TABLE 1.
Results of meta-analysis and summary of findings.
| Outcomes | Subgroup | No. participants (RCTs) | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | I 2 value (%) | Quality of evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|---|---|
| Risk with control group | Risk with HM group | |||||||
| HM versus placebo | ||||||||
| TER | Total (PI) | 235 (3) | 590 per 1,000 | 932 per 1,000 (790–1,000) | RR 1.58 (1.34, 1.85) | 77 | High | — |
| AE | Total (PI) | 247 (3) | 75 per 1,000 | 48 per 1,000 (18–128) | RR 0.66 (0.25, 1.75) | NA | Moderate | Imprecision (-1) |
| HM versus active control | ||||||||
| TER | Total | 14,097 (130) | 729 per 1,000 | 911 per 1,000 (889–933) | RR 1.25 (1.22, 1.28) | 54 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| — | PI | 7,679 (69) | 725 per 1,000 | 913 per 1,000 (884–949) | RR 1.26 (1.22, 1.31) | 67 | Very low | Risk of bias (-1) |
| Inconsistency (-1) | ||||||||
| Publication bias (-1) | ||||||||
| — | Not PI | 6,418 (61) | 733 per 1,000 | 909 per 1,000 (880–931) | RR 1.24 (1.20, 1.27) | 23 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| Food intake (g/day) | Total | 395 (3) | — | MD 7.23 higher (5.24 to 9.22 higher) | — | 96 | Moderate | Risk of bias (-1) |
| — | PI | 160 (1) | — | MD 6.1 higher (4.09 to 8.11 higher) | — | NA | Moderate | Risk of bias (-1) |
| — | Not PI | 235 (2) | — | MD 52.91 higher (40.11 to 65.71 higher) | — | 0 | Moderate | Risk of bias (-1) |
| Body weight (kg) | Total | 1,112 (11) | — | MD 0.89 higher (0.23 to 1.54 higher) | — | 79 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | PI | 395 (4) | — | MD 0.72 higher (0.42 lower to 1.87 higher) | — | 92 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| Imprecision (-1) | ||||||||
| — | Not PI | 717 (7) | — | MD 0.96 higher (0.48 to 1.45 higher) | — | 0 | Moderate | Risk of bias (-1) |
| Height (cm) | Total (PI) | 161 (2) | — | MD 0.4 lower (4.3 lower to 3.51 higher) | — | 0 | Moderate | Risk of bias (-1) |
| BMI (kg/cm2) | Total | 166 (2) | — | MD 2.03 higher (1.57 to 2.49 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | PI | 94 (1) | — | MD 1.85 higher (1.2 to 2.5 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 72 (1) | — | MD 2.2 higher (1.55 to 2.85 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Leptin | Total | 961 (11) | — | SMD 1.08 lower (1.98 to 0.18 lower) | — | 97 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | PI | 737 (8) | — | SMD 0.33 lower (1.15 lower to 0.49 higher) | — | 96 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| Imprecision (-1) | ||||||||
| — | Not PI | 224 (3) | — | SMD 3.13 lower (4.53 to 1.73 lower) | — | 92 | Moderate | Risk of bias (-1) |
| Gastrin (ng/L) | Total | 532 (5) | — | MD 13.23 higher (11.06 to 15.39 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | PI | 326 (3) | — | MD 14.85 higher (11.19 to 18.52 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | Not PI | 206 (2) | — | MD 12.36 higher (9.68 to 15.04 higher) | — | 57 | Moderate | Risk of bias (-1) |
| Motilin (ng/L) | Total (PI) | 431 (4) | — | MD 28.6 higher (19.74 to 37.45 higher) | — | 14 | Moderate | Risk of bias (-1) |
| NPY | Total | 762 (8) | — | SMD 1.02 higher (0.87 to 1.17 higher) | — | 50 | Moderate | Risk of bias (-1) |
| — | PI | 476 (5) | — | SMD 0.9 higher (0.71 to 1.09 higher) | — | 12 | Moderate | Risk of bias (-1) |
| — | Not PI | 286 (3) | — | SMD 1.22 higher (0.97 to 1.48 higher) | — | 64 | Moderate | Risk of bias (-1) |
| Ghrelin | Total | 349 (4) | — | SMD 0.7 higher (0.47 to 0.93 higher) | — | 95 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | PI | 265 (3) | — | SMD 0.44 higher (0.18 to 0.69 higher) | — | 94 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | Not PI | 84 (1) | — | SMD 1.76 higher (1.25 to 2.26 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Orexin (ng/ml) | Total | 146 (2) | — | MD 1.67 higher (1.58 to 1.75 higher) | — | 99 | Moderate | Risk of bias (-1) |
| — | PI | 86 (1) | — | MD 0.18 higher (0.09 lower to 0.45 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 60 (1) | — | MD 1.84 higher (1.75 to 1.93 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Serum Zn (umol/L) | Total | 1,410 (16) | — | MD 3.87 higher (2.51 to 5.23 higher) | — | 88 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| — | PI | 1,129 (13) | — | MD 3.08 higher (1.77 to 4.38 higher) | — | 83 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| — | Not PI | 281 (3) | — | MD 7.45 higher (1.06 lower to 15.96 higher) | — | 96 | Moderate | Risk of bias (-1) |
| Serum Fe (umol/L) | Total | 141 (3) | — | MD 1.36 higher (0.73 to 1.98 higher) | — | 92 | Moderate | Risk of bias (-1) |
| — | PI | 55 (2) | — | MD 47.89 higher (29.98 to 65.8 higher) | — | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 86 (1) | — | MD 1.3 higher (0.68 to 1.92 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Serum Ca (mmol/L) | Total (PI) | 245 (4) | — | MD 0.03 higher (0 to 0.05 higher) | — | 79 | Moderate | Risk of bias (-1) |
| Hb (g/L) | Total | 846 (9) | — | MD 9.78 higher (5.19 to 14.37 higher) | — | 92 | Moderate | Risk of bias (-1) |
| — | PI | 526 (5) | — | MD 6.91 higher (1.34 to 12.48 higher) | — | 95 | Moderate | Risk of bias (-1) |
| — | Not PI | 320 (4) | — | MD 15.37 higher (3.61 to 27.12 higher) | — | 86 | Moderate | Risk of bias (-1) |
| Hair Zn (ppm) | Total | 134 (2) | — | MD 21.79 higher (16.91 to 26.67 higher) | — | 87 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | PI | 67 (1) | — | MD 23.5 higher (18.47 to 28.53 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 67 (1) | — | MD 5.78 lower (25.99 lower to 14.43 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Recurrence rate | Total | 690 (8) | 266 per 1,000 | 40 per 1,000 (24–67) | RR 0.15 (0.09, 0.25) | 22 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | PI | 191 (3) | 200 per 1,000 | 72 per 1,000 (32–164) | RR 0.36 (0.16, 0.82) | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 499 (5) | 294 per 1,000 | 29 per 1,000 (15–59) | RR 0.10 (0.05, 0.20) | 10 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| AE | Total | 3,059 (29) | 10 per 1,000 | 3 per 1,000 (1–8) | RR 0.34 (0.14, 0.80) | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| PI | 1760 (18) | 10 per 1,000 | 5 per 1,000 (2–15) | RR 0.52 (0.18, 1.47) | 14 | Low | Risk of bias (-1) | |
| Imprecision (-1) | ||||||||
| Not PI | 1,299 (11) | 10 per 1,000 | 1 per 1,000 (0–8) | RR 0.14 (0.03, 0.77) | 0 | Low | Risk of bias (-1) | |
| Imprecision (-1) | ||||||||
| HM + active control versus active control alone | ||||||||
| TER | Total | 6,953 (70) | 767 per 1,000 | 936 per 1,000 (905–959) | RR 1.22 (1.18, 1.25) | 53 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| — | PI | 2,870 (28) | 775 per 1,000 | 945 per 1,000 (899–999) | RR 1.22 (1.16, 1.29) | 74 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| — | Not PI | 4,083 (42) | 761 per 1,000 | 921 per 1,000 (898–944) | RR 1.21 (1.18, 1.24) | 0 | Low | Risk of bias (-1) |
| Publication bias (-1) | ||||||||
| Appetite recovery time (day) | Total | 324 (4) | — | MD 2.09 lower (2.44 to 1.75 lower) | — | 83 | Moderate | Risk of bias (-1) |
| — | PI | 104 (1) | — | MD 1.42 lower (1.89 to 0.95 lower) | — | NA | Moderate | Risk of bias (-1) |
| — | Not PI | 220 (3) | — | MD 2.88 lower (3.39 to 2.37 lower) | — | 0 | Moderate | Risk of bias (-1) |
| Food intake (g/day) | Total | 144 (2) | — | MD 37.96 higher (23.13 to 52.78 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | PI | 74 (1) | — | MD 44.1 higher (17.47 to 70.73 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 70 (1) | — | MD 35.2 higher (17.35 to 53.05 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Body weight (kg) | Total | 1,185 (13) | — | MD 1.34 higher (1.03 to 1.66 higher) | — | 58 | Moderate | Risk of bias (-1) |
| — | PI | 410 (4) | — | MD 1.15 higher (0.86 to 1.43 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | Not PI | 775 (9) | — | MD 1.42 higher (0.98 to 1.85 higher) | — | 69 | Moderate | Risk of bias (-1) |
| BMI (kg/cm2) | Total | 549 (5) | — | MD 0.89 higher (0.64 to 1.13 higher) | — | 87 | Moderate | Risk of bias (-1) |
| — | PI | 389 (4) | — | MD 1.53 higher (1.17 to 1.88 higher) | — | 50 | Moderate | Risk of bias (-1) |
| — | Not PI | 160 (1) | — | MD 0.3 higher (0.04 lower to 0.64 higher) | — | NA | Moderate | Risk of bias (-1) |
| Subcutaneous fat thickness (cm) | Total (not PI) | 332 (3) | — | MD 0.09 higher (0.05 to 0.13 higher) | — | 0 | Moderate | Risk of bias (-1) |
| Leptin | Total | 803 (8) | — | SMD 1.49 lower (2.37 to 0.61 lower) | — | 97 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | PI | 631 (6) | — | SMD 1.75 lower (2.93 to 0.57 lower) | — | 97 | Very low | Risk of bias (-1) |
| Inconsistency (-2) | ||||||||
| — | Not PI | 172 (2) | — | SMD 0.74 lower (1.2 to 0.28 lower) | — | 54 | Moderate | Risk of bias (-1) |
| Gastrin (ng/L) | Total | 407 (4) | — | MD 14.75 higher (11.74 to 17.77 higher) | — | 81 | Moderate | Risk of bias (-1) |
| — | PI | 325 (3) | — | MD 13.08 higher (9.95 to 16.21 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | Not PI | 82 (1) | — | MD 35.88 higher (24.76 to 47 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| Motilin (ng/L) | Total | 415 (4) | — | MD 31.34 higher (24.8 to 37.88 higher) | — | 44 | Moderate | Risk of bias (-1) |
| — | PI | 325 (3) | — | MD 31.66 higher (24.77 to 38.55 higher) | — | 62 | Moderate | Risk of bias (-1) |
| — | Not PI | 90 (1) | — | MD 28.48 higher (7.88 to 49.08 higher) | — | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| NPY | Total | 686 (7) | — | SMD 1.11 higher (0.72 to 1.5 higher) | — | 82 | Moderate | Risk of bias (-1) |
| — | PI | 514 (5) | — | SMD 1.03 higher (0.77 to 1.28 higher) | — | 47 | Moderate | Risk of bias (-1) |
| — | Not PI | 172 (2) | — | SMD 1.34 higher (0.4 lower to 3.08 higher) | — | 96 | Moderate | Risk of bias (-1) |
| Ghrelin | Total (PI) | 358 (3) | — | SMD 1.35 higher (1.12 to 1.58 higher) | — | 0 | Moderate | Risk of bias (-1) |
| Serum Zn | Total | 1,381 (15) | — | SMD 0.92 higher (0.74 to 1.1 higher) | — | 61 | Moderate | Risk of bias (-1) |
| — | PI | 622 (7) | — | SMD 0.73 higher (0.51 to 0.95 higher) | — | 41 | Moderate | Risk of bias (-1) |
| — | Not PI | 759 (8) | — | SMD 1.09 higher (0.85 to 1.32 higher) | — | 55 | Moderate | Risk of bias (-1) |
| Serum Fe | Total | 503 (6) | — | SMD 1.21 higher (0.72 to 1.7 higher) | — | 84 | Moderate | Risk of bias (-1) |
| — | PI | 170 (2) | — | SMD 1.16 higher (0.69 to 1.63 higher) | — | 51 | Moderate | Risk of bias (-1) |
| — | Not PI | 333 (4) | — | SMD 1.25 higher (0.49 to 2.02 higher) | — | 90 | Moderate | Risk of bias (-1) |
| Serum Ca (mmol/L) | Total | 442 (5) | — | MD 0.17 higher (0.13 to 0.21 higher) | — | 87 | Moderate | Risk of bias (-1) |
| — | PI | 302 (3) | — | MD 0.15 higher (0.1 to 0.21 higher) | — | 79 | Moderate | Risk of bias (-1) |
| — | Not PI | 140 (2) | — | MD 0.2 higher (0.13 to 0.28 higher) | — | 95 | Moderate | Risk of bias (-1) |
| Hb (g/L) | Total | 793 (9) | — | MD 8.47 higher (5.59 to 11.35 higher) | — | 72 | Moderate | Risk of bias (-1) |
| — | PI | 144 (2) | — | MD 8.24 higher (5.74 to 10.74 higher) | — | 0 | Moderate | Risk of bias (-1) |
| — | Not PI | 649 (7) | — | MD 8.51 higher (4.48 to 12.53 higher) | — | 79 | Moderate | Risk of bias (-1) |
| Recurrence rate | Total | 450 (6) | 342 per 1,000 | 113 per 1,000 (79–164) | RR 0.33 (0.23, 0.48) | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | PI | 254 (3) | 273 per 1,000 | 101 per 1,000 (57–175) | RR 0.37 (0.21, 0.64) | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 196 (3) | 444 per 1,000 | 133 per 1,000 (80–222) | RR 0.30 (0.18, 0.50) | 0 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| AE | Total | 2,791 (29) | 12 per 1,000 | 7 per 1,000 (3–15) | RR 0.58 (0.27, 1.24) | 8 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | PI | 808 (9) | 10 per 1,000 | 7 per 1,000 (2–31) | RR 0.75 (0.18, 3.14) | NA | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
| — | Not PI | 1983 (20) | 14 per 1,000 | 7 per 1,000 (3–18) | RR 0.53 (0.22, 1.30) | 38 | Low | Risk of bias (-1) |
| Imprecision (-1) | ||||||||
Abbreviations: AE, adverse event; BMI, body mass index; CI, confidence interval; GRADE, grading of recommendations assessment, development, and evaluation; Hb, hemoglobin; HM, herbal medicine; MD, mean difference; NA, not applicable; NPY, neuropeptide Y; PI, pattern identification; RCT, randomized controlled trial; RR, risk ratio; SMD, standardized mean difference; TER, total effective rate.
Bold values mean significant differences between the groups.