Growth Performance and Antioxidant Responses to Dietary Flavonoids in Swine: A Systematic Review and Meta-Analysis with Exploratory Dose-Time Relationships.

Dietary flavonoids are increasingly investigated in swine nutrition, but how supplementation level, intervention duration, and growth stage are associated with growth and antioxidant responses remains unclear. This PRISMA 2020 systematic review and meta-analysis evaluated dietary flavonoid supplementation in pigs. Twenty-eight randomized controlled trials were synthesized using three-level random-effects models to account for dependent effect sizes. Flavonoid supplementation was associated with increased average daily gain (ADG; SMD = 0.719, 95% CI: 0.428 to 1.009; I2=51.85%) and a lower feed-to-gain ratio (F/G; SMD = -0.708, 95% CI: -0.929 to -0.487; I2=32.25%), whereas the association with average daily feed intake (ADFI) was not statistically significant (SMD = 0.217, 95% CI: -0.101 to 0.535; I2=59.30%). Supplementation was also associated with increased superoxide dismutase (SMD = 0.907) and glutathione peroxidase activities (SMD = 0.666) and reduced malondialdehyde concentrations (SMD = -0.989), although heterogeneity was substantial for these outcomes (I2=96.47-97.83%). The certainty of evidence was assessed as low for ADG and moderate for ADFI, F/G, and antioxidant outcomes under the adapted GRADE framework. Exploratory stage-specific dose-time meta-regression identified potential relationships between supplementation intensity and ADG in weaned pigs (35 effect sizes from 14 studies) and finishing pigs (12 effect sizes from four studies). In finishing pigs, intervention duration was associated with growth responses. However, this subgroup contained few independent studies, and intervention duration covaried with age, physiological stage, flavonoid source, dose, health status, and basal diet. This association therefore does not establish an independent causal effect of intervention duration.