Dosage exploration of the effects of honey and its derivatives on cardiometabolic outcomes: an overview of systematic reviews and GRADE-assessed updated meta-analysis

Cardiovascular diseases and diabetes are associated with significant mortality, morbidity, and economic burden, highlighting the need for alternative preventive strategies. Honey bee products, including honey, royal jelly, and propolis, are considered potential interventions for managing cardiometabolic risk factors. This umbrella review aimed to compare the effectiveness of these products in cardiometabolic health. PubMed, Scopus, and Web of Science databases were systematically searched from inception through 21 ST October 2024 to identify eligible meta-analyses and primary randomized controlled trials (RCTs). Random-effect pairwise analysis combined trial findings, while dose-response and influence analyses assessed result robustness. Evidence quality and certainty were evaluated using AMSTAR-II, ROB, GRADE, and ICEMAN criteria. Analysis of 69 RCTs with 3544 participants revealed that 10 g of honey daily may lower Hemoglobin A1C but adversely affect systolic blood pressure, Aspartate transferase, triglycerides, fasting blood glucose, and high-sensitive C-reactive protein. Royal jelly improved blood pressure, lipid profiles, glycemic indices, and total antioxidant capacity. Propolis demonstrated reductions in anthropometric measures and improvements in lipid profile, glycemic control, liver enzymes, and inflammation and oxidative stress markers. While long-term or high-dose honey consumption in individuals with health concerns warrants caution, RJ and propolis demonstrated dose-dependent benefits for cardiometabolic health with proper certainty. Future research should focus on population-specific characteristics and optimized dosages.