1. Introduction
The probability of an individual developing cardiovascular diseases (CVDs), such as coronary artery disease or stroke, is referred as cardiovascular risk. This risk is influenced by a variety of factors, which can be broadly categorized into non-modifiable and modifiable risk factors [1]. Part of the modifiable factors are dietary patterns, well-known among physicians, researchers, and patients, and considered very important in modern lifestyle medicine. To assess CVD risk in patients, a Framingham Risk Score and the American College of Cardiology/American Heart Association (ACC/AHA) risk calculator are used in the United States, while the Systematic Coronary Risk Estimation 2 (SCORE2) is the standard for European countries. All of them are based on recognized CVD risk factors such as systolic blood pressure, lipid profile, smoking status, and sex [1]. Elevated blood pressure and diabetes promote endothelium dysfunction and damage, which along with elevated low-density cholesterol (LDL) levels leads to atherosclerosis development. If atherosclerotic lesions are present in coronary arteries, such a condition is defined as coronary heart disease. CVD is a major cause of death worldwide [2]. This is why the impact of lifestyle aspects, including diet, on modifiable CVD risk factors such as hypertension and dyslipidemia is being investigated extensively [3,4,5].
Polysaccharides, carbohydrates consisting of monosaccharide units forming longer chains, are integral components of the diet. They play a crucial role in energy intake and other physiological functions [6]. Their role in health, particularly cardiovascular disorders, is an area of active research, revealing risk factors and beneficial effects, depending on the investigated compound. Dietary polysaccharides are usually categorized based on their sources and structures, and examples of their differed structures are presented in Figure 1. Most reported macromolecules in health-related studies have been derived as either starches, non-starch polysaccharides like dietary fibers, or specialized prebiotic fibers [7]. Fibers can be categorized into soluble (pectin, beta-glucan, guar gum, or mucilages) and insoluble fibers (cellulose, hemicellulose, lignin). Cellulose, hemicellulose, pectin, and beta-glucans are generally indigestible by humans, but play an important role in gut health and metabolic regulation [8,9]. Cellulose is widely found in broccoli, cabbage, kale, and green beans [10]. In fruits, apples, pears, and berries contain cellulose, as do whole grains, and legumes like beans, lentils, and peas [11,12]. Moreover, hemicellulose is abundant in whole grains, nuts, and seeds, including sunflower seeds, flaxseeds, almonds, and root vegetables like carrots, potatoes, and turnips. Legumes such as soybeans, beans, and chickpeas are also rich in hemicellulose [13]. Pectins are particularly commonly found in fruits, with high concentrations in apples, oranges, grapefruits, lemons, and other citrus fruits. Known for their gelling properties, they are widely used as a setting agent in jams and jellies. Similarly, beta-glucans present gel-like properties, but contrary to pectins, they are reported to be biodegradable in the digestive system. They are present in oats, including oatmeal, bran, and whole oat products, but also in barley grains, barley flakes, and barley flour. The most prominent sources of the differences between these molecules are in their molecular structures and viscosity. Oat beta-glucans typically consist of linear chains of β-(1→4) and β-(1→3) linked D-glucose molecules with a ratio of about 3:1. Similar to oat beta-glucans, barley beta-glucans also contain β-(1→4) and β-(1→3) linkages, but with a ratio closer to 2:1.
Certain types of mushrooms, such as shiitake, maitake, and reishi, along with some edible seaweeds, contain significant amounts of beta-glucans. Dietary fibers, including soluble fibers, found in oats, legumes, and certain fruits, dissolve in water to form viscous gels, which can modulate blood glucose levels and lower serum cholesterol [14,15,16]. Insoluble fibers, present in whole grains and vegetables, promote bowel regularity and prevent constipation. Prebiotic polysaccharides, such as inulin and fructooligosaccharides, selectively stimulate the growth of beneficial gut microbiota, enhancing gut health and systemic immunity. Dietary fibers have little to no nutritional value, but modulate the transit of food in the gastrointestinal tract [5].
The cardiovascular benefits of polysaccharides are multifaceted. Soluble fibers, by their high viscosity and water-binding properties, are known to bind bile acids in the intestine, facilitating their excretion and thereby reducing circulating cholesterol levels [17]. This mechanism is pivotal in lowering the risk of atherosclerosis, a major CVD contributor. Moreover, the fermentation of dietary fibers by gut microbiota produces short-chain fatty acids (SCFAs), such as butyrate, propionate, and acetate, which have anti-inflammatory properties and improve endothelial function. These SCFAs also play a role in regulating lipid metabolism and glucose homeostasis, further mitigating CVD risk. Interestingly, a popular low-carbohydrate diet also reduces the dietary intake of polysaccharides, which was not considered to lower cardiovascular risk in two-year observations of randomized clinical trials [18].
A group of potential sources of polysaccharides is marine macroalgae, also known as seaweed. They are traditionally harvested in Asian countries and used in the food industry, agriculture, and medicine [19]. The key effects that can be linked to CV risk are generally characterized as antioxidant activity, microbial modulation, and obesity prevention by lowering food intake.
However, not all polysaccharides confer health benefits. Refined starches, prevalent in processed foods, can lead to rapid spikes in blood glucose and insulin levels, contributing to insulin resistance, obesity, and metabolic syndrome [20]. These conditions are significant CVD risk factors [5]. Additionally, excessive consumption of certain soluble fibers through supplements can interfere with absorbing essential minerals, potentially leading to deficiencies and gastrointestinal discomfort. Others can have ambiguous effects on the microbiome, resulting in decreased diversity, not necessarily promoting beneficial bacteria.
This review aims to explore the dualistic nature of polysaccharides in health, emphasizing their beneficial roles in reducing CVD risk factors and highlighting the potential adverse effects of specific types (as presented in Figure 2). Their impact on cardiovascular health, supported by epidemiological evidence, leads to an understanding of particular mechanisms, which translates to potential dietary interventions that can be subjected to optimization. For facilitated understanding of polysaccharide group activity, the summarized information on their influence is presented in Table 1.
2. Dyslipidemia
Low-density lipoprotein cholesterol (LDL) is considered a major risk factor for atherosclerotic CVD [29]. Brown et al. performed a metanalysis on soluble fibers, indicating that the consumption of 2–10 g/day led to a statistically significant lowering of total cholesterol (TC) and LDL [23]. The effect was not observed for high-density lipoprotein cholesterol (HDL) and triglycerides (TG). The differences between sources of soluble fiber were not statistically important, also considering background fat content. The findings complied with recommendations by Reynolds et al. indicating that intake of 15–30 g fiber/day improves lipid profile in diabetic patients, especially in terns if LDL, TC, and TG [22]. The 2019 ESC/EAS guidelines for the management of dyslipidemia recommend a dietary fiber intake of 25–40 g/day, including ≥7–13 g of soluble fiber, preferably from wholegrain products, e.g., oats and barley [4]. Comparison of polysaccharide effects in lipid profiles is briefly presented in Table 2.
The studies performed by the group reported by Fernandez et al. on guinea pigs revealed that pectin, guar gum, and psyllium-fed guinea pigs were observed to have faster catabolism and cholesterol clearance, resulting in increased LDL-ApoB 100 [29]. The meta-analysis performed by Li et al. of 17 randomized clinical trials on a homogenic group of dyslipidemic patients resulted in no difference in reducing major cardiovascular events with oat-based product supplementation in the diet [30]. Lipid profiles were altered by lowering LDL and TC, and little through the lowering of HDL and TG, resulting in the lowering of coronary heart disease incidence by 4%. However, direct evidence is lacking, and the observation was classified as moderate in clinical meaning.
A meta-analysis focused on the effects of soluble fiber supplementation on blood lipid parameters in adults, which included 181 RCTS and 14,505 participants, showed in the overall analysis that there was a significant reduction in LDL, TC, TG, and apolipoprotein B (apoB) after soluble fiber supplementation. The dose-response analysis indicated that each 5 g/day increase in soluble fiber supplementation had a significant reduction effect on TC and LDL [31].
Oats are one of the main everyday sources of dietary fiber. A meta-analysis of 17 trials with 1731 subjects showed that oat intervention (based on both beta-glucan-based and bran-based and wholegrain oat products) compared to the placebo or usual diet resulted in a significant reduction in LDL and TC, with little effect on HDL and TG [30]. On the other hand, one study included in the aforementioned meta-analysis indicated that oat-based products made no significant difference in major cardiovascular events. As already indicated, oats are a good source of beta-glucan. A meta-analysis of 58 trials with total of 3974 participants showed that a median dose of 3.5 g/day of oat beta-glucan significantly lowered LDL, non-HDL-cholesterol, and apoB. The 3.5 g/day intake lowered the abovementioned cholesterol fractions by −0.19 mmol/L and −0.2 mmol/L, respectively, which equates to 4.2%. Increasing the dosage to 6.9 g/day of barley beta-glucan lowered LDL and non-HDL-cholesterol by 7% compared with control diets. As intake in modern society is very often supplemented by alternative sources, high-viscosity fibers (glucomannan, psyllium) were also reported to lower LDL and non–HDL-cholesterol with dosages of 10 g/day and 3–4 g/day, respectively [32].
A meta-analysis focused on beta-glucan consumption in hypercholesterolemic patients, which included 17 RCTs covering 916 subjects, confirmed that beta-glucan consumption significantly lowered TC and LDL concentration, while there were no significant differences in HDL, TG, and glucose [33]. Further investigation of 28 studies, totaling 1494 subjects, confirmed that whole oats intervention decreased TC and LDL [34]. This meta-analysis also showed that isolated beta-glucan interventions decreased TC and TG; however, HDL was not altered by either oat or isolated β-glucan [34]. Barley, as another source of beta-glucan, in a meta-analysis of 8 trials covering 391 patients, showed that it significantly lowered TC, LDL, and TG, but did not alter HDL significantly [35]. A meta-analysis of 11 RCTs confirmed that barley and beta-glucan isolated from barley lowered TC and LDL concentrations. However, there were no significant subgroup differences by the food matrix [36]. On the other hand, a similar interesting approach was presented in a meta-analysis which focused on the different delivery matrices of beta-glucan. It confirmed that consuming ≥3 g/day of beta-glucan for at least 3 weeks significantly reduced TC and LDL in mildly hypercholesterolemic individuals, while no significant difference was observed in TG and HDL. It indicated that the effects of food matrices with both solid and liquid products where beta-glucan was incorporated were ranked as the best way to exert its beneficial properties, compared to only liquid or solid products alone [37]. These differences might be caused by the fact the first mentioned meta-analysis was focused on barley-derived beta-glucan, while the second one did not narrow down the source of beta-glucan.
Chia seeds are another source of dietary fiber. A meta-analysis of 10 clinical trials showed that chia consumption decreased TC, TG, and LDL, and increased HDL; however, the results were not statistically significant [38]. For psyllium, a meta-analysis of 28 trials covering a total of 1924 participants showed that supplementation of 10.2 g psyllium significantly reduced LDL, non-HDL, and apoB [39]. Psyllium can be an addition to other cholesterol-lowering actions, and adding psyllium fiber resulted in reductions in LDL equivalent to doubling the statin dose [40]. A meta-analysis of 21 studies, covering 1030 subjects with mild-to-moderate hypercholesterolemia, confirmed that consumption of psyllium lowered serum TC and LDL. What is more, a significant dose–response relationship was found between doses from 3 to 20.4 g/day [41]. Moreover, a meta-analysis covering 384 mild-to-moderate hypercholesterolemia patients based on eight studies showed that 10.2 g psyllium/day added to a low-fat diet lowered serum TC by 4%, LDL by 7%, and the ratio of apoB to apo A-I by 6% compared to placebo, i.e., a low-fat diet alone. No significant differences were observed for HDL or TG levels [42]. Olson et al., in a meta-analysis of 12 studies, observed that subjects who consumed a psyllium-enriched cereal had lower TC and LDL concentrations than the ones who ate a control cereal. HDL levels were not significantly changed [43]. Additionally, data sourced from 10 trials covering 268 participants showed that a diet rich in non-soy legumes, which are sources of fiber, reduced TC and LDL [44]. Brown seaweeds, as a source of marine polysaccharides (mostly laminarines and sulfonated ones), were evaluated by Shin et al. in a meta-analysis, which concluded that fucoidans do not have a significant effect on dyslipidemia markers or obesity based on seaweed supplementation in diet [45].
Familial hypercholesterolemia is a genetic condition resulting in significantly elevated LDL levels and high cardiovascular risk without a previous lifestyle background. The Cochrane Database analysis, focused on dietary interventions in familiar hypercholesterolemia, underlined that in the available literature, only short-term, secondary outcomes could be assessed. However, it indicated that guar gum, when given as an add-on therapy to bezafibrate, reduced TC and LDL levels as compared to bezafibrate alone [46]. The inulin-type fructans-related meta-analysis of 20 RCTs with 607 adults showed that the supplementation reduced LDL [27]. A meta-analysis of 14 trials encompassing 1108 participants showed that chitosan supplementation significantly improved TC and LDL concentrations, while no significant changes were seen in HDL and TG [47].
In summary, soluble fiber supplementation plays a significant role in improving lipid profiles, particularly by reducing TC and LDL, which are major risk factors for CVD in various populations. The effects on HDL and TG are often minimal or not statistically significant regardless of the sources (oats, barley, psyllium) and populations. The beneficial effects of soluble fiber appear dose-dependent, with higher intakes yielding greater reductions in LDL and TC. Psyllium, in particular, shows potential as an adjunct therapy to standard cholesterol-lowering treatments, such as statins. Despite the overall positive trends observed, further research to clarify the impact of polysaccharides on dyslipidemia is needed. Nevertheless, it can be concluded that fiber in particular is a valuable dietary intervention for risk management.
3. Hypertension
One of the most worth mentioning and widespread recommendations in hypertension management is the introduction of Mediterranean and/or Dietary Approaches to Stop Hypertension (DASH) dietary patterns in cardiovascular disease prevention. These have been reported to reduce cardiovascular risk [25]. The DASH pattern is high in carbohydrates (including fiber), moderate in protein, and low in total fat and saturated fatty acids, and are also high in potassium, calcium, and magnesium, and low in sodium, with a high intake of polysaccharide-rich fruits, vegetables, and whole grains [25]. High-fiber diets like DASH are often rich in potassium, which can help lower blood pressure by counteracting the effects of sodium and promoting vasodilation.
A meta-analysis performed by Ghavami et al. on 83 trials with 5985 participants evaluated the supplementation of soluble fiber on systolic blood pressure by a significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP). SBP and DBP had a larger reduction in the guar gum and inulin subsets [48]. The effect was observed in dose-responsive manners in hypertensive participants, as SBP decreased proportionally with the increase in soluble fiber in the course of supplementation up to 20 g/day. With moderate certainty, high fiber intake reduces mortality (RR = 0.75, (95% confidence interval, CI 0.58–0.97)), irrespective of cardioprotective therapies [49]. Another meta-analysis, which focused particularly on psyllium impact and covered 11 trials with 592 participants, showed a significant reduction in SBP after psyllium supplementation [50]. Moreover, this relationship was stronger in participants with higher baseline blood pressure. The positive impact of psyllium supplementation on SBP was confirmed in another meta-analysis [51]. Flaxseed is another popular source of fiber. A meta-analysis of 14 trials by Khalesi et al. indicated that flaxseed supplementation significantly reduced SBP and DBP [52]. Interestingly, these results were not influenced by higher baseline blood pressure. For oat consumption, a meta-analysis of 21 RCTs involving 1569 participants proved that consuming oats significantly reduced SBP, particularly in hypertensive participants [53]. There was no significant impact noted for DBP in the overall group, but subgroup analysis revealed that this relationship was significant in participants who were prehypertensive at baseline. These effects were observed when the consumption was at a level of ≥5 g/day β-glucan, or over ≥8 weeks [53]. A similar pattern has been observed for chitosan, as in a meta-analysis of eight trials with 617 total participants [54]. Although overall chitosan supplementation did not significantly change SBP or DBP, the subgroup analysis indicated that chitosan consumption significantly reduced DBP in higher doses (>2.4 g/day) or, interestingly, shorter-term (<12 weeks) arms [54].
Besides the mentioned binding of fiber and glucans to bile acids and excretion of cholesterol, dietary fibers can improve endothelial function and increase the production of nitric oxide, a vasodilator that helps in maintaining blood vessel elasticity and lowering blood pressure, as well as reducing inflammation and oxidative stress [55]. Low fiber with high fat in a cafeteria diet, which accurately reflects a Western obese diet, results also in endothelium dysfunction, with a significant reduction of vasodilatory response to acetylcholine [55].
Similarly to dyslipidemia, fiber supplementation has been shown to be beneficial and to consistently bring improvement in hypertensive individuals. Meta-analyses have highlighted that sources like oats, barley, psyllium, and beta-glucans are effective across various populations and dosages, as summarized in Table 3. Meta-analyses have provided information showing that soluble fiber supplementation significantly reduces both SBP and DBP, with larger reductions observed for guar gum, inulin, and psyllium. The dose-dependent effects suggest that higher intakes of fiber, up to 20 g/day, result in greater reductions in blood pressure. Additionally, dietary fiber improves endothelial function and enhances nitric oxide production, which supports vasodilation. High fiber intake lowers hypertension and also improves cardiovascular outcomes regardless of other cardioprotective therapies.
4. Obesity
A high intake of refined starches (such as white bread or white rice) has been associated with poor cardiometabolic health and an increased risk of CVD events [25]. It is crucial to avoid them, especially in carbohydrate-restricted diets, as their intake increases the risk of cardiovascular events [56,57]. This is also an important factor in calorie-focused diets, where fat limitation can result in a reduction of healthful vegetable oils and replacement with starch. Generally, dietary fiber increases the feeling of fullness (satiety) by slowing gastric emptying and prolonging digestion. This reduces overall caloric intake, contributing to weight loss or prevention of weight gain, both of which are critical factors in reducing CV risk, which was concluded in Table 4.
Inulin was also considered in trials comparing dietary interventions to a control diet, indicating a TG decrease, but meta-analyses did not indicate statistical significance [27]. A similar situation was indicated for TC, except for trials performed in type 2 diabetes mellitus (T2DM) patients. For obese groups of patients, inulin was also reported in three trials to lower LDL and improve lipid profile. It also acts by stimulating the feeling of being full, as a low-calorie dietary fiber. Generally, CVD risk is lowered also by the influence of fibers, leading to weight reduction, which follows their influence on hypertension, lowering LDL cholesterol and inflammation via colonic microbiota [58,59]. Beneficial gut bacteria produce SCFA such as butyrate, which have anti-inflammatory effects that can reduce systemic inflammation and consequently lower cardiovascular risk [60]. These SCFAs improve endothelial function and increase nitric oxide production, a vasodilator that helps maintain blood vessel elasticity and lower blood pressure. A similar mode of action has been assigned to pectins, which are abundant cell wall polysaccharides in plants [61].
Chitosan’s role in overweight patients was evaluated in 15 trials on 1219 participants by Jull et al., and it was concluded that chitosan may have a small effect on body weight, but this effect was considered to be minimal. Chitosan is a natural polymer in the exoskeletons of crustaceans and has several properties in the biomedical and food industries. Its effects on weight loss in overweight adults were studied in a metanalysis of 111 trials [62]. The mean difference was −1.70 kg, alongside −3.7 and 1.36 kg for psyllium and glucomannan, respectively, compared with the placebo [62]. The effect, however, was observed in trials longer than 12 weeks, indicating chronic intake is crucial to acquire the desired dietary effect [54]. In such prolonged use, other chitosan properties need to be considered; it is liable to alter the balance of intestinal microbiota, as it has antimicrobial activity by binding to cell membranes, interfering with enzymes and metal chelation [63]. Antimicrobial activity can be more selective towards pathogenic bacteria while sparing beneficial gut bacteria, but further studies are still needed in this area, because prolonged use may disrupt the balance of gut microbiota, potentially leading to reduced diversity and dysbiosis.
Regarding seaweed polysaccharides and oligosaccharides, sulfated polysaccharides extracted from Undaria pinnatifida (Phaeophyceae) can modulate the gut microbiota, thereby inhibiting weight gain and lipid metabolism, which could benefit weight loss, as indicated by Zhang et al. [64]. Similar observations, alongside anti-inflammatory action related with fucoidins and alginates, often co-exist in sources rich in polyphenols [65]. Obesity is a main factor in metabolic syndrome, and the proper management of inflammation is crucial. Alginate oligosaccharides have been proven to attenuate the postprandial blood glucose response by the consumption of alginate glucose drinks and a reduction in cholesterol and glucose absorption from the intestines. Animal tests have also provided information on improving insulin sensitivity, but further trials are needed [66].
Algal polysaccharides were also considered in mitigating atherosclerosis. Fucoidan has anti-inflammatory and anticoagulant effects, modulating a decrease in LDL-C and TG [67]. Laminarin contributes by reducing oxidative stress and inflammation, key factors in atherosclerosis development, and both can help regulate lipid metabolism, aid in weight management, and promote gut health, which indirectly lowers cardiovascular risk [67].
In obesity, poor cardiometabolic health has been linked to refined starches, which should be avoided in a calorie-focused diet and replaced with beneficial fats. Dietary fibers, in general, lower CVD risk by promoting weight loss, improving blood pressure, reducing LDL levels, and modulating the gut microbiota to reduce inflammation, similar to pectins and chitosan.
5. Diabetes
Diabetic patients are another group of interest in terms of cardiovascular risk, which is possible to modify multi-directionally, as presented in Table 5. It is worth noting that diabetes itself raises CVD risk to high or extremely high [1]. In T2DM, a meta-analysis of 11 papers demonstrated a significant reduction in total cholesterol and low-density lipoprotein cholesterol following guar gum supplementation. Moreover, the subgroup analysis showed that ≥20 g/day of guar gum led to a notable decrease in triglyceride levels versus < 20 g/day. Guar gum supplementation had no effects on high-density lipoprotein cholesterol [68]. The other way round assessment, i.e., glycemic control in hypercholesterolemic individuals, based on 12 trials with a total of 603 subjects, indicated that beta-glucan consumption did not significantly affect measures of glycemic control [69]. Studies have shown also that supplementation with inulin can improve insulin sensitivity in overweight adults by increasing the abundance of Bacteroides and promoting a bifidogenic effect [70].
Observational studies have shown that a higher intake of dietary fiber is associated with a reduced risk of CVD as well as T2DM and obesity [5]. Diabetes mellitus is a group of metabolic disorders of carbohydrate metabolism, resulting in chronic hyperglycemia [71]. Insulin resistance resulting from chronic inflammation accompanying obesity leads to relative insulin deficiency, which forces the pancreatic islets to increase insulin secretion. In the longer term, it can lead to beta islet degradation. Progressive loss of beta cells and their function manifests clinically as hyperglycemia, particularly connecting polysaccharides with positive and negative effects. Without proper management of diabetes, chronic complication risk rises, possibly leading to microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary artery disease, atherosclerosis, peripheral artery disease, etc.), although rates of progression may differ. The current recommendations for diabetes-related carbohydrate management are based on proper counting, which is an evidence-based approach based on World Health Organization (WHO) guidelines [72,73,74]. Low-carbohydrate diets in diabetes have been shown to reduce the risk of cardiovascular diseases, hypertension, and insulin resistance. However, given their restrictive nature, it is considered that they can also lower the intake of fiber-rich elements, causing an imbalance in macronutrient intake, suboptimal micronutrient intake, and increased disease risk over time [18].
The antidiabetic effect of macroalgae was postulated by Tavares et al. in their work on its possible applications in healthcare [75]. Sulfate polysaccharides, such as agar and carrageenan, were reported to inhibit digestive enzymes (namely, α-amylase and α-glucosidase), resulting in lowering glycemia. Also, as mentioned in the Obesity section, alginates and fucoidins have the potential to lower inflammation. Algae are also a rich source of fibers, facilitating satiety, as indicated earlier.
Beta-glucans, composed of D-glucose units connected with beta-glycosidic bonds, are reported to have a beneficial impact on the gastrointestinal and immune systems [20]. Such nonspecific immune system responses and immunostimulation have been reported in humans and animals [76,77]. They are not digested after ingestion, and their enzymatic breakdown is slower than starch, which results in reduced glycemic spikes, which is desired in proper diabetes management [18]. Oat beta-glucans present a linear dose-response impact on acute glucose and insulin response after carbohydrate meals [78]. Moreover, a meta-analysis of 18 studies confirmed that oat intake resulted in a greater decrease in fasting glucose insulin and hemoglobin A1c compared to the control [79]. Similar conclusions were made in the systematic review by Andrade et al., which indicated that doses of beta-glucans of 6 g/day for >4 weeks led to improvements in blood glucose levels. However, blood glucose levels do not reach normal levels with the application of beta-glucans alone [80].
Starches are digested rapidly (high glycemic index) in the mouth and stomach, and this is particularly concerning for individuals with diabetes. However, the long-term effects of starchy vegetables have been evaluated, and have been shown to have uncertain cardiometabolic effects [81]. Some starches, known as resistant starches, resist digestion in the small intestine and reach the large intestine to become fermented by microorganisms. One of the most common forms of resistant starches in use is high amylose corn-starch (HAM-RS2), which lowers caloric intake by replacement of flour carbohydrates. It has been reported to improve insulin sensitivity among individuals at risk of or with type 2 diabetes, thus lowering cardiovascular risk, with a high level of confidence in 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes [26]. By reducing insulin resistance, fiber intake decreases the risk of developing type 2 diabetes and associated cardiovascular conditions. However, while carbohydrates lower overall CVD risk, the rapidly digestible starch and sugar provided by whole vegetables and fruit may need to be taken into consideration in people with diabetes if intakes are very high [74]. Additionally, an interesting remark on the role of polysaccharides was postulated by Castro-Acosta et al., as their presence (e.g., starch) enables polyphenols to bind to them instead of the digestive enzymes, diminishing anthocyanins’ effects of lowering glycemia [20].
What is more, in a meta-analysis of 10 trials including 1473 participants, chitosan supplementation led to a significant reduction in fasting glucose levels and hemoglobin A1c levels, with no effect on insulin levels [82]. Further analysis showed significant reductions in fasting glucose levels after supplementation of 1.6–3 g/day or for >13 weeks [82].
Diabetic patients are liable to an elevated risk of CVD and can particularly benefit from the use of dietary fiber. Polysaccharide supplementation in T2DM has shown a reduction in TC and LDL, while also decreasing TG. On the other hand, beta-glucan consumption, while not significantly impactful with regard to glycemic control, has been linked to improved gastrointestinal and immune functions, as well as reduced postprandial glycemic spikes in diabetes management. While low-carbohydrate diets can reduce CVD risk and improve insulin sensitivity, they may also reduce fiber intake, which is crucial in preventing long-term complications. Resistant starches have demonstrated the ability to improve insulin sensitivity, thus lowering CVD risk. Additionally, polysaccharides can impact the bioavailability of polyphenols, potentially diminishing their glycemic-lowering effects.
6. Conclusions
In terms of selected CVD risk factors, polysaccharides such as dietary fiber and beta-glucans have a positive impact on lipid profiles, particularly on TC and LDL levels, which are mediated by lipid absorption and microbiome modulation. A positive impact on blood pressure control, mainly SBP, has also been noted. What is more, polysaccharides present beneficial properties for body mass control, which is important in the context of obesity prevention, and in this way, they indirectly contribute to the control of other risk factors secondary to it, alongside chitosan or inulin dietary addition. For diabetes, the reported impact depends on the polysaccharide type, as refined starches can lead to rapid glucose spikes, which are not desired in T2DM patients, and prolonged changes in ingested carbohydrates need to be evaluated in terms of their quality or overuse. On the other hand, dietary fiber and beta-glucans can stabilize acute glucose blood levels as well as fasting glucose and hemoglobin A1c. To sum up, fiber and beta-glucan intake is considered an advised approach to CVD prevention.
Conceptualization, J.P.-K. and G.K.; methodology, J.P.-K. and G.K.; investigation, J.P.-K. and G.K.; visualization: J.P.-K. and G.K.; writing—original draft preparation, J.P.-K. and G.K.; writing—review and editing, J.P.-K. and G.K. All authors have read and agreed to the published version of the manuscript.
Data sharing is not applicable. Data are contained within the article and derived from publicly published papers.
We want to thank Lilianna and Alicja for their support in the creation of the manuscript. J.P.-K. would like to acknowledge the support of the Ministry of Science and Higher Education in Young Scientists Award.
The authors declare no conflicts of interest.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
Enlarge this image.Figure 1. Examples of structural formulae of described dietary polysaccharides: (A) starch, (B) beta-D-glucan, (C) pectin, (D) chitosan.
Enlarge this image.Figure 2. The main dietary-manageable disorders related to increased CVD risk. Created with Biorender.com.
Consumption of polysaccharides and their influence on cardiovascular risk constituents.
| Polysaccharides | Sources | Recommendation | Result |
|---|---|---|---|
| Soluble Fiber | Oats, barley, beans, lentils, peas, apples, citrus fruits, carrots, psyllium husk | intake of 4–10 g/day [ | protective in cardiometabolic complications |
| Insoluble fiber | Whole grains (wheat bran, brown rice), nuts, seeds, vegetables (cauliflower, green beans, potatoes) | 70–75% of total fiber [ | |
| Beta-glucans | Oats, barley, mushrooms (e.g., shiitake, maitake), yeast | 3–6 g/day [ | lowers LDL and non-HDL |
| Refined starches | White bread, white rice, pastries, many processed foods, crackers, cakes, and some breakfast cereals | should be minimized 1–2 servings/day [ | worsening of cardiometabolic health and an increased risk of CVD events |
| Starch | Potatoes, corn, peas, pasta, bread, and other grains | No recommendation | high glycemic index, glycemia spikes |
| Resistant starch | Green bananas, legumes, cooked and cooled potatoes, rice, pasta, high-amylose cornstarch | 15–60 g/day [ | decrease of available energy |
| Inulin | Chicory root, onions, garlic, leeks, asparagus, artichokes, bananas | 5–10 g/day [ | lowering TC and LDL |
| Chitosan | Exoskeleton of crustaceans (crab, shrimp, lobster) | no recommendation, considered 1–6 g/day [ | Decreasing body weight |
Summary of dietary components and their effects in dyslipidemic patients.
| Dietary Component | Key Effect in Dyslipidemia |
|---|---|
| Soluble fibers | ↓TC, ↓LDL |
| Beta-glucans | ↓LDL, ↓non-HDL, ↓apoB |
| Guar gum | ↓TC, ↓LDL (with therapy of familial hypercholesterolemia) |
| Inulin-type fructans | ↓LDL |
| Chitosan | ↓TC, ↓LDL |
| Psyllium | ↓LDL, ↓non-HDL, ↓apoB |
↓—lowering effect, ↑—increasing effect.
Summary of dietary components and their effects in hypertensive patients.
| Dietary Component | Key Effect in Hypertension |
|---|---|
| Soluble fibers | ↓SBP, ↓DBP, improves endothelial function, |
| Beta-glucans | ↓SBP |
| Chitosan | ↓DBP (in high doses) |
| Psyllium | ↓SBP |
↓—lowering effect, ↑—increasing effect.
Summary of dietary components and their effects in obese patients.
| Dietary Component | Key Effects in Obesity |
|---|---|
| Dietary fiber | ↑satiety, ↓gastric emptying, ↓caloric intake, ↑body weight loss, ↓CV risk, ↓LDL-C, ↓inflammation |
| Inulin | ↓LDL-C, improves lipid profile |
| Pectins | improve endothelial function, ↓inflammation, ↓CV risk |
| Chitosan | ↓body weight in overweight patients, |
| Psyllium and Glucomannan | ↓body weight |
| Alginates | ↓cholesterol and glucose absorption |
↓—lowering effect, ↑—increasing effect.
Summary of dietary components and their effects in diabetic patients.
| Dietary Component | Key Effects in Diabetes |
|---|---|
| Low carbohydrate diets (High fiber) | ↓CVD risk, ↓hypertension, ↓insulin resistance |
| Beta-glucans | ↓postprandial glycemic spikes, ↓fasting glucose, ↓insulin, ↓HbA1c |
| Chitosan | ↓fasting glucose, ↓HbA1c |
| Resistant starches | ↑insulin sensitivity, ↓caloric intake, |
| Guar gum | ↓TC, ↓LDL-C, ↓TG |
↓—lowering effect, ↑—increasing effect.
References
1. Visseren, F.L.J.; Mach, F.; Smulders, Y.M.; Carballo, D.; Koskinas, K.C.; Bäck, M.; Benetos, A.; Biffi, A.; Boavida, J.-M.; Capodanno, D. et al. 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Eur. Heart J.; 2021; 42, pp. 3227-3337. [DOI: https://dx.doi.org/10.1093/eurheartj/ehab484] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34458905]
2. Pagidipati, N.J.; Gaziano, T.A. Estimating Deaths From Cardiovascular Disease: A Review of Global Methodologies of Mortality Measurement. Circulation; 2013; 127, pp. 749-756. [DOI: https://dx.doi.org/10.1161/CIRCULATIONAHA.112.128413] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23401116]
3. Popiolek-Kalisz, J.; Blaszczak, P.; Fornal, E. Dietary Isorhamnetin Intake Is Associated with Lower Blood Pressure in Coronary Artery Disease Patients. Nutrients; 2022; 14, 4586. [DOI: https://dx.doi.org/10.3390/nu14214586] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36364848]
4. Mach, F.; Baigent, C.; Catapano, A.L.; Koskinas, K.C.; Casula, M.; Badimon, L.; Chapman, M.J.; De Backer, G.G.; Delgado, V.; Ference, B.A. et al. 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk. Eur. Heart J.; 2020; 41, pp. 111-188. [DOI: https://dx.doi.org/10.1093/eurheartj/ehz455]
5. Trautwein, E.A.; McKay, S. The Role of Specific Components of a Plant-Based Diet in Management of Dyslipidemia and the Impact on Cardiovascular Risk. Nutrients; 2020; 12, 2671. [DOI: https://dx.doi.org/10.3390/nu12092671]
6. Ma, J.; Karlsen, M.C.; Chung, M.; Jacques, P.F.; Saltzman, E.; Smith, C.E.; Fox, C.S.; McKeown, N.M. Potential Link between Excess Added Sugar Intake and Ectopic Fat: A Systematic Review of Randomized Controlled Trials. Nutr. Rev.; 2016; 74, pp. 18-32. [DOI: https://dx.doi.org/10.1093/nutrit/nuv047] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26518034]
7. Li, S.; Liu, J.; Wang, Z.; Duan, F.; Jia, Z.; Chen, X.; Li, S. The Promising Role of Probiotics/Prebiotics/Synbiotics in Energy Metabolism Biomarkers in Patients with NAFLD: A Systematic Review and Meta-Analysis. Front. Public Health; 2022; 10, 862266. [DOI: https://dx.doi.org/10.3389/fpubh.2022.862266] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35958869]
8. Froidurot, A.; Julliand, V. Cellulolytic Bacteria in the Large Intestine of Mammals. Gut Microbes; 2022; 14, 2031694. [DOI: https://dx.doi.org/10.1080/19490976.2022.2031694]
9. Llewellyn, S.R.; Britton, G.J.; Contijoch, E.J.; Vennaro, O.H.; Mortha, A.; Colombel, J.-F.; Grinspan, A.; Clemente, J.C.; Merad, M.; Faith, J.J. Interactions Between Diet and the Intestinal Microbiota Alter Intestinal Permeability and Colitis Severity in Mice. Gastroenterology; 2018; 154, pp. 1037-1046.e2. [DOI: https://dx.doi.org/10.1053/j.gastro.2017.11.030] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29174952]
10. Li, H.; Xia, Y.; Liu, H.-Y.; Guo, H.; He, X.-Q.; Liu, Y.; Wu, D.-T.; Mai, Y.-H.; Li, H.-B.; Zou, L. et al. Nutritional Values, Beneficial Effects, and Food Applications of Broccoli (Brassica Oleracea Var. Italica Plenck). Trends Food Sci. Technol.; 2022; 119, pp. 288-308. [DOI: https://dx.doi.org/10.1016/j.tifs.2021.12.015]
11. Güzel, M.; Akpınar, Ö. Preparation and Characterization of Bacterial Cellulose Produced from Fruit and Vegetable Peels by Komagataeibacter hansenii GA2016. Int. J. Biol. Macromol.; 2020; 162, pp. 1597-1604. [DOI: https://dx.doi.org/10.1016/j.ijbiomac.2020.08.049]
12. Saldívar, S.O.S.; Hernández, D.S. Dietary Fiber in Cereals, Legumes, Pseudocereals and Other Seeds. Science and Technology of Fibers in Food Systems; Springer: Cham, Switzerland, 2020; pp. 87-122.
13. Qiu, S.; Yadav, M.P.; Yin, L. Characterization and Functionalities Study of Hemicellulose and Cellulose Components Isolated from Sorghum Bran, Bagasse and Biomass. Food Chem.; 2017; 230, pp. 225-233. [DOI: https://dx.doi.org/10.1016/j.foodchem.2017.03.028] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28407904]
14. Surampudi, P.; Enkhmaa, B.; Anuurad, E.; Berglund, L. Lipid Lowering with Soluble Dietary Fiber. Curr. Atheroscler. Rep.; 2016; 18, 75. [DOI: https://dx.doi.org/10.1007/s11883-016-0624-z] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27807734]
15. Chen, C.; Zeng, Y.; Xu, J.; Zheng, H.; Liu, J.; Fan, R.; Zhu, W.; Yuan, L.; Qin, Y.; Chen, S. et al. Therapeutic Effects of Soluble Dietary Fiber Consumption on Type 2 Diabetes Mellitus. Exp. Ther. Med.; 2016; 12, pp. 1232-1242. [DOI: https://dx.doi.org/10.3892/etm.2016.3377] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27446349]
16. Giuntini, E.B.; Sardá, F.A.H.; de Menezes, E.W. The Effects of Soluble Dietary Fibers on Glycemic Response: An Overview and Futures Perspectives. Foods; 2022; 11, 3934. [DOI: https://dx.doi.org/10.3390/foods11233934] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/36496742]
17. Anderson, J.W.; Baird, P.; Davis Jr, R.H.; Ferreri, S.; Knudtson, M.; Koraym, A.; Waters, V.; Williams, C.L. Health Benefits of Dietary Fiber. Nutr. Rev.; 2009; 67, pp. 188-205. [DOI: https://dx.doi.org/10.1111/j.1753-4887.2009.00189.x]
18. Naude, C.E.; Brand, A.; Schoonees, A.; Nguyen, K.A.; Chaplin, M.; Volmink, J. Low-Carbohydrate versus Balanced-Carbohydrate Diets for Reducing Weight and Cardiovascular Risk. Cochrane Database Syst. Rev.; 2022; CD013334. [DOI: https://dx.doi.org/10.1002/14651858.CD013334]
19. Xie, C.; Lee, Z.J.; Ye, S.; Barrow, C.J.; Dunshea, F.R.; Suleria, H.A.R. A Review on Seaweeds and Seaweed-Derived Polysaccharides: Nutrition, Chemistry, Bioactivities, and Applications. Food Rev. Int.; 2024; 40, pp. 1312-1347. [DOI: https://dx.doi.org/10.1080/87559129.2023.2212055]
20. Castro-Acosta, M.L.; Lenihan-Geels, G.N.; Corpe, C.P.; Hall, W.L. Berries and Anthocyanins: Promising Functional Food Ingredients with Postprandial Glycaemia-Lowering Effects. Proc. Nutr. Soc.; 2016; 75, pp. 342-355. [DOI: https://dx.doi.org/10.1017/S0029665116000240] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27170557]
21. Reynolds, A.; Mann, J.; Cummings, J.; Winter, N.; Mete, E.; Morenga, L.T. Carbohydrate Quality and Human Health: A Series of Systematic Reviews and Meta-Analyses. The Lancet; 2019; 393, pp. 434-445. [DOI: https://dx.doi.org/10.1016/S0140-6736(18)31809-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30638909]
22. Reynolds, A.N.; Akerman, A.P.; Mann, J. Dietary Fibre and Whole Grains in Diabetes Management: Systematic Review and Meta-Analyses. PLoS Med.; 2020; 17, e1003053. [DOI: https://dx.doi.org/10.1371/journal.pmed.1003053] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32142510]
23. Brown, L.; Rosner, B.; Willett, W.W.; Sacks, F.M. Cholesterol-Lowering Effects of Dietary Fiber: A Meta-Analysis. Am. J. Clin. Nutr.; 1999; 69, pp. 30-42. [DOI: https://dx.doi.org/10.1093/ajcn/69.1.30] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9925120]
24. Yu, J.; Xia, J.; Yang, C.; Pan, D.; Xu, D.; Sun, G.; Xia, H. Effects of Oat Beta-Glucan Intake on Lipid Profiles in Hypercholesterolemic Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients.; 2022; 14, 2043. [DOI: https://dx.doi.org/10.3390/nu14102043]
25. Pagidipati, N.J.; Taub, P.R.; Ostfeld, R.J.; Kirkpatrick, C.F. Dietary Patterns to Promote Cardiometabolic Health. Nat. Rev. Cardiol.; 2025; 22, pp. 38-46. [DOI: https://dx.doi.org/10.1038/s41569-024-01061-7] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/39020052]
26. Marx, N.; Federici, M.; Schütt, K.; Müller-Wieland, D.; Ajjan, R.A.; Antunes, M.J.; Christodorescu, R.M.; Crawford, C.; Di Angelantonio, E.; Eliasson, B. et al. 2023 ESC Guidelines for the Management of Cardiovascular Disease in Patients with Diabetes: Developed by the Task Force on the Management of Cardiovascular Disease in Patients with Diabetes of the European Society of Cardiology (ESC). Eur. Heart J.; 2023; 44, pp. 4043-4140. [DOI: https://dx.doi.org/10.1093/eurheartj/ehad192] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37622663]
27. Liu, F.; Prabhakar, M.; Ju, J.; Long, H.; Zhou, H.-W. Effect of Inulin-Type Fructans on Blood Lipid Profile and Glucose Level: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Eur. J. Clin. Nutr.; 2017; 71, pp. 9-20. [DOI: https://dx.doi.org/10.1038/ejcn.2016.156]
28. Scientific Opinion on the Substantiation of Health Claims Related to Chitosan and Reduction in Body Weight (ID 679, 1499), Maintenance of Normal Blood LDL-Cholesterol Concentrations (ID 4663), Reduction of Intestinal Transit Time (ID 4664) and Reduction of Inflammation (ID 1985) Pursuant to Article 13(1) of Regulation (EC) No 1924/2006. Eur. Heart J.; 2011; 9, 2214. [DOI: https://dx.doi.org/10.2903/j.efsa.2011.2214]
29. Soliman, G.A. Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients; 2019; 11, 1155. [DOI: https://dx.doi.org/10.3390/nu11051155] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31126110]
30. Li, A.; Gao, J.; Li, Y.; Qi, S.; Meng, T.; Yu, S.; Zhang, Y.; He, Q. Efficacy of Oats in Dyslipidemia: A Systematic Review and Meta-Analysis. Food Funct.; 2024; 15, pp. 3232-3245. [DOI: https://dx.doi.org/10.1039/D3FO04394K]
31. Ghavami, A.; Ziaei, R.; Talebi, S.; Barghchi, H.; Nattagh-Eshtivani, E.; Moradi, S.; Rahbarinejad, P.; Mohammadi, H.; Ghasemi-Tehrani, H.; Marx, W. et al. Soluble Fiber Supplementation and Serum Lipid Profile: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Adv. Nutr.; 2023; 14, pp. 465-474. [DOI: https://dx.doi.org/10.1016/j.advnut.2023.01.005]
32. Ho, H.V.T.; Sievenpiper, J.L.; Zurbau, A.; Blanco Mejia, S.; Jovanovski, E.; Au-Yeung, F.; Jenkins, A.L.; Vuksan, V. The Effect of Oat β -Glucan on LDL-Cholesterol, Non-HDL-Cholesterol and apoB for CVD Risk Reduction: A Systematic Review and Meta-Analysis of Randomised-Controlled Trials. Br. J. Nutr.; 2016; 116, pp. 1369-1382. [DOI: https://dx.doi.org/10.1017/S000711451600341X]
33. Zhu, X.; Sun, X.; Wang, M.; Zhang, C.; Cao, Y.; Mo, G.; Liang, J.; Zhu, S. Quantitative Assessment of the Effects of Beta-Glucan Consumption on Serum Lipid Profile and Glucose Level in Hypercholesterolemic Subjects. Nutr. Metab. Cardiovasc. Dis.; 2015; 25, pp. 714-723. [DOI: https://dx.doi.org/10.1016/j.numecd.2015.04.008]
34. de Morais Junior, A.C.; Schincaglia, R.M.; Viana, R.B.; Armet, A.M.; Prado, C.M.; Walter, J.; Mota, J.F. The Separate Effects of Whole Oats and Isolated Beta-Glucan on Lipid Profile: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin. Nutr. ESPEN; 2023; 53, pp. 224-237. [DOI: https://dx.doi.org/10.1016/j.clnesp.2022.12.019]
35. Talati, R.; Baker, W.L.; Pabilonia, M.S.; White, C.M.; Coleman, C.I. The Effects of Barley-Derived Soluble Fiber on Serum Lipids. Ann. Fam. Med.; 2009; 7, pp. 157-163. [DOI: https://dx.doi.org/10.1370/afm.917]
36. AbuMweis, S.S.; Jew, S.; Ames, N.P. β-Glucan from Barley and Its Lipid-Lowering Capacity: A Meta-Analysis of Randomized, Controlled Trials. Eur. J. Clin. Nutr.; 2010; 64, pp. 1472-1480. [DOI: https://dx.doi.org/10.1038/ejcn.2010.178] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20924392]
37. Xu, D.; Liu, H.; Yang, C.; Xia, H.; Pan, D.; Yang, X.; Yang, L.; Wang, S.; Sun, G. Effects of Different Delivering Matrices of β-Glucan on Lipids in Mildly Hypercholesterolaemic Individuals: A Meta-Analysis of Randomised Controlled Trials. Br. J. Nutr.; 2021; 125, pp. 294-307. [DOI: https://dx.doi.org/10.1017/S0007114520001610] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32378501]
38. Silva, L.d.A.; Verneque, B.J.F.; Mota, A.P.L.; Duarte, C.K. Chia Seed (Salvia hispanica L.) Consumption and Lipid Profile: A Systematic Review and Meta-Analysis. Food Funct.; 2021; 12, pp. 8835-8849. [DOI: https://dx.doi.org/10.1039/D1FO01287H] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/34378609]
39. Jovanovski, E.; Yashpal, S.; Komishon, A.; Zurbau, A.; Blanco Mejia, S.; Ho, H.V.T.; Li, D.; Sievenpiper, J.; Duvnjak, L.; Vuksan, V. Effect of Psyllium (Plantago ovata) Fiber on LDL Cholesterol and Alternative Lipid Targets, Non-HDL Cholesterol and Apolipoprotein B: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am. J. Clin. Nutr.; 2018; 108, pp. 922-932. [DOI: https://dx.doi.org/10.1093/ajcn/nqy115] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30239559]
40. Brum, J.; Ramsey, D.; McRorie, J.; Bauer, B.; Kopecky, S.L. Meta-Analysis of Usefulness of Psyllium Fiber as Adjuvant Antilipid Therapy to Enhance Cholesterol Lowering Efficacy of Statins. Am. J. Cardiol.; 2018; 122, pp. 1169-1174. [DOI: https://dx.doi.org/10.1016/j.amjcard.2018.06.040]
41. Wei, Z.; Wang, H.; Chen, X.; Wang, B.; Rong, Z.; Wang, B.; Su, B.; Chen, H. Time- and Dose-Dependent Effect of Psyllium on Serum Lipids in Mild-to-Moderate Hypercholesterolemia: A Meta-Analysis of Controlled Clinical Trials. Eur. J. Clin. Nutr.; 2009; 63, pp. 821-827. [DOI: https://dx.doi.org/10.1038/ejcn.2008.49] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18985059]
42. Anderson, J.W.; Allgood, L.D.; Lawrence, A.; Altringer, L.A.; Jerdack, G.R.; Hengehold, D.A.; Morel, J.G. Cholesterol-Lowering Effects of Psyllium Intake Adjunctive to Diet Therapy in Men and Women with Hypercholesterolemia: Meta-Analysis of 8 Controlled Trials. Am. J. Clin. Nutr.; 2000; 71, pp. 472-479. [DOI: https://dx.doi.org/10.1093/ajcn/71.2.472]
43. Olson, B.H.; Anderson, S.M.; Becker, M.P.; Anderson, J.W.; Hunninghake, D.B.; Jenkins, D.J.A.; LaRosa, J.C.; Rippe, J.M.; Roberts, D.C.K.; Stoy, D.B. et al. Psyllium-Enriched Cereals Lower Blood Total Cholesterol and LDL Cholesterol, but Not HDL Cholesterol, in Hypercholesterolemic Adults: Results of a Meta-Analysis. J. Nutr.; 1997; 127, pp. 1973-1980. [DOI: https://dx.doi.org/10.1093/jn/127.10.1973] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9311953]
44. Bazzano, L.A.; Thompson, A.M.; Tees, M.T.; Nguyen, C.H.; Winham, D.M. Non-Soy Legume Consumption Lowers Cholesterol Levels: A Meta-Analysis of Randomized Controlled Trials. Nutr. Metab. Cardiovasc. Dis.; 2011; 21, pp. 94-103. [DOI: https://dx.doi.org/10.1016/j.numecd.2009.08.012] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19939654]
45. Shin, D.; Shim, S.R.; Wu, Y.; Hong, G.; Jeon, H.; Kim, C.-G.; Lee, K.J. How Do Brown Seaweeds Work on Biomarkers of Dyslipidemia? A Systematic Review with Meta-Analysis and Meta-Regression. Mar. Drugs; 2023; 21, 220. [DOI: https://dx.doi.org/10.3390/md21040220]
46. Malhotra, A.; Shafiq, N.; Arora, A.; Singh, M.; Kumar, R.; Malhotra, S. Dietary Interventions (Plant Sterols, Stanols, Omega-3 Fatty Acids, Soy Protein and Dietary Fibers) for Familial Hypercholesterolaemia. Cochrane Database Syst. Rev.; 2014; 2014, CD001918. [DOI: https://dx.doi.org/10.1002/14651858.CD001918.pub3]
47. Huang, H.; Zou, Y.; Chi, H.; Liao, D. Lipid-Modifying Effects of Chitosan Supplementation in Humans: A Pooled Analysis with Trial Sequential Analysis. Mol. Nutr. Food Res.; 2018; 62, 1700842. [DOI: https://dx.doi.org/10.1002/mnfr.201700842]
48. Ghavami, A.; Banpouri, S.; Ziaei, R.; Talebi, S.; Vajdi, M.; Nattagh-Eshtivani, E.; Barghchi, H.; Mohammadi, H.; Askari, G. Effect of Soluble Fiber on Blood Pressure in Adults: A Systematic Review and Dose–Response Meta-Analysis of Randomized Controlled Trials. Nutr. J.; 2023; 22, 51. [DOI: https://dx.doi.org/10.1186/s12937-023-00879-0]
49. Reynolds, A.N.; Akerman, A.; Kumar, S.; Diep Pham, H.T.; Coffey, S.; Mann, J. Dietary Fibre in Hypertension and Cardiovascular Disease Management: Systematic Review and Meta-Analyses. BMC Med.; 2022; 20, 139. [DOI: https://dx.doi.org/10.1186/s12916-022-02328-x]
50. Clark, C.C.T.; Salek, M.; Aghabagheri, E.; Jafarnejad, S. The Effect of Psyllium Supplementation on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Korean J. Intern. Med.; 2020; 35, pp. 1385-1399. [DOI: https://dx.doi.org/10.3904/kjim.2019.049]
51. Khan, K.; Jovanovski, E.; Ho, H.V.T.; Marques, A.C.R.; Zurbau, A.; Mejia, S.B.; Sievenpiper, J.L.; Vuksan, V. The Effect of Viscous Soluble Fiber on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutr. Metab. Cardiovasc. Dis.; 2018; 28, pp. 3-13. [DOI: https://dx.doi.org/10.1016/j.numecd.2017.09.007]
52. Khalesi, S.; Irwin, C.; Schubert, M. Flaxseed Consumption May Reduce Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Trials. J. Nutr.; 2015; 145, pp. 758-765. [DOI: https://dx.doi.org/10.3945/jn.114.205302] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25740909]
53. Xi, H.; Zhou, W.; Niu, Y.; Zhu, R.; Wang, S.; Guo, Y.; Liu, W.; Xiong, X.; Guo, L. Effect of Oat Consumption on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Acad. Nutr. Diet.; 2023; 123, pp. 809-823. [DOI: https://dx.doi.org/10.1016/j.jand.2022.11.010]
54. Huang, H.; Zou, Y.; Chi, H. Quantitative Assessment of the Effects of Chitosan Intervention on Blood Pressure Control. Drug Des. Dev. Ther.; 2018; 12, pp. 67-75. [DOI: https://dx.doi.org/10.2147/DDDT.S148064]
55. Man, A.W.C.; Li, H.; Xia, N. Impact of Lifestyles (Diet and Exercise) on Vascular Health: Oxidative Stress and Endothelial Function. Oxidative Med. Cell. Longev.; 2020; 2020, 1496462. [DOI: https://dx.doi.org/10.1155/2020/1496462]
56. Virani, S.S.; Newby, L.K.; Arnold, S.V.; Bittner, V.; Brewer, L.C.; Demeter, S.H.; Dixon, D.L.; Fearon, W.F.; Hess, B.; Johnson, H.M. et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients with Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation; 2023; 148, pp. e9-e119. [DOI: https://dx.doi.org/10.1161/CIR.0000000000001168] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37471501]
57. Griel, A.E.; Ruder, E.H.; Kris-Etherton, P.M. The Changing Roles of Dietary Carbohydrates: From Simple to Complex. Arterioscler. Thromb. Vasc. Biol.; 2006; 26, pp. 1958-1965. [DOI: https://dx.doi.org/10.1161/01.ATV.0000233384.97125.bd] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16794219]
58. Dreher, M. Fiber and Hypertension. Dietary Fiber in Health and Disease; Springer: Cham, Switzerland, 2018; pp. 291-303.
59. Khalid, W.; Arshad, M.S.; Jabeen, A.; Muhammad Anjum, F.; Qaisrani, T.B.; Suleria, H.A.R. Fiber-Enriched Botanicals: A Therapeutic Tool against Certain Metabolic Ailments. Food Sci. Nutr.; 2022; 10, pp. 3203-3218. [DOI: https://dx.doi.org/10.1002/fsn3.2920]
60. Hu, T.; Wu, Q.; Yao, Q.; Jiang, K.; Yu, J.; Tang, Q. Short-Chain Fatty Acid Metabolism and Multiple Effects on Cardiovascular Diseases. Ageing Res. Rev.; 2022; 81, 101706. [DOI: https://dx.doi.org/10.1016/j.arr.2022.101706] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/35932976]
61. Havlik, J.; Marinello, V.; Gardyne, A.; Hou, M.; Mullen, W.; Morrison, D.J.; Preston, T.; Combet, E.; Edwards, C.A. Dietary Fibres Differentially Impact on the Production of Phenolic Acids from Rutin in an In Vitro Fermentation Model of the Human Gut Microbiota. Nutrients; 2020; 12, 1577. [DOI: https://dx.doi.org/10.3390/nu12061577] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/32481553]
62. Shahinfar, H.; Jayedi, A.; Torabynasab, K.; Payandeh, N.; Martami, F.; Moosavi, H.; Bazshahi, E.; Shab-Bidar, S. Comparative Effects of Nutraceuticals on Body Weight in Adults with Overweight or Obesity: A Systematic Review and Network Meta-Analysis of 111 Randomized Clinical Trials. Pharmacol. Res.; 2023; 196, 106944. [DOI: https://dx.doi.org/10.1016/j.phrs.2023.106944]
63. Rajestary, R.; Landi, L.; Romanazzi, G. Chitosan and Postharvest Decay of Fresh Fruit: Meta-Analysis of Disease Control and Antimicrobial and Eliciting Activities. Compr. Rev. Food Sci. Food Saf.; 2021; 20, pp. 563-582. [DOI: https://dx.doi.org/10.1111/1541-4337.12672]
64. Zhang, P.; Jia, J.; Jiang, P.; Zheng, W.; Li, X.; Song, S.; Ai, C. Polysaccharides from Edible Brown Seaweed Undaria Pinnatifida Are Effective against High-Fat Diet-Induced Obesity in Mice through the Modulation of Intestinal Microecology. Food Funct.; 2022; 13, pp. 2581-2593. [DOI: https://dx.doi.org/10.1039/D1FO04012J]
65. Murakami, S.; Hirazawa, C.; Ohya, T.; Yoshikawa, R.; Mizutani, T.; Ma, N.; Moriyama, M.; Ito, T.; Matsuzaki, C. The Edible Brown Seaweed Sargassum horneri (Turner) C. Agardh Ameliorates High-Fat Diet-Induced Obesity, Diabetes, and Hepatic Steatosis in Mice. Nutrients; 2021; 13, 551. [DOI: https://dx.doi.org/10.3390/nu13020551] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33567531]
66. Wang, J.; Zhang, Z.; Dai, T.; Zhang, Z.; Zhang, Q.; Yao, J.; Wang, L.; He, N.; Li, S. The Therapeutic Effect and Possible Mechanisms of Alginate Oligosaccharide on Metabolic Syndrome by Regulating Gut Microbiota. Food Funct.; 2024; 15, pp. 9632-9661. [DOI: https://dx.doi.org/10.1039/D4FO02802C]
67. Patil, N.P.; Le, V.; Sligar, A.D.; Mei, L.; Chavarria, D.; Yang, E.Y.; Baker, A.B. Algal Polysaccharides as Therapeutic Agents for Atherosclerosis. Front. Cardiovasc. Med.; 2018; 5, 153. [DOI: https://dx.doi.org/10.3389/fcvm.2018.00153] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30417001]
68. Li, J.; Chen, R.; Chen, Y.; Zhu, D.; Wu, Z.; Chen, F.; Huang, X.; Ali Khan, B.; Al Hennawi, H.E.; Albazee, E. et al. The Effect of Guar Gum Consumption on the Lipid Profile in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Crit. Rev. Food Sci. Nutr.; 2023; 63, pp. 2886-2895. [DOI: https://dx.doi.org/10.1080/10408398.2021.1981228]
69. Zou, Y.; Liao, D.; Huang, H.; Li, T.; Chi, H. A Systematic Review and Meta-Analysis of Beta-Glucan Consumption on Glycemic Control in Hypercholesterolemic Individuals. Int. J. Food Sci. Nutr.; 2015; 66, pp. 355-362. [DOI: https://dx.doi.org/10.3109/09637486.2015.1034250] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26001090]
70. Chambers, E.S.; Byrne, C.S.; Morrison, D.J.; Murphy, K.G.; Preston, T.; Tedford, C.; Garcia-Perez, I.; Fountana, S.; Serrano-Contreras, J.I.; Holmes, E. et al. Dietary Supplementation with Inulin-Propionate Ester or Inulin Improves Insulin Sensitivity in Adults with Overweight and Obesity with Distinct Effects on the Gut Microbiota, Plasma Metabolome and Systemic Inflammatory Responses: A Randomised Cross-over Trial. Gut; 2019; 68, pp. 1430-1438. [DOI: https://dx.doi.org/10.1136/gutjnl-2019-318424] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30971437]
71. American Diabetes Association Professional Practice Committee 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024. Diabetes Care; 2024; 47, pp. S20-S42. [DOI: https://dx.doi.org/10.2337/dc24-S002]
72. World Health Organization. Guideline: Sugars Intake for Adults and Children; WHO Guidelines Approved by the Guidelines Review Committee World Health Organization: Geneva, Switzerland, 2015; ISBN 978-92-4-154902-8
73. Vaz, E.C.; Porfírio, G.J.M.; Nunes, H.R.D.C.; Nunes-Nogueira, V.D.S. Effectiveness and Safety of Carbohydrate Counting in the Management of Adult Patients with Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Arch. Endocrinol. Metab.; 2018; 62, pp. 337-345. [DOI: https://dx.doi.org/10.20945/2359-3997000000045] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29791661]
74. Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD) Evidence-Based European Recommendations for the Dietary Management of Diabetes. Diabetologia; 2023; 66, pp. 965-985. [DOI: https://dx.doi.org/10.1007/s00125-023-05894-8] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37069434]
75. Tavares, J.O.; Cotas, J.; Valado, A.; Pereira, L. Algae Food Products as a Healthcare Solution. Mar. Drugs; 2023; 21, 578. [DOI: https://dx.doi.org/10.3390/md21110578] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/37999402]
76. Fizpatrick, F.W.; DiCarlo, F.J. Zymosan. Ann. N. Y. Acad. Sci.; 1964; 118, pp. 235-261. [DOI: https://dx.doi.org/10.1111/j.1749-6632.1964.tb33982.x]
77. Nakashima, A.; Yamada, K.; Iwata, O.; Sugimoto, R.; Atsuji, K.; Ogawa, T.; Ishibashi-Ohgo, N.; Suzuki, K. β-Glucan in Foods and Its Physiological Functions. J. Nutr. Sci. Vitaminol.; 2018; 64, pp. 8-17. [DOI: https://dx.doi.org/10.3177/jnsv.64.8] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29491277]
78. Zurbau, A.; Noronha, J.C.; Khan, T.A.; Sievenpiper, J.L.; Wolever, T.M.S. The Effect of Oat β-Glucan on Postprandial Blood Glucose and Insulin Responses: A Systematic Review and Meta-Analysis. Eur. J. Clin. Nutr.; 2021; 75, pp. 1540-1554. [DOI: https://dx.doi.org/10.1038/s41430-021-00875-9] [PubMed: https://www.ncbi.nlm.nih.gov/pubmed/33608654]
79. He, L.; Zhao, J.; Huang, Y.; Li, Y. The Difference between Oats and Beta-Glucan Extract Intake in the Management of HbA1c, Fasting Glucose and Insulin Sensitivity: A Meta-Analysis of Randomized Controlled Trials. Food Funct.; 2016; 7, pp. 1413-1428. [DOI: https://dx.doi.org/10.1039/C5FO01364J]
80. Francelino Andrade, E.; Vieira Lobato, R.; Vasques Araújo, T.; Gilberto Zangerônimo, M.; Vicente Sousa, R.; José Pereira, L. Effect of Beta-Glucans in the Control of Blood Glucose Levels of Diabetic Patients: A Systematic Review. Nutr. Hosp.; 2014; 31, pp. 170-177. [DOI: https://dx.doi.org/10.3305/nh.2015.31.1.7597]
81. Mozaffarian, D. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation; 2016; 133, pp. 187-225. [DOI: https://dx.doi.org/10.1161/CIRCULATIONAHA.115.018585]
82. Guo, W.; Yi, L.; Zhou, B.; Li, M. Chitosan Modifies Glycemic Levels in People with Metabolic Syndrome and Related Disorders: Meta-Analysis with Trial Sequential Analysis. Nutr. J.; 2020; 19, 130. [DOI: https://dx.doi.org/10.1186/s12937-020-00647-4]
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
Details
; Popiolek-Kalisz, Joanna 2
1 Department of Bioanalytics, Chair of Dietetics and Bioanalytics, Medical University of Lublin, Jaczewskiego 8b St., 20-090 Lublin, Poland
2 Department of Clinical Dietetics, Chair of Dietetics and Bioanalytics, Medical University of Lublin, Chodzki 7 St., 20-090 Lublin, Poland; Department of Cardiology, Cardinal Wyszynski Hospital in Lublin, al. Krasnicka 100, 20-718 Lublin, Poland