Chi-Hua Yen, 1,2,3 Shu-Ju Chen, 4 Jen-Tzu Liu, 5 Yu-Fen Tseng, 5 and Ping-Ting Lin 5,6. 1. Introduction

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1 BioMed Reserch Interntionl Volume 213, Article ID 89234, 8 pges Clinicl Study Effects of Wter Extrcts of Grptopetlum prguyense on Blood Pressure, Fsting Glucose, nd Lipid Profiles of Subjects with Metbolic Syndrome Chi-Hu Yen, 1,2,3 Shu-Ju Chen, 4 Jen-Tzu Liu, 5 Yu-Fen Tseng, 5 nd Ping-Ting Lin 5,6 1 Deprtment of Fmily nd Community Medicine, Chung Shn Medicl University Hospitl, Tichung 421, Tiwn 2 School of Medicine, Chung Shn Medicl University, Tichung 421, Tiwn 3 Center for Eduction nd Reserch on Geritrics nd Gerontology, Chung Shn Medicl University, Tichung 421, Tiwn 4 Deprtment of Helth Food, Chung Chou University of Science nd Technology, Chnghu 513, Tiwn 5 School of Nutrition, Chung Shn Medicl University, Tichung 421, Tiwn 6 Deprtment of Nutrition, Chung Shn Medicl University Hospitl, Tichung 421, Tiwn Correspondence should be ddressed to Ping-Ting Lin; pt81@csmu.edu.tw Received 16 September 213; Accepted 29 October 213 Acdemic Editor: Estebn Mrtinez Copyright 213 Chi-Hu Yen et l. This is n open ccess rticle distributed under the Cretive Commons Attribution License, which permits unrestricted use, distribution, nd reproduction in ny medium, provided the originl work is properly cited. This study ws imed to investigte the effects of wter extrcts of Grptopetlum prguyense (, 4 g/d) on blood pressure, blood glucose level, nd lipid profiles in subjects with metbolic syndrome (MS). Prticipnts with MS (n =54) were rndomly ssigned to the plcebo (n = 28) nd groups(n = 26), nd the intervention ws dministered for 12 weeks. Systolic blood pressure (SBP), distolic blood pressure (DBP), fsting glucose (FG), lipid profiles (totl cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), nd high density lipoprotein (HDL-C)), nd ntioxidnt enzymes ctivities (ctlse (CAT), superoxide dismutse (SOD), nd glutthione peroxidse (GPx)) were mesured. Forty-two subjects completed the study (plcebo, n=19;, n=23). FG, SBP, nd LDL-C levels were significntly lower nd HDL-C level nd ntioxidnt enzymes ctivities (CAT nd SOD) were significntly higher fter supplementtion. Blood pressure, FG, nd lipid profiles were significntly correlted with ntioxidnt enzymes ctivities fter supplementtion (P <.5). The present study demonstrted significnt reduction in blood pressure, blood glucose, nd lipid profiles nd n increse in ntioxidnt enzymes ctivities in subjects with MS fter supplementtion. Tken together, the ntioxidtive cpcity of might exert beneficil effect on MS. This tril is registered with CliniclTrils.gov NCT Introduction Metbolic syndrome (MS) represents collection of physiologicl nd nthropometric bnormlities [1] nd is recognized s significnt risk fctor for crdiovsculr disese nd type II dibetes [2]. The Ntionl Helth nd Nutrition Exmintion Surveys (NHANES) indicted tht more thn 3% of the dult popultion in the USA suffered from MS [3 5]. In Tiwn, reports from the Nutrition nd Helth Survey in Tiwn (NAHSIT) indicted tht the prevlence of MS in dults ( 18 y) ws 2% during nd incresed to 28.5% during [6]. The chrcteristics of MS, including insulin resistnce, type II dibetes, hypertension, dyslipidemi, nd viscerl obesity, my increse oxidtive stress [7 9] nd reduce ntioxidnt defenses [1 12]. Increses in oxidtive stress contribute to impired vsculr function, thrombosis, nd therosclerosis tht ultimtely result in vsculr disese [13]. Grptopetlum prguyense E. Wlther is populr trditionl Chinese herbl medicine tht belongs to the Crssulcee fmily. Severl biologicl ctivities of Grptopetlum prguyense hve been reported, including ntityrosine [14], rdicl-scvenging [15], ntihypertensive [16, 17], nd heptoprotective effects [18 2], in ddition to protection ginst brin injury in ischemic rts[21]. Most studies hve investigted the functions of Grptopetlum prguyense in cell

2 2 BioMed Reserch Interntionl or nimls models [14 21]. To our knowledge, Lin et l. [22] conducted the only clinicl study where subjects with hypercholesterolemi consumed Grptopetlum prguyense s serving of vegetble (1 g/d) for 8 weeks nd found significnt decrese in the level of oxidtive stress but no chnge in lipid profiles. These results my be becuse of the suboptiml Grptopetlum prguyense dosge nd short intervention durtion. Therefore, this study ws imed to exmine the effects of 12-week supplementtion with wter extrcts of Grptopetlum prguyense () on blood pressure, fsting glucose (FG), nd lipid profiles of subjects with MS. 2. Mterils nd Methods 2.1. Prticipnts. Individuls with MS were recruited from the Deprtment of Fmily nd Community Medicine t the Chung Shn Medicl University Hospitl in Tiwn. The inclusion criteri for MS in dults were bsed on the guidelines of the Administrtion of Helth Promotion, Ministry of Helth nd Welfre, Tiwn (27). Subjects were considered to hve MS if they hd three of the following five chrcteristics: (1) bdominl obesity (wist circumference 9 cm in men nd 8 cm in women), (2) impired FG ( 5.6 mmol/l), (3) hypertriglyceridemi (triglyceride (TG) 1.7 mmol/l), (4) low high density lipoprotein cholesterol (HDL-C) <1. mmol/l in men nd <1.3 mmol/l in women, nd (5) incresed blood pressure (systolic blood pressure (SBP) 13 mmhg nd distolic blood pressure (DBP) 85 mmhg). Subjects using ntidibetic, ntihypertensive, nd lipid-lowering medictions were considered to hve elevted FG, elevted blood pressure, nd dyslipidemi, respectively. The dignostic criteri for MS in Tiwn re in ccordnce with the Ntionl Cholesterol Eduction Progrm Adult Tretment Pnel III (ATP III, 21), Interntionl Dibetes Federtion (IDF, 25), nd the Americn Hert Assocition/Ntionl Hert, Lung, nd Blood Institute (AHA/NHLBI, 25) criteri [1, 23, 24]. Therefore, the dignostic criteri for MS in Tiwn re similr with these interntionl criteri. This study ws pproved by the Institutionl Review Bord of the Chung Shn Medicl Hospitl in Tiwn, nd the written informed consent ws obtined from ech subject. The tril ws registered t CliniclTrils.gov (no. NCT ) Administrtion of Wter Extrcts of Grptopetlum prguyense (). Fresh Grptopetlum prguyense E. Wlther ws purchsed from locl orgnic frm (TOPF24, Yunlin County, Tiwn). The dose (4 g/d) of the Grptopetlum prguyense dministered ws chosen ccording to the report by Lin et l. [22]. The wter extrction rte of Grptopetlum prguyense ws 4% [14], nd s result, 1 g of Grptopetlum prguyense provides 4 g. The sfety of the dose ws ssessed by Chung et l. [25], nd is considered sfe with no observed dverse effect level (NOAEL) of 1. g/kg body weight in rts, which is equivlent to dily dose of.16 g/kg of body weight in humns. The nd plcebo (strch) cpsules were prepred by the Gold Chi Fong Biotech Co., Ltd. (Tichung, Tiwn) Study Design. We conducted single-blind rndomized, prllel, plcebo-controlled study. The smpling nd tril schemes re summrized in Figure 1. Withsmplesize clcultion, we expected tht the chnge in the levels of ntioxidnt enzymes ctivities would be 5. ± 7. units/mg of protein fter the intervention; therefore, the desired power ws set t.8 to detect true effect nd t n α vlue equlto.5withminimlsmplesizeof18subjectsin ech intervention group. We enrolled 54 subjects with MS in this study tht were rndomly ssigned to the plcebo (n =28)or(n=26)group.Thefemlesubjectsinthis study were postmenopusl women who were not receiving hormone therpy. The intervention ws dministered for 12 weeks, nd the subjects were instructed to tke eight cpsules dily ( 4 g/d nd.5 g/cpsule). To monitor complince, the reserchers reminded subjects to check the cpsule bg every 4 weeks to confirm tht the bg ws empty. The ge; blood pressure; nd smoking, drinking, nd exercise hbits of ll subjects were recorded. Body weight nd height were mesured; the body mss index (kg/m 2 )wsthenclculted Biochemicl Mesurement. Fsting venous blood smples(15ml)werecollectedtoestimtethehemtologicl prmeters. Blood specimens were collected in vcutiner tubes without EDTA s n nticogulnt. Serum ws prepred nd then frozen ( 8 C) for storge until nlysis. The quntittive mesurements of FG nd blood lipid profiles [i.e., totl cholesterol (TC), triglyceride (TG), LDL-C, nd HDL- C] were mesured using n utomted biochemicl nlyzer (Hitchi-718E, Tokyo, Jpn). Red blood cells (RBCs) were diluted with 25x sodium phosphte buffer for superoxide dismutse (SOD) nd glutthione peroxidse (GPx) mesurements nd with 25x sodium phosphte buffer for ctlse (CAT) mesurement. The methods for mesuring CAT, SOD, nd GPx were previously described [26 28]. The protein content of plsm nd RBCs ws determined bsed on the biuret rection using BCA kit (Thermo, Rockford, IL, USA). The ntioxidnt enzymes ctivities were expressed s units/mg of protein. All nlyses were performed in duplicte Sttisticl Anlyses. The dt were nlyzed using SigmPlot softwre (version 12., Systt, Sn Jose, CA, USA). The normlity of the distribution of the vribles ws evluted using the Shpiro-Wilk test. Differences in subject demogrphics nd hemtologicl mesurements between the plcebo nd groups were nlyzed by Student s t-test or the Mnn-Whitney rnk sum test. The pired t-test or Wilcoxon signed rnk test ws used to nlyze the dt within ech group before (bseline) nd fter intervention (week 12). For ctegoricl response vribles, differences between the two groups were ssessed by the Chi-squre test or Fisher s exct test. To exmine the correltions of blood pressure, FG, lipid profiles, nd ntioxidnt enzymes ctivities fter supplementtion, the Person product moment correltion or Spermn rnk order correltion ws used. The dt re

3 BioMed Reserch Interntionl 3 Enrollment Assessed for eligibility Rndomized (n =54) Alloction Allocted to intervention - (n =28) Lost to followup (n =9) - Declined to prticipte Anlyzed (n =19) Followup Anlysis Allocted to intervention - (4 g/d, n=26) Lost to followup (n =3) - Declined to prticipte Anlyzed (n =23) Figure 1: CONSORT scheme. : wter extrcts of Grptopetlum prguyense. Tble 1: Subjects chrcteristics. (n =19) (n=23) P vlues Mle/femle (n) 12/7 14/9.88 Age (y) 56.2 ± 9.7 (57.) 5.8 ± 11.8 (52.).12 Wist circumference (cm) 1.2 ± 1.4 (1.) 98.5 ± 12.3 (96.).62 Wist hip rtio.9 ±.1 (.9).9 ±.1 (.9).87 Body mss index (kg/m 2 ) 29.4 ± 4.1 (29.1) 29.3 ± 4.7 (29.3).8 Current smoker 1, n (%) 3 (15.8%) 2 (8.7%).64 Consuming lcohol 2, n (%) 2 (1.5%) 2 (8.7%) 1. Exercise 3, n (%) 11 (57.9%) 14 (61.9%).9 Dt re given s men ± SD (medin). 1 Current smoker: individuls currently smoking one or more cigrettes per dy. 2 Consuming lcohol: individuls regulrly drinking one or more lcoholic beverges per dy. 3 Exercise: individuls exercising regulrly t lest three times every week. : wter extrcts of Grptopetlum prguyense. expressed s the mens ± stndrd devitions (SD). The results were considered sttisticlly significnt t P < Results 3.1. Chrcteristics of the Prticipnts. Forty-two subjects completed the study (plcebo, n=19;,n=23). Tble 1 presents the demogrphic dt nd helth chrcteristics of the subjects. There were no significnt differences between the two groups with respect to ge; nthropometric mesurements; nd the frequency of smoking, drinking, or exercise t bseline Blood Pressure, FG, nd Lipid Profiles fter Supplementtion. Blood pressure, FG, nd lipid profiles mesurements re presented in Figures 2 nd 3.ThelevelsofSBP(P<.1) ndldl-c(p =.6) were significntly decresed, while HDL-C ws significntly incresed (P =.1) fter supplementtion.thesubjectsinthegrouphd significntly lower SBP (P =.1), FG (P =.4), TC (P =.8), TG (P =.7), nd LDL-C (P =.4) levels nd higher HDL-C (P =.1) level thn those in the plcebo group t week Antioxidnt Enzymes Activities fter Supplementtion. The ntioxidnt enzymes ctivities re presented in Figure 4. ThectivitiesofCAT(P <.1) ndsod(p =.2) were significntly incresed fter supplementtion. The subjects in the group hd significntly higher CAT nd SOD ctivities thn those in the plcebo group t week 12 (P <.1) Correltions between Blood Pressure, FG, Lipid Profiles, nd Antioxidnt Enzymes Activities fter Supplementtion. The correltions between blood pressure, FG, lipid profiles, nd ntioxidnt enzymes ctivities fter 12 weeks of supplementtion re presented in Tble 2.After 12 weeks of supplementtion, the ntioxidnt enzymes ctivities were

4 4 BioMed Reserch Interntionl Tble 2: Correltions (r 1 ) between blood pressure, fsting glucose, lipid profiles, nd ntioxidnt enzymes ctivities fter 12 weeks of supplementtion. CAT (U/mg protein) SOD (U/mg protein) GPx (U/mg protein) Week 12 Δ12 2 Week 12 Δ12 Week 12 Δ12 SBP (mmhg) Week Δ DBP (mmhg) Week Δ FG (mmol/l) Week Δ TC (mmol/l) Week Δ TG (mmol/l) Week Δ LDL-C (mmol/l) Week Δ HDL-C (mmol/l) Week Δ Correltion coefficient. Δ12, chnges from week to week 12. P <.5. CAT: ctlse; FG: fsting glucose; GPx: glutthionine peroxidse; HDL-C: high density lipoprotein-cholesterol; LDL-C: low density lipoprotein-cholesterol; SOD: superoxide dismutse; TC: totl cholesterol; TG: triglyceride; : wter extrcts of Grptopetlum prguyense SBP (mmhg) 1 DBP (mmhg) 4 5 Figure 2: Blood pressure mesurements. Dt re mens ± SD. Week, Week 12. Vlues were significntly different fter intervention within the group, P <.5.,b Vlues with different superscripts were significntly different between two groups, P <.5. DBP:distolic blood pressure; SBP: systolic blood pressure; : wter extrcts of Grptopetlum prguyense.

5 BioMed Reserch Interntionl FG (mmol/l) 5 b TC (mmol/l) TG (mmol/l) 2 1 LDL-C (mmol/l) HDL-C (mmol/l) Figure 3: Fsting glucose level nd blood lipid profiles. Dt re mens ± SD. Week, Week 12. Vlues were significntly different fter intervention within the group; P =.6; P =.1.,b Vlues with different superscripts were significntly different between two groups, P <.5. FG: fsting glucose; HDL-C: high density lipoprotein cholesterol; LDL-C: low density lipoprotein cholesterol; TC: totl cholesterol; TG: triglyceride; : wter extrcts of Grptopetlum prguyense.

6 6 BioMed Reserch Interntionl 6 8 CAT (U/mg protein) 4 2 SOD (U/mg protein) GPx (U/mg protein) 2 1 Figure 4: Antioxidnt enzymes ctivities. Dt re mens ± SD. Week, Week 12. Vlues were significntly different fter intervention within the group, P <.5.,b Vlues with different superscripts were significntly different between two groups, P <.5. CAT:ctlse; GPx: glutthione peroxidse; SOD: superoxide dismutse; : wter extrcts of Grptopetlum prguyense. significntly negtively correlted with the SBP, DBP, nd FG level nd positively correlted with HDL-C level (P <.5). The chnge in ntioxidnt enzymes ctivities ws significntly correlted with the chnge in DBP nd lipid profiles levels (TC, TG, nd HDL-C, P <.5) Adverse Events. There were no cliniclly significnt chnges in the subjects vitl signs, serum chemicl vlues, or hemtologicl vlues, nd there were no serious dverse events in either group. 4. Discussion This is the first clinicl study to report sttisticlly significnt link between the components of MS nd ntioxidnt sttus in MS subjects treted with. In the present study, we observed tht the chrcteristics of MS (blood pressure, FG, nd lipid profiles) were significntly correlted with the ntioxidnt sttus (Tble 2) fter 12 weeks of supplementtion. The ntioxidnt cpcity of Grptopetlum prguyense hs been demonstrted in both in vitro nd in vivo studies [14 22]. Oxidtive stress is thought to ply n importnt role in the development of MS [9]. In generl, individuls with MS re typiclly bdominlly obese. Obesity is n oxidtive burden tht my led to the reduction of ntioxidnt enzymes ctivities [29]. Antioxidnt enzymes re the first line of defense ginst rective oxygen species (ROS) nd led to decrese in their ctivities [12, 3]. Inthepresentstudy,thectivitiesofCATndSODwere significntly incresed by 51% nd 28%, respectively, fter 12 weeks of supplementtion. Plnt phenol nd polyphenolic compounds, such s flvonoids nd nthocynins, re widely distributed in nturl herb nd spice extrcts, nd they possess significnt ntioxidnt ctivities [3, 31]. Chung et l. reported tht the totl phenolic compounds nd nthocynins in Grptopetlum prguyense extrcts rnged from 11. to 34. mg/g nd from.3 to 1.29 μmol/g, respectively; these compounds my increse the rdicl-scvenging bility

7 BioMed Reserch Interntionl 7 [15]. As result, my contribute to the first line of ntioxidtion, leding to increses in ntioxidnt sttus. Hypertension nd hyperglycemi induce the ctivtion of oxidtive stress pthwys nd medite the development of crdiovsculr disese nd dibetes [2, 32]. In this study, we treted subjects with MS using t dose of 4 g dily for 12 weeks; SBP nd FG levels were significntly decresed by 8% nd 3%, respectively, fter tretment. Similr results were lso found in nimls models [17, 33]. For hypertension tretment, the inhibition of ngiotensin converting enzyme (ACE) is mjor modern therpeutic pproch. The extrcts of Grptopetlum prguyense hve demonstrted n ntihypertension effect becuse of their inhibitory effects on ACE ctivity [17]. With respect to glucose regultion, pncretic β-cellsresensitivetorosndtheperoxidtion of β-cells my mplify the glucotoxicity nd lipotoxicity effects of hyperglycemi [34]. Therefore, ntioxidnts, such s, my exhibit protective effect ginst oxidtive stress by neutrlizing ROS nd improving insulin sensitivity in subjects with MS. Previous studies on lipid metbolism hve demonstrted tht humn serum proxonse (PON 1) my inhibit the oxidtion of LDL-C nd exclusively bind to HDL-C [35 37]. After 12 weeks of supplementtion, LDL-C level ws significntly decresed by 16% nd HDL-C level ws significntly incresed by 1%. Grptopetlum prguyense couldmodultethelipidmetbolismbyincresingpon1 gene expression [38]. PON 1 cn hydrolyze lipid peroxides in oxidized lipoproteins nd therosclerotic lesions [39]. In ddition, Grptopetlum prguyense might contin flvonoids nd dietry fiber, which re importnt meditors in the regultion of lipid metbolism in MS nd obesity [4, 41]. Lin et l. [22]reportedthtGrptopetlum prguyense ws relted to side effects including dirrhe nd orl ulcers. However, no subjects reported these side effects in the present study, possibly becuse the Grptopetlum prguyense ws dministered s n orl supplement in cpsule form. There were no cliniclly significnt chnges in the subjects vitl signs, serum chemicl vlues, or hemtologicl vlues, nd no subject withdrew becuse of dverse events. Thus, tdoseof4g/dissfeforindividulswithms. The popultion size is limittion of the present study. The number of prticipnts ws smll, lthough we recruited more subjects thn expected. Lrge studies re needed to estblish the beneficil effects of supplementtion. In conclusion, subjects suffering from MS my exhibit higher level of oxidtive stress. The present study demonstrted significnt reduction in blood pressure, blood glucose, nd lipid profiles nd n increse in the ntioxidnt enzymesctivitiesinsubjectswithmsftersupplementtion. might exert beneficil effect on MS relted to its ntioxidtive cpcity. Conflict of Interests The uthors hve no conflict of interests. 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