Discussion
MetS, hypertension, steatohepatitis, MetS.Previous
NONALCOHOLIC FATTY LIVER, HYPERTENSION, STEATOHEPATITIS, OXIDATIVE STRESS
The current cross-over RCT revealed that sumac supplementation has significantly decreased systolic blood pressure among adults with MetS. Sumac supplementation might also prevent a significant rise in serum triglyceride among study subjects. This was the first cross-over trial that examined the effect of sumac supplementation on MetS markers in both men and women with MetS.Previous evidence has shown that having MetS is drastically related to increased risk of nonalcoholic fatty liver, steatohepatitis [Similar to our study, Asgary et al. [Previous studies suggested some pathways to explain the mechanisms for beneficial effects of sumac on MetS components. Sumac extract is a good source of natural antioxidants. Oxidative stress could lead to hypertension by two pathways including, increasing vascular contractile activity through damaging the endothelium [In the current investigation, there are some points that strengthen this RCT. The study was conducted on both male and female population. The cross-over design of the study resulted in independent relations from personal features or genetic variables. Moreover, performing ITT analysis helped us to include all subjects in the analysis. Additionally, triple-blinded design of the trial would decrease risk of bias. Nevertheless, some limitations must be kept in mind. High prevalence of covid-19 pandemic and the traffic restrictions for this pandemic during the study implementation increased loss to follow-up of participants. Furthermore, there was no biomarker to evaluate compliance of individuals to the sumac supplementation. Additionally, because of low number of participants we could not perform stratified analysis by gender.