Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract. 2019;157:107843.

PubMed  Google Scholar 

Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine. 2010;38(11):602–6.

Google Scholar 

DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Reviews Disease Primers. 2015;1(1):1–22.

Google Scholar 

Association AD. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033–46.

Google Scholar 

Xu L, Li Y, Dai Y, Peng J. Natural products for the treatment of type 2 diabetes mellitus: Pharmacology and mechanisms. Pharmacol Res. 2018;130:451–65.

CAS  PubMed  Google Scholar 

Association AD. Introduction: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Supplement1):S1–2.

Google Scholar 

Eghbali S, Askari SF, Avan R, Sahebkar A. Therapeutic effects of Punica granatum (Pomegranate): an updated review of clinical trials. J Nutr Metab. 2021;2021:5297162. https://doi.org/10.1155/2021/5297162. PMID: 34796029; PMCID: PMC8595036.

Zhang Y-J, Gan R-Y, Li S, Zhou Y, Li A-N, Xu D-P, et al. Antioxidant phytochemicals for the prevention and treatment of chronic diseases. Molecules. 2015;20(12):21138–56.

CAS  PubMed  PubMed Central  Google Scholar 

Holland D, Hatib K. Bar-Ya’akov I. Pomegranate: botany, horticulture, breeding. Hortic Reviews. 2009;35:127–91.

Google Scholar 

Cheng J, Li J, Xiong R-G, Wu S-X, Huang S-Y, Zhou D-D, et al. Bioactive compounds and health benefits of pomegranate: an updated narrative review. Food Bioscience. 2023;53:102629.

CAS  Google Scholar 

Akhtar S, Ismail T, Layla A. Pomegranate bioactive molecules and health benefits. Bioactive Molecules Food. 2019;3:1253–79.

Google Scholar 

Bajaj S, Khan A. Antioxidants and diabetes. Indian J Endocrinol Metabol. 2012;16(Suppl 2):S267.

Google Scholar 

Asgary S, Sahebkar A, Afshani MR, Keshvari M, Haghjooyjavanmard S, Rafieian-Kopaei M. Clinical evaluation of blood pressure lowering, endothelial function improving, hypolipidemic and anti-inflammatory effects of pomegranate juice in hypertensive subjects. Phytother Res. 2014;28(2):193–9. https://doi.org/10.1002/ptr.4977. Epub 2013 Mar 21. PMID: 23519910.

CAS  PubMed  Google Scholar 

Babaeian S, Ebrahimi Mameghani M, Niafar M, Sanaii S. The effect of unsweetened pomegranate juice on insulin resistance, high sensitivity C-reactive protein and obesity among type 2 diabetes patients. J Ardabil Univ Med Sci (JAUMS) [Internet]. 2013;13(1(47)):7–15. Available from: https://sid.ir/paper/392762/en

Google Scholar 

Laurindo LF, Barbalho SM, Marquess AR, Grecco AIS, Goulart RA, Tofano RJ, et al. Pomegranate (Punica granatum L.) and metabolic syndrome risk factors and outcomes: A systematic review of clinical studies. Nutrients. 2022;14(8):1665.

CAS  PubMed  PubMed Central  Google Scholar 

Banihani S, Swedan S, Alguraan Z. Pomegranate and type 2 diabetes. Nutr Res. 2013;33(5):341–8.

CAS  PubMed  Google Scholar 

Bashan N, Kovsan J, Kachko I, Ovadia H, Rudich A. Positive and negative regulation of insulin signaling by reactive oxygen and nitrogen species. Physiol Rev. 2009;89(1):27–71. https://doi.org/10.1152/physrev.00014.2008

Abedini M, Ghasemi-Tehrani H, Tarrahi MJ, Amani R. The effect of concentrated pomegranate juice consumption on risk factors of cardiovascular diseases in women with polycystic ovary syndrome: A randomized controlled trial. Phytother Res. 2021;35(1):442–51.

CAS  PubMed  Google Scholar 

Esmaeilinezhad Z, Babajafari S, Sohrabi Z, Eskandari MH, Amooee S, Barati-Boldaji R. Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: a randomized, triple blind, controlled trial. Nutr Metab Cardiovasc Dis. 2019;29(2):201–8. https://doi.org/10.1016/j.numecd.2018.07.002. Epub 2018 Jul 17. PMID: 30538082.

CAS  PubMed  Google Scholar 

Faghihimani Z, Mirmiran P, Sohrab G, Iraj B, Faghihimani E. Effects of pomegranate seed oil on metabolic state of patients with type 2 diabetes mellitus. Int J Prev Med. 2016;7:124.

PubMed  PubMed Central  Google Scholar 

Goodarzi R, Jafarirad S, Mohammadtaghvaei N, Dastoorpoor M, Alavinejad P. The effect of pomegranate extract on anthropometric indices, serum lipids, glycemic indicators, and blood pressure in patients with nonalcoholic fatty liver disease: A randomized double-blind clinical trial. Phytother Res. 2021;35(10):5871–82.

CAS  PubMed  Google Scholar 

Akbarpour M, Fathollahi Shoorabeh F, Mardani M, Amini Majd F. Effects of eight weeks of resistance training and consumption of pomegranate on GLP-1, DPP-4 and glycemic statuses in women with type 2 diabetes: A randomized controlled trial. Nutr Food Sci Res. 2021;8(1):5–10.

CAS  Google Scholar 

Hosseini B, Saedisomeolia A, Wood LG, Yaseri M, Tavasoli S. Effects of pomegranate extract supplementation on inflammation in overweight and obese individuals: A randomized controlled clinical trial. Complement Ther Clin Pract. 2016;22:44–50.

PubMed  Google Scholar 

Nemati S, Tadibi V, Hoseini R. Pomegranate juice intake enhances the effects of aerobic training on insulin resistance and liver enzymes in type 2 diabetic men: a single-blind controlled trial. BMC Nutr. 2022;8(1):48.

PubMed  PubMed Central  Google Scholar 

Sohrab G, Nasrollahzadeh J, Zand H, Amiri Z, Tohidi M, Kimiagar M. Effects of pomegranate juice consumption on inflammatory markers in patients with type 2 diabetes: a randomized, placebo-controlled trial. J Res Med Sciences: Official J Isfahan Univ Med Sci. 2014;19(3):215.

Google Scholar 

Jandari S, Hatami E, Ziaei R, Ghavami A, Yamchi AM. The effect of pomegranate (Punica granatum) supplementation on metabolic status in patients with type 2 diabetes: A systematic review and meta-analysis. Complement Ther Med. 2020;52:102478.

PubMed  Google Scholar 

Huang H, Liao D, Chen G, Chen H, Zhu Y. Lack of efficacy of pomegranate supplementation for glucose management, insulin levels and sensitivity: evidence from a systematic review and meta-analysis. Nutr J. 2017;16(1):1–14.

CAS  Google Scholar 

Bahari H, Ashtary-Larky D, Goudarzi K, Mirmohammadali SN, Asbaghi O, Naderian M, et al. The effects of pomegranate consumption on glycemic indices in adults: A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews; 2024. p. 102940.

Google Scholar 

Barghchi H, Milkarizi N, Belyani S, Norouzian Ostad A, Askari VR, Rajabzadeh F, et al. Pomegranate (Punica granatum L.) Peel extract ameliorates metabolic syndrome risk factors in patients with non-alcoholic fatty liver disease: a randomized double-blind clinical trial. Nutr J. 2023;22(1):40.

CAS  PubMed  PubMed Central  Google Scholar 

Zare M, Tarrahi MJ, Sadeghi O, Karimifar M, Goli SAH, Amani R, et al. Effects of bread fortification with pomegranate peel powder on inflammation biomarkers, oxidative stress, and mood status in patients with type 2 diabetes: a randomized placebo-controlled trial. Food Sci Nutr. 2025;13(8):e70577. https://doi.org/10.1002/fsn3.70577

Hajizade F, Mogharnasi M, Ghahremani R, Kazemi T. Effect of four weeks of pomegranate supplementation and exercise at home on cardiac electrical activity and lipid profile in overweight and obese postmenopausal women. J Birjand Univ Med Sci. 2023;30(1):44–55. http://journal.bums.ac.ir/article-1-3248-en.html

Akkuş ÖÖ, Metin U, Çamlık Z. The effects of pomegranate Peel added bread on anthropometric measurements, metabolic and oxidative parameters in individuals with type 2 diabetes: a double-blind, randomized, placebo-controlled study. Nutr Res Pract. 2023;17(4):698–716.

Google Scholar 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.

PubMed  Google Scholar 

Sim J, Wright CC. The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005;85(3):257–68.

PubMed  Google Scholar 

Borenstein M, Rothstein H. Comprehensive meta-analysis: Biostat; 1999.

Higgins J, Altman D, Sterne J. Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1. 0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook cochrane org. 2011:243 – 96.

Higgins J. Cochrane handbook for systematic reviews of interventions. Cochrane Collaboration and John Wiley & Sons Ltd.; 2008.

Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.

CAS  PubMed  Google Scholar 

Mirmiran P, Fazeli MR, Asghari G, Shafiee A, Azizi F. Effect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trial. Br J Nutr. 2010;104(3):402–6.

CAS  PubMed  Google Scholar 

Moazzen H, Alizadeh M. Effects of pomegranate juice on cardiovascular risk factors in patients with metabolic syndrome: a Double-Blinded, randomized crossover controlled trial. Plant Foods Hum Nutr. 2017;72(2):126–33.

CAS  PubMed  Google Scholar 

Seyed Hashemi M, Namiranian N, Tavahen H, Dehghanpour A, Rad MH, Jam-Ashkezari S, et al. Efficacy of pomegranate seed powder on glucose and lipid metabolism in patients with type 2 diabetes: a prospective randomized double-blind placebo-controlled clinical trial. Complement Med Res. 2021;28(3):226–33. English. https://doi.org/10.1159/000510986. Epub 2020 Dec 10. PMID: 33302270.

Sohrab G, Angoorani P, Tohidi M, Tabibi H, Kimiagar M, Nasrollahzadeh J. Pomegranate (Punicagranatum) juice decreases lipid peroxidation, but has no effect on plasma advanced glycated end-products in adults with type 2 diabetes: a randomized double-blind clinical trial. Food Nutr Res. 2015;59:28551.

PubMed  Google Scholar 

Sohrab G, Ebrahimof S, Sotoudeh G, Neyestani T, Angoorani P, Hedayati M et al. Effects of pomegranate juice consumption on oxidative stress in patients with type 2 diabetes: a single-blind, randomized clinical trial. Int J Food Sci Nutr. 2016;17.

Zarezadeh M, Saedisomeolia A, Hosseini B, Emami M. The effect of Punica granatum (Pomegranate) extract on inflammatory biomarkers, lipid profile and glycemic indices in patients with overweight and obesity: A randomized placebo-controlled clinical trial. Qom Univ Med Sci J. 2019;13:14–25.

Google Scholar 

Khajebishak Y, Payahoo L, Alivand M, Hamishehkar H, Mobasseri M, Ebrahimzadeh V, et al. Effect of pomegranate seed oil supplementation on the GLUT-4 gene expression and glycemic control in obese people with type 2 diabetes: A randomized controlled clinical trial. J Cell Physiol. 2019;234(11):19621–8.

CAS  PubMed  Google Scholar 

Haji MM, Oveysi MR, Sadeghi N, Janat B, Nateghi M. Antioxidant capacity of plasma after pomegranate intake in human volunteers. Acta Medica Iranica. 2009;47(2):125–32. https://www.sid.ir/en/vewssid/j_pdf/86520090210.pdf

Sumner MD, Elliott-Eller M, Weidner G, Daubenmier JJ, Chew MH, Marlin R, et al. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol. 2005;96(6):810–4.

CAS  PubMed  Google Scholar 

Heber D, Seeram NP, Wyatt H, Henning SM, Zhang Y, Ogden LG, et al. Safety and antioxidant activity of a pomegranate ellagitannin-enriched polyphenol dietary supplement in overweight individuals with increased waist size. J Agric Food Chem. 2007;55(24):10050–4. https://doi.org/10.1021/jf071689v. Epub 2007 Oct 30. PMID: 17966977.

Cerdá B, Soto C, Albaladejo MD, Martínez P, Sánchez-Gascón F, Tomás-Barberán F, et al. Pomegranate juice supplementation in chronic obstructive pulmonary disease: a 5-week randomized, double-blind, placebo-controlled trial. Eur J Clin Nutr. 2006;60(2):245–53. https://doi.org/10.1038/sj.ejcn.1602309. PMID: 16278692.

Fuster-Muñoz E, Roche E, Funes L, Martínez-Peinado P, Sempere JM, Vicente-Salar N. Effects of pomegranate juice in circulating parameters, cytokines, and oxidative stress ma