Dietary glucosamine under question

Silbert, Jeremiah E.

doi:10.1093/glycob/cwp014

Cited by 16 publications

(8 citation statements)

References 38 publications

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“…A contribution of dietary glucosamine to the synthesis of cartilage components (GAG) requires exogenous glucosamine to be taken up by chondrocytes in sufficient quantities. At achievable concentrations (~10 µM) in synovial fluid with a daily intake of 1500 mg glucosamine, two reviews concluded that the contribution of dietary glucosamine to the synthesis of GAG would be negligible (Silbert, 2009;Block et al, 2010). This conclusion takes into account the competition of glucosamine with much higher concentrations of glucose for uptake into cartilage cells, and the large excess of endogenously produced glucosamine for incorporation into GAG.…”

Section: Mechanistic Studiesmentioning

confidence: 99%

Scientific Opinion on the substantiation of a health claim related to glucosamine and maintenance of normal joint cartilage pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Publication¹

2012

EFSA Journal

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Following an application from Merck Consumer Healthcare, submitted pursuant to Article 13(5) of Regulation (EC) via the Competent Authority of Belgium, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to glucosamine, formulated as glucosamine sulphate or hydrochloride, and maintenance of normal joint cartilage. Glucosamine is sufficiently characterised. The claimed effect is "contributes to the maintenance of normal joint cartilage". The target population as proposed by the applicant is the general population, and in particular people exposing their joints to high mechanical load and people with joint cartilage deterioration due to normal ageing. The Panel considers that the maintenance of normal joint cartilage is a beneficial physiological effect. The applicant provided references to studies in patients with osteoarthritis, in healthy subjects, in animals and in vitro as being pertinent to the health claim. In weighing the evidence, the Panel took into account that no human studies were provided from which conclusions could be drawn on the effect of dietary glucosamine on the maintenance of cartilage in individuals without osteoarthritis, and that the evidence provided in the in vitro and animal studies in support of the biological plausibility for a possible contribution of dietary glucosamine to the maintenance of joint cartilage in humans is weak. The Panel concludes that a cause and effect relationship has not been established between the consumption of glucosamine and maintenance of normal joint cartilage in individuals without osteoarthritis. © European Food Safety Authority, 2012 The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. KEY WORDSThe food constituent that is the subject of the health claim is glucosamine, formulated as glucosamine sulphate or hydrochloride. The Panel considers that glucosamine is sufficiently characterised.The claimed effect is "contributes to the maintenance of normal joint cartilage". The target population as proposed by the applicant is the general population, and in particular people exposing their joints to high mechanical load, for example through extensive sports activities or obesity, and people with joint cartilage deterioration due to normal ageing. From the information provided, the Panel notes that the claimed effect relates to the maintenance of joint cartilage. The Panel considers that the maintenance of normal joint cartilage is a beneficial physiological effect.In the original application, the applicant identified a total of 61 references as being pertinent to the health claim. These references comprised 20 references describing 12 human intervention studies, 13 reviews on the effects of glucosamine supplementation on maintenance of joints, four animal studies on the effects of glucosamine on joints, 14 in vitro studies on the effects of glucosamine on cartilage cells/tissues, nine studies i...

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Section: Mechanistic Studiesmentioning

confidence: 99%

Scientific Opinion on the substantiation of a health claim related to glucosamine and maintenance of normal joint cartilage pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Publication¹

2012

EFSA Journal

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“…This hypothesis is also based entirely on in vitro studies that use glucosamine at concentrations that are physiologically irrelevant and 100-to 1000-fold higher than what is typically observed after oral ingestion in vivo (plasma or synovial fluid) [5].…”

Section: Commentarymentioning

confidence: 99%

“…Moreover, the notion that exogenous glucosamine acts as a 'precursor' molecule to enhance chondroitin synthesis also lacks evidential support [5]. Consistent with this, in recent meta-analyses restricted to well-designed randomized controlled trials that include adequate allocation concealment or to non-industry-funded studies, oral glucosamine fails to show any significant clinical benefit in individuals with OA [3,6].…”

Section: Commentarymentioning

confidence: 99%

Glucosamine and osteoarthritis: time to quit?

Muniyappa

2011

Diabetes Metabolism Res

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Glucosamine (2-amino-2-deoxy-D-glucose), an amino monosaccharide derivative of glucose, is a precursor of the glycosaminoglycans and proteoglycans that make up articular cartilage. The notion that augmenting the intake of the precursor molecule, glucosamine, may directly stimulate articular proteoglycan synthesis to modulate osteoarthritis has provided the rationale for its widespread use. Theoretically, exogenous glucosamine may augment glycosaminoglycan synthesis in cartilage. There is a simultaneous theoretical concern that it might also induce insulin resistance in insulin-sensitive tissues.In a previous issue of DMRR, Simon et al. conclude that typical doses of oral glucosamine have no significant effects on glucose metabolism or insulin sensitivity. On the basis of the results from clinical, animal, and cell-based studies they conclude that oral glucosamine neither augments the hexosamine biosynthetic pathway nor reduces insulin-mediated glucose uptake. In recent meta-analyses restricted to well-designed randomized controlled trials that include adequate allocation concealment or to nonindustry-funded studies, oral glucosamine fails to show any significant clinical benefit in individuals with osteoarthritis. These data should raise serious questions from patients and their health care providers about its continued use.

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“…4 And clinical studies purporting to show slowing of knee joint-space narrowing with glucosamine fail to give sufficient weight to the considerable problems of measurement error in evaluating knee joint space. 5 The availability of a licensed preparation for glucosamine sulphate is only relevant if one accepts that glucosamine sulphate is effective beyond placebo.…”

Section: Trial Evidencementioning

confidence: 99%

“…The authors' conclusion that patients who perceive a benefit www.prescriber.co.uk 34 Prescriber 5 June 2011 4 that licensed products available in the UK should be used wherever possible, even for off-label use. Prescribing a licensed glucosamine sulphate medicine over an unlicensed preparation ensures that the patient receives a drug that is up to standard in pharmaceutical quality terms to treat their disease.…”

Section: Other Assessmentsmentioning

confidence: 99%

Glucosamine in OA of the knee: the case for and against

Daly¹,

Jobanputra²

2011

Prescriber

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Current issueswhich included the government's commitment to ensuring that Quality, Innovation, Productivity and Prevention (QIPP) supports the NHS to make efficiency savings. Table 1 sets out the author's QIPP assessment of the use of glucosamine sulphate in OA. Other assessmentsThe Scottish Medicines Consortium (SMC) in 2008 did not recommend glucosamine hydrochloride for use within NHS Scotland. 9 However, it should be noted that this was specifically for glucosamine hydrochloride and this concurs with the NICE guidance, which details that there is no evidence of effectiveness for this salt.In 2009 there was a Health Technology Assessment completed for glucosamine. 10 The review again recognised the superiority of glucosamine sulphate over glucosamine hydrochloride and the statistical significance of the findings for glucosamine sulphate.The update of the Cochrane review of glucosamine in 2009 1 demonstrated pain reduction, improvements in markers related to the severity of OA (and improvements in those related to the severity of arthritis) all in favour of glucosamine sulphate, and statistically more favourable than the previous review in 2005. 11 This 2005 Cochrane review is one of the reviews used by the Drug and Therapeutics Bulletin (DTB) in 2008, 12 which demonstrated that there was a significantly larger effect size for glucosamine sulphate than glucosamine hydrochloride. The DTB also reiterated the NICE recommendation that only a once-daily dose of 1500mg of glucosamine sulphate should be used, but again their review predated the availability of a licensed product in the UK and so could not recommend its use for the NHS at that time.A more recent meta-analysis was published in 2010. 13 Unfortunately studies using both glucosamine sulphate and hydrochloride and OA of the knee and hip were pooled resulting in a dilution of the beneficial effect of glucosamine, for which the meta-analysis has been criticised. 14 Even so, the metaanalysis still demonstrated a statistically significant benefit for glucosamine sulphate.The authors' conclusion that patients who perceive a benefit www.prescriber.co.uk 34 Prescriber 5 June 2011 Table 1. The author's QIPP assessment of glucosamine sulphate in OA Quality A licensed glucosamine sulphate preparation (Glusartel) has recently been made available in the UK. The MHRA reiterated in 2008 4 that licensed products available in the UK should be used wherever possible, even for off-label use. Prescribing a licensed glucosamine sulphate medicine over an unlicensed preparation ensures that the patient receives a drug that is up to standard in pharmaceutical quality terms to treat their disease. The quality of unlicensed glucosamine preparations, being prescribed on the NHS, cannot be guaranteed. InnovationThe availability of a licensed nutraceutical is an innovation for the UK prescription-only medicine market. It is important, however, to note that the evidence from trials and meta-analyses is that the benefit is obtained from crystalline glucosamine sulphate at the dose ...

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Dietary glucosamine under question

Cited by 16 publications

References 38 publications

Scientific Opinion on the substantiation of a health claim related to glucosamine and maintenance of normal joint cartilage pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Scientific Opinion on the substantiation of a health claim related to glucosamine and maintenance of normal joint cartilage pursuant to Article 13(5) of Regulation (EC) No 1924/2006

Glucosamine and osteoarthritis: time to quit?

Glucosamine in OA of the knee: the case for and against

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