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

Abstract

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. This review aimed to assess the potential effects of tomato-based interventions on obesity-related and cardiometabolic outcomes in individuals with overweight or obesity. We conducted a PRISMA-compliant systematic review and meta-analysis. Eligible studies included populations with a mean BMI ≥ 25 kg m⁻², evaluated tomatoes, tomato-based products, or tomato extracts (excluding isolated lycopene) and reported at least one anthropometric outcome. The risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs). Epidemiological and preclinical evidence was synthesized qualitatively. Forty-seven studies met the inclusion criteria: 11 clinical trials (RCTs), 5 epidemiological studies, and 31 preclinical studies. In the RCTs, tomato-based interventions produced a small but significant reduction in waist circumference (MD: −1.153 cm, 95% CI: −2.27 to −0.04, p = 0.0432), with no consistent effects on body weight or BMI. Meta-regression analyses indicated that supplementation type influenced blood pressure-related outcomes. Epidemiological studies consistently linked higher tomato intake to more favorable cardiometabolic profiles, whereas preclinical models showed reduced visceral adiposity, inflammation, and oxidative stress, together with improved glucose and lipid homeostasis. Tomato-based interventions confer modest but biologically consistent 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 compound. Combined clinical, epidemiological, and preclinical evidence suggests potential beneficial effects of tomatoes and tomato-based products on cardiometabolic health, which deserve further investigation. This review underscores the need to standardize tomato-derived interventions to improve comparability and strengthen the evidence base.