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

Clinical Snapshot

Key Findings

• P Value: p = 0.0432

• Effect Size: Mean Difference (MD): −1.153 cm reduction in waist circumference

• Primary Outcome: Waist circumference reduction with tomato-based interventions versus control in adults with overweight or obesity

• Nnt Or Sensitivity: No NNT calculable from continuous outcome data. No significant effect detected for body weight or BMI. Meta-regression indicated supplementation type influenced blood pressure-related outcomes. Effect size for waist circumference is below the commonly cited minimal clinically important difference of ~2–3 cm for cardiometabolic risk reduction.

• Confidence Interval: 95% CI: −2.27 to −0.04 cm

Clinical Application

Tomato-based dietary interventions are highly feasible, low-cost, widely available, and culturally acceptable across most populations. They carry no known safety concerns at dietary doses. However, the heterogeneity of effective 'doses' and product types across studies makes specific prescriptive recommendations difficult. Standardisation of intervention type and dose is currently lacking. Tomatoes are among the most commonly consumed vegetables in Australia and are readily accessible year-round. There is no PBS-listed tomato-based therapeutic product, and TGA regulation does not apply to whole food interventions. RACGP guidelines on obesity management emphasise dietary pattern approaches (including Mediterranean-style diets) over single-food interventions. The modest waist circumference benefit identified in this review is consistent with, but does not substantially advance, existing RACGP and NHMRC dietary guidance. Australian clinicians may reasonably encourage increased tomato consumption as part of a Mediterranean-style dietary pattern for patients with cardiometabolic risk, without overstating the magnitude of benefit. No change to current clinical guidelines is warranted on the basis of this evidence alone. Adults with overweight or obesity (BMI ≥ 25 kg/m²) seeking dietary strategies to support cardiometabolic health, particularly those with central adiposity, hypertension, dyslipidaemia, or insulin resistance. Most applicable in the context of broader dietary pattern modification rather than as a standalone therapeutic intervention.

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.

References

1. 1.Sani, L., Mounien, L., & Landrier, J.-F. (2026). Impact of tomatoes and tomato-derived products on obesity and cardiometabolic health: a systematic review and meta-analysis. Food & Function. https://doi.org/10.1039/d6fo00495d