Article - The effects of pomegranate consumption on obesity indices in adults: A systematic review and meta-analysis.

Plain Language Summary

Obesity is a growing global concern and is linked to the development of diseases such as diabetes, heart disease, and stroke. Pomegranate is a fruit with a high content of naturally occurring chemicals, which may have health benefits due to their anti-inflammatory, antioxidant, and anti-obesity effects. However, findings from research have given controversial results. This systematic review and meta-analysis of 28 randomised controlled trials aimed to determine the effect of pomegranate juice on obesity indices in adults. The results showed that pomegranate consumption led to body weight loss and a reduction in body mass index (BMI) in comparison to control. However, there were no effects on waist circumference (WC), fat mass, free fat mass, and body fat percentage (BFP). When the study looked at individual groups, it was shown that amongst those who were obese, pomegranate juice did reduce WC and BFP. The authors concluded that pomegranate juice consumption can reduce BMI and body weight, however this decrease was not clinically meaningful. This study could be used by healthcare professionals to understand that although this clinical trial showed some benefit of pomegranate juice to people with obesity, it is not an effective strategy for meaningful weight loss.

Expert Review

Reviewer: Karin Elgar

10th Apr 2025

Conflict of interest

None

Take home message

Whilst the evidence is limited, pomegranate intake for at least 8 weeks may help reduce liver enzymes in patients with metabolic disorders or obesity.

Evidence category

A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)

Summary review

Introduction

This systematic review and meta-analysis aimed to evaluate the effects of pomegranate supplementation on liver enzymes in adults with various medical conditions.

Methods

Systematic review and meta-analysis of randomised controlled trials (RCTs) of adults who consumed pomegranate for at least 2 weeks, reporting liver enzymes, aspartate aminotransferase (AST), alanine transaminase (ALT), and gamma glutamyl transferase (GGT) as an outcome.
Study quality was assessed with the Cochrane Risk of Bias (RoB) tool and certainty of evidence was evaluated with GRADE.

Results

Nine articles (12 study arms, 425 participants) were included in the review.
Populations included patients with cardiometabolic disease, pulmonary disease, and athletes.
Pomegranate interventions (2-12 weeks) used juices, extracts and seed oil.
Pomegranate significantly reduced GGT compared to controls (WMD -5.43; 95% CI −7.78, −3.08; p<0.001; n=3), with no significant heterogeneity (P=0.024, I²=73.1%). No significant effects were observed for ALT (WMD -1.13; CI −4.18, 1.91; p=0.466; n=10) or AST (WMD -0.58; CI −2.58, 1.42; p=0.570; n=12), with substantial heterogeneity (ALT: P<0.001, I²=87.5%; AST: P<0.001, I²=92.8%).
Subgroup analysis showed significant benefits for ALT with durations of ≥8 weeks (WMD -5.31 (CI −8.28, −2.34) p<0.001, n=4) and in patients with metabolic disorders (WMD -4.29 (CI −7.21, −1.37) p=0.004, n=6); and for AST with durations of ≥8 weeks (WMD -4.06 (CI -5.73, −2.38) p<0.001, n=5), in obese patients (WMD -2.15 (CI -4.18, −0.11) p<0.038, n=5) and patients with metabolic disorders (WMD -2.88 (CI -4.64, −1.11) p<0.001, n=7),
RoB was good for 6, fair for 1 and bad for 2 studies. Certainty of evidence was considered very low for ALT and AST, and as high for GGT. Limitations included small sample sizes, short durations, and varied pomegranate formulations.

Conclusion

While pomegranate had no overall effect on liver enzymes in general populations, it may benefit individuals with elevated liver enzyme risk, particularly those with metabolic disorders or obesity when taken longer term.

Clinical practice applications

Pomegranate intake for at least 8 weeks may have a beneficial effect on liver enzymes in patients with metabolic disorders and obesity. However, based on the quality of evidence presented, and limited number of studies, findings should be interpreted with caution.

Considerations for future research

Larger, longer-terms RCTs in patients with elevated liver enzymes and using standardised pomegranate supplements would be of value.

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Abstract

Evidence supports the potential application of polyphenols as agents against obesity. Pomegranate is one of the fruits that possess a high content of polyphenols. This systematic review and meta-analysis of randomized controlled trials (RCTs) sought to evaluate the effects of pomegranate consumption on obesity indices, including body mass index (BMI), body weight, waist circumference (WC), fat mass (FM), body fat percentage (BFP), and fat-free mass (FFM) in adults. Relevant RCTs were obtained by searching databases, including PubMed, SCOPUS, and Web of Science, up to May 2023. Heterogeneity tests of the included trials were performed using the statistic. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as the weighted mean difference with a 95% confidence interval. Pooled analysis of 28 trials revealed that pomegranate consumption led to a significant reduction in body weight (WMD: -1.97, 95% CI: -2.91, -1.03, < .05), and a significant decrease in BMI (WMD: -0.48, 95% CI: -0.76, -0.20, < .05) in comparison with the control group. However, there were no significant effects on WC, FM, FFM, and BFP in comparison with the control group. Pomegranate consumption may yield a beneficial effect on body weight and BMI in adults. However, there were no significant effects on WC, FM, FFM, and BFP, by pomegranate consumption. Also, pomegranate consumption can reduce body weight, BMI, WC, and BFP in obese adults. Long-term trials with different doses of pomegranate are needed.