1. By: Kristin Izzo Preceptors: Elizabeth Koustis, MS, RD Pamela Jessup, MS, RD WADE PARK NUTRITION CLINIC

2.  Askari, F., Rashidkhani, B., Hekmatdoost, A. Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Nutrition Research. 2014; 34:143-148. CITATION

3.  What do we know about Cinnamon?  Previous research - Type 2 Diabetes  Insulin resistance, HbA1c, FBG, lipid profiles 3  Supplementation daily of 1g, 1.5g, and 6g 2,3,4  NAFLD  Highest cause for hepatic injury  Current therapies: alter insulin resistance and reduce oxidative stress BACKGROUND

4.  Typical therapy includes:  1. Modulating insulin resistance  2. Reducing oxidative stress  Goal:  Determine if daily supplementation of 1.5g of cinnamon will provide therapeutic effects NAFLD characteristics? OBJECTIVE

5.  Randomized double blinded, placebo- controlled trial  Two parallel groups  Control and treatment  Supplements  Prepared by third party  Cinnamon v wheat flour DESIGN

6.  Inclusion:  NAFLD diagnosis past 6 months  50 patients enrolled  Ages 20-65  Exclusion:  Alcohol or drug abuse, chemotherapy, other liver disease, biliary disease, autoimmune disease, cancer, pregnant/lactating, diabetic, metformin, hyperlipidemia, HTN, Vit E, or use of hepatotoxic drugs last 6 months  Tehran, Iran PARTICIPANTS/SETTING

7.  Groups  Treatment:  Cinnamon capsules at 750mg each x2/day  Control:  Placebo x2/day  Time Period  12 weeks INTERVENTION

8.  Blood Sampling – at baseline and 12 weeks  FBG, serum insulin, insulin resistance and sensitivity  Lipid Profile  Liver Enzymes  Hs-CRP  Anthropometrics  Diet and physical activity survey MEASURES

9.  Nutritionist 4 software  Dietary information  SPSS software  Qualitative and quantitative data  Student’s and paired t-tests  Compare variables between the groups  ANCOVA  Eliminate confounding factors  Sample size  Power of 80%, calculated 21 patients  P statistical significance STATISTICAL ANALYSIS

10. RESULTS P <0.05

11.  After 12 weeks of 1.5g supplementation/day…  Cinnamon exhibited an effect on reducing insulin resistance and positively modified lipid profile. CONCLUSIONS Go Cinnamon!

12.  What do we tell the Veterans?  Not a cure  Implement gradually to avoid risk of unknown adverse effects  Affordable  Home spice v supplement  For RDs  Listen to our patients  Maintain current understanding of hot topics PRACTICAL APPLICATION

13. 1.Askari, F., Rashidkhani, B., Hekmatdoost, A. Cinnamon may have therapeutic benefits on lipid profile, liver enzymes, insulin resistance, and high-sensitivity C-reactive protein in nonalcoholic fatty liver disease patients. Nutrition Research. 2014; 34:143-148. 2.Crawford, P. Effectiveness of Cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: a randomized, controlled trial. J Am Board Fam Med 2009;22(5):507-12 3.Jamal, AR. Effects of cinnamon on blood glucose and lipids levels in diabetic patients (Type1). Afr J Biochem Res 2009;3(5):181-4 4.Vanschoonbeek, K. et al. Cinnamon supplementation does improve glycemic control in postmenopausal type 2 diabetes patients. J Nutr 2006;136(4):977-80 REFERENCES