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Heart failure (HF) is associated with multi-organ dysfunction and significant morbidity and mortality. Despite advances in treatment, prognosis remains poor, highlighting the need to explore adjunctive therapies such as integrative medicine. This umbrella review synthesises top-tier evidence from systematic reviews and meta-analyses of randomised controlled trials (RCTs) assessing the safety and effectiveness of integrative medicine in patients with HF, in order to inform clinical decision-making. We searched MEDLINE, Cochrane, PsycINFO and EMBASE until April 2024. Primary outcomes included mortality, hospitalisation rates, and severity or prognostic indicators, including brain natriuretic peptide (BNP) and exercise capacity. A hierarchical evidence synthesis method was used whereby we included the most recent, highly ranked and comprehensive reviews for our research question. We assessed review quality using ‘A MeaSurement Tool to Assess systematic Reviews’ and, where possible, evidence certainty for our primary outcomes using the Grading of Recommendations Assessment, Development and Evaluation approach. Twenty-two reviews were included. Co-enzyme Q10 or Tai Chi may reduce mortality and hospitalisation rates (moderate certainty evidence), and acupuncture or intravenous Chinese herbal medicines may improve BNP (low to very low certainty evidence). The benefits of yoga and other nutrient supplements including L-carnitine remain unclear. Vitamin E may increase hospitalisation rates and should be avoided. The evidence for most integrative medicine modalities for adjunctive management of HF remains limited. Well-designed and rigorous RCTs are needed, particularly with long-term follow up and evaluation of clinically meaningful outcomes. •This review synthesised top-tier evidence on integrative medicine for heart failure.•Co-enzyme Q10 or Tai Chi may reduce mortality and hospitalisation rates.•Acupuncture or intravenous Chinese herbal medicines may improve biomarkers.•Vitamin E should be avoided due to potential for increased risk for hospitalisation.•Certainty of evidence was low to very low in general.

Cancer survivors experience a range of side effects during and after treatment. There is a need for a rigorous synthesis of the most recent and best available evidence on the role of nutritional supplements for supportive care in cancer, to inform shared decision-making. We searched 5 databases for umbrella reviews, meta-analyses and systematic reviews on nutritional supplements for supportive cancer care, excluding studies on pain, anxiety and depression, which are covered in recent guidelines. We found 52 reviews that reported on 250 RCTs on 18 supplements for 16 indications. Almost all reviews were of low/critically low quality (assessed using A MeaSurement Tool to Assess systematic Reviews version 2). There was moderate-certainty evidence for benefit from the following supplements: amino acids and oral proteolytic enzymes for severity of radiation-induced dermatitis, N-acetyl cysteine for prevention of chemotherapy-induced peripheral neuropathy (CIPN) in individuals with gastrointestinal cancers. There was low to very low certainty evidence that glutamine, zinc, probiotics and melatonin may be effective for oral mucositis; Vitamin E, omega-3 fatty acids, glutamine and other amino acids may be effective for preventing CIPN. Serious adverse events were reported for high-dose Vitamin A, and dose-related adverse events were reported with zinc and Vitamin E. However, the majority of nutritional supplements were associated with only minor adverse events. Due to the low to very low certainty of the majority of evidence, firm clinical recommendations cannot be made. Further research to conclusively evaluate benefit and harm, including potential impact on efficacy of standard treatments, should be conducted.

Background Women with polycystic ovary syndrome (PCOS) use Ayurveda and yoga to manage the symptoms, including excess weight. However, heterogeneity in the components of clinical trials limits the quality of current evidence in this area. This Delphi study aimed to address these issues of heterogeneity by developing a list of recommendations of key components for the design of a combined Ayurvedic diet and yoga therapy (AY) program for weight management in PCOS. Methods Two rounds of an online Delphi method were used to establish consensus from qualified and experienced Ayurveda and yoga experts. Round one presented a mix of multiple-choice and open-ended questions, allowing experts to individually identify components they considered key to the design of AY interventions. Items that did not reach consensus (≤ 80%) and new items suggested by the experts in the first round were analysed and presented for agreement in round 2. Any statement demonstrating ≥ 75% agreement was determined to have reached a consensus in the second round. Results 17 experts completed the first round, and 16 completed the second round of this Delphi study. There was a strong consensus that a combined AY intervention would be more effective than Ayurveda diet or yoga alone for weight-related outcomes. The experts reached a consensus on the parameters of the intervention (dosage and setting), provider qualification and training, approach, and components to be included in an AY program. Conclusions This study represents the first step in developing a consensus-based AY program for lifestyle management of PCOS. Future studies are needed to confirm the feasibility and acceptability of this program.

Aim The global prevalence of diabetes is increasing rapidly. While glycaemic control remains the cornerstone of type 2 diabetes (T2DM) management, hypoglycaemic medications are associated with side effects. Many individuals with T2DM use herbal medicines despite potential risks. This review aims to comprehensively evaluate the efficacy and safety of herbal medicines for T2DM. Methods Four electronic databases were searched from August 2018-August 2023 for umbrella reviews, meta-analyses, and systematic reviews on herbal medicine for T2DM. The primary outcome was glycaemic control assessed by glycated haemoglobin (HbA1c); secondary outcomes included measures of insulin resistance, quality of life and adverse events. Quality assessment was performed using A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2) and certainty of evidence for the primary outcome was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results Eight meta-analyses and two systematic reviews were included. Ginger, turmeric, and Jinlida granules significantly decreased HbA1c compared to placebo (mean differences (MD): -0.467%, -0.486%, -0.283%, respectively) with moderate to high certainty evidence. Berberis vulgaris , Gegen Qinlian decoction and pycnogenol may potentially decrease HbA1c (very low certainty evidence). Ginger, turmeric, cardamom, Berberis vulgaris , Nigella sativa , and various Chinese herbal medicines demonstrated improvements in insulin resistance measures. However, overall confidence in these findings is limited due to the low to very low quality of the included reviews. Few mild adverse effects were reported, but data was incomplete. Conclusions Current evidence supports the use of ginger and turmeric for glycaemic control in type 2 diabetes, however, given the high clinical heterogeneity and low quality of the review, our confidence in this finding is somewhat limited. Herbal medicines should be used only as an adjunct to conventional treatment, with shared decision-making between clinicians and patients. Careful monitoring for hypoglycaemia is essential, particularly when herbal medicines are used concurrently with antidiabetic drugs, given a current lack of data on herb-drug interactions. Future research should clarify optimal regimens, safety profiles, and include diverse populations to enhance generalisability.

An umbrella review was conducted to provide a comprehensive evaluation of the evidence on lifestyle medicine and integrative therapies for inflammatory arthritis. Five electronic databases were searched for umbrella reviews, meta-analyses, and systematic reviews of randomised controlled trials on acupuncture, diet, exercise, herbal medicine, nutrient supplements, and mind-body therapies for rheumatoid arthritis, spondyloarthritis, and gout published from January 2012 to December 2022. The primary outcomes were functional status and quality of life. Quality assessment was performed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool, and the certainty of evidence for our primary outcomes was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach where possible. We included 52 reviews. Exercise was beneficial for functional status in both rheumatoid arthritis and spondyloarthritis, with moderate certainty of evidence. Chinese herbal medicine in combination with disease-modifying anti-rheumatic drugs may improve functional status in rheumatoid arthritis (very low certainty evidence). Acupuncture may improve functional status in rheumatoid arthritis and pain in both rheumatoid arthritis and gout; however, the evidence is of very low certainty. Evidence for other therapies was not clinically significant; however, it suggests possible benefits from quercetin and polyunsaturated fatty acids. Yoga may result in a moderate improvement in functional status when used as an adjunct to medication; however, the certainty of evidence is very low. Diet interventions offered inconsistent improvements to functional status in rheumatoid arthritis, spondyloarthritis, and gout with low to very low certainty. Exercise should be prescribed for people with rheumatoid arthritis and spondyloarthritis. More research is needed to confirm or refute evidence for Chinese herbal medicine, acupuncture, yoga, and anti-inflammatory diets.

Diminished ovarian reserve (DOR) is defined as the reduced number of oocytes in the ovary. Loss of oocytes as women age is a normal transition towards natural menopause; however, the number of antral follicles present in young women and the rate of oocyte loss over reproductive life can vary, with some women having significantly fewer oocytes as early as age 30 years. In young women with DOR, the proportion of high quality oocytes is higher than in older women with DOR but lower than in young women with normal ovarian reserve. Risk factors for DOR include smoking, a history of unexplained infertility, a family history of premature menopause and previous chemotherapy or radiotherapy. Implications of DOR include both reproductive and physical risk factors. For example, DOR is associated with an early menopause, and increased risks of osteoporosis, cardiovascular disease and distress, especially due to permanent infertility and unexpected changes of personal identity. In addition, because many couples delay their child-bearing years until a later stage of their reproductive life, DOR leading to early menopause can directly affect women's reproductive potential. Furthermore, DOR is associated with a poor ovarian response in stimulation cycles of assisted reproductive technology (ART), and the quality of oocytes and health of pregnancies and babies remains controversial. There are no medical treatments to directly increase ovarian oocyte quality, count, nor delay diminishing ovarian reserve. Instead, ART treatments focus on the use of procedures such as IVF and ICSI, egg freezing and donation. Studies have shown that dietary patterns may influence the age of natural menopause. Reduced dietary intake of fruit and carotenoids for example was a significant predictor of earlier onset of natural menopause and, as such, diet and other naturopathic interventions should also be considered as possible contributing factors in managing DOR. In addition, in Australia, women attempting to conceive are significantly more likely to seek complementary medicine (CM) including acupuncture and naturopathy compared to women who are not. As such, this article explores the case for research into the efficacy of naturopathy for treatment of women with DOR.

Background/ObjectivesA systematic review with meta-analysis was conducted to synthesise evidence on the efficacy of dietary supplements containing isolated organic compounds for weight loss.Subjects/MethodsFour electronic databases (Medline, Embase, Web of Science, Cinahl) were searched until December 2019. Sixty-seven randomised placebo-controlled trials of dietary supplements containing isolated organic compounds for weight loss were included. Meta-analyses were conducted for chitosan, glucomannan, conjugated linoleic acid and fructans, comparing mean weight difference post-intervention between participants receiving the dietary supplement or placebo.ResultsStatistically significant weight differences compared to placebo were observed for chitosan (−1.84 kg; 95% confidence interval [CI] −2.79, −0.88; p < 0.01), glucomannan (−1.27 kg; 95%CI −2.45, −0.09; p = 0.04), and conjugated linoleic acid (−1.08 kg; 95%CI −1.61, −0.55; p < 0.01). None met our threshold for clinical significance (≥2.5 kg). There was no statistically significant effect on weight for fructans compared to placebo (p = 0.24). For dietary supplements with an inadequate number of trials for meta-analysis, a statistically and borderline clinically significant weight difference compared to placebo was found for modified cellulose, manno-oligosaccharides (in males), blood orange juice extract, and three multiple-ingredient dietary supplements. These were only reported in one trial of each. Thus, more evidence is needed before recommending them for weight loss.ConclusionsWhile some dietary supplements containing isolated organic compounds warrant further investigation to determine efficacy and safety, there is currently insufficient evidence to recommend any of these dietary supplements for weight loss.

Abstract Context Insulin resistance is common in women with polycystic ovary syndrome (PCOS). Inositol may have insulin sensitizing effects; however, its efficacy in the management of PCOS remains indeterminate. Objective To inform the 2023 international evidence-based guidelines in PCOS, this systematic review and meta-analysis evaluated the efficacy of inositol, alone or in combination with other therapies, in the management of PCOS. Data Sources Medline, PsycInfo, EMBASE, All EBM, and CINAHL from inception until August 2022. Study Selection Thirty trials (n = 2230; 1093 intervention, 1137 control), with 19 pooled in meta-analyses were included. Data Extraction Data were extracted for hormonal, metabolic, lipids, psychological, anthropometric, reproductive outcomes, and adverse effects by 1 reviewer, independently verified by a second. Data Synthesis Thirteen comparisons were assessed, with 3 in meta-analyses. Evidence suggests benefits for myo-inositol or D-chiro-inositol (DCI) for some metabolic measures and potential benefits from DCI for ovulation, but inositol may have no effect on other outcomes. Metformin may improve waist-hip ratio and hirsutism compared to inositol, but there is likely no difference for reproductive outcomes, and the evidence is very uncertain for body mass indexI. Myo-inositol likely causes fewer gastrointestinal adverse events compared with metformin; however, these are typically mild and self-limited. Conclusion The evidence supporting the use of inositol in the management of PCOS is limited and inconclusive. Clinicians and their patients should consider the uncertainty of the evidence together with individual values and preferences when engaging in shared decision-making regarding the use of inositol for PCOS.

Background and Objectives: Nutrient supplements are commonly used to improve fertility outcomes by women with infertility trying to conceive spontaneously or utilising medically assisted reproduction (MAR). However, despite their widespread use and perceived safety, there is a lack of clear guidance on the efficacy and safety of these supplements for female infertility. The aim of this umbrella review was to identify the best available and most recent evidence on the efficacy and safety of nutrient supplements for female infertility to provide evidence-based guidance for clinicians and reproductive couples. Methods: Five electronic databases were searched for umbrella reviews, meta-analyses, and systematic reviews of randomised controlled trials on nutrient supplements for female infertility, published from August 2017 to January 2024. The primary outcomes were live birth, and clinical and biochemical pregnancy rates. Secondary outcomes were adverse effects including miscarriage and ectopic or multiple pregnancy. Quality assessment was performed using the A MeaSurement Tool to Assess systematic Reviews Version 2.0 (AMSTAR 2), and the certainty of evidence for outcomes were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, where possible. Results: Four meta-analyses were included. Multiple micronutrients and antioxidants increased live birth rates in women utilising MAR and/or trying to conceive spontaneously compared to placebo, standard or no treatment (odds ratio (OR) 2.59 and 1.81 respectively) with very low certainty evidence. L-carnitine, coQ10, melatonin, myo-inositol, NAC and vitamin D increased clinical pregnancy rates in women with PCOS and/or undergoing MAR compared to placebo, standard or no treatment (odds ratio (OR) 11.14, 2.49, 1.66, relative risk (RR) 1.52, OR 2.15, and 1.49 respectively) with very low certainty evidence. Vitamin D did not increase biochemical pregnancy rates in women utilising MAR with very low certainty evidence. NAC, vitamin D, and pooled antioxidants had no effect on miscarriage rates or multiple pregnancy rates in women trying to conceive spontaneously or utilising MAR, with low to very low certainty evidence. Pooled antioxidants had no effect on ectopic pregnancy rates in women trying to conceive spontaneously or utilising MAR, with low certainty evidence. Conclusions: The available evidence is insufficient to recommend nutrient supplementation to improve female infertility in women trying to conceive naturally and those utilising MAR. However, there is currently no indication that these nutrients pose any risk of significant harm. Registration: PROSPERO (CRD42022365966) 20 October 2022.