State of the science/evidence base for integrative modalities
Secondary Topic: Integrative medicine delivery models
Tertiary Topic: Research Methodology
Randomized Controlled Trials Investigating the Association between Dietary Pattern and High-sensitivity C-reactive Protein: A Systematic Review
Late Breaker: Yes
Context. Elevated serum concentration of high-sensitivity C-reactive protein (hsCRP), a biomarker of systemic inflammation, is associated with increased risk for coronary heart disease (CHD) and cardiovascular events (CVE). Evaluation of non-pharmaceutical methods for lowering hsCRP has not been emphasized in the literature due to the efficacy of pharmacological methods (i.e., statin drugs) in reducing hsCRP as well as the historically low adherence to intensive lifestyle modification. Alternatives to statins to lower serum hsCRP, including dietary modification, merit investigation.
Objective. To systematically review clinical trials focused on dietary interventions and hsCRP.
Methods. National Library of Medicine (i.e., MEDLINE) and Google Scholar® searches were performed utilizing the search terms “C-reactive protein,” “CRP,” “dietary pattern,” and/or “diet” from January 2000 to October 2017. Identified abstracts were reviewed and cross-referenced for relevance to dietary pattern. Full text manuscripts were then abstracted for their principal findings. An assessment of risk of bias for each study incldued in the review was performed according to Cochrane Review guidelines.
Discussion of the current review would be appropriate in a poster or presentation format.
Results. Fifty-six manuscripts met inclusion criteria for detailed review. The value of modifications to dietary pattern for hsCRP reduction has been investigated in many populations, including those at risk for CHD, type 2 diabetes, and other chronic disease. Collectively, results suggest that the adoption of several dietary patterns may lead to clinically significant reductions in hsCRP in both healthy and diseased populations. These patterns include low fat, Mediterranean, Portfolio, Paleolithic, and the Dietary Approaches to Stop Hypertension (DASH) diets. Other interventions, e.g., low carbohydrate diets, have had mixed results.
Conclusion. Clinical trials of dietary interventions to lower hsCRP are mixed in terms of quality, risk of bias, and findings. Despite the variability of results, randomized clinical trials to assess dietary interventions for lowering hsCRP are justified and valuable.