Impact of tomato and tomato-derived products on obesity and cardiometabolic health: a systemic review and meta-analysis

Abstract

Background: Tomatoes and tomato-based products are central components of the Mediterranean diet and have been associated with improved cardiometabolic health, but their effects on anthropometric parameters remain unclear. Methods: We conducted a PRISMA-compliant systematic review and meta-analysis. Eligible studies evaluated tomatoes, tomato-based products, or tomato extracts (excluding isolated lycopene) and reported at least one anthropometric outcome. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs) and ROBINS-I for non-randomized interventions. Epidemiological and preclinical evidence was synthesized qualitatively. Results: Seventy-two studies met inclusion criteria: 20 clinical trials (13 RCTs), 5 epidemiological studies, and 42 preclinical studies. In RCTs, tomato-based interventions produced a small but significant reduction in waist circumference (MD -1.15 cm, 95% CI -2.27 to -0.04), with no consistent effect on BMI. Secondary before–after analyses showed a modest decrease in body weight (MC -0.75 kg, 95% CI -1.48 to -0.02). Meta-regressions indicated no association between lycopene intake and anthropometric or metabolic outcomes. Epidemiological studies consistently linked higher tomato intake to more favorable cardiometabolic profiles, while preclinical models demonstrated reduced visceral adiposity, hepatic steatosis, inflammation, and oxidative stress. Conclusions: Tomato-based interventions confer modest but biologically coherent benefits, targeting visceral adiposity and cardiometabolic pathways rather than overall weight loss. The absence of a lycopene dose-response and the efficacy of lycopene-free matrices support a food-matrix synergy rather than lycopene as the primary bioactive. Combined clinical, epidemiological, and preclinical evidence indicates that tomatoes and tomato-based products represent a promising preventive nutritional strategy targeting adiposity and, consequently, cardiometabolic risk.