An updated systematic review and meta-analysis of pomegranate consumption on lipid profile

Pomegranate, rich in bioactive compounds such as polyphenols and flavonoids, has been studied for its potential lipid-modulating effects, yet evidence remains inconsistent. This systematic review and meta-analysis aimed to evaluate the impact of pomegranate consumption on plasma lipid profiles by synthesizing data from randomized controlled trials (RCTs). Following PRISMA guidelines, 37 RCTs (n = 2695 participants) were included after searching Scopus and MEDLINE databases. Studies assessed pomegranate products (juice, extract, seed oil) administered orally for ≥ 7 days, with lipid parameters, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) as outcomes. Data were pooled using RevMan 5.3 with random-effects models. Results indicated that pomegranate intake significantly increased HDL-C levels (mean difference: 2.50 mg/dL, 95 % CI: 1.00-4.00, p < 0.05), while no significant changes were observed in TC, LDL-C, or TG. Subgroup analyses revealed pronounced HDL-C elevation in non-alcoholic fatty liver disease (NAFLD) patients, health participants and interventions lasting ≥ 8 weeks. Heterogeneity across studies was attributed to variations in intervention duration, dosage forms, and participant characteristics. Publication bias was nonsignificant (Egger's test, p > 0.05). These findings suggest that pomegranate supplementation may improve HDL-C, potentially through modulation of HDL-associated enzymes like paraoxonase. However, further large-scale, long-term RCTs are warranted to confirm these effects and explore synergistic benefits with standard lipid-lowering therapies.