Curcuma longa and curcumin on metabolic syndrome: a systematic review

Abstract

Background: Metabolic syndrome (MS) is a complex condition that predisposes the population to an
increased risk of cardiovascular diseases (CVD), meaning a high burden to health care systems. Medicinal
plants and natural compounds have gained ground in the therapeutic approach to MS due to their
effectiveness, reduced costs, and few adverse effects. Among many plants with positive impacts to improve
MS risk factors is Curcuma longa. This plant can benefit the treatment of several pathological conditions
since it exhibits actions such as anti-inflammatory and antioxidant. By virtue of these reasons, this study aims
to perform a systematic review of the effects of Curcuma longa on MS.
Methods: PubMed, EMBASE, and COCHRANE databases were searched, and PRISMA guidelines were
followed to build this review.
Results: The results showed that eleven clinical trials met the inclusion criteria.
Discussion: These studies showed that this plant could improve Body Mass Index, glycemia, lipids
(reducing triglycerides and increasing HDL-C), adiponectin, C reactive proteins, and cytokines levels [tumor
necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), and monocyte chemoattractant protein-1
(MCP-1)]. No severe adverse effects were referenced in the included studies. We conclude that the use of
Curcuma longa can help control risk factors in patients with MS. However, more clinical trials are necessary
to show the doses and formulations that should be used to prevent or as adjuvants to treat metabolic
conditions associated with MS

Full text

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Introduction
Metabolic syndrome (MS) is a complex condition predisposes
the population to an increased risk of cardiovascular diseases
(CVD). It is characterized by at least three risk factors:
elevated blood pressure, triglycerides, glycemia, waist
circumference, and reduced levels of HDL-C. These clusters
of factors increase inflammatory and oxidative processes
that promote and aggravate other metabolic conditions that
increase morbidity and mortality (1,2).
Subjects with MS usually develop diabetes, dyslipidemia,
Review Article
Curcuma longa and curcumin on metabolic syndrome:
a systematic review
Lucas Fornari Laurindo1, Sandra Maria Barbalho1,2,3^, Rakesh Kumar Joshi4, Bruna de Alvarez Rezende2,
Ricardo de Alvares Goulart2, Elen Landgraf Guiguer1,2,3, Adriano Cressoni Araújo1,2
1Department of Biochemistry and Pharmacology, School of Medicine, University of Marília (UNIMAR), Marília, Brazil; 2Postgraduate Program
in Structural and Functional Interactions in Rehabilitation, University of Marília (UNIMAR), Marília, Brazil; 3School of Food and Technology of
Marilia (FATEC), Marilia, Brazil; 4Department of Education, Government of Uttarakhand, Uttarakhand, India
Contributions: (I) Conception and design: SM Barbalho, LF Laurindo; (II) Administrative support: SM Barbalho; (III) Provision of study materials or
patients: SM Barbalho; (IV) Collection and assembly of data: RK Joshi, RA Goulart, BA Rezende; (V) Data analysis and interpretation: SM Barbalho,
RK Joshi, EL Guiguer, AC Araújo; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Sandra Maria Barbalho. Department of Biochemistry and Pharmacology, School of Medicine, University of Marília, Av. Higino
Muzzi Filho 1001, Marília 15525-902, Brazil. Email: smbarbalho@gmail.com.
Background: Metabolic syndrome (MS) is a complex condition that predisposes the population to an
increased risk of cardiovascular diseases (CVD), meaning a high burden to health care systems. Medicinal
plants and natural compounds have gained ground in the therapeutic approach to MS due to their
effectiveness, reduced costs, and few adverse effects. Among many plants with positive impacts to improve
MS risk factors is Curcuma longa. This plant can benet the treatment of several pathological conditions
since it exhibits actions such as anti-inammatory and antioxidant. By virtue of these reasons, this study aims
to perform a systematic review of the effects of Curcuma longa on MS.
Methods: PubMed, EMBASE, and COCHRANE databases were searched, and PRISMA guidelines were
followed to build this review.
Results: The results showed that eleven clinical trials met the inclusion criteria.
Discussion: These studies showed that this plant could improve Body Mass Index, glycemia, lipids
(reducing triglycerides and increasing HDL-C), adiponectin, C reactive proteins, and cytokines levels [tumor
necrosis factor-α (TNF-α), transforming growth factor-β (TGF-β), and monocyte chemoattractant protein-1
(MCP-1)]. No severe adverse effects were referenced in the included studies. We conclude that the use of
Curcuma longa can help control risk factors in patients with MS. However, more clinical trials are necessary
to show the doses and formulations that should be used to prevent or as adjuvants to treat metabolic
conditions associated with MS.
Keywords: Curcuma longa; anti-inammatory; antioxidant; cancer
Received: 21 June 2021; Accepted: 24 August 2021; Published: 30 December 2021.
doi: 10.21037/lcm-21-25
View this article at: https://dx.doi.org/10.21037/lcm-21-25
12
^ ORCID: 0000-0002-5035-876X.

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hypertension, and abdominal obesity. This condition, which
is more common in adults, is also increasing in children
and adolescents. This is due to unhealthy lifestyle habits
with high consumption of carbohydrates, fats, processed
and ultra-processed foods, and lack of physical exercise.
Thus, lifestyle modication strategies, drug treatment, and
adjuvant therapies are essential to improve risk factors.
Medicinal plants and natural compounds have gained
ground in the therapeutic approach to MS due to their
effectiveness, reduced costs, and few adverse effects. Among
many plants with positive impacts to improve MS risk
factors is Curcuma longa (3-5).
Curcuma longa, popularly known as or turmeric, belongs
to the family Zingiberaceae, which grows in Indian and
tropical countries and has been used in Indian Ayurvedic
medicine for more than 6,000 years. Due to its golden color
and slightly bitter taste, turmeric is considered a versatile
spice and is very used in culinary preparations (6-8).
Turmeric shows diversity in its chemical composition,
and the quality and amount of the bioactive compounds
can vary according to locations and growing conditions.
Many phenolic compounds and terpenoids are present
in this plant. The main compounds of the rhizomes are
curcuminoids: curcumin (77%) that is responsible for
the yellow color bisdemethoxycurcumin (17%), and
demethoxycurcumin (3%) (9,10). Curcumin is broadly
used as a color-inducing agent and was designated as a food
additive, and is Generally Recognized as Safe by the American
Food and Drug Administration (11).
Several studies have shown that Curcuma longa can benet
the treatment of several pathological conditions since it
exhibits anti-inflammatory, antioxidant, antimicrobial,
antibacterial, antiviral, antifungal anti-hypoglycemic,
antiobesity, anti-hypertension, neuroprotective,
antidepressant, and chemo-preventive (12-14). Figure 1 shows
the main compounds and some effects of Curcuma longa.
Figure 1 Curcuma longa main bioactive compounds and the effects on metabolic diseases. ↓, decrease.
Demethoxycurcumin
Curcumin Bisdemethoxycurcumin
CARDIOPROTECTIVE
EFFECTS
Anti-inflammatory
Antioxidant
Antihypertension
Antidiabetic
Antihyperlipidemic
Anti-obesity
↓Risk of metabolic syndrome
↓Risk of cardiovascular diseases
O
O
O
O
O
O
O
O
O
OH
OH
OH
HO
HO
HO
CH3
CH3
Curcuma longa

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Due to the properties mentioned earlier of Curcuma
longa, this study aims to perform a systematic review of the
effects of this plant on MS.
We present the following article in accordance with the
PRISMA reporting checklist (available at https://dx.doi.
org/10.21037/lcm-21-25).
Methods
Focal question
The focal question for this systematic review was: Can
Curcuma longa show benets on MS?
Language
Only studies published in English were selected.
Databases
This review was built with studies published in PubMed,
EMBASE, and COCHRANE databases. The mesh-terms
were Curcuma longa or curcuminoids or curcumin and
MS. PRISMA (Preferred Reporting Items for a Systematic
Review and Meta-Analysis) guidelines were used to perform
this review (15) (Figure 2).
Study selection
This review was built with studies that associated Curcuma longa
or Curcuminoids or curcumin [Code of Federal Regulations
(FDA): §73.600] and MS. The inclusion criteria enclosed
Randomized clinical trials (RCTs), double-blind RCTs, and
placebo-controlled studies. We only used full-text studies
that were performed with MS patients and not those with the
plant and isolated MS risk factors. We also considered PICO
(population, intervention, comparison and outcomes) format.
The exclusion criteria were studies not in English,
reviews, studies with animals or in vitro, clinical trials that
associated different plant formulations, case reports, poster
presentations, and editorials. Reviews were examined to build
the discussion but were not included in the systematic review.
Figure 2 Flow diagram showing the study selection.
Records identified through
data-base searching
(n=83)
Records after duplicates removed
(n=28)
Records screened
(n=18)
Articles accessed for eligibility
(n=18)
Articles included in qualitative synthesis
(n=0)
Articles included in quantitative synthesis
(n=11)
Articles excluded, with reasons (n=7)
(studies that did not use patients with
diagnosed metabolic syndrome)
Records excluded
(n=0)
Additional records identified
through other sources
(n=0)
IdentificationEligibilityIncluded Screening

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Data extraction
The period for the search included clinical trials performed
in the past ten years (February 2011 to June 2021). Two
judges performed data extraction. A third judge resolved
disagreements between them.
The selected studies are included in Table 1.
Quality assessment
The quality of the included studies followed the Cochrane
Handbook for Systematic Reviews of Interventions was
used to perform this quality assessment.
Results
Table 1 shows the results of this systematic review. After using
the inclusion and exclusion criteria, eleven randomized trials
that investigated the effects of Curcuma longa in patients
with MS were included. Both sexes were present in all the
studies. Most of them were double-blinded studies. Of these
studies, five (22-26) have used the same group of patients
from Iran, and the other four, also in Iran (17,18,20,21),
present this same characteristic. The other studies were
performed in Taiwan (16) and Italy (19).
The studies presented in Table 1 show that Curcuma
longa can bring benets in patients with MS. These studies
showed that this plant can improve Body Mass Index,
weight gain, glycemia, lipids (reduction of triglycerides
and increase of HDL-C), adiponectin, C reactive proteins,
and cytokines levels [tumor necrosis factor-α (TNF-α),
transforming growth factor-β (TGF-β), and monocyte
chemoattractant protein-1 (MCP-1)]. No severe adverse
effects were reported in the included studies. In Table 2 we
show the risk of bias for the included studies.
Discussion
MS
MS has a multifactorial etiology and is considered one of
the major public health problems in people worldwide. It
is observed that rates of 30% can afict some populations
and the consequences are a high burden to health systems.
There are different diagnostic criteria for MS, but most
enclose risk factors for developing CVD. These risks are
altered levels (high levels) of blood glucose and triglycerides,
obesity, hypertension, and reduced HDL-C (27-29).
The National Cholesterol Education Program ATP III
(NCEP ATP III) criteria comprise the presence of any three
of the following conditions: fasting glucose ≥110 mg/dL;
triglycerides levels ≥150 mg/dL; HDL-C levels ≤40 mg
(men) or ≤50 mg/dL (women); waist circumference (WC)
≥102 cm (men) or ≥88 cm (women); and blood pressure
≥130/85 mmHg. The criteria established for the International
Diabetes Federation (IDF, 2006) considers fasting glucose
≥100 mg/dL, triglycerides levels ≥150 mg/dL; HDL-C levels
≤40 mg (men) or ≤50 mg/dL (women); WC >90 cm for men
and >80 cm for women; and blood pressure ≥130/85 mmHg.
Following IDF (2006), the patient has MS when possessing
altered WC with the presence of two other risk factors (IDF,
2006) (2,30-33).
The multisystemic character of MS denotes that many
chronic-degenerative diseases that are also associated
with oxidative stress, a pro-inflammatory state, and
atherosclerosis are superimposed in “dysmetabolic”
subjects. The most common associated conditions are
CVD, non-alcoholic steatohepatitis, chronic kidney disease,
neurodegeneration, and cancer (34-38).
Understanding the components of MS and its metabolic
and systemic repercussions is essential to take measures to
contain the progression of the number of affected patients.
Lifestyle changes are imperative; however, the search for
therapeutic strategies that control risk factors is important
to reduce the long-term complications of MS. Medicinal
plants and their bioactive compounds can collaborate to
prevent or treat risk factors at attractive prices and low side
effects.
Curcuma longa, curcumin, and MS
Curcuma longa and its derivatives, such as curcumin, have
been used for medical purposes to treat several conditions
since ancient times. Many of the effects of this plant are
related to its antioxidant and anti-inammatory properties.
Several diseases are related to inflammation and oxidative
damage. Oxidation leads to chronic inflammation, and
chronic inflammation increases oxidative stress. Alone or
together, these conditions mediate most known chronic
diseases. Hyperglycemia, for example, can lead to the
increased entrance of glucose in non-insulin-dependent
tissues and cause the production of advanced glycation
products (AGEs), which are reactive species related to
numerous events that trigger metabolic changes. Obesity
is considered a low-grade inammatory process that leads
to a shift in the secretory pattern of macrophages from
M2 (related to the release of anti-inammatory mediators)

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Table 1 Descriptive table of the included studies
Reference Local Patients Intervention and time of intervention Outcomes Adverse effects
Yang et al. (16) Taiwan Randomized, double-blind, placebo-controlled trial
with 65 ♂ and ♀ subjects (59.30±12.00 y) with MS
who have had stable medical treatment for at least 6 m
prior to the study enrollment
Subjects were randomized into 2 groups: curcumin (n=33, 12 ♂,
59.03±10.10 y, 630 mg curcumin extract capsule 3× d) and placebo
(n=32, 17 ♂, 59.61±14.09, placebo capsule 3× d)/12 w
Subjects that received curcumin presented anti-lipid effects but the
intake was not associated with weight or glucose homeostasis
Two participants in the curcumin group had mild
diarrhea and nausea as adverse effects
Panahi et al. (17) Iran Randomized, double-blind, placebo-controlled,
parallel-group design trial with 117 ♂ and ♀ subjects
(25–75 y) with MS
Subjects were randomized into 2 groups: curcumin (n=59, 44.80±8.67
y, 23 ♀, 1,000 mg/d +10 mg of piperine to improve the bioavailability
of the curcumin) and placebo (n=58, 43.46±9.70 y, 27 ♀, 1,000 mg of
placebo +10 mg of piperine)/8 w
Curcumin significantly reduced serum LDL-C, non-HDL-C, total
cholesterol, triglycerides, and Lp(a). Curcumin elevated HDL-C
Diarrhea (n=2), constipation (n=2), headache (n=1),
and skin rash (n=2) in the curcumin group. Headache
(n=2) and constipation (n=1) in the placebo group
Pahani et al. (18) Iran Phase III, randomized, double-blind, placebo-controlled
study with a parallel-group design. This study had 117
♂ and ♀ subjects with MS and that were not receiving
lipid-lowering therapy
Subjects were randomized into 2 groups: curcumin (n=59, 44.80±8.67 y,
23 ♀, 1,000 mg/day +10 mg of piperine to improve the bioavailability of
the curcumin) and placebo (n=58, 43.46±9.70 y, 27 ♀, placebo)/8 w
Curcumin-piperine combination significantly improved serum
superoxide dismutase activities and reduced malondialdehyde
concentrations. The treated group showed reduced circulating CRP
and significantly improved oxidative and inflammatory ambiances
NR
Di Pierro et al. (19) Italy Randomized, controlled clinical trial with 17 ♂ and 27
♀ caucasian overweight subjects (18–70 y) with MS
and BMI between 25.0–29.9 under 30 d with diet or
with another intervention of lifestyle and have shown
less than 2% of weight loss
Subjects were randomized into group 1: 800 mg/dose/d of Curcuma
longa extract with 95% of curcumin + lifestyle intervention, and G2:
phosphatidylserine + lifestyle intervention (400 mg/dose/d of pure
phosphatidylserine)/1 m
Participants of group 1 presented a reduction in the weight and fat
percentage, improved hip circumference reduction, and enhanced
BMI reduction (these effects were no significant in G2)
Gastric burning in phosphatidylserine group
Pahani et al. (20) Iran Randomized, double-blind, placebo-controlled trial
with parallel group design with 117 ♂ and ♀ with MS
and that were not receiving lipid-lowering therapy
Subjects were randomized into 2 groups: curcumin (n=59, 44.80±8.67 y,
23 ♀, 1,000 mg/d +10 mg of piperine/day to improve the bioavailability
of the curcumin) and placebo (n=58, 43.46±9.70 y, 27 ♀, placebo +10
mg/d of piperine)/8 w
Curcumin was associated with a significant elevation in serum
adiponectin and reduction in leptin levels
Diarrhea (n=2), constipation (n=2), headache (n=1),
and skin rash (n=2) were reported in the curcumin
group. Headache (n=2) and constipation (n=1) in the
placebo group
Pahani et al. (21) Iran Randomized, double-blind, placebo-controlled trial
with 117 ♂ and ♀ subjects with MS and that were not
receiving lipid-lowering therapy
Subjects were randomized into 2 groups: curcumin (n=59, 44.80±8.67 y,
23 ♀, 1,000 mg/d +10 mg of piperine to improve the bioavailability of
the curcumin) and placebo (n=58, 43.46±9.70 y, 27 ♀, placebo +10 mg
of piperine). The study intervention took 8 weeks to be completed
The curcumin supplementation was associated with a significant
decrease in serum cytokines levels (TNF-α, IL-6, TGF-β and MCP-1)
of subjects with MS
Diarrhea (n=2), constipation (n=2), headache (n=1),
and skin rash (n=2) in the curcumin group. Headache
(n=2) and constipation (n=1) in the placebo group
Ghazimoradi et al. (22) Iran Randomized, double-blind, placebo-controlled study
with 120 ♂ and ♀ participants (18–65 y) affected with
MS and that did not receive nutritional supplements
and drugs in the past 3–6 m before the study
Subjects were randomized into 3 groups: phospholipidated curcumin
(1,000 mg/d of phospholipidated curcumin), curcumin (1,000 mg/d), and
placebo/6 w
In the final analysis of the study, the results showed that the
supplementation with curcumin did not suggest any improvements
of pro-oxidant-antioxidant balance in patients affected by MS
Nausea (n=1 group 1), and abdominal pain (n=1
placebo group)
Mohammadi et al. (23) Iran Randomized, placebo-controlled clinical trial with 120
♂ and ♀ participants (18–65 y) diagnosed with MS
Participants were randomized into 3 groups: absorption-enhanced
curcumin-phospholipid complex group (40.05±10.48 y, 25 ♀, 1 g/d,
equivalent to 200 mg/d of pure curcumin, n=40), unformulated curcumin
group (37.52±9.47 y, 31 ♀, 1 g/d, n=40) and placebo group (control
group, 38.59±10.28 y, 30 ♀, n=40)/6 w
Any curcumin formulations used in the study interventions
suggested significant effects on serum levels of vitamin E
Group 1: hypersensitivity (n=1, sneezing and cold
sore). Group 2: cold sore (n=1) and nausea (n=1)
Mohammadi et al. (24) Iran Randomized, double-blind, placebo-controlled clinical
trial with 120 ♂ and ♀ subjects (18–65 y) diagnosed
with MS
Participants were randomized into 3 groups: curcumin (n=40, 500 mg/2×
d for 6 w, 31 ♀, 37.52±9.47 y), phospholipidated curcumin (n=40, 500
mg/2× d/6 w, 25 ♀, 40.05±10.48 y), and placebo (500 mg/2× d, 30 ♀,
38.59±10.28)
Both curcumin and phospholipidated curcumin supplementations
did not show effects on serum levels of anti-Hsp 27 in patients with
MS
NR
Safarian et al. (25) Iran Randomized, double-blind, placebo-controlled study
with 120 ♂ and ♀ participants (18–65 y) diagnosed
with MS
Participants were randomized into 3 groups: phospholipidated curcumin
(n=40, 25 ♀, 40±10.4 y, 1,000 mg/d of phospholipidated curcumin/6 w),
curcumin (n=40, 31 ♀, 37.5±9.4 y, 1,000 mg/d of curcumin/6 w) and
placebo (n=40, 30 ♀, 38.5±10.2 y, 1,000 mg of placebo/d/6 w)
Serum Zn/Cu levels in phospholipidated curcumin and in curcumin
groups were higher than control group, being more significant in the
phospholipidated curcumin group
One subject of the phospholipidated curcumin group
did not complete the study because of nausea, as
well as 2 participants of the curcumin group because
of cold sore and nausea and 1 participant of the
placebo group because of abdominal pain
Shirmohammadi et al. (26) Iran Randomized, double-blind, placebo-controlled with 80
♂ and ♀ subjects (18–65 y) with MS
Participants were randomized into 2 groups: treatment (curcumin-
phospholipidated complex group, 40.05±10.48 y, 25 ♀, 1,000 mg
of curcumin-phosphatidylcholine complex for 6 w, n=40) and control
(placebo, 38.59±10.28 y, 30/6 w)
The study intervention with curcumin-phospholipid complex did
not suggest any significant effects of the curcumin complex on the
serum levels of cathepsin D of the participants diagnosed with MS
In the curcumin-phospholipid group, 1 subject
dropped out the study due to nausea. In the placebo
group, 1 subject dropped out due to abdominal pain
y, year; m, month; d, day; w, week; MS, metabolic syndrome; NR, not reported; CRP, C reactive protein; TNF-α, tumor necrosis factor-α; IL-6, interleukin-6; TGF-β, transforming growth factor-β; MCP-1, monocyte chemoattractant protein-1.

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Table 2 Descriptive table of the biases of the included RCTs
Reference Question
focus
Appropriate
randomization
Allocation
blinding
Double-
blind
Losses
(<20%)
Prognostics or
demographic
characteristics
Outcomes Intention to
treat analysis
Sample
calculation
Adequate
follow-up
Yang et al. (16) Yes Yes Yes Yes Yes Yes Yes No NR No
Pahani et al. (17) Yes Yes Ye s Ye s Ye s Ye s Ye s Yes NR Yes
Pahani et al. (18) Yes Yes Ye s Ye s Ye s Ye s Ye s Yes NR Yes
Di Pierro et al.
(19)
Yes Yes No No Yes Ye s Ye s Ye s NR Ye s
Pahani et al. (20) Yes Yes Ye s Ye s Ye s Ye s Ye s Yes NR Yes
Pahani et al. (21) Yes Yes Ye s Ye s Ye s Ye s Ye s Yes NR Yes
Ghazimoradi
et al. (22)
Yes Yes Ye s Ye s Ye s Ye s Ye s Yes Ye s Ye s
Mohammadi
et al. (23)
Yes Yes No No Yes No Yes Yes Yes Ye s
Mohammadi
et al. (24)
Yes Yes Ye s Ye s Ye s Ye s Ye s Yes Ye s Ye s
Safarian et al.
(25)
Yes Yes Ye s Ye s Ye s Ye s Ye s Yes Ye s Ye s
Shirmohammadi
et al. (26)
Yes Yes Yes Yes No Yes Yes No Yes Yes
NR, not reported; RCTs, randomized clinical trials.
to M1 (associated with the release of pro-inflammatory
mediators), resulting in a low-grade inflammatory state.
Adipose tissue, especially visceral tissue, releases pro-
inflammatory mediators such as interleukin 6 (IL-6),
TNF-α, resistin, and reduces production of beneficial
mediators such as adiponectin and IL-10. Obesity is related
to hypertension, insulin resistance, and dyslipidemia, which
are risk factors for establishing MS (31,39-41).
Curcumin has been shown to decrease glycemia and
insulin levels and improve insulin resistance. It is also
associated with reducing the levels of resistin, IL-1 β, IL-6,
IL-8, and TNF-α in patients with type 2 diabetes mellitus
(T2DM). In these patients, it is shown that curcumin
increases adiponectin levels (42). For these reasons, these
compounds can interfere with glucose homeostasis, chronic
diabetic complications, and vascular risk (43). Also, in
patients with T2DM, this compound improved the lipid
prole and the total antioxidant capacity (44,45), supporting
evidence that this compound can reduce cardiometabolic
risks (39,46-49).
In an animal model, the authors investigated the effects
of different commercial supplements with Curcuma longa.
The antioxidant activity and glucose diffusion and starch
digestion were measured, and the results showed that the
five different supplements were able to reduce glucose
diffusion and the activity of α-glucosidase enzyme, and
inhibited lipid peroxidation. However, the biological
activity of the Curcuma longa supplements varies among
them (50).
A study showed that the use of Curcuma longa extract
in overweight or hypertension middle-aged and elderly
participants significantly reduced glycemia, glycated
hemoglobin, triglycerides, and increased HDL-C. The
treated patients also showed significant improvement
of chronic low-grade inflammation, contributing to the
amelioration of metabolic disorders (51). Figure 3 shows the
effects of curcumin in the components of the MS.
A recent systematic review and meta-analysis to
investigate the effects of curcuminoids on triglycerides,
cholesterol, LDL, and HDL of adults with prediabetes,
diabetes, overweight, dyslipidemia, MS, or nonalcoholic
fatty liver disease performed by Yuan et al. (52) showed that
curcuminoids can signicantly improve lipid prole in these
subjects. Moreover, Ganjali et al. (53) showed that curcumin

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Figure 3 The effects of curcumin in inammation, oxidative stress and risk factors of metabolic syndrome. ↑, increase; ↓, decrease. SOD,
superoxide dismutase; IL-6, interleukin 6; TNF-α, tumor necrosis factor-α.
can modulate biomarkers of HDL-C function, such as the
activity and the levels of apolipoprotein-AI, cholesteryl
ester transfer protein, lecithin cholesterol acyl transferase,
paraoxonase 1, and Myeloperoxidase. Besides that, this
compound can subsequently ameliorate conditions in which
HDL-C is dysfunctional and could work as a promising
therapeutic drug in the future.
Choi et al. (54) evaluated the association among
Curcuma longa consumers with hypertension and blood
levels of heavy metals in Korean subjects. They found
that participants that had intake a curry dish more than
once per month during the previous year exhibited
signicantly reduced Pb, Hg, and Cd concentrations. The
concentrations of these metals were signicantly linked to
the prevalence of hypertension. Indeed, the Curcuma longa
intake decreased the risk of hypertension prevalence. In
mice, when captopril was associated with Curcuma longa,
there was a reduction of cardiac muscle and left ventricle
thickness in animals with hypertension, suggesting that
this association can prevent cardiac complications of
hypertension (55).
Curcuma longa can reduce body weight and body fat
percentage in obese and overweight females. Furthermore,
it can prevent excessive weight gain and play an important
role in regulating inflammatory reactions observed in
the overweight subjects, helping reduce the body-weight
excess (56,57).
In addition to these studies described above, it is possible
to observe that the RCTs presented in Table 1 also show
positive effects of curcumin in MS patients; however,
the parameters evaluated were varied. Only two studies
investigated the effects of curcumin on dyslipidemia (16,17),
and both found an improvement in the lipid profile. One
study showed the benefits of reducing body weight, waist
circumference, and fat percentage (19). The other studies
did not assess the outcomes in parameters directly related
to the diagnosis of MS. One study showed improvement in
superoxide dismutase activity and improved malonaldehyde
levels and reduced C reactive protein (CRP) levels (18).
The levels of adiponectin were increased, and leptin levels
were decreased in other RCTs (20). The pro-inammatory
parameters (TNF-α and IL-6) were also improved in
one RCT (21). Safarian et al. (25) showed improvement
in the levels of Zn/Cu in patients treated with curcumin.
The remaining four included RCT found no effects of
curcumin on vitamin E levels (23), oxidant-antioxidant
balance (22), anti-Hsp 27 (24), and cathepsin D levels (26).
The improvement in body weight, glycemia, lipids, and
biomarkers of inflammation reduce the risk of developing
diabetes, CVD, cancer, and other conditions associated with
the presence of MS (Figures 4,5).
However, some relevant biases can be mentioned in
↓Glycemia
↓HbA1c
↓Insulin resistance
↓Triglycerides
↓Total cholesterol
↓LDL-c
↓HDL-c
↓SOD
↓Malonaldehyde
↓Lipid peroxidation
↓Oxidative stress
↓IL-6
↓TNF-α↓Obesity
↓Waist circumference
↓Hypertension
HO
OCH3
OCH3
Curcumin
O O
OH

Longhua Chinese Medicine, 2021Page 8 of 12
© Longhua Chinese Medicine. All rights reserved. Longhua Chin Med 2021;4:32 | https://dx.doi.org/10.21037/lcm-21-25
Figure 4 The risk factors of metabolic syndrome and its consequences, and the role of curcumin. ↑, increase; ↓, decrease; Φ, inhibition.
these studies, such as the high number of patients who
discontinued the study, not reporting adverse events, and
not-blinded studies. Furthermore, as described above, many
of the eleven studies included in this review used the same
patients and evaluated different variables.
Despite the limitations presented by the included studies,
the results of this review may help professionals when using
Curcuma longa in the management of patients with MS.
Conclusions
We conclude that the use of Curcuma longa can help control
risk factors in patients with MS. However, more clinical
trials are necessary to show the doses and formulations
that should be used in the prevention or as adjuvants in the
treatment of metabolic conditions associated with MS.
Limitations
The limitations of this study lie in the fact that the included
studies are very heterogeneous with regard to the doses
administered and the formulation of Curcuma longa.
Summary
Curcuma longa and curcumin show impressive anti-
inammatory and antioxidant actions and can improve the
risk factors that characterize the presence of MS.
Insulin resistance
Hypertension
High triglycerides levels
Low HDL levels
Obesity
↑Oxidative stress
↑Pro-inflammatory ambiance
METABOLIC SYNDROME
↓Body
weight gain
IMPROVES:
- Hyperglycemia
- Hyperlipidemia
- Insulin resistance
- LDL cholesterol oxidation
ФLeptin signaling,
↑adiponectin
expression
CURCUMIN
Glucose
metabolism Weight
control
Lipid
metabolism
Improves blood pressure
CURCUMIN
↓Triglycerides
levels/↑HDL-c
Improves fasting
blood glucose
IMPROVES INFLAMMATION
AND OXIDATIVE STRESS
PROTECTION AGAINST METABOLIC
SYNDROME AND ITS OUTCOMES
ФObesity-related
Wnt/β-catenin
pathway
↑Cardiovascular risk
↑Cerebrovascular risk
↑Risk of atherosclerotic
cardiovascular outcomes
↑Insulin resistance
↑Systemic hypertension
↑Atherogenic dyslipidemia

Longhua Chinese Medicine, 2021 Page 9 of 12
© Longhua Chinese Medicine. All rights reserved. Longhua Chin Med 2021;4:32 | https://dx.doi.org/10.21037/lcm-21-25
Figure 5 The role of curcumin against inammation and oxidative stress observed in MS. ↑, increase; ↓, decrease; Ф, inhibition. ROS,
reactive oxygen species; RNS, reactive nitrogen species; MS, metabolic syndrome; SOD, superoxide dismutase; GSH, reduced glutathione;
NF-KB, nuclear factor kappa B; TNF-α, tumor necrosis factor-α; TGF-β, transforming growth factor beta; IL-6, interleukin 6; MCP-1,
chemoattractant protein 1.
Acknowledgments
The authors declare attribution to Smart Servier (https://
smart.servier.com/) due to the provision of some scientic
images that were used in this article under an attribution
license of public copyrights (https://creativecommons.org/
licenses/by/3.0/) and under disclaimer of warranties. All
Smart Servier’s images were not changed, except the heart
image in the Figure 4, which had its color changed.
Systemic inflammation +
↑inflammatory biomarkers
METABOLIC SYNDROME
↓ANTIOXIDANT
SYSTEMS OF THE CELLS
PROGRESSION OF THE METABOLIC SYNDROME AND OF THE
POSSIBLE CARDIOVASCULAR DISEASES OUTCOMES
ANTI-INFLAMMATORY EFFECTS
OF CURCUMIN AGAINST MS
ФROS-generating enzymes
(lipoxygenase, cyclooxygenase,
xanthine hydrogenase/oxidase)
Scavenger effects
against ROS and RNS
Scavenger effects against
peroxyl radicals = chain-
breaking antioxidant actions
↑SOD serum
activities levels
ФNF-KB, Фactivating
protein-1, ↓intracellular
signaling protein kinases
ФMacrophages
actions
↓Cyclooxygenase,
↓lipoxygenase, and ↓nitric
oxide synthase activities
↓TNF-α, ↓TGF-β,
↓IL-6, ↓MCP-1
Curcumin has effects
against many features that
compound the diagnosis of
metabolic syndrome, and
these actions can reduce
the production of pro-
inflammatory cytokines, too.
Antihypertension, antidiabetic,
antihyperlipidemic, and anti-obesity
actions are the most relevant in
fighting against inflammation
ANTIOXIDANT EFFECTS OF
CURCUMIN AGAINST MS
Improvements of SOD, GSH, and
catalase systems antioxidant activities
↑Free radical
neutralizing
↓ROS productions ↓Pro-inflammatory
cytokines productions
CHRONIC PRO-INFLAMMATORY AMBIANCE
(↑inflammatory cytokines, ↑advanced glycated
end-products, ↑protein kinase c activation)
Human’s tissues and vasculature
+ ↑ oxidation biomarkers
↑OXIDATIVE STRESS (ROS / RNS) AND
↑INTRACELLULAR REDOX IMBALANCE
(activation of oxidant enzymatic machinery of the
cells + mitochondrial dysfunctions = ↑ROS/↑RNS)
OH
OO
CURCUMIN
OCH3
OCH3
HO

Longhua Chinese Medicine, 2021Page 10 of 12
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Funding: None.
Footnote
Reporting Checklist: The authors have completed the
PRISMA reporting checklist. Available at https://dx.doi.
org/10.21037/lcm-21-25
Peer Review File: Available at https://dx.doi.org/10.21037/
lcm-21-25
Conicts of Interest: All authors have completed the ICMJE
uniform disclosure form (available at https://dx.doi.
org/10.21037/lcm-21-25). SMB serves as an unpaid
editorial board member of Longhua Chinese Medicine from
June 2020 to May 2022. The other authors have no conicts
of interest to declare.
Ethical Statement: The authors are accountable for all
aspects of the work in ensuring that questions related
to the accuracy or integrity of any part of the work are
appropriately investigated and resolved.
Open Access Statement: This is an Open Access article
distributed in accordance with the Creative Commons
Attribution-NonCommercial-NoDerivs 4.0 International
License (CC BY-NC-ND 4.0), which permits the non-
commercial replication and distribution of the article with
the strict proviso that no changes or edits are made and the
original work is properly cited (including links to both the
formal publication through the relevant DOI and the license).
See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
1. Wong SK. Repurposing New Use for Old Drug
Chloroquine against Metabolic Syndrome: A Review
on Animal and Human Evidence. Int J Med Sci
2021;18:2673-88.
2. Tofano RJ, Pescinni-Salzedas LM, Chagas EFB, et al.
Association of Metabolic Syndrome and Hyperferritinemia
in Patients at Cardiovascular Risk. Diabetes Metab Syndr
Obes 2020;13:3239-48.
3. Yarmohammadi F, Ghasemzadeh Rahbardar M,
Hosseinzadeh H. Effect of eggplant (Solanum melongena)
on the metabolic syndrome: A review. Iran J Basic Med Sci
2021;24:420-7.
4. Eisvand F, Razavi BM, Hosseinzadeh H. The effects
of Ginkgo biloba on metabolic syndrome: A review.
Phytother Res 2020;34:1798-811.
5. Lee K, Kim J. Serum vitamin D status and metabolic
syndrome: a systematic review and dose-response meta-
analysis. Nutr Res Pract 2021;15:329-45.
6. Schaffer M, Schaffer PM, Bar-Sela G. An update on
Curcuma as a functional food in the control of cancer
and inammation. Curr Opin Clin Nutr Metab Care
2015;18:605-11.
7. Mazieiro R, Frizon RR, Barbalho SM, et al. Is Curcumin a
Possibility to Treat Inammatory Bowel Diseases? J Med
Food 2018;21:1077-85.
8. Kocaadam B, Şanlier N. Curcumin, an active component
of turmeric (Curcuma longa), and its effects on health.
Crit Rev Food Sci Nutr 2017;57:2889-95.
9. Cunha Neto F, Marton LT, de Marqui SV, et al.
Curcuminoids from Curcuma Longa: New adjuvants for
the treatment of crohn's disease and ulcerative colitis? Crit
Rev Food Sci Nutr 2019;59:2136-43.
10. Goulart RA, Barbalho SM, Lima VM, et al. Effects of
the Use of Curcumin on Ulcerative Colitis and Crohn's
Disease: A Systematic Review. J Med Food 2021;24:675-85.
11. Amalraj A, Pius A, Gopi S, et al. Biological activities of
curcuminoids, other biomolecules from turmeric and
their derivatives - A review. J Tradit Complement Med
2016;7:205-33.
12. Barbalho SM, de Sousa Gonzaga HF, de Souza GA, et al.
Dermatological effects of Curcuma species: a systematic
review. Clin Exp Dermatol 2021;46:825-33.
13. Goulart RA, Barbalho SM, Rubira CJ, et al. Curcumin
therapy for ulcerative colitis remission: systematic review
and meta-analysis. Expert Rev Gastroenterol Hepatol
2020;14:1171-9.
14. Bandyopadhyay D. Farmer to pharmacist: curcumin as an
anti-invasive and antimetastatic agent for the treatment of
cancer. Front Chem 2014;2:113.
15. Moher D, Liberati A, Tetzlaff J, Altman DG, et al.
Preferred reporting items for systematic reviews and
meta-analyses: the PRISMA statement. Ann Intern Med
2009;151:264-9.
16. Yang YS, Su YF, Yang HW, et al. Lipid-lowering effects
of curcumin in patients with metabolic syndrome: a
randomized, double-blind, placebo-controlled trial.
Phytother Res 2014;28:1770-7.
17. Panahi Y, Khalili N, Hosseini MS, et al. Lipid-modifying
effects of adjunctive therapy with curcuminoids-piperine
combination in patients with metabolic syndrome: results
of a randomized controlled trial. Complement Ther Med

Longhua Chinese Medicine, 2021 Page 11 of 12
© Longhua Chinese Medicine. All rights reserved. Longhua Chin Med 2021;4:32 | https://dx.doi.org/10.21037/lcm-21-25
2014;22:851-7.
18. Panahi Y, Hosseini MS, Khalili N, et al. Antioxidant
and anti-inammatory effects of curcuminoid-piperine
combination in subjects with metabolic syndrome: A
randomized controlled trial and an updated meta-analysis.
Clin Nutr 2015;34:1101-8.
19. Di Pierro F, Bressan A, Ranaldi D, et al. Potential role
of bioavailable curcumin in weight loss and omental
adipose tissue decrease: preliminary data of a randomized,
controlled trial in overweight people with metabolic
syndrome. Preliminary study. Eur Rev Med Pharmacol Sci
2015;19:4195-202.
20. Panahi Y, Hosseini MS, Khalili N, et al. Effects of
supplementation with curcumin on serum adipokine
concentrations: A randomized controlled trial. Nutrition
2016;32:1116-22.
21. Panahi Y, Hosseini MS, Khalili N, et al. Effects of
curcumin on serum cytokine concentrations in subjects
with metabolic syndrome: A post-hoc analysis of a
randomized controlled trial. Biomed Pharmacother
2016;82:578-82.
22. Ghazimoradi M, Saberi-Karimian M, Mohammadi F, et
al. The Effects of Curcumin and Curcumin-Phospholipid
Complex on the Serum Pro-oxidant-Antioxidant Balance
in Subjects with Metabolic Syndrome. Phytother Res
2017;31:1715-21.
23. Mohammadi A, Sadeghnia HR, Saberi-Karimian M, et al.
Effects of Curcumin on Serum Vitamin E Concentrations
in Individuals with Metabolic Syndrome. Phytother Res
2017;31:657-62.
24. Mohammadi F, Ghazi-Moradi M, Ghayour-Mobarhan
M, et al. The Effects of Curcumin on Serum Heat Shock
Protein 27 Antibody Titers in Patients with Metabolic
Syndrome. J Diet Suppl 2019;16:592-601.
25. Safarian H, Parizadeh SMR, Saberi-Karimain M, et al.
The Effect of Curcumin on Serum Copper and Zinc and
Zn/Cu Ratio in Individuals with Metabolic Syndrome: A
Double-Blind Clinical Trial. J Diet Suppl 2019;16:625-34.
26. Shirmohammadi L, Ghayour-Mobarhan M, Saberi-
Karimian M, et al. Effect of Curcumin on Serum Cathepsin
D in Patients with Metabolic Syndrome. Cardiovasc
Hematol Disord Drug Targets 2020;20:116-21.
27. Tofano RJ, Barbalho SM, Bechara MD, et al.
Hypertension, C Reactive Protein and Metabolic
Prole: What is the Scenario in Patients Undergoing
Arteriography? J Clin Diagn Res 2017;11:BC19-23.
28. Su Z, Zeng K, Feng B, et al. Kun-Dan Decoction
Ameliorates Insulin Resistance by Activating AMPK/
mTOR-Mediated Autophagy in High-Fat Diet-Fed Rats.
Front Pharmacol 2021;12:670151.
29. Ishaku SM, Karima T, Oboirien KA, et al. Metabolic
syndrome following hypertensive disorders in pregnancy
in a low-resource setting: A cohort study. Pregnancy
Hypertens 2021;25:129-35.
30. de Oliveira Dos Santos AR, de Oliveira Zanuso B, Miola
VFB, et al. Adipokines, Myokines, and Hepatokines:
Crosstalk and Metabolic Repercussions. Int J Mol Sci
2021;22:2639.
31. Barbalho SM, Bechara MD, Quesada K, et al. Síndrome
metabólica, aterosclerose e inamação: tríade indissociável?
J Vasc Bras 2015;14:319-27.
32. Ning J, Zhang Y, Hu H, et al. Association between
ambient particulate matter exposure and metabolic
syndrome risk: A systematic review and meta-analysis. Sci
Total Environ 2021;782:146855.
33. Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing
the metabolic syndrome: a joint interim statement of
the International Diabetes Federation Task Force on
Epidemiology and Prevention; National Heart, Lung,
and Blood Institute; American Heart Association; World
Heart Federation; International Atherosclerosis Society;
and International Association for the Study of Obesity.
Circulation 2009;120:1640-5.
34. Juanola O, Martínez-López S, Francés R, et al. Non-
Alcoholic Fatty Liver Disease: Metabolic, Genetic,
Epigenetic and Environmental Risk Factors. Int J Environ
Res Public Health 2021;18:5227.
35. Kim HB, Kim GJ, Han KD, et al. Changes in metabolic
syndrome status and risk of laryngeal cancer: A nationwide
cohort study. PLoS One 2021;16:e0252872.
36. Keskin H, Cadirci K, Gungor K, et al. Association
between TSH Values and GFR Levels in Euthyroid
Cases with Metabolic Syndrome. Int J Endocrinol
2021;2021:8891972.
37. Schönfeld P, Reiser G. How the brain ghts fatty acids'
toxicity. Neurochem Int 2021;148:105050.
38. Hosseini A, Razavi BM, Banach M, et al. Quercetin and
metabolic syndrome: A review. Phytother Res 2021. [Epub
ahead of print]. doi: 10.1002/ptr.7144.
39. Marton LT, Pescinini-E-Salzedas LM, Camargo MEC,
et al. The Effects of Curcumin on Diabetes Mellitus:
A Systematic Review. Front Endocrinol (Lausanne)
2021;12:669448.
40. Saffarionpour S, Diosady LL. Curcumin, a potent
therapeutic nutraceutical and its enhanced delivery and
bioaccessibility by pickering emulsions. Drug Deliv Transl

Longhua Chinese Medicine, 2021Page 12 of 12
© Longhua Chinese Medicine. All rights reserved. Longhua Chin Med 2021;4:32 | https://dx.doi.org/10.21037/lcm-21-25
Res 2021. [Epub ahead of print]. doi: 10.1007/s13346-021-
00936-3.
41. Zhang P, Sun X, Jin H, et al. Association Between Obesity
Type and Common Vascular and Metabolic Diseases:
A Cross-Sectional Study. Front Endocrinol (Lausanne)
2020;10:900.
42. Hajavi J, Momtazi AA, Johnston TP, et al. Curcumin: A
Naturally Occurring Modulator of Adipokines in Diabetes.
J Cell Biochem 2017;118:4170-82.
43. Katsiki N, Mikhailidis DP, Banach M. Leptin,
cardiovascular diseases and type 2 diabetes mellitus. Acta
Pharmacol Sin 2018;39:1176-88.
44. Panahi Y, Khalili N, Sahebi E, et al. Antioxidant effects
of curcuminoids in patients with type 2 diabetes mellitus:
a randomized controlled trial. Inammopharmacology
2017;25:25-31.
45. Panahi Y, Khalili N, Sahebi E, et al. Curcuminoids modify
lipid prole in type 2 diabetes mellitus: A randomized
controlled trial. Complement Ther Med 2017;33:1-5.
46. Cicero AFG, Colletti A, Bajraktari G, et al. Lipid-
lowering nutraceuticals in clinical practice: position paper
from an International Lipid Expert Panel. Nutr Rev
2017;75:731-67.
47. Johnston TP, Korolenko TA, Pirro M, et al. Preventing
cardiovascular heart disease: Promising nutraceutical and
non-nutraceutical treatments for cholesterol management.
Pharmacol Res 2017;120:219-25.
48. Ward N, Sahebkar A, Banach M, et al. Recent perspectives
on the role of nutraceuticals as cholesterol-lowering
agents. Curr Opin Lipidol 2017;28:495-501.
49. Sahebkar A. Curcuminoids for the management of
hypertriglyceridaemia. Nat Rev Cardiol 2014;11:123.
50. Guerrero-Romero F, Simental-Mendía LE, Martínez-
Aguilar G, et al. Hypoglycemic and antioxidant effects of
ve commercial turmeric (Curcuma longa) supplements. J
Food Biochem 2020;44:e13389.
51. Uchio R, Muroyama K, Okuda-Hanafusa C, et al. Hot
Water Extract of Curcuma longa L. Improves Serum
Inammatory Markers and General Health in Subjects
with Overweight or Prehypertension/Mild Hypertension:
A Randomized, Double-Blind, Placebo-Controlled Trial.
Nutrients 2019;11:1822.
52. Yuan F, Dong H, Gong J, et al. A Systematic Review
and Meta-analysis of Randomized Controlled Trials on
the Effects of Turmeric and Curcuminoids on Blood
Lipids in Adults with Metabolic Diseases. Adv Nutr
2019;10:791-802.
53. Ganjali S, Blesso CN, Banach M, et al. Effects of curcumin
on HDL functionality. Pharmacol Res 2017;119:208-18.
54. Choi JW, Oh C, Shim SY, et al. Reduction in Prevalence
of Hypertension and Blood Heavy Metals among Curry-
Consumed Korean. Tohoku J Exp Med 2018;244:219-29.
55. Hijriani N, Yusetyani L, Hasmono D. The effect of
curcuma (Curcuma xanthorrizha roxb.) extract as an
adjuvant of captopril therapy on cardiac histopathology of
male mice (Mus musculus) with hypertension. J Basic Clin
Physiol Pharmacol 2020. doi: 10.1515/jbcpp-2019-0280.
56. Latif R, Mumtaz S, Al Sheikh MH, et al. Effects of
Turmeric on Cardiovascular Risk Factors, Mental Health,
and Serum Homocysteine in Overweight, Obese Females.
Altern Ther Health Med 2021;27:114-9.
57. Jarząb A, Kukula-Koch W. Recent Advances in Obesity:
The Role of Turmeric Tuber and Its Metabolites in the
Prophylaxis and Therapeutical Strategies. Curr Med
Chem 2018;25:4837-53.
doi: 10.21037/lcm-21-25
Cite this article as: Laurindo LF, Barbalho SM, Joshi RK, de
Alvarez Rezende B, de Alvares Goulart R, Guiguer EL, Araújo
AC. Curcuma longa and curcumin on metabolic syndrome: a
systematic review. Longhua Chin Med 2021;4:32.