## 3 Effect of PS on Components of MetS
### Effect of PS on Dyslipidemia and Its Complications
In vivo studies showed that PS reduced the visceral fat deposition and diameter of adipocytes as well as increasing the adiponectin levels, thereby reducing the visceral fat accumulation and lipid content in adipocytes in animals. PS also increased vasodilation and decreased vasoconstriction, thereby decreasing SBP, DBP, and MABP in animals. PS supplementation reduced the fasting blood/urine glucose levels and prevented renal failure in diabetic rats. PS also reduced HMGCR expression, TG, TC, and LDL, and increased HDL in hyperlipidemia rats. An overview of the effects of PS on components of MetS is presented in Table 1. The literature search revealed a lack of in vitro and clinical trials validating the effect of PS on MetS and its components. These research gaps should be considered in future studies. \begin{table}
\begin{tabular}{c c c} \hline \hline
**Researcher** & **Study Design** & **Findings** \\ \hline \hline \multicolumn{3}{c}{Obesity} \\ \hline \multirow{7}{*}{[PERSON] et al. [53]} & Animals: 42 female Sprague Dawley rats (180–200 g) & \(\downarrow\) 11 HISD-1 activity in liver and adipose \\  & Mode of disease induction: ovariectomy-induced & tissue compared to negative control \\  & obesity & \(\leftrightarrow\) 11 HISD-1 activity in heart compared to \\  & Treatment: 125 mg/kg/day of AEPS for 5 months & negative control \\  & Control: & \(\leftrightarrow\) blood pressure at 3 and 5 months \\  & Negative: no treatment & compared to negative control \\  & Positive: 120 mg/kg/day of GCA for 5 months & \(\leftrightarrow\) body weight compared to negative control \\  & Animals: 28 female Sprague Dawley rats (180–200 g) & \(\downarrow\) blood glucose level at 3 and 5 months \\  & Mode of disease induction: ovariectomy-induced & compared to negative control \\  & obesity & \(\uparrow\) plasma adiponectin level at 3 and 5 months \\  & Treatment: 125 mg/kg/day of AEPS for 5 months & compared to negative control \\  & Control: & \(\leftrightarrow\) body weight compared to negative and \\  & Negative: no treatment & positive control \\  & Positive: 120 mg/kg/day of GCA for 5 months & \(\downarrow\) food, fluid, and calorie intake compared to \\  & Animals: 40 male Wistar rats (180–200 g) & negative control \\  & Treatment: 125 mg/kg/day of MEPS for 4 weeks & \(\downarrow\) body weight compared to negative control \\  & Control: & at week 2; negative and positive control at \\  & Negative: no treatment & week 4 \\  & Positive: 100 mg/kg/day of naringin for 4 weeks & \(\downarrow\) fat mass and fat percentage compared to \\  & Positive and positive control & negative and positive control \\  & \(\downarrow\) adj adipocyte surface area compared to \\  & negative control & \\  & Animals: 21 male Sprague Dawley rats (200–250 g) & \(\downarrow\) visceral fat deposition compared to \\  & Mode of disease induction: adrenalectomy + & negative control \\  & dexamethasone-induced visceral obesity & \(\downarrow\) diameter of adipocyte membrane \\  & Treatment: 125 mg/kg/day of PS extract for 48 days & compared to positive and negative control \\  & Control: & \(\leftrightarrow\) area, perimeter, and width of individual \\  & Negative: no treatment & perirenal adipocytes compared to positive \\  & Positive: 240 mg/kg/day of GCA for 48 days & and negative control \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Protective effect of PS against MetS components. Figure 5: Protective effect of PS supplementation against dyslipidemia/hyperlipidemia: current knowledge and future area of investigation. List of abbreviation: PS, _Piper samentosum_; \(\uparrow\), increase; \(\downarrow\), decrease; \(+\), in combination; TG, triglyceride; TC, total cholesterol; LDL, low-density lipoprotein; HDL, high-density lipoprotein; HMGCR, 3-hydroxy-3-methyl glutaryl coenzyme A reductase.