title: The effects of lutein on cardiometabolic health across the life course: a systematic review and meta-analysis.
abstract: BACKGROUND
  The antioxidant lutein is suggested as being beneficial to cardiometabolic health because of its protective effect against oxidative stress, but evidence has not systematically been evaluated.
  
  
  OBJECTIVE
  We aimed to evaluate systematically the effects of lutein (intake or concentrations) on cardiometabolic outcomes in different life stages.
  
  
  METHODS
  This is a systematic review with meta-analysis of literature published in MEDLINE, Embase, Cochrane Central, Web of Science, PubMed, and Google Scholar up to August 2014. Included were trials and cohort, case-control, and cross-sectional studies in which the association between lutein concentrations, dietary intake, or supplements and cardiometabolic outcomes was reported. Two independent investigators reviewed the articles.
  
  
  RESULTS
  Seventy-one relevant articles were identified that included a total of 387,569 participants. Only 1 article investigated the effects of lutein during pregnancy, and 3 studied lutein in children. Furthermore, 31 longitudinal, 33 cross-sectional, and 3 intervention studies were conducted in adults. Meta-analysis showed a lower risk of coronary heart disease (pooled RR: 0.88; 95% CI: 0.80, 0.98) and stroke (pooled RR: 0.82; 95% CI: 0.72, 0.93) for the highest compared with the lowest tertile of lutein blood concentration or intake. There was no significant association with type 2 diabetes mellitus (pooled RR: 0.97; 95% CI: 0.77, 1.22), but higher lutein was associated with a lower risk of metabolic syndrome (pooled RR: 0.75; 95% CI: 0.60, 0.92) for the highest compared with the lowest tertile. The literature on risk factors for cardiometabolic diseases showed that lutein might be beneficial for atherosclerosis and inflammatory markers, but there were inconsistent associations with blood pressure, adiposity, insulin resistance, and blood lipids.
  
  
  CONCLUSIONS
  Our findings suggest that higher dietary intake and higher blood concentrations of lutein are generally associated with better cardiometabolic health. However, evidence mainly comes from observational studies in adults, whereas large-scale intervention studies and studies of lutein during pregnancy and childhood are scarce.
authors.affiliation: Department of Epidemiology and e.leermakers@erasmusmc.nl.
authors.forename: Elisabeth Tm
authors.initials: ET
authors.lastname: Leermakers
authors.affiliation: Department of Epidemiology and.
authors.forename: Sirwan Kl
authors.initials: SK
authors.lastname: Darweesh
authors.affiliation: School of Medicine, Pontificia Universidade Católica do Paraná, Paraná, Brazil;
authors.forename: Cristina P
authors.initials: CP
authors.lastname: Baena
authors.affiliation: Department of Epidemiology and.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Moreira
authors.affiliation: Department of Epidemiology and.
authors.forename: Debora
authors.initials: D
authors.lastname: Melo van Lent
authors.affiliation: Department of Epidemiology and.
authors.forename: Myrte J
authors.initials: MJ
authors.lastname: Tielemans
authors.affiliation: Department of Epidemiology and.
authors.forename: Taulant
authors.initials: T
authors.lastname: Muka
authors.affiliation: Department of Epidemiology and.
authors.forename: Anna
authors.initials: A
authors.lastname: Vitezova
authors.affiliation: Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; and.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Medical Library, Erasmus University Medical Center, Rotterdam, Netherlands;
authors.forename: Wichor M
authors.initials: WM
authors.lastname: Bramer
authors.affiliation: Department of Epidemiology and Leiden University College, The Hague, Netherlands.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.affiliation: Department of Epidemiology and.
authors.forename: Janine F
authors.initials: JF
authors.lastname: Felix
authors.affiliation: Department of Epidemiology and.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D000367:Age Factors; D000975:Antioxidants / Q000032:analysis / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D002338:Carotenoids / Q000097:blood / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D004032:Diet; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D014975:Lutein / Q000097:blood / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000975:Antioxidants; D015415:Biomarkers; D002338:Carotenoids; D014975:Lutein
keywords: antioxidant; cardiometabolic health; life course; lutein; systematic review