Skip to main content
Download PDF

The effect of sesame oil consumption compared to sunflower oil on lipid profile, blood pressure, and anthropometric indices in women with non-alcoholic fatty liver disease: a randomized double-blind controlled trial

Trials volume 23, Article number: 551 (2022) Cite this article

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in the world. There is strong evidence that dyslipidemia and other cardio-metabolic disorders are highly prevalent in patients with NAFLD. This trial aimed at examining the effect of sesame oil (SO) in the context of a weight loss program on lipid profile, blood pressure, and anthropometric indices in women with NAFLD.

Methods

This randomized, double-blind, controlled trial was carried out on 60 women with NAFLD. Subjects were randomly assigned to the SO group (n = 30) and sunflower oil (SFO) group (n = 30), each person consuming 30 g of oil per day for 12 weeks. All the participants received a hypocaloric diet (− 500 kcal/day) during the study. Lipid profile, blood pressure, and anthropometric indices were assessed at pre- and post-intervention phases.

Results

In total, 53 participants completed the study. Following 12 weeks of intervention, anthropometric indices (p < 0.001) and systolic blood pressure (SBP) (p < 0.05) were significantly decreased in both groups and diastolic blood pressure (DBP) was significantly decreased in So group (p = 0.03). There was no significant change in lipid profile in both groups (p > 0.05). After adjusting for confounders, DBP (p = 0.031) and total cholesterol (TC) divided by high-density lipoprotein cholesterol (HDL-C) (p = 0.039) in the SO group were significantly reduced compared to the SFO group (p < 0.05).

Conclusions

The present clinical trial revealed that SO and SFO may not differently affect anthropometric indices, SBP, and lipid profile except for TC/HDL-C. In addition, SO may be effective in improvement of DBP and TC/HDL-C compared to the SFO group.

Trial registration

Ethical approval of this trial was obtained at Isfahan University of Medical Sciences with the reference number of IR.MUI.RESEARCH.REC.1399.548 (https://ethics.research.ac.ir/ProposalCertificateEn.php?id=158942&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true), and it was registered before the start of the patient recruitment on December 12th, 2020 in the Iranian Registry of Clinical Trials (IRCT) with the registration number of IRCT20140208016529N6.

Peer Review reports

Introduction

NAFLD is known to be the leading cause of liver-related deaths and is one of the most common liver diseases in the world [1,2,3,4]. The prevalence of this disease throughout the world and Iran, which is the host of this clinical trial, is 25% and 33.9%, respectively [5, 6]. There are strong evidences that cardio-metabolic disorders are highly prevalent in patients with NAFLD [7]. Among patients with NAFLD, the prevalence of obesity, hypertension, and hyperlipidemia is 67, 46.7, and 77.1%, respectively [8]. These comorbidities have extensive negative effects on NAFLD. There are common pathogenic mechanisms and similar biological processes between NAFLD and these markers [5]. In fact, the severity of NAFLD is strongly influenced by obesity, which leads to the worsening of liver fibrosis and the progression of liver diseases. The presence of NAFLD is also effective in the development of cardiovascular diseases (CVD) [5]. Studies have shown that individuals with NAFLD had a higher risk of heart disease than individuals without NAFLD [9].

The results of pharmacological studies for NAFLD treatment have remained inconclusive [10]. To date, the best proven treatment for the management of NAFLD is lifestyle modification (having physical activity and a healthy diet) [1, 10, 11]. Among macronutrients, fats have a great impact on chronic diseases such as CVD and NAFLD [12]. Types and amount of the dietary fats play an important role in fat accumulation in the liver, which are responsible for 15% of the total liver fat content [13]. High fat diet is well known as a dietary factor in the progression of hepatic steatosis [14]. Changes in dietary fatty acids may play an important role in the prevention and treatment of coronary heart diseases, hypertension, and fatty liver disease [10, 15, 16]. Monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs) are parts of a complete diet that have beneficial effects in preventing the occurrence and progression of NAFLD [10].

SO is used as a healthy oil in Asian countries [17] and is a good source of MUFAs and PUFAs (83–90% of fatty acids), which contains 36–54% oleic acid and 38–49% linoleic acid. PUFAs of SO improve the lipid profile by increasing HDL-C and decreasing LDL-C, TG, and fat oxidation [18]. MUFAs reduce TG by increasing the oxidation of fatty acids [19]. SO is rich in natural antioxidants such as tocopherol, polyphenols, phytosterols, flavonoids, and lignans [20] and minerals such as magnesium, calcium, copper, iron, and zinc [11], which reduces blood pressure, hyperlipidemia, and lipid peroxidation by increasing enzymatic and non-enzymatic antioxidants [11]. Sesamin in SO has anti-atherosclerotic properties [21] and may control blood pressure [22, 23].

Animal studies have shown that SO lignans protect the liver by the decrease in lipogenesis and lowering the concentration of cholesterol in the liver [14, 24]. A number of studies have shown that SO improves TC, LDL-C [22, 25, 26], TG [23, 25, 26], HDL-C [25,26,27], and blood pressure [20, 28]. However, some studies were unable to confirm this effect on TC and LDL-C [28, 29], TG [22, 27, 29] HDL-C, [20, 28, 29], and blood pressure [29]. A number of animal studies have examined the beneficial effects of SO on liver diseases [11, 30,31,32]. To the best of our knowledge, no human study has examined the effect of SO on cardio-metabolic biomarkers in patients with NAFLD. Therefore, the present clinical trial investigates the effect of SO on cardio-metabolic biomarkers including lipid profile, blood pressure, and anthropometric indices in women with NAFLD.

Materials and methods

Study design and patients’ characteristics

The study was a randomized, double-blind, parallel, controlled trial in Shahroud, Iran. The current study aimed to assess the effects of SO on lipid profile, blood pressure, and anthropometric indices in women with NAFLD. SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) was used as a framework for reporting the present protocol [33]. The ethical approval of this trial was obtained from the ethics committee of Isfahan University of Medical Sciences on November 9th, 2020, with a reference number of IR.MUI.RESEARCH.REC.1399.548 and was registered in the Iranian registry of clinical trials (https://www.irct.ir/trial/52288) with the registration code of IRCT20140208016529N6 on December 12th, 2020.

Sixty women with NAFLD were recruited from the liver and gastrointestinal clinics of Shahroud, Iran. The mean of age was 39 years, and the mean of BMI was 31.3 kg/m2.

Female participants, being 20 to 50 years old, having 1–3 fatty liver grade by examining ultrasonography, consuming SFO as the routine oil, having BMI between 25 and 40, were included in the study (inclusion criteria).

The exclusion criteria applied to the potential participants were as follows: having been smokers, alcohol consuming, menopausal, pregnant, breastfeeding; having undergone insulin therapy throughout the study period; having hormone-dependent cysts and allergies, history of breast cancer, sclerosing cholangitis, renal failure, autoimmunity, malignancies, celiac disease, hereditary hemochromatosis (transferrin saturation greater than 45%), Wilson’s disease, liver diseases (cirrhosis, alcoholic liver disease, viral hepatitis, hepatitis, primary biliary cirrhosis, biliary obstruction and liver damage induced by hereditary hemochromatosis drugs); have consumed hepatotoxicity drugs such as tamoxifen and lithium, drugs affecting the levels of liver enzymes ALP, AST, and ALT including valproic acid, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, acetaminophen, salicylates, phenytoin, benzodiazepines, drugs causing fatty liver such as methotrexate, tamoxifen, valproate, drugs such as corticosteroids, amiodarone, perhexiline, aspirin, hydralazine, contraceptives, estrogen; have participated in other studies in the last 6 months; having any weight loss diet or special diet in the last 3 months; and consuming multivitamin mineral and omega-3 supplements 3 months prior the trial.

The participants who lost to follow-up the study for any reason or had improper adherence were excluded from the analysis (drop-out criteria).

At the first visit, all study protocols were explained to the participants, and written consents, demographic information, and their medical histories were obtained. During the run-in, participants used routine oil (SFO) and healthy eating recommendations. SFO is widely produced and distributed in Iran and is well known as the main type of oil consumed by Iranians [34].

Chemical analysis of SO and SFO

Fatty acids composition of SO and SFO (Kamjed Company, Shahroud, Iran) were evaluated using high-performance gas chromatography at the reference food chemistry laboratory (ViroMed Specialized Laboratories, Tehran, Iran). The percentages of PUFAs, MUFAs, and SFAs were 52.57%, 35.83%, and 11.6% in the SFO and were 46.57%, 38.25%, and 15.18% in the SO, respectively. The concentrations of n-3 and n-6 fatty acids were 0.16% and 52.41% in SFO and 0.26% and 46.31% in SO, respectively. The fatty acid profiles of both types of oils are shown in Table 1.

Table 1 Fatty acid composition of sesame and sunflower oils
Full size table

Randomization and intervention

After 2 weeks of run-in, 60 individuals were randomly divided into two groups using random allocation method (using permuted block randomization method with block sizes of four) by a third party who did not know about the study and its objectives: (1) 30 individuals in group A received 30 g per day of SO and hypocaloric diet and (2) 30 individuals in group B received 30 g per day of SFO and hypocaloric diet. Then, the intervention was performed for 12 weeks. The types of oils used for the trial and the study objectives were blinded by a person out of this study. The refined, odorless oils were placed in similar, opaque bottles with A and B labels. As a result, participants, facilitators, and researchers became blind to the types of oils being consumed.

The estimated energy requirement (EER) for each individual was calculated, using the Mifflin-St Jeor equation [35], and 500 cal were deducted. The energy distributions consisted of 50–55% carbohydrates, 14–18% protein, and 27–32% fat. Food groups and the food-exchanging were explained to the participants. Half of the oil containers were given to the participants at the beginning of the trial for the first 6 weeks of the study, and the rest were given after the 6-week period. Calibrated cups were given to individuals to consume the exact amount of 30 g of oil per day on their cooked foods or salads for 12 weeks. Four clinical visits were performed at the beginning of run-in and at the beginning, middle, and end of the intervention. Participants were asked not to change their recommended diet, physical activity, and medications during the study. Furthermore, they were asked to report any changes. In addition, participants were followed up by short text messages or phone calls each week. The patients determined to be adhering to the trial were identified by the number of containers they returned and also consumed more than 90% of the provided oils.

Anthropometric measurements

Body weight was measured using a digital calibrated scale (mode BG 51XXL, Seca, Germany) with light clothes and an accuracy of 0.1 kg. Height was measured in the standing position without shoes while leaning against the wall and shoulders being in normal condition with an accuracy of 0.5 cm using a tape measure mounted on the wall. BMI was calculated based on body weight (kg) divided by height squared (m2). Waist circumference (WC) was measured in the middle area between the lowest rib and the upper iliac bone with a non-stretchable measuring tape at the end of a normal exhalation. The hip circumference (HC) is measured as the largest part of the hip, which is also defined as the widest part of the buttocks. The waist to hip ratio (WHR) is calculated by dividing WC over HC. Moreover, index of central obesity (ICO) is calculated by dividing WC over height. To eliminate measurement errors, all measurements are performed by a trained person, three times per visit.

Dietary intake and physical activity assessment

To assess the diet, participants were instructed in a public session by a nutritionist on how to fill out the food records (the type and amount of all consumed foods and beverages). Participants completed the 3-day weighted food record forms (two weekdays and one weekend day) at the beginning, middle, and end of the intervention to measure dietary nutrients intake, including energy, macronutrients, and micronutrients intake. A total of nine food records for each individual were analyzed using Nutritionist IV software modified for Iranian foods (version 3.5.2, Axxya Systems, Redmond, Washington, DC, USA).

A 3-day self-report record (two weekdays and one weekend day) was used to assess physical activity at the beginning, middle, and end of the intervention. A total of nine physical activity records were obtained for each individual. The participants were asked to maintain their usual physical activity patterns throughout the study. Physical activity data were converted to metabolic equivalents (MET) hour/day, using the updated compendium of physical activities [36].

Blood pressure measurement

Blood pressure was measured after 10 to 15 min of rest and being away from any excitement and in a sitting position using a mercury sphygmomanometer (model JHSM, China) at the beginning and at the end of the study. To eliminate errors, blood pressure measurements were performed two times per visit by a trained person.

Laboratory data

At the beginning and the end of the intervention, 10 ml of venous blood from the participants’ left arm was taken after an overnight fast (12 h) between 7 and 10 AM. The blood samples were taken in the sitting position, at the laboratory of Razavi clinic, Shahroud, Iran. It was centrifuged at 3000 rpm for 5 min, and after serum separation, it was kept at − 80 °C until the analysis. TC, TG, HDL-C, and LDL-C were measured using an enzymatic colorimetric method (Pars Azmoon, Tehran, Iran). Non-HDL-C, which is the summation of LDL-C, intermediate-density lipoproteins cholesterol (IDL-C), and very low-density lipoprotein cholesterol (VLDL-C) was determined by the subtraction of HDL-C from TC.

Statistical analyses

The sample size was calculated for parallel clinical trial studies containing an intervention and a control groups [37]. A sample size of 30 for each group was calculated based on a previous study [38]. It is determined to detect a between-group difference in mean of 0.46 for fatty liver grade as the primary outcome with standard deviation of 0.01 for fatty liver, type one error (α) of 0.01, and type two errors (β) of 0.20 (power = 80%), and approximately 20% dropout.

Shapiro–Wilk’s test was used to assess the normality of quantitative data distribution. Qualitative and quantitative variables were expressed as frequency report (percentage, %) and mean ± standard deviation, respectively. For the intra-group analyses, paired sample t-test (variables with normal distribution) and Wilcoxon test (variables without normal distribution and qualitative variables) were used for comparing the mean of variables. For the inter-group analyses, independent sample t-test and Mann–Whitney test were used to examine the mean of quantitative variables with and without normal distribution, respectively. However, chi-square test were used for qualitative variables. Analysis of covariance (ANCOVA and non-parametric ANCOVA) was used to compare the changes of quantitative variables between two groups in the presence of confounders. The potential confounders of age, baseline BMI, physical activity changes, energy intake changes, and baseline values of the variables were included as covariates in the univariate-adjusted model. p-value < 0.05 was considered statistically significant. SPSS software (version 25, SPSS Inc., Chicago, IL, USA) was used for data analyses.

Results

Study baseline characteristics

Of the total 110 patients with NAFLD assessed for eligibility, 50 patients were excluded based on the exclusion criteria, and 60 participants enrolled, gave their informed written consents, and participated in the trial. They were randomly divided into either the SO group as the intervention group (n = 30) or the SFO group as the control group (n = 30). Three subjects from the intervention group and four subjects from the control group dropped out during the intervention: adhered improperly (n = 2), moved to another city (n = 2), and did not intend to continue (n = 3). In total, 53 subjects completed this trial and were included in the analysis (Fig. 1). No side effects were observed from oil consumption during the intervention period.

Fig. 1
figure 1

Flow chart of patient recruitment for the clinical trial

Full size image

There were no significant differences in age, education level, lipid profile, blood pressure, and anthropometric indices between the two groups at the beginning of the study (Table 2).

Table 2 Baseline characteristics of the participants
Full size table

Dietary intake of participants

Table 3 summarizes the physical activity and the intake of macronutrients and micronutrients of participants at the baseline and at the averages of mid- and post-intervention of each group. There was a significant decrease in levels of total energy, carbohydrates, proteins, fat, PUFAs, MUFAs, and SFAs in each group after the intervention. At the end of the intervention, the level of MUFAs in the SO group was significantly higher than the control group (p < 0.05), and the level of PUFAs in the control group was significantly higher than the SO (p < 0.001). Physical activity remained unchanged throughout the study period in both groups. After the intervention, no significant differences between the two groups were observed for total energy and macronutrient and micronutrient intake except for vitamin E (p < 0.05). Vitamin E increased significantly in the SO group compared to the SFO group.

Table 3 Physical activity and dietary intake of study participants at baseline and after intervention
Full size table

The effect of SO on lipid profile, blood pressure, and anthropometric indices

Clinical and anthropometrical variables and their changes after 12 weeks of intervention are presented in Table 4. Given a weight loss diet at the beginning of the study, significant reductions in body weight, BMI, WC, HC, WHR, and ICO were observed in both groups at the end of the study (p < 0.001), while no significant differences were observed between the two groups (p > 0.05). After 12 weeks of intervention, SBP decreased significantly in both groups, but no significant difference was observed between the two groups (p > 0.05). However, changes in DBP (− 4 ± 6.11 mmHg) in the SO group were significant compared to the control group in both unadjusted and adjusted models (p < 0.05). At the end of the intervention, HDL-C decreased significantly in both groups (p < 0.05), but no significant difference was observed between the groups. No significant changes of LDL-C, TG, TC, VLDL-C, non-HDL-C, LDL-C/HDL-C, and TG/HDL-C were observed at the end of the intervention in both groups (p > 0.05). Nevertheless, TC/HDL-C significantly decreased in SO group compared to the control group (p < 0.05).

Table 4 Analysis of variables after 12 weeks of intervention
Full size table

Discussion

The purpose of this randomized controlled trial was to compare the effects of SO in the context of a weight loss program on lipid profile, blood pressure, and anthropometric indices in women with NAFLD. Following 12 weeks of SO consumption, despite having no effect on lipid profile, favorable changes in SBP, DBP, body weight, WC, HC, WHR, and ICO were observed. Similar results were observed following SFO intake, except for DBP with no changes. At the end of the intervention, HDL-C decreased in both groups. Comparisons between treatment groups showed significant reductions in DBP and TC/HDL-C in SO group compared to SFO group.

Lipid profile

In our study, TC and LDL-C levels decreased in the SO group but they were not statistically significant. However, the ratio of TC to HDL-C was significantly reduced in the SO group compared to the control group. In support of our results, in a parallel study, Khajehdehi et al. examined patients with kidney problems that ingested SO for 8 weeks. They showed TC, TG, and LDL-C levels remained unchanged at end of the intervention [29]. On the contrary, a number of studies with parallel design in patients with metabolic disorders that consumed SO showed significant decreases in TC, LDL-C, and TG levels compared to the control group [20, 23, 26, 28]. Differences in participants’ diseases, dosages of SO, and the particular study designs may have been the reasons for the differences between the results of these studies and our study. Perhaps another reason for the lack of significant reductions in TC and LDL-C is their normal levels in the base line that may have not allowed seeing the best benefit of SO consumption. While, two meta-analysis studies showed the beneficial effect of sesame on lipid profile [39, 40].

There were some probable mechanisms, which can show the hypocholesterolemic effects of SO. SO is rich in MUFA [20] and various studies have shown that high levels MUFA inhibits lipogenesis by increasing the oxidation of fatty acids by activating the peroxisome proliferator-activated receptor alpha or by decreasing the activation of the sterol regulatory element binding protein [19]. Sankar’s et al. stated that the decrease in LDL-C and TC may be due to high levels of MUFA in SO [28]. SO lignans belong to phytochemical family [41]. A human study showed that sesamin, a lignan in SO, significantly reduced LDL-C [42]. In this study, it was suggested that sesamin can potentially reduce 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase activity [42]. In our study, dietary assessment showed the level of MUFAs in the SO group was significantly higher than the control group at the end of the intervention. However, we did not examine the fatty acid content of red blood cells (RBC), which is one of the limitations of our study.

Studies showed that γ-tocopherol in SO can cause platelet aggregation reduction, LDL-C oxidation, intra-arterial thrombosis delay [43], and cholesterol biosynthesis inhibition [44]. Our study showed that vitamin E intake was increased with SO consumption. However, we did not examine serum levels of vitamin E, which is another limitation of our study.

In our study, HDL-C level significantly reduced in both groups but these reductions were not much different between the two groups. A number of studies have shown that consuming SO increases HDL-C levels [25,26,27], while other studies have shown that it remains unchanged [20, 29]. The reason for HDL-C level reduction in our study may be due to the adherence to low-calorie diets and the reduction in fat intake [45].

Blood pressure

In this trial, SBP decreased significantly in both groups and DBP decreased significantly in the SO group compared to the control group. Some studies have shown beneficial effects of SO consumption on blood pressure [20, 22, 23, 28], while one study has not shown this effect [29]. In our study, the significant reduction in DBP in SO group compared to the control group may be due to the oil composition.

A systematic review done by Cardoso et al. reported positive effects of dietary intake of sesame derivatives on blood pressure [46]. Multiple possible mechanisms explain the beneficial effects of SO on blood pressure. The antihypertensive effect of SO is related to antioxidant lignans, including sesamolin, sesamol, episesamin, and sesamin as well as its multiple tocopherol homologs [α-tocopherol, δ-tocopherol, γ-tocopherol, and tocotrienols] content that break the radical chain in membranes and lipoproteins [20, 28]. A study showed that black sesame meal capsule supplementations for 4 weeks in prehypertension patients leads to an increase in serum levels of vitamin E and a decrease in blood pressure [47]. Experimental models showed that the antihypertensive effects of sesamin were related to its antagonistic activity on calcium channels [48,49,50]. Another experimental study showed that sesamin increases the concentration of nitric oxide and inhibits the production of endothelin-1 by endothelial cells [50]. Vitamin E in SO improves endothelial dysfunction by reducing free radicals [51] and leads to an increase in vasodilator or nitric oxide factors and consequently reduces blood pressure [52].

Anthropometric indices

This trial showed significant decreases in body weight, BMI, HC, WC, WHR, and ICO in both groups. However, no significant differences in these indicators were observed between the two groups. In support of our results, in a well-designed study conducting by Raeisi et al., which assessed the effect of SO consumption for 9 weeks in adults, no change in body weight and BMI were observed [53]. Also, Yazdi et al. showed similar results [54]. On the contrary, Sankar et al. showed that the consumption of 35 g SO for 45 days in hypertension patients has beneficial effects on body weight and BMI [28]. It should be considered that this study had no control group and also the participants and researchers were not blind to the oils. In a parallel study, Sankar et al. examined the effect of 35 g SO consumption for 60 days on hypertension patients and observed that body weight and BMI decreased after the intervention [23]. In this study, the results may have been affected due to the concomitant use of nifedipine with SO. A meta-analysis that evaluated the effects of sesame seed and its products on BMI and body weight showed that SO reduced body weight and BMI. The weak design and the small number of studies were the two limitations of this meta-analysis, which may make it results become unreliable.

Strengths and limitations

Our study has several strengths: (1) the methodology and design of previous studies were not rigorous due to the lack of allocation concealment, blinding of participants and personnel, physical activity, and dietary intake assessments. We did all of them to minimize the potential risk of biases. (2) All participants were female and aged 20–50 years old who were almost homogeneous in physiological and hormonal conditions.

Our study has several limitations that should be taken into account when interpreting the results: (1) we did not examine the fatty acid content of RBC and serum levels of vitamin E. Therefore, future research is needed to use more objective methods of assessing the type of fatty acids (MUFAs and PUFAs) in RBC and serum levels of vitamin E to confirm adherence [55, 56]. (2) We did not include oils with high saturated fatty acids such as hydrogenated oils and palm oil found in the western diet. It does not seem ethical to use unhealthy oils for a long time (12 weeks) in clinical trials. (3) Normal levels of blood lipids of the patients may have not allowed seeing the best benefit from the administered oil.

Conclusions

The present investigation provides evidences that SO may be effective in improvement of DBP and TC/HDL-C, whereas no significant effects were observed in anthropometric indices, SBP, TG, TC, LDL-C, HDL-C, VLDL-C, non-HDL-C, LDL-C/HDL-C, and TG/HDL-C compared to the control group. Further well-designed studies should be conducted to confirm these results. Also, it is suggested that future studies examine the effects of SO on fatty liver diseases undergoing an isocaloric diet.

Availability of data and materials

Available upon request.

Abbreviations

NAFLD:

Non-alcoholic fatty liver

SO:

Sesame oil

SFO:

Sunflower oil

SBP:

Systolic blood pressure

DBP:

Systolic blood pressure

TC:

Total cholesterol

HDL-C:

High-density lipoprotein cholesterol

TG:

Triglyceride

LDL-C:

Low-density lipoprotein cholesterol

IRCT:

Iranian registry of clinical trials

CVD:

Cardiovascular disease

MUFAs:

Monounsaturated fatty acids

PUFAs:

Polyunsaturated fatty acids

SPIRIT:

Standard Protocol Items: Recommendations for Interventional Trials

EER:

Estimated energy requirement

WC:

Waist circumference

HC:

Hip circumference

WHR:

Waist to hip ratio

ICO:

Index of central obesity

MET:

Metabolic equivalents

IDL-C:

Intermediate-density lipoproteins cholesterol

VLDL-C:

Very low-density lipoprotein cholesterol

ANCOVA:

Analysis of covariance

RBC:

Red blood cells

References

  1. Anania C, Massimo Perla F, Olivero F, Pacifico L, Chiesa C. Mediterranean diet and nonalcoholic fatty liver disease. World J Gastroenterol. 2018;24:2083–94. https://doi.org/10.3748/wjg.v24.i19.2083.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Paik JM, Golabi P, Younossi Y, Mishra A, Younossi ZM. Changes in the global burden of chronic liver diseases from 2012 to 2017: the growing impact of NAFLD. Hepatology. 2020;72:1605–16. https://doi.org/10.1002/hep.31173.

    Article  PubMed  Google Scholar 

  3. Younossi ZM, Marchesini G, Pinto-Cortez H, Petta S. Epidemiology of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: implications for liver transplantation. Transplantation. 2019;103:22–7. https://doi.org/10.1097/TP.0000000000002484.

    Article  PubMed  Google Scholar 

  4. Huang T, Behary J, Zekry A. Non-alcoholic fatty liver disease: a review of epidemiology, risk factors, diagnosis and management. Intern Med J. 2020;50:1038–47. https://doi.org/10.1111/imj.14709.

    Article  PubMed  Google Scholar 

  5. Sookoian S, Pirola CJ. Review article: shared disease mechanisms between non-alcoholic fatty liver disease and metabolic syndrome – translating knowledge from systems biology to the bedside. Aliment Pharmacol Ther. 2019;49:516–27. https://doi.org/10.1111/apt.15163.

    Article  PubMed  Google Scholar 

  6. Paik JM, Kabbara K, Eberly KE, Younossi Y, Henry L, Younossi ZM. Global burden of NAFLD and chronic liver disease among adolescents and young adults. Hepatology. 2021. https://doi.org/10.1002/hep.32228.

    Article  PubMed  Google Scholar 

  7. El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Cardio-metabolic disorders in non-alcoholic fatty liver disease. Int J Mol Sci. 2019;20:2215. https://doi.org/10.3390/ijms20092215.

    Article  CAS  PubMed Central  Google Scholar 

  8. Golabi P, Otgonsuren M, De Avila L, Sayiner M, Rafiq N, Younossi ZM. Components of metabolic syndrome increase the risk of mortality in nonalcoholic fatty liver disease (NAFLD). Med (United States). 2018;97. https://doi.org/10.1097/MD.0000000000010214.

  9. Motamed N, Rabiee B, Poustchi H, Dehestani B, Hemasi GR, Khonsari MR, et al. Non-alcoholic fatty liver disease (NAFLD) and 10-year risk of cardiovascular diseases. Clin Res Hepatol Gastroenterol. 2017;41:31–8. https://doi.org/10.1016/j.clinre.2016.07.005.

    Article  PubMed  Google Scholar 

  10. George ES, Forsyth A, Itsiopoulos C, Nicoll AJ, Ryan M, Sood S, et al. Practical dietary recommendations for the prevention andmanagement of nonalcoholic fatty liver disease in adults. Adv Nutr. 2018;9:30–40. https://doi.org/10.1093/advances/nmx007.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Periasamy S, Chien SP, Chang PC, Hsu DZ, Liu MY. Sesame oil mitigates nutritional steatohepatitis via attenuation of oxidative stress and inflammation: a tale of two-hit hypothesis. J Nutr Biochem. 2014;25:232–40. https://doi.org/10.1016/j.jnutbio.2013.10.013.

    Article  CAS  PubMed  Google Scholar 

  12. Atefi M, Pishdad GR, Faghih S. Canola oil and olive oil impact on lipid profile and blood pressure in women with type 2 diabetes: a randomized, controlled trial. Prog Nutr. 2018;20:102–9. https://doi.org/10.23751/pn.v20i1-S.5854.

    Article  Google Scholar 

  13. Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115:1343–51. https://doi.org/10.1172/JCI23621.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kim M, Woo M, Noh JS, Choe E, Song YO. Sesame oil lignans inhibit hepatic endoplasmic reticulum stress and apoptosis in high-fat diet-fed mice. J Funct Foods. 2017;37:658–65. https://doi.org/10.1016/j.jff.2017.08.036.

    Article  CAS  Google Scholar 

  15. Breslow JL. n-3 Fatty acids and cardiovascular disease. Am J Clin Nutr. 2006;83:1477S-1482S. https://doi.org/10.1093/ajcn/83.6.1477s.

    Article  CAS  PubMed  Google Scholar 

  16. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233:674–88. https://doi.org/10.3181/0711-MR-311.

    Article  CAS  Google Scholar 

  17. Amiri M, Ghaneian MT, Zare-Sakhvidi MJ, Rahmanian M, Nadjarzadeh A, Moghtaderi F, et al. The effect of canola oil compared with sesame and sesame-canola oil on cardiometabolic biomarkers in patients with type 2 diabetes: design and research protocol of a randomized, triple-blind, three-way, crossover clinical trial. ARYA Atheroscler. 2019;15:168–78. https://doi.org/10.22122/arya.v15i4.1940.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Aslam F, Iqbal S, Nasir M, Anjum AA. White sesame seed oil mitigates blood glucose level, reduces oxidative stress, and improves biomarkers of hepatic and renal function in participants with type 2 diabetes mellitus. J Am Coll Nutr. 2019;38:235–46. https://doi.org/10.1080/07315724.2018.1500183.

    Article  CAS  PubMed  Google Scholar 

  19. Nigam P, Bhatt S, Misra A, Chadha DS, Vaidya M, Dasgupta J, et al. Effect of a 6-month intervention with cooking oils containing a high concentration of monounsaturated fatty acids (olive and canola oils) compared with control oil in male asian indians with nonalcoholic fatty liver disease. Diabetes Technol Ther. 2014;16:255–61. https://doi.org/10.1089/dia.2013.0178.

    Article  CAS  PubMed  Google Scholar 

  20. Farajbakhsh A, Mazloomi SM, Mazidi M, Rezaie P, Akbarzadeh M, Ahmad SP, et al. Sesame oil and vitamin E co-administration may improve cardiometabolic risk factors in patients with metabolic syndrome: a randomized clinical trial. Eur J Clin Nutr. 2019;73:1403–11. https://doi.org/10.1038/s41430-019-0438-5.

    Article  CAS  PubMed  Google Scholar 

  21. Bhaskaran S, Santanam N, Penumetcha M, Parthasarathy S. Inhibition of atherosclerosis in low-density lipoprotein receptor-negative mice by sesame oil. J Med Food. 2006;9:487–90. https://doi.org/10.1089/jmf.2006.9.487.

    Article  CAS  PubMed  Google Scholar 

  22. Sankar D, Ramakrishna Rao M, Sambandam G, Pugalendi KV. A pilot study of open label sesame oil in hypertensive diabetics. J Med Food. 2006;9:408–12. https://doi.org/10.1089/jmf.2006.9.408.

    Article  CAS  PubMed  Google Scholar 

  23. Sankar D, Sambandam G, Ramakrishna Rao M, Pugalendi KV. Modulation of blood pressure, lipid profiles and redox status in hypertensive patients taking different edible oils. Clin Chim Acta. 2005;355:97–104. https://doi.org/10.1016/j.cccn.2004.12.009.

    Article  CAS  PubMed  Google Scholar 

  24. Abdul-Lattif RF. Effect of sesame oil on lipid profile and liver enzymes in male albino rats treated with carbone tetrachloride (CCl4). Ibn AL- Haitham J Pure Appl Sci. 2018;41. https://doi.org/10.30526/2017.ihsciconf.1769.

  25. Namayandeh SM, Kaseb F, Lesan S. Olive and sesame oil effect on lipid profile in hypercholesterolemic patients, which better? Int J Prev Med. 2013;4:1059–62.

    PubMed  PubMed Central  Google Scholar 

  26. Sankar D, Ali A, Sambandam G, Rao R. Sesame oil exhibits synergistic effect with anti-diabetic medication in patients with type 2 diabetes mellitus. Clin Nutr. 2011;30:351–8. https://doi.org/10.1016/j.clnu.2010.11.005.

    Article  CAS  PubMed  Google Scholar 

  27. Mitra A. Study on the benefits of sesame oil over coconut oil in patients of insulin resistance syndrome, notably type 2 diabetes and dyslipidaemia. J Hum Ecol. 2007;22:61–6. https://doi.org/10.1080/09709274.2007.11906001.

    Article  Google Scholar 

  28. Sankar D, Ramakrishna Rao M, Sambandam G, Pugalendi KV. Effect of sesame oil on diuretics or ß-blockers in the modulation of blood pressure, anthropometry, lipid profile, and redox status. Yale J Biol Med. 2006;79:19–26.

    CAS  PubMed  Google Scholar 

  29. Khajehdehi P. Lipid-lowering effect of polyunsaturated fatty acids in hemodialysis patients. J Ren Nutr. 2000;10:191–5. https://doi.org/10.1053/jren.2000.16326.

    Article  CAS  PubMed  Google Scholar 

  30. Periasamy S, Hsu DZ, Chang PC, Liu MY. Sesame oil attenuates nutritional fibrosing steatohepatitis by modulating matrix metalloproteinases-2, 9 and PPAR-γ. J Nutr Biochem. 2014;25:337–44. https://doi.org/10.1016/j.jnutbio.2013.11.008.

    Article  CAS  PubMed  Google Scholar 

  31. Soliman MM, Attia HF, El-Ella GAA. Genetic and histopathological alterations induced by cypermethrin in rat kidney and liver: Protection by sesame oil. Int J Immunopathol Pharmacol. 2015;28:508–20. https://doi.org/10.1177/0394632015575950.

    Article  CAS  PubMed  Google Scholar 

  32. Abdou HM, Hussien HM, Yousef MI. Deleterious effects of cypermethrin on rat liver and kidney: Protective role of sesame oil. J Environ Sci Heal - Part B Pestic Food Contam Agric Wastes. 2012;47:306–14. https://doi.org/10.1080/03601234.2012.640913.

    Article  CAS  Google Scholar 

  33. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, Krleža-Jerić K, et al. SPIRIT 2013 statement: Defining standard protocol items for clinical trials. Japanese Pharmacol Ther. 2017;45:1895–904.

    Google Scholar 

  34. Raeisi-Dehkordi H, Amiri M, Zimorovat A, Moghtaderi F, Zarei S, Forbes SC, et al. Canola oil compared with sesame and sesame-canola oil on glycaemic control and liver function in patients with type 2 diabetes: a three-way randomized triple-blind cross-over trial. Diabetes Metab Res Rev. 2021;37: e3399. https://doi.org/10.1002/dmrr.3399.

    Article  CAS  PubMed  Google Scholar 

  35. Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:241–7. https://doi.org/10.1093/ajcn/51.2.241.

    Article  CAS  PubMed  Google Scholar 

  36. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32:S498-504. https://doi.org/10.1097/00005768-200009001-00009.

    Article  CAS  PubMed  Google Scholar 

  37. Chow S-C, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. New York: Chapman and Hall/CRC; 2017.

  38. Rezaei S, Akhlaghi M, Sasani MR, Barati BR. Olive oil lessened fatty liver severity independent of cardiometabolic correction in patients with non-alcoholic fatty liver disease: A randomized clinical trial. Nutrition. 2019;57:154–61. https://doi.org/10.1016/j.nut.2018.02.021.

    Article  CAS  PubMed  Google Scholar 

  39. Khalesi S, Paukste E, Nikbakht E, Khosravi-Boroujeni H. Sesame fractions and lipid profiles: a systematic review and meta-analysis of controlled trials. Br J Nutr. 2016;115:764–73. https://doi.org/10.1017/S0007114515005012.

    Article  CAS  PubMed  Google Scholar 

  40. Huang H, Zhou G, Pu R, Cui Y, Liao D. Clinical evidence of dietary supplementation with sesame on cardiovascular risk factors: An updated meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr. 2021;1–11. https://doi.org/10.1080/10408398.2021.1888689.

  41. Mekky RH, Hegazy MM, Cádiz-Gurrea M de la L, Fernández-Ochoa Á, Segura Carretero A. Bioactive phytochemicals from Sesame oil processing by-products. In: Ramadan Hassanien MF, editor. Bioact Phytochem from Veg Oil Oilseed Process By-products. Cham: Springer International Publishing; 2021. p. 1–40. https://doi.org/10.1007/978-3-030-63961-7_9-1.

  42. Hirata F, Fujita K, Ishikura Y, Hosoda K, Ishikawa T, Nakamura H. Hypocholesterolemic effect of sesame lignan in humans. Atherosclerosis. 1996;122:135–6. https://doi.org/10.1016/0021-9150(95)05769-2.

    Article  CAS  PubMed  Google Scholar 

  43. Li D, Saldeen T, Romeo F, Mehta JL. Relative effects of α- and γ-tocopherol on low-density lipoprotein oxidation and superoxide dismutase and nitric oxide synthase activity and protein expression in rats. J Cardiovasc Pharmacol Ther. 1999;4:219–26. https://doi.org/10.1177/107424849900400403.

    Article  CAS  PubMed  Google Scholar 

  44. Qureshi AA, Bradlow BA, Brace L, Manganello J, Peterson DM, Pearce BC, et al. Response of hypercholesterolemic subjects to administration of tocotrienols. Lipids. 1995;30:1171–7. https://doi.org/10.1007/BF02536620.

    Article  CAS  PubMed  Google Scholar 

  45. Santos HO, Lavie CJ. Weight loss and its influence on high-density lipoprotein cholesterol (HDL-C) concentrations: a noble clinical hesitation. Clin Nutr ESPEN. 2021;42:90–2. https://doi.org/10.1016/j.clnesp.2021.01.033.

    Article  PubMed  Google Scholar 

  46. Cardoso CA, Oliveira GMM de, Gouveia L de AV, Moreira ASB, Rosa G. The effect of dietary intake of sesame (Sesamumindicum L.) derivatives related to the lipid profile and blood pressure: a systematic review. Crit Rev Food Sci Nutr. 2018;58:116–25. https://doi.org/10.1080/10408398.2015.1137858.

    Article  CAS  PubMed  Google Scholar 

  47. Wichitsranoi J, Weerapreeyakul N, Boonsiri P, Settasatian C, Settasatian N, Komanasin N, et al. Antihypertensive and antioxidant effects of dietary black sesame meal in pre-hypertensive humans. Nutr J. 2011;10:1–7. https://doi.org/10.1186/1475-2891-10-82.

    Article  CAS  Google Scholar 

  48. Nakano D, Itoh C, Ishii F, Kawanishi H, Takaoka M, Kiso Y, et al. Effects of sesamin on aortic oxidative stress and endothelial dysfunction in deoxycorticosterone acetate-salt hypertensive rats. Biol Pharm Bull. 2003;26:1701–5. https://doi.org/10.1248/bpb.26.1701.

    Article  CAS  PubMed  Google Scholar 

  49. Matsumura Y, Kita S, Morimoto S, Akimoto K, Furuya M, Oka N, et al. Antihypertensive effect of sesamin. I. protection against deoxycorticosterone acetate-salt-induced hypertension and cardiovascular hypertrophy. Biol Pharm Bull. 1995;18:1016–9. https://doi.org/10.1248/bpb.18.1016.

    Article  CAS  PubMed  Google Scholar 

  50. Lee CC, Chen PR, Lin S, Tsai SC, Wang BW, Chen WW, et al. Sesamin induces nitric oxide and decreases endothelin-1 production in HUVECs: possible implications for its antihypertensive effect. J Hypertens. 2004;22:2329–38. https://doi.org/10.1097/00004872-200412000-00015.

    Article  CAS  PubMed  Google Scholar 

  51. Ito H, Torii M, Suzuki T. Comparative study on free radical injury in the endothelium of SHR and WKY aorta. Clin Exp Pharmacol Physiol. 1995;22:S157–9. https://doi.org/10.1111/j.1440-1681.1995.tb02862.x.

    Article  CAS  Google Scholar 

  52. Thomas SR, Chen K, Keaney JF. Oxidative stress and endothelial nitric oxide bioactivity. Antioxidants Redox Signal. 2003;5:181–94. https://doi.org/10.1089/152308603764816541.

    Article  CAS  Google Scholar 

  53. Raeisi-Dehkordi H, Amiri M, Moghtaderi F, Zimorovat A, Rahmanian M, Mozaffari-Khosravi H, et al. Effects of sesame, canola and sesame-canola oils on body weight and composition in adults with type 2 diabetes mellitus: a randomized, triple-blind, cross-over clinical trial. J Sci Food Agric. 2021. https://doi.org/10.1002/jsfa.11265.

    Article  PubMed  Google Scholar 

  54. Mosallaieepour-Yazdi M, Eghtesadi S, Kaseb F, Afkhami-Ardakani M, Hoseini F. Effects of sesame oil on blood glucose and lipid profile in type II diabetic patients referring to the Yazd diabetes research center. J Shahid Sadoughi Univ Med Sci Heal Serv. 2008;16:31–5.

    Google Scholar 

  55. Estruch R, Ros E, Salas-Salvadó J, Covas M-I, Corella D, Arós F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90. https://doi.org/10.1056/NEJMoa1200303.

    Article  CAS  PubMed  Google Scholar 

  56. Carbone S, Billingsley HE, Canada JM, Kadariya D, Medina Chazal H, Rotelli B, et al. Unsaturated fatty acids to improve cardiorespiratory fitness in patients with obesity and HFpEF: the UFA-preserved pilot study. JACC Basic to Transl Sci. 2019;4:563–5. https://doi.org/10.1016/j.jacbts.2019.04.001.

    Article  Google Scholar 

Download references

Acknowledgements

This study was extracted from a Ph.D. dissertation, which was approved by the School of Nutrition & Food Science, Isfahan University of Medical Sciences (code: IR.MUI.RESEARCH.REC.1399.548).

Funding

This work was supported by the Isfahan University of Medical Sciences under grant number 399632.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Islamic Republic of Iran

    Hamid Vahedi

  2. Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran

    Masoumeh Atefi

  3. Food Security Research Centre and Department of Clinical Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran

    Mohammad Hassan Entezari

  4. Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran

    Akbar Hassanzadeh

Authors
  1. Hamid Vahedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masoumeh Atefi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohammad Hassan Entezari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akbar Hassanzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have made substantial contributions to all of the following: (M.A and M.H.E) drafting the article or revising it and final approval of the version to be submitted, (M.H.E, A.H) the conception and design of the study, (M.A and A.H) analysis and interpretation of data, and (M.A and H.V) acquisition of data. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Mohammad Hassan Entezari.

Ethics declarations

Ethics approval and consent to participate

This study involves human testing, and it was approved by the Institutional Review Board of Isfahan University of Medical Sciences (code: IR.MUI.RESEARCH.REC.1399.548). Written informed consent was obtained from all study participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vahedi, H., Atefi, M., Entezari, M.H. et al. The effect of sesame oil consumption compared to sunflower oil on lipid profile, blood pressure, and anthropometric indices in women with non-alcoholic fatty liver disease: a randomized double-blind controlled trial. Trials 23, 551 (2022). https://doi.org/10.1186/s13063-022-06451-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13063-022-06451-1

Keywords

Trials

ISSN: 1745-6215