The Effect of Honey Intake on Lipid Risk Factors: a Systematic Review and Meta‐Analysis of Controlled Trials
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ObjectiveExcessive fructose intake has an adverse effect on established lipid risk factors when added to existing diets. It is not known whether honey, a naturally occurring fructose‐containing sugar, exerts a different effect on lipid risk factors. We undertook a systematic review and meta‐analysis of controlled trials to assess the effects of honey intake on lipid risk factors.MethodsMEDLINE, EMBASE and the Cochrane Library were searched through September 27, 2016 for controlled trials with follow‐up of ≥7 days, which investigated the effect of oral honey intake compared to a sugar equivalent (or usual diet) on lipid outcomes including LDL‐Cholesterol (LDL‐C), HDL‐C and fasting triglycerides in participants from all health backgrounds (normal, overweight‐obese, high cholesterol, pre‐diabetes, diabetes). Two reviewers independently extracted relevant data. Data were pooled using inverse variance random effects model and expressed as mean difference (MD) with 95% Confidence Intervals (CI). Inter‐study heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The overall quality of the evidence was assessed using the Grading of recommendations assessment, development, and evaluation (GRADE).ResultsEligibility criteria were met by 10 trials (n=444, median length=5 weeks) with an average honey dose of 70 grams/day (range 40–100 grams/day). Only 3 trials used monofloral honey. Regular honey intake reduced LDL‐C (n=9; MD −0.29 mmol/L [95% CIs, −0.52, −0.05]; P=0.02), fasting triglycerides (n=10; MD −0.29 mmol/L [95% CIs, −0.35, −0.22]; P<0.001), and increased HDL‐C (n=9; MD 0.08 mmol/L [95% CIs, 0.05, 0.11]; P<0.001). There was evidence of substantial inter‐study heterogeneity for LDL‐C (I2=92.5%, p<0.001), and non‐significant heterogeneity for fasting triglycerides and HDL‐C (P>0.10 for both). The overall quality of the evidence was graded as “low quality” for LDL‐C owing to downgrades for serious inconsistency and serious imprecision, “moderate quality” for fasting triglycerides owing to downgrade for strongly suspected publication bias, and of “moderate‐quality” for HDL‐C owing to downgrade for serious imprecision.ConclusionPooled analyses show a beneficial effect of honey intake on lipid risk factors including LDL‐C, triglycerides, and HDL‐C in people from all health backgrounds. There is a need for larger, longer and higher quality trials, as our confidence in the results is low.Registered at PROSPERO 2015=CRD42015023580Support or Funding InformationCanadian Diabetes Association, PSI Foundation, Banting and Best Diabetes Centre, and Bee Maid Honey Ltd (unrestricted travel donation).
