The effects of pycnogenol on plasma lipids are controversial. A systematic review and meta-analysis of clinical trials were conducted to obtain a conclusive result in humans.PubMed, Scopus, and Google Scholar were systematically searched until March 2018, to explore the clinical trials that examined the effect of pycnogenol supplementation on lipid parameters among adult human. Methodological quality of the eligible studies was evaluated using the Cochrane Collaboration's tool. To estimate the effect size, changes in blood lipids were implemented. Results were pooled using a random effects model. Potential sources of heterogeneity were explored by subgroup analysis. A systematic review and meta-analysis of 14 clinical trials with 1,065 participants suggested a significant increase in plasma concentration of high density lipoprotein cholesterol (HDL-C; 3.27 mg/dL; 95% CI [0.19, 6.36]; p = 0.038). In contrast, plasma levels of total cholesterol (TC; −4.45 mg/dL, 95% CI [−11.24, 2.34]; p = 0.199), triacylglycerol (TAG; −3.64 mg/dL; 95% CI [−17.89, 10.61]; p = 0.616), and low density lipoprotein cholesterol (LDL-C; −3.61 mg/dl; 95% CI [−8.76, 1.55]; p = 0.171) were not altered. Adjustment for confounding variables was poor in included studies. Also, these studies did not assess dietary lipid intake. The results indicate that pycnogenol supplementation improves levels of HDL-C; however, the changes in TC, TAG, and LDL-C were not clinically relevant. Since there are few phytochemicals that have a significant increasing effect on HDL-C levels, pycnogenol may have important role in prevention of cardiovascular diseases.

Neck circumference (NC) has been suggested as a predictor for blood pressure disorders. Therefore, we sought to conduct a systematic review and meta-analysis regarding the association between NC and blood pressure in adults. Pertinent studies were identified by searching PubMed and Scopus databases, up to March 2018. Studies which reported the correlation coefficient between NC, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were selected. Also, studies reported the odds ratio (OR) of hypertension or pre-hypertension included adults older than 18 years old were selected. Results were pooled using a random-effects model. Of 29 studies included in meta-analysis, 26 studies reported only correlation coefficient, 3 studies reported only odds ratio and 2 studies reported both correlation coefficient and odds ratio. Overall, NC was significantly correlated with SBP [ES (z)=0.20; 95% CI=0.18, 0.23] and DBP [ES (z)=0.20; 95% CI=0.16, 0.24]. Type of correlation coefficient was the sources of observed heterogeneity. Also, NC was directly associated with the risk of hypertension (OR=1.29; 95% CI: 1.06–1.56), but not pre-hypertension (OR=1.18; 95% CI: 0.92, 1.52). Furthermore, subgroup analysis based on the region indicated that the studies conducted in Western regions reported higher risk of HTN in association with NC (OR=1.27; 95% CI: 1.23–1.32), but not among those conducted in the Eastern regions (OR=1.11; 95% CI: 0.96–1.28). NC seems to be a new anthropometric measurement, which is probably a good predictor of elevated blood pressure, especially in the Western population.

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