The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials

Jhalok Ronjan Talukdar; Matthew Cooper; Lyuba Lyutvyn; Dena Zeraatkar; Rahim Ali; Rachel Berbrier; Sabrina Janes; Vanessa Ha; Pauline B Darling; Mike Xue; Alexandro Chu; Fariha Chowdhury; Hope E Harnack; Louise Huang; Mikail Malik; Jacqui Powless; Florence V Lavergne; Xuehong Zhang; Shelley Ehrlich; David Ja Jenkins; John L Sievenpiper; Laura Banfield; Lawrence Mbuagbaw; Russell J de Souza

doi:10.1016/j.ajcnut.2023.10.030

The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials

Am J Clin Nutr. 2024 Feb;119(2):496-510. doi: 10.1016/j.ajcnut.2023.10.030. Epub 2024 Jan 5.

Authors

Jhalok Ronjan Talukdar¹, Matthew Cooper², Lyuba Lyutvyn¹, Dena Zeraatkar³, Rahim Ali⁴, Rachel Berbrier⁵, Sabrina Janes⁶, Vanessa Ha⁷, Pauline B Darling⁸, Mike Xue⁹, Alexandro Chu⁹, Fariha Chowdhury¹⁰, Hope E Harnack¹¹, Louise Huang⁹, Mikail Malik⁹, Jacqui Powless¹, Florence V Lavergne¹², Xuehong Zhang¹³, Shelley Ehrlich¹⁴, David Ja Jenkins¹⁵, John L Sievenpiper¹⁵, Laura Banfield¹⁶, Lawrence Mbuagbaw¹⁷, Russell J de Souza¹⁸

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
² Department of Medicine, University of Alberta, Edmonton, AB, Canada.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Blavatnik Institute, Harvard Medical School, Boston, MA, United States.
⁴ Faculty of Law, Common Law Section, University of Ottawa, Ottawa, ON, Canada.
⁵ Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada.
⁶ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁷ School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
⁸ School of Nutrition Sciences, University of Ottawa, Ottawa, ON, Canada.
⁹ Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
¹⁰ Department of Rehabilitation Science(s), McMaster University, Hamilton, ON, Canada.
¹¹ Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada.
¹² School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada.
¹³ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
¹⁴ Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
¹⁵ Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada.
¹⁶ Health Sciences Library, McMaster University, Hamilton, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada.
¹⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon; Department of Global Health, Stellenbosch University, Cape Town, South Africa.
¹⁸ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada. Electronic address: desouzrj@mcmaster.ca.

PMID: 38309832
DOI: 10.1016/j.ajcnut.2023.10.030

Abstract

Background: Inulin-type fructans (ITF) are the leading prebiotics in the market. Available evidence provides conflicting results regarding the beneficial effects of ITF on cardiovascular disease risk factors.

Objectives: This study aimed to evaluate the effects of ITF supplementation on cardiovascular disease risk factors in adults.

Methods: We searched MEDLINE, EMBASE, Emcare, AMED, CINAHL, and the Cochrane Library databases from inception through May 15, 2022. Eligible randomized controlled trials (RCTs) administered ITF or placebo (for example, control, foods, diets) to adults for ≥2 weeks and reported one or more of the following: low, very-low, or high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C); total cholesterol; apolipoprotein A1 or B; triglycerides; fasting blood glucose; body mass index; body weight; waist circumference; waist-to-hip ratio; systolic or diastolic blood pressure; or hemoglobin A1c. Two reviewers independently and in duplicate screened studies, extracted data, and assessed risk of bias. We pooled data using random-effects model, and assessed the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development and Evaluation approach.

Results: We identified 1767 studies and included 55 RCTs with 2518 participants in meta-analyses. The pooled estimate showed that ITF supplementation reduced LDL-C [mean difference (MD) -0.14 mmol/L, 95% confidence interval (95% CI: -0.24, -0.05), 38 RCTs, 1879 participants, very low CoE], triglycerides (MD -0.06 mmol/L, 95% CI: -0.12, -0.01, 40 RCTs, 1732 participants, low CoE), and body weight (MD -0.97 kg, 95% CI: -1.28, -0.66, 36 RCTs, 1672 participants, low CoE) but little to no significant effect on other cardiovascular disease risk factors. The effects were larger when study duration was ≥6 weeks and in pre-obese and obese participants.

Conclusion: ITF may reduce low-density lipoprotein, triglycerides, and body weight. However, due to low to very low CoE, further well-designed and executed trials are needed to confirm these effects.

Prospero registration number: CRD42019136745.

Keywords: cardiovascular disease; inulin-type fructans; low-density lipoprotein; meta-analysis; systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Body Weight
Cardiovascular Diseases* / prevention & control
Cholesterol, LDL
Fructans / pharmacology
Fructans / therapeutic use
Humans
Inulin* / pharmacology
Inulin* / therapeutic use
Obesity
Randomized Controlled Trials as Topic
Triglycerides

Substances

Inulin
Fructans
Cholesterol, LDL
Triglycerides