Lipid‐Modifying Effects of Chitosan Supplementation in Humans: A Pooled Analysis with Trial Sequential Analysis

Huang, Haohai; Zou, Ying; Chi, Honggang; Liao, Dan

doi:10.1002/mnfr.201700842

Cited by 10 publications

(6 citation statements)

References 44 publications

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“…Thus, the present study had enlarged sample sizes and added statistical power of at least 1600 cases. Second, to explore whether the current evidence was reliable and conclusive, and to prevent repeated updates from increasing the risk of random errors, we further applied TSA to evaluate the effects of repetitive testing, which increased the robustness of our findings ( Huang et al., 2018 ; Huang et al., 2020 ). Third, we rated the quality of evidence using GRADE approach with the guidance of an experienced GRADE methodological expert.…”

Section: Discussionmentioning

confidence: 99%

Enteral Lactoferrin Supplementation for Preventing Sepsis and Necrotizing Enterocolitis in Preterm Infants: A Meta‑Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Gao

Hou

et al. 2020

Front. Pharmacol.

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Background Several clinical trials investigated the effects of enteral lactoferrin supplementation on the prevention of sepsis and necrotizing enterocolitis (NEC) in preterm infants, but the efficacy and safety remain disputed. Therefore, we systematically evaluated the effect of enteral lactoferrin supplementation in preterm infants through a meta‑analysis with trial sequential analysis (TSA). Methods We searched six databases to identify randomized controlled trials (RCTs) that evaluated the effects of lactoferrin supplementation compared with placebo or no intervention in preterm infants. RevMan version 5.3 software was used to estimate pooled relative risks (RRs) with the random-effects model. TSA, subgroup analyses, and meta-regression analyses were also performed. Results Nine RCTs with 3515 samples were included. With low to moderate quality of evidence, compared with placebo, enteral lactoferrin supplementation did not significantly decrease the incidences of late-onset sepsis (RR = 0.63, 95% CI: 0.38 to 1.02, P = 0.06), NEC stage II or III (RR = 0.68, 95% CI: 0.30 to 1.52, P = 0.35), all-cause mortality (RR = 0.89, 95% CI: 0.51 to 1.57, P = 0.69), bronchopulmonary dysplasia (RR = 1.01, 95% CI: 0.90 to 1.13, P = 0.92), retinopathy of prematurity (RR = 0.80, 95% CI: 0.49 to 1.32, P = 0.38), invasive fungal infection (RR = 0.27, 95% CI: 0.02 to 3.94, P = 0.34), intraventricular hemorrhage (RR = 1.40, 95% CI: 0.39 to 5.08, P = 0.61), and urinary tract infection (RR = 0.35, 95% CI: 0.11 to 1.06, P = 0.06). Subgroup analysis revealed that lactoferrin significantly reduced the incidence of sepsis in infants with a birth weight below 1500 g (RR = 0.43, 95% CI: 0.22 to 0.84, P = 0.01). TSAs of the primary outcomes showed that the evidence is insufficient and further data is required. Conclusions Limited evidence suggested that enteral lactoferrin supplementation was associated with a reduction of late-onset sepsis in infants with a birth weight below 1500g, however, did not decrease the incidence of NEC stage II or III, all-cause mortality, and other adverse events in preterm infants. The present evidence was insufficient to inform clinical practice.

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Section: Discussionmentioning

confidence: 99%

Enteral Lactoferrin Supplementation for Preventing Sepsis and Necrotizing Enterocolitis in Preterm Infants: A Meta‑Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Gao

Hou

et al. 2020

Front. Pharmacol.

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“…Compared to previous studies, our study has several advantages. First, only two meta-analyses of chitosan have been performed, which evaluated body weight and lipid modification [ 25 , 70 ]. This is the first meta-analysis to evaluate regulation of the glycemic index following supplementation with chitosan, making it the latest and most comprehensive study to date.…”

Section: Discussionmentioning

confidence: 99%

“…As a deacetylated form of chitin, chitosan is an important dietary fiber source and among the most abundant natural polysaccharides worldwide [19], as it is derived from numerous taxa, including crustacean shells, insect exoskeletons, parasitic nematode eggs and gut linings, and fungi cell walls [20]. Chitosan is generally considered as a non-toxic nutritional cellulose supplement [21], and several animal studies and human clinical trials have demonstrated its good health effects, such as the prevention of cancer, hypertension, hyperglycemia, diabetes, dyslipidemia, and inflammation [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Chitosan modifies glycemic levels in people with metabolic syndrome and related disorders: meta-analysis with trial sequential analysis

Guo

Zhou

et al. 2020

Nutr J

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Background Chitosan supplementation has been shown to modulate glycemic levels; however, studies have reported conflicting results. The present meta-analysis with trial sequential analysis was conducted to verify the overall influence of chitosan on glycemic levels in patients with metabolic syndrome. Methods The PubMed, Cochrane library, and EMBASE databases were systematically searched for randomized controlled studies of chitosan intake and glycemic levels. Results A total of ten clinical trials including 1473 subjects were included in this meta-analysis. Pooled effect sizes were determined by random-effects meta-analysis. Subgroup analysis was performed to analyze the sources of heterogeneity and their influence on the overall results. The results revealed a significant reduction in fasting glucose levels (SMD: − 0.39 mmol/L, 95% CI: − 0.62 to − 0.16) and hemoglobin A1c (HbA1c) levels (SMD: -1.10; 95% CI: − 2.15 to − 0.06) following chitosan supplementation but no effect on insulin levels (SMD: − 0.20 pmol/L, 95% CI: − 0.64 to 0.24). Subgroup analyses further demonstrated significant reductions in fasting glucose levels in subjects administered 1.6–3 g of chitosan per day and in studies longer than 13 weeks. Trial sequential analysis of the pooled results of the hypoglycemic effect demonstrated that the cumulative Z-curve crossed both the conventional boundary and trial sequential monitoring boundary for glucose and HbA1c. Conclusions The glucose level of patients who are diabetic and obese/overweight can be improved by supplementation with chitosan for at least 13 weeks at 1.6–3 g per day. Additional clinical research data are needed to confirm the role of chitosan, particularly in regulating glycosylated hemoglobin and insulin.

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“…Although several clinical trials studied the efficacy of chitosan, the benefits of chitosan and its derivatives on glycemic regulation are not conclusive, due to these clinical trials varying substantially regarding the design of clinical research, the dosage, and the duration of chitosan supplementation, and characteristics of the enrolled population. Notably, a pooled analysis with trial sequential analysis showed that supplementation with chitosan effectively reduced plasma TC and LDL-C levels, indicating that daily chitosan consumption might be a worthwhile dietary approach to prevent hypercholesterolemia [105]. A meta-analysis of randomized controlled trials further showed that body weight, body mass index (BMI) and body fat were significantly reduced by chitosan supplementation, particularly in obese and overweight individuals [106].…”

Section: Application Of Chitosan and Its Derivatives In Clinical Trialsmentioning

confidence: 99%

Antidiabetic Properties of Chitosan and Its Derivatives

2022

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Diabetes mellitus is a chronic metabolic disorder. In addition to taking medication, adjusting the composition of the diet is also considered one of the effective methods to control the levels of blood glucose. Chitosan and its derivatives are natural and versatile biomaterials with health benefits. Chitosan has the potential to alleviate diabetic hyperglycemia by reducing hepatic gluconeogenesis and increasing skeletal muscle glucose uptake and utility. Scientists also focus on the glucose-lowering effect of chitosan oligosaccharide (COS). COS supplementation has the potential to alleviate abnormal glucose metabolism in diabetic rats by inhibiting gluconeogenesis and lipid peroxidation in the liver. Both high and low molecular weight chitosan feeding reduced insulin resistance by inhibiting lipid accumulation in the liver and adipose tissue and ameliorating chronic inflammation in diabetic rats. COS can reduce insulin resistance but has less ability to reduce hepatic lipids in diabetic rats. A clinical trial showed that a 3-month administration of chitosan increased insulin sensitivity and decreased body weight and triglycerides in obese patients. Chitosan and COS are considered Generally Recognized as Safe; however, they are still considered to be of safety concerns. This review highlights recent advances of chitosan and its derivatives in the glucose-lowering/antidiabetic effects and the safety.

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Lipid‐Modifying Effects of Chitosan Supplementation in Humans: A Pooled Analysis with Trial Sequential Analysis

Abstract: Supplementation with chitosan effectively reduces plasma concentrations of TC and LDL-C. Current evidence indicates daily chitosan supplementation as a candidate for therapeutic lipid management strategies.

Cited by 10 publications

References 44 publications

Enteral Lactoferrin Supplementation for Preventing Sepsis and Necrotizing Enterocolitis in Preterm Infants: A Meta‑Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Enteral Lactoferrin Supplementation for Preventing Sepsis and Necrotizing Enterocolitis in Preterm Infants: A Meta‑Analysis With Trial Sequential Analysis of Randomized Controlled Trials

Chitosan modifies glycemic levels in people with metabolic syndrome and related disorders: meta-analysis with trial sequential analysis

Antidiabetic Properties of Chitosan and Its Derivatives

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