Abstract
Objectives
Excess calories from free sugars have been implicated in the epidemics of obesity and type 2 diabetes. Honey has been lumped into the category of free sugars according to the World Health Organization but is considered a healthy alternative to sugar by many in the public. The objective of this study was to assess the effect of honey on cardiometabolic risk factors by conducting a systematic review and meta-analysis of controlled trials using GRADE.
Methods
MEDLINE, Embase, and Cochrane Library were searched up to 4 January 2021 for controlled trials of ≥1 weeks’ duration assessing the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of non-alcoholic fatty liver disease. Trial designs were prespecified based on energy control: substitution (energy matched replacement of honey by other macronutrients); addition (excess energy from honey added to diets); subtraction (energy from honey subtracted from diets); and ad libitum (energy from honey freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95% CIs. Certainty of evidence was assessed using the GRADE approach. (PROSPERO identifier, CRD42015023580)
Results
We included 17 controlled trials (29 trial comparisons, n = 1073) assessing the effect of honey across two energy levels, substitution and addition. Honey reduced glycated hemoglobin (mean difference (MD), −0.27%, [95% confidence interval (CI), −0.50 to −0.04%], P = 0.019), LDL cholesterol (MD, −0.34 mmol/L, [95% CI, −0.67 to −0.042 mmol/L], P = 0.040), and fasting triglycerides (MD, −0.15 mmol/L, [95% CI, −0.30 to −0.00 mmol/L], P = 0.043) in addition trials. No effects of honey were seen in substitution trials on any of the outcomes assessed. The overall certainty of the evidence was low to very low for most comparisons.
Conclusions
The available evidence provides some indication that honey might have a benefit for glycemic control and lipid levels when consumed in a healthy dietary pattern. More high-quality randomized controlled trials are needed to improve our estimates.
Funding Sources
CIHR, Diabetes Canada, PSI, Banting & Best Diabetes Centre, Toronto 3D foundation.