The aim of the study was to evaluate the effect of Oxyjun™ on cardiovascular fitness of overweight individuals by reducing obesity induced systemic inflammation. Male participants between the ages of 18 - 35 years and body mass index of 25 - 34.9 kg/m2 were recruited in the study. Change in neutrophil lymphocyte ratio (NLR), high density lipoprotein (HDL-c) and quality of life using 36-item Short form survey (SF-36) was assessed over a period of 8-weeks. Results demonstrated that NLR was reduced by 0.71 in Oxyjun™ and by 0.42 in the placebo group at the end of study period. Also, within group comparison was significant for Oxyjun™ group when compared from baseline; p<0.001. Further, HDL-c levels were increased in the OxyjunTM group by 4.04 mg/dL and reduced for the placebo group by 1.22 mg/dL when compared from baseline; p=0.09. For SF-36 quality of life assessments, the health concepts of fatigue, mental health, and social function showed significant improvement and no adverse or serious adverse events were reported for both groups during the course of the study. In conclusion, Oxyjun™ when consumed for 8-weeks reduced NLR of study volunteers thereby demonstrating its potential for lowering obesity induced systemic inflammation. Oxyjun™ also increased HDL levels that could further promote cardiovascular fitness and prevent the risk of cardiovascular events.


Obesity Cardiovascular fitness Inflammation SF-36 High density lipoprotein cholesterol Neutrophil Lymphocyte Ratio


  1. M.M. Bosma-den Boer, M.L. van Wetten, L, Pruimboom, Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering, Nutrition & metabolism, 9(1) (2012) 32.
  2. G. Ghigliotti, C. Barisione, S. Garibaldi, P. Fabbi, C. Brunelli, P. Spallarossa, P. Altieri, G. Rosa, G. Spinella, D. Palombo, R. Arsenescu, V. Arsenescu, Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions, Inflammation, 34(4) (2014) 1337-1353.
  3. M.S. Burhans, D.K. Hagman, J.N. Kuzma, K.A. Schmidt, M. Kratz, Contribution of Adipose Tissue Inflammation to the Development of Type 2 Diabetes Mellitus, Comprehesive Physiology, 9(1) (2018) 1-58.
  4. L. Venkatraghavan, T.P. Tan, J. Mehta, A. Arekapudi, A. Govindarajulu, E. Siu, Neutrophil Lymphocyte Ratio as a predictor of systemic inflammation - A cross-sectional study in a pre-admission setting, F1000Res, 4(123) (2015).
  5. E. Yu, V.S. Malik, F.B. Hu, Cardiovascular Disease Prevention by Diet Modification: JACC Health Promotion Series, Journal of the American College of Cardiology, 72(8) (2018) 914-926
  6. R. Zahorec, Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill, Bratislavske lekarske listy, 102(1) (2001) 5-14.
  7. K.M, Beavers, T.E. Brinkley, B.J. Nicklas, Effect of exercise training on chronic inflammation, Clinica Chimica Acta; International Journal of Clinical Chemistry, 411(11-12) (2010) 785-793.
  8. A.S. Wedell-Neergaard, R. Krogh-Madsen, G.L. Petersen, A.M. Hansen, B.K. Pedersen, R. Lund, H. Bruunsgaard, Cardiorespiratory fitness and the metabolic syndrome: Roles of inflammation and abdominal obesity, PLoS One, 13(3) (2018) e0194991.
  9. M. E. Piché, A. Tchernof, J.P. Després, Obesity Phenotypes, Diabetes, and Cardiovascular Diseases, Circulation research, 126(11) (2020) 1477–1500.
  10. A. Syauqy, C.Y. Hsu, H.H. Rau, J.C. Chao, Association of dietary patterns, anthropometric measurements, and metabolic parameters with C-reactive protein and neutrophil-to-lymphocyte ratio in middle-aged and older adults with metabolic syndrome in Taiwan: a cross-sectional study, Nutrition Journal, 17(1) (2018) 106.
  11. R. Wang, P.J. Chen, W.H. Chen, Diet and exercise improve neutrophil to lymphocyte ratio in overweight adolescents, International Journal of Sports Medicine, 32(12) (2011) 982-986
  12. I.J. Kullo, M. Khaleghi, D.D. Hensrud, Markers of inflammation are inversely associated with VO2 max in asymptomatic men, Journal of Applied Physiology (1985), 102(4) (2007) 1374-1379.
  13. R. Michishita, N. Shono, T. Inoue, T. Tsuruta, K. Node, Associations of monocytes, neutrophil count, and C-reactive protein with maximal oxygen uptake in overweight women, Journal of Cardiology, 52(3) (2008) 247-253.
  14. R. Furutate, T. Ishii, T. Motegi, K. Hattori, Y. Kusunoki, A. Gemma, K. Kida, The Neutrophil to Lymphocyte Ratio Is Related to Disease Severity and Exacerbation in Patients with Chronic Obstructive Pulmonary Disease, Internal Medicine, 55(3) (2016) 223-229.
  15. A. Yıldız, M. Yüksel, M. Oylumlu, N. Polat, M.A. Akıl, H. Acet, The association between the neutrophil/lymphocyte ratio and functional capacity in patients with idiopathic dilated cardiomyopathy, The Anatolian Journal of Cardiology, 15(1) (2015) 13-17.
  16. P. Paliogiannis, A.G. Fois, S. Sotgia, A.A. Mangoni, E. Zinellu, P. Pirina, C. Carru, A. Zinellu, The neutrophil-to-lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta-analysis, European Journal of Clinical Investigation, 48(8) (2018) e12984.
  17. I.K. Kwaifa, H. Bahari, Y.K. Yong, S.M. Noor, Endothelial Dysfunction in Obesity-Induced Inflammation: Molecular Mechanisms and Clinical Implications, Biomolecules, 10(2) (2020) 291.
  18. P. Rajendran, T. Rengarajan, J. Thangavel, Y. Nishigaki, D. Sakthisekaran, G. Sethi, I. Nishigaki, The vascular endothelium and human diseases. International Journal of Biological Sciences, 9(10) (2013) 1057-1069.
  19. E. Galkina, K. Ley, Immune and inflammatory mechanisms of atherosclerosis (*), Annual Review of Immunology, 27 (2009) 165-197.
  20. H.O. Santos, L.F.M. Izidoro, Neutrophil-Lymphocyte Ratio in Cardiovascular Disease Risk Assessment, International Journal of Cardiovascular Sciences, 31(5) (2018) 532-537.
  21. Y. Ohno, T. Hashiguchi, R. Maenosono, H. Yamashita, Y. Taira, K. Minowa, Y. Yamashita, Y. Kato, K. Kawahara, I. Maruyama, The diagnostic value of endothelial function as a potential sensor of fatigue in health. Vascular Health and Risk Management, 6 (2010) 135-144.
  22. G.D. Florida-James, R. Simpson, G. Davison, G. Close, Exercise, Free Radical Metabolism, and Aging: Cellular and Molecular Processes, Oxidative Medicine and Cellular Longevity, 2016 (2016) 3813680.
  23. D.C. Lee, X. Sui, T.S. Church, C.J. Lavie, A.S. Jackson, S.N. Blair, Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia, Journal of the American College of Cardiology, 57(7) (2012) 665-672.
  24. I. Raz, H. Rosenblit, J.D. Kark, Effect of moderate exercise on serum lipids in young men with low high-density lipoprotein cholesterol, Arteriosclerosis, 8(3) (1988) 245‐251.
  25. H.B. G, V.S. Rao, V.V Kakkar, Friend Turns Foe: Transformation of Anti-Inflammatory HDL to Proinflammatory HDL during Acute-Phase Response, Cholesterol, 2011 (2011) 274629.
  26. P.P Toth, High-density lipoprotein and cardiovascular risk, Circulation, 109,15 (2004) 1809-1812.
  27. S. Rashid, J. Genest, Effect of obesity on high-density lipoprotein metabolism, Obesity (Silver Spring), 15(12) (2007) 2875-2888.
  28. R. Ross, S.N. Blair, R. Arena, T.S. Church, J.P. Després, B.A. Franklin, W.L. Haskell, L.A. Kaminsky, B.D. Levine, C.J. Lavie, J. Myers, J. Niebauer, R. Sallis, S.S. Sawada, X. Sui, U. Wisløff, Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association, Circulation, 134(24) (2016) e653-e699.
  29. H. Henriksson, P. Henriksson, P. Tynelius, M. Ekstedt, D. Berglind, I. Labayen, J.R. Ruiz, C.J. Lavie, F.B. Ortega, Cardiorespiratory fitness, muscular strength, and obesity in adolescence and later chronic disability due to cardiovascular disease: a cohort study of 1 million men, European Heart Journal, 41(15) (2020) 1503-1510.
  30. X. Zhang, R.E. Cash, J.K. Bower, B.C. Focht, E.D. Paskett, Physical activity and risk of cardiovascular disease by weight status among U.S adults, PLoS One, 15(5) (2020) e0232893.
  31. M.A. Allison, N.E. Jensky, S.J. Marshall, A.G. Bertoni, M. Cushman, Sedentary behavior and adiposity-associated inflammation: the Multi-Ethnic Study of Atherosclerosis, American Journal of Preventive Medicine, 42(1) (2012) 8-13.
  32. U.K. Sampson, S. Fazio, M.F. Linton, Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges, Current Atherosclerosis Reports, 14(1) (2012) 1-10.
  33. D, Lorber, Importance of cardiovascular disease risk management in patients with type 2 diabetes mellitus, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7 (2014) 169-183.
  34. S. Mandal, A. Patra, A. Samanta, S. Roy, A.Mandal, T.D. Mahapatra, S. Pradhan, K. Das, D.K. Nandi, Analysis of phytochemical profile of Terminalia arjuna bark extract with antioxidative and antimicrobial properties, Asian Pacific Journal of Tropical Biomedicine, 3(12) (2013) 960-966.
  35. A. Amalraj, S. Gopi, Medicinal properties of Terminalia arjuna (Roxb.) Wight & Arn.: A review, Journal of Traditional and Complementary Medicine, 7(1) (2016) 65-78.
  36. A. Rees, G.F. Dodd, J.P.E. Spencer, The Effects of Flavonoids on Cardiovascular Health: A Review of Human Intervention Trials and Implications for Cerebrovascular Function, Nutrients, 10(12) (2018) 1852.
  37. D. Singh, P.K. Chaudhuri, Structural characteristics, bioavailability and cardioprotective potential of saponins, Integrative Medicine Research, 7(1) (2018) 33-43.
  38. A. Bharani, A. Ganguly, K.D. Bhargava, Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure, International Journal of Cardiology, 49(3) (1995) 191-199.
  39. S. Dwivedi, A. Aggarwal, M.P. Agarwal, S. Rajpal, Role of Terminalia arjuna in ischaemic mitral regurgitation, International Journal of Cardiology, 100(3) (2005) 507-508.
  40. D. Kapoor, R. Vijayvergiya, V. Dhawan, Terminalia arjuna in coronary artery disease: ethnopharmacology, pre-clinical, clinical & safety evaluation, Journal of Ethnopharmacology, 155(2) (2014) 1029-1045.
  41. R. Gupta, S. Singhal, A. Goyle, V.N. Sharma, Antioxidant and hypocholesterolaemic effects of Terminalia arjuna tree-bark powder: a randomised placebo-controlled trial, Journal of the Association of Physicians of India, 49 (2001) 231-235.
  42. A. Bharani, L.K. Ahirwar, N. Jain, Terminalia arjuna reverses impaired endothelial function in chronic smokers, Indian Heart Journal, 56(2) (2004) 123-128.
  43. R.N. Girandola, S. Srivastava, Effect of E-OJ-01 on Cardiac Conditioning in Young Exercising Adults: A Randomized Controlled Trial [published correction appears in American Journal of Therapeutics, American Journal of Therapeutics, 24(3) (2017) e298-e307.
  44. C.A. McHorney, J.E. Ware Jr, J.F. Lu, C.D. Sherbourne, The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups, Medical Care, 32(1) (1994) 40-66.
  45. Tutino VM, Poppenberg KE, Li L, H. Shallwani, K. Jiang, J.N. Jarvis, Y. Sun, K.V. Snyder, E.I. Levy, A.H. Siddiqui, J. Kolega, H. Meng, Biomarkers from circulating neutrophil transcriptomes have potential to detect unruptured intracranial aneurysms, Journal of Translational Medicine, 16(1) (2018) 373.
  46. A.R. Dancsok, N. Setsu, D. Gao, J.Y. Blay, D. Thomas, R.G. Maki, T.O. Nielsen, E.G. Demicco, Expression of lymphocyte immunoregulatory biomarkers in bone and soft-tissue sarcomas, Modern Pathology, 32,12 (2019) 1772-1785.
  47. P. Forget, C. Khalifa, J.P. Defour, D. Latinne, M.C. Van Pel, M. De Kock, What is the normal value of the neutrophil-to-lymphocyte ratio?, BMC Research Notes, 10,1 (2017) 12.
  48. E.J. Whitney, R.A. Krasuski, B.E. Personius, J.E. Michalek, A.M. Maranian, M.W. Kolasa, E. Monick, B.G. Brown, A.M. Gotto Jr, A randomized trial of a strategy for increasing high-density lipoprotein cholesterol levels: effects on progression of coronary heart disease and clinical events, Annals of Internal Medicine, 142, 2 (2005) 95-104.
  49. R.S. Birjmohun, B.A. Hutten, J.J. Kastelein, E.S. Stroes, Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controlled trials, Journal of the American Colege ofl Cardiology, 45,2 (2005) 185-197.
  50. N. Priya, K.C. Mathur, A. Sharma, R.P. Agrawal, V. Agarwal, J. Acharya, Effect of Terminalia Arjuna on total platelet count and lipid profile in patients of coronary artery disease, Advances in Human Biology, 9, (2019) 98-101.
  51. G. Rajagopal, V. Suresh, A. Sachan, High-density lipoprotein cholesterol: How High, Indian Journal of Endocrinology and Metabolism, 16 (Suppl2) (2012) S236-S238.
  52. A. Lopez-Candales, P.M. Hernández Burgos, D.F. Hernandez-Suarez, D. Harris, Linking Chronic Inflammation with Cardiovascular Disease: From Normal Aging to the Metabolic Syndrome, Journal of Nature and Science, 3,4 (2017) e341.
  53. L. Pirola, J.C. Ferraz, Role of pro- and anti-inflammatory phenomena in the physiopathology of type 2 diabetes and obesity, World Journal of Biological Chemistry, 8,2 (2017) 120-128.
  54. J. Myers, P. Kokkinos, E. Nyelin, Physical Activity, Cardiorespiratory Fitness, and the Metabolic Syndrome, Nutrients, 11(7) (2019) 1652.
  55. Z. Wang, T. Nakayama, Inflammation, a link between obesity and cardiovascular disease, Mediators of Inflammation, 2010 (2010) 535918.
  56. J.E. Lewis, S.E. Atlas, O.L. Higuera, A. Fiallo, A. Rasul, A. Farooqi, O. Kromo, L.A. Lantigua, E. Tiozzo, J.M. Woolger, S. Goldberg, A. Mendez, A.E. Rodriguez, J. Konefal, The Effect of a Hydrolyzed Polysaccharide Dietary Supplement on Biomarkers in Adults with Nonalcoholic Fatty Liver Disease, Evidence-Based Complementary and Alternative Medicine, 2020 (2020) 9575878.
  57. A. Sut, K. Chiżyński, M. Różalski, J. Golański, Dietary intake of omega fatty acids and polyphenols and its relationship with the levels of inflammatory markers in men with chronic coronary syndrome after percutaneous coronary intervention, Kardiologia Polska, 75(2) (2020) 117-123.
  58. K. Matsuo, M. Kubota, H. Sasaki, J. Toyooka, R. Nagatomi, The association of the blood lymphocytes to neutrophils ratio with overtraining in endurance athletes, New Studies in Athletics, 24(4) (2009) 23-29.
  59. M.E. Afari, T. Bhat, Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: an update, Expert Review of Cardiovascular Therapy, 14,5 (2016) 573-577.
  60. N.M. Johannsen, D.L. Swift, W.D. Johnson, V.D. Dixit, C.P. Earnest, S.N. Blair, T.S. Church, Effect of different doses of aerobic exercise on total white blood cell (WBC) and WBC subfraction number in postmenopausal women: results from DREW, PLoS One, 7(2) (2012) e31319.
  61. Y. Jiang, N. Qiao, A6326 Correlation between neutrophil/lymphocyte ratio and endothelial dysfunction in essential hypertension, Journal of Hypertension, 36 (2018) 158.
  62. O. Assumpção Cde, L.C. Lima, F.B. Oliveira, C.C. Greco, B.S. Denadai, Exercise-induced muscle damage and running economy in humans, The Scientific World Journal, 2013, (2013) 189149.
  63. D.G. Burt, C. Twist, The effects of exercise-induced muscle damage on cycling time-trial performance, The Journal of Strength and Conditioning Research, 25(8) (2011) 2185-2192.
  64. T. Kawamura, K. Suzuki, M. Takahashi, M. Tomari, R. Hara, Y. Gando, I. Muraoka, Involvement of Neutrophil Dynamics and Function in Exercise-Induced Muscle Damage and Delayed-Onset Muscle Soreness: Effect of Hydrogen Bath, Antioxidants (Basel), 7(10) (2018) 127.
  65. M. Mittal, M.R. Siddiqui, K. Tran, S.P. Reddy, A.B. Malik, Reactive oxygen species in inflammation and tissue injury, Antioxidants & Redox Signaling, 20(7) (2014) 1126-1167.
  66. R.K. Mehta, Impacts of obesity and stress on neuromuscular fatigue development and associated heart rate variability, International Journal of Obesity, 39(2) (2015) 208-213.
  67. P.D. Thompson, E.M. Cullinane, S.P. Sady, M.M. Flynn, C.B. Chenevert, P.N. Herbert, High density lipoprotein metabolism in endurance athletes and sedentary men, Circulation, 84(1) (1991) 140-152.
  68. E. Kasikcioglu, H. Oflaz, H. Akhan, A. Kayserilioglu, Right ventricular myocardial performance index and exercise capacity in athletes, Heart Vessels, 20(4) (2005) 147-152.
  69. E. Eren, N. Yilmaz, O. Aydin, High Density Lipoprotein and it's Dysfunction, The Open Biochemistry Journal, 6 (2012) 78-93.
  70. K.A. Rye, C.A Bursill, G. Lambert, F, P.J. Tabet, The metabolism and anti-atherogenic properties of HDL, Journal of Lipid Research, 50, Suppl(Suppl) (2009) S195-S200.
  71. T.D. Filippatos, M.S. Elisaf, High density lipoprotein and cardiovascular diseases, World Journal of Cardiology, 5(7) (2013) 210-214.
  72. B.J. Ansell, K.E. Watson, A.M. Fogelman, M. Navab, G.C. Fonarow, High-density lipoprotein function recent advances, Journal of the American College of Cardiology, 45(10) (2005) 1792-1798.
  73. P.P. Toth, M.H. Davidson, High-density lipoproteins: marker of cardiovascular risk and therapeutic target, Journal of Clinical Lipidology, 4(5) (2010) 359-64.
  74. K.A. Rye, P.J. Barter, Antiinflammatory actions of HDL: a new insight, Arteriosclerosis, Thrombosis, and Vascular Biology, 28(11) (2008) 1890-1891.
  75. S. Leclerc, C. Allard, J. Talbot, R. Gauvin, C. Bouchard, High density lipoprotein cholesterol, habitual physical activity and physical fitness, Atherosclerosis, 57(1) (1985) 43-51.
  76. M. Cooke, M. Iosia, T. Buford, B. Shelmadine, G. Hudson, C. Kerksick, C. Rasmussen, M. Greenwood, B. Leutholtz, D. Willoughby, R. Kreider, Effects of acute and 14-day coenzyme Q10 supplementation on exercise performance in both trained and untrained individuals, The Journal of the International Society of Sports Nutrition, 5 (2008) 8.
  77. S. Kolahi, B. Pourghassem Gargari, M. Mesgari Abbasi, M. Asghari Jafarabadi, Ghamarzad Shishavan, Effects of phylloquinone supplementation on lipid profile in women with rheumatoid arthritis: a double blind placebo controlled study, Nutrition Research and Practice, 9(2) (2015) 186-191.
  78. K. Mahdy Ali, A. Wonnerth, K. Huber, J. Wojta, Cardiovascular disease risk reduction by raising HDL cholesterol--current therapies and future opportunities, British Journal of Pharmacology, 167(6) (2012) 1177-1194.