SABBA, CARLO - University Of Bari; BEAVERS, DANIEL - Wake Forest University; CAULEY, JANE - University Of Pittsburgh; ESPELAND, MARK - Wake Forest University; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KRITCHEVSKY, STEPHEN - Wake Forest University; LIU, CHRISTINE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; MCDERMOTT, MARY - Northwestern University; MILLER, MICHAEL - Wake Forest University; TRACY, RUSSELL - University Of Vermont; NEWMAN, ANNE - University Of Pittsburgh; AMBROSIUS, WALTER - Wake Forest University; PAHOR, MARCO - University Of Florida; ANTON, STEVE - University Of Florida

Submitted to: Ageing Research Reviews
Publication Type: Review Article
Publication Acceptance Date: 5/21/2018
Publication Date: 5/25/2018
Citation: Custodero, C., Mankowski, R.T., Lee, S.A., Chen, Z., Wu, S., Manini, T.M., Hincapie Echeverri, J., Sabba, C., Beavers, D.P., Cauley, J.A., Espeland, M.A., Fielding, R.A., Kritchevsky, S.B., Liu, C.K., Mcdermott, M.M., Miller, M.E., Tracy, R.P., Newman, A.B., Ambrosius, W.T., Pahor, M., Anton, S.D. 2018. Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: a systematic review and meta-analysis. Ageing Research Reviews. 46:42-59. https://doi.org/10.1016/j.arr.2018.05.004.
DOI: https://doi.org/10.1016/j.arr.2018.05.004

Interpretive Summary:

Technical Abstract: Growing evidence suggests chronic low-grade inflammation (LGI) as a possible mechanism underlying the aging process. Some biological and pharmaceutical compounds may reduce systemic inflammation and potentially avert functional decline occurring with aging. The aim of the present meta-analysis was to examine the association of pre-selected interventions on two established biomarkers of inflammation, interleukin-6 (IL-6), and C-reactive protein (CRP) in middle-age and older adults with chronic LGI. We reviewed the literature on potential anti-inflammatory compounds, selecting them based on safety, tolerability, acceptability, innovation, affordability, and evidence from randomized controlled trials. Six compounds met all five inclusion criteria for our systematic review and meta-analysis: angiotensin II receptor blockers (ARBs), metformin, omega-3, probiotics, resveratrol and vitamin D. We searched in MEDLINE, PubMed and EMBASE database until January 2017. A total of 49 articles fulfilled the selection criteria. Effect size of each study and pooled effect size for each compound were measured by the standardized mean difference. I2 was computed to measure heterogeneity of effects across studies. The following compounds showed a significant small to large effect in reducing IL-6 levels: probiotics (-0.68 pg/ml), ARBs (-0.37 pg/ml) and omega-3 (-0.19 pg/ml). For CRP, a significant small to medium effect was observed with probiotics (-0.43 mg/L), ARBs (-0.2 mg/L), omega-3 (-0.17 mg/L) and metformin (-0.16 mg/L). Resveratrol and vitamin D were not associated with any significant reductions in either biomarker. These results suggest that nutritional and pharmaceutical compounds can significantly reduce established biomarkers of systemic inflammation in middle-age and older adults. The findings should be interpreted with caution, however, due to the evidence of heterogeneity across the studies.