Original article The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial Alireza Gheflati a, b , Reihaneh Bashiri a, b , Marjan Tajik Kord c , Akram Ghadiri-Anari d , Javad Zavar Reza e , Azadeh Nadjarzadeh a, b, * a Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran b Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran c Department of Biochemistry and Biology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran d Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran e Department of Biochemistry, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran article info Article history: Received 24 March 2019 Accepted 13 June 2019 Keywords: Apple vinegar Type 2 diabetes Dyslipidemia Oxidative stress summary Background: Some foods and drinks contain special ingredients, causing impressive effects on human health. The aim of the current study was to assess the health effects of apple vinegar in patients with diabetes and dyslipidemia. Method: Seventy participants with type 2 diabetes and hyperlipidemia were randomly assigned into an intervention and control group in order to assess the effect of 20 ml apple vinegar per day using an 8- week parallel study. Fasting blood sugar (FBS), homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for b-cell function (HOMA-B), quantitative insulin sensitivity checks index (QUICKI), insulin, malondialdehyde (MDA), 2,20-Diphenyl-1- picrylhydrazyl (DPPH), ho- mocysteine, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured at the beginning and end of the study. Results: The intervention with apple vinegar could significantly improve FBS (mean change: 10.16 ± 19.48 mg/dl, p ¼ 0.006) and DPPH (mean change: 16.58 ± 11.56, p < 0.001) within intervention group and in comparison with control group (p < 0.001). Additionally, the significant in- crease of MDA in control group (p < 0.05) caused a considerable difference between two groups. Gly- cemic indices containing insulin, HOMA-IR, HOMA-B, and QUICKI decrease significantly in both groups (p < 0.05). No considerable effect was observed on blood pressure and homocysteine in intervention group as well as control group. Conclusion: This trial provided some evidences that apple vinegar consumption may cause beneficial effects on glycemic indices and oxidative stress in individuals with diabetes and dyslipidemia. This randomized clinical trial was registered in the Iranian Registry of Clinical Trials (https://www.irct.ir/) as 2013070710826N5. © 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Diabetes mellitus is one of the most prevalent metabolic disor- ders worldwide [1]. The number of individuals with diabetes has been increasing between 1980 and 2014 from 108 million to 422 million [2], its number will rise to 552 million people by 2030 [3]. Type 2 diabetes mellitus (T2DM), the most common type of dia- betes mellitus [4], is associated with deterioration of life quality, causing a considerable reduction in life expectancy [5]. Based on previous studies, diabetes imposes a significant burden on people with diabetes as well as the healthcare system [6]. This disorder leads to several complications such as cardiovascular diseases (CVDs), chronic kidney disorders [7], and some type of cancers * Corresponding author. Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Fax: þ98 35 38209119. E-mail addresses: azadnajarzadeh@ssu.ac.ir, azadehnajarzadeh@gmail.com (A. Nadjarzadeh). Contents lists available at ScienceDirect Clinical Nutrition ESPEN journal homepage: http://www.clinicalnutritionespen.com https://doi.org/10.1016/j.clnesp.2019.06.006 2405-4577/© 2019 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Clinical Nutrition ESPEN xxx (xxxx) xxx Please cite this article as: Gheflati A et al., The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial, Clinical Nutrition ESPEN, https:// doi.org/10.1016/j.clnesp.2019.06.006