title: Insight into the prebiotic concept: lessons from an exploratory, double blind intervention study with inulin-type fructans in obese women Effects of Probiotic and Prebiotic Supplementation on Leptin, Adiponectin, and Glycemic Parameters in Non-alcoholic Fatty Liver Disease: A Randomized Clinical Trial Freeze-dried powdered yacon: effects of FOS on serum glucose, lipids and intestinal transit in the elderly A randomized controlled trial: the effect of inulin on weight management and ectopic fat in subjects with prediabetes Replacement of glycaemic carbohydrates by inulin-type fructans from chicory (oligofructose, inulin) reduces the postprandial blood glucose and insulin response to foods: report of two double-blind, randomized, controlled trials Consumption of Synbiotic Bread Decreases Triacylglycerol and VLDL Levels While Increasing HDL Levels in Serum from Patients with Type-2 Diabetes Chronic consumption of short-chain fructooligosaccharides does not affect basal hepatic glucose production or insulin resistance in type 2 diabetics. Supplementation of Diet With Galacto-oligosaccharides Increases Bifidobacteria, but Not Insulin Sensitivity, in Obese Prediabetic Individuals. Assessing the Effect of High Performance Inulin Supplementation via KLF5 mRNA Expression in Adults with Type 2 Diabetes: A Randomized Placebo Controlled Clinical Trail Effects of High Performance Inulin Supplementation on Glycemic Control and Antioxidant Status in Women with Type 2 Diabetes Effects of a Multispecies Probiotic Mixture on Glycemic Control and Inflammatory Status in Women with Gestational Diabetes: A Randomized Controlled Clinical Trial The effect of the daily intake of inulin on fasting lipid, insulin and glucose concentrations in middle-aged men and women. The inclusion of a partial meal replacement with or without inulin to a calorie restricted diet contributes to reach recommended intakes of micronutrients and decrease plasma triglycerides: A randomized clinical trial in obese Mexican women. Double blind randomized clinical trial controlled by placebo with a fos enriched cookie on saciety and cardiovascular risk factors in obese patients. The effects of a diet rich in inulin or wheat fibre on markers of cardiovascular disease in overweight male subjects. GRADE guidelines: 3. Rating the quality of evidence. Inulin supplementation prevents high fructose diet-induced hypertension in rats. Effect of Butyrate and Inulin Supplementation on Glycemic Status, Lipid Profile and Glucagon-Like Peptide 1 Level in Patients with Type 2 Diabetes: A Randomized Double-Blind, Placebo-Controlled Trial. Host-microbiome interactions in human type 2 diabetes following prebiotic fibre (galacto-oligosaccharide) intake. Histological improvement of non-alcoholic steatohepatitis with a prebiotic: a pilot clinical trial Effects of Fructo-Oligosaccharide Supplementation on Constipation in Elderly Continuous Ambulatory Peritoneal Dialysis Patients Long-term administration of inulin-type fructans has no significant lipid-lowering effect in normolipidemic humans. Impact of prebiotic supplementation on T-cell subsets and their related cytokines, anthropometric features and blood pressure in patients with type 2 diabetes mellitus: A randomized placebo-controlled Trial. Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults. A Randomised Crossover Trial: The Effect of Inulin on Glucose Homeostasis in Subtypes of Prediabetes
abstract: Objective To highlight the contribution of the gut microbiota to the modulation of host metabolism by dietary inulin-type fructans ( ITF prebiotics ) in obese women . Methods A double blind , placebo controlled , intervention study was performed with 30 obese women treated with ITF prebiotics ( inulin/oligofructose 50/50 mix ; n=15 ) or placebo ( maltodextrin ; n=15 ) for 3 months ( 16 g/day ) .  Blood , faeces and urine sampling , oral glucose tolerance test , homeostasis model assessment and impedancemetry were performed before and after treatment . The gut microbial composition in faeces was analysed by phylogenetic microarray and qPCR analysis of 16S rDNA . Plasma and urine metabolic profiles were analysed by 1H-NMR spectroscopy . Results Treatment with ITF prebiotics , but not the placebo , led to an increase in Bifidobacterium and Faecalibacterium prausnitzii ; both bacteria negatively correlated with serum lipopolysaccharide levels .  ITF prebiotics also decreased Bacteroides intestinalis , Bacteroides vulgatus and Propionibacterium , an effect associated with a slight decrease in fat mass and with plasma lactate and phosphatidylcholine levels . No clear treatment clustering could be detected for gut microbial analysis or plasma and urine metabolomic profile analyses . However , ITF prebiotics led to subtle changes in the gut microbiota that may importantly impact on several key metabolites implicated in obesity and /or diabetes . Conclusions ITF prebiotics selectively changed the gut microbiota composition in obese women , leading to modest changes in host metabolism , as suggested by the correlation between some bacterial species and metabolic endotoxaemia or metabolomic signatures BACKGROUND According to previous studies , probiotic and prebiotic supplementation have desirable effects on glycemic parameters . Thus far , the effect of supplementation on the glycemic parameters and adipokines in non-alcoholic fatty liver disease ( NAFLD ) has not been assessed . Therefore , the aim of this study was to determine the effects of supplementation with probiotic and prebiotic on adiokines and glycemic parameters in the patients with NAFLD . METHODS In the present r and omized , double-blind , placebo-controlled trial , 89 patients with NAFLD were r and omly divided into three groups to receive one probiotic capsule + 16 g/d maltodextrin ( probiotic group ) or 16 g/d oligofructose powder + one placebo capsule ( prebiotic group ) , and one placebo capsule + 16 g/d maltodextrin ( control group ) for 12 weeks . All the subjects in the study were advised to follow the weight loss diet and physical activity recommendations during the intervention . Fasting blood sample s were taken at baseline and after the intervention to measure leptin , adiponectin , insulin , and fasting blood sugar . RESULTS At the end of the study , serum concentrations of leptin , insulin , and HOMA-IR decreased significantly in the probiotic and prebiotic groups compared with the control group . Despite the changes within the groups , serum concentrations of adiponectin did not change significantly between the three groups . Also , fasting blood sugar did not change between the groups , but decreased in the prebiotic group . Quantitative insulin-sensitivity check index ( QUICKI ) increased significantly in probiotic and prebiotic groups compared with the control group . CONCLUSION Probiotic and prebiotic supplementation along with lifestyle intervention has a favorable impact on glycemic parameters and leptin levels compared with lifestyle intervention alone Abstract Background and aims Freeze-dried powdered yacon ( FDY ) can be considered a prebiotic product due to its fructooligosaccharides ( FOS ) content . The effect of 9 weeks of daily intake of FDY containing 7.4 g of FOS on glucose , lipid metabolism and intestinal transit in a group of elderly people was investigated . Methods Seventy-two elderly ( mean age 67.11 ± 6.11 ) men and women were studied for 9 weeks in a double-blind , placebo-controlled experiment . They were r and omly assigned to the supplement group ( which received 7.4 g of FOS as FDY ) or the control group . At the beginning and end of the study , anthropometric measurements , blood sampling , clinical analyses and dietary intake were assessed . Results A daily intake of FDY containing 7.4 g of FOS for 9 weeks was associated with a mean decrease in serum glucose ( p = 0.013 ) , but supplementation did not reduce serum lipids in the study group . The administered dose did not adversely affect intestinal transit . It did not cause bloating , flatulence or intestinal discomfort . Conclusion Freeze-dried powdered yacon is a good source of FOS , and daily consumption can have a favourable effect on serum glucose in the elderly . It is also practical , easy and safe to use and store Background Fat infiltration of the liver , muscle and pancreas is associated with insulin resistance and risk of diabetes . Weight loss reduces ectopic fat deposition and risk of diabetes , but is difficult to sustain to due to compensatory increases in appetite . Fermentable carbohydrates have been shown to decrease appetite and food intake , and promote weight loss in overweight subjects . In animal studies , fermentable carbohydrate reduces ectopic fat independent of weight loss . We aim ed to investigate the effect of the fermentable carbohydrate inulin on weight maintenance , appetite and ectopic fat in subjects with prediabetes . Methods Forty-four subjects with prediabetes were r and omized to 18 weeks ’ inulin or cellulose supplementation .  During weeks 1–9 ( weight loss phase ) all subjects had four visits with a dietitian to guide them towards a 5 % weight loss . During weeks 10–18 ( weight maintenance phase ) subjects continued taking their assigned supplementation and were asked to maintain the weight they had lost but were offered no further support . All subjects attended study sessions at baseline , 9 and 18 weeks for measurement of weight ; assessment of adipose tissue and ectopic fat content by magnetic resonance imaging and magnetic resonance spectroscopy ; glucose , insulin and GLP-1 levels following a meal tolerance test ; and appetite by ad libitum meal test and visual analogue scales . Results Both groups lost approximately 5 % of their body weight by week nine ( −5.3 ± 0.1 % vs −4.3 ± 0.4 % , p = 0.13 , but the inulin group lost significantly more weight between 9 and 18 weeks ( −2.3 ± 0.5 % vs −0.6 ± 0.4 % , p = 0.012 ) . Subjects taking inulin had lower hepatic ( p = 0.02 ) and soleus muscle ( p < 0.05 ) fat content at 18 weeks compared to control even after controlling for weight loss and consumed less at the ad libitum meal test ( p = 0.027 ) . Fasting glucose significantly decreased at week nine only ( p = 0.005 ) , insulin concentrations did not change , and there was a significant increase in GLP-1 in the cellulose group at 9 and 18 weeks ( p < 0.03 , p < 0.00001 ) . Conclusion Inulin may have a two-pronged effect on the risk of diabetes by 1 ) promoting weight loss 2 ) reducing intrahepatocellular and intramyocellular lipid in people with prediabetes independent of weight loss . Trial registration Clinical trial number : NCT01841073 Purpose Inulin-type fructans are recognized as prebiotic dietary fibres and classified as non-digestible carbohydrates that do not contribute to glycaemia . The aim of the present studies was to investigate the glycaemic response ( GR ) and insulinaemic response ( IR ) to foods in which sucrose was partially replaced by inulin or oligofructose from chicory . Methods In a double-blind , r and omized , controlled cross-over design , 40–42 healthy adults consumed a yogurt drink containing oligofructose or fruit jelly containing inulin and the respective full-sugar variants .  Capillary blood glucose and insulin were measured in fasted participants and at 15 , 30 , 45 , 60 , 90 , and 120 min after starting to drink/eat . For each test food , the incremental area under the curve ( iAUC ) for glucose and insulin was calculated and the GR and IR determined . Results Consumption of a yogurt drink with oligofructose which was 20 % reduced in sugars significantly lowered the glycaemic response compared to the full-sugar reference ( iAUC120min 31.9 and 37.3 mmol/L/min , respectively ; p < 0.05 ) . A fruit jelly made with inulin and containing 30 % less sugars than the full-sugar variant likewise result ed in a significantly reduced blood glucose response ( iAUC120min 53.7 and 63.7 mmol/L/min , respectively ; p < 0.05 ) . In both studies , the postpr and ial insulin response was lowered in parallel ( p < 0.05 ) . The reduction of postpr and ial glycaemia was positively correlated to the proportion of sugars replaced by inulin-type fructans ( p < 0.001 ) . Conclusions In conclusion , the studies confirmed that substitution of glycaemic sugars by inulin or oligofructose from chicory may be an effective strategy to reduce the postpr and ial blood glucose response to foods To our knowledge , no reports are available indicating the favorable effects of synbiotic bread consumption on blood lipid profiles among patients with type 2 diabetes mellitus ( T2DM ) . This study was conducted to evaluate the effects of the daily consumption of synbiotic bread on blood lipid profiles of patients with T2DM . This r and omized double-blinded controlled clinical trial was performed with 78 diabetic patients , aged 35–70 years . After a 2-week run-in period , subjects were r and omly assigned to consume either synbiotic ( n = 26 ) , probiotic ( n = 26 ) or control bread ( n = 26 ) for 8 weeks . The synbiotic bread contained viable and heat-resistant probiotic Lactobacillus sporogenes ( 1 × 108 CFU ) and 0.07 g inulin ( HPX ) as prebiotic per 1 g. The probiotic bread contained L. sporogenes ( 1 × 108 CFU ) per 1 g. Patients were asked to consume the synbiotic , probiotic and control breads three times a day in a 40 g package for a total of 120 g/day . Biochemical measurements including blood lipid profiles were conducted before and after 8 weeks of intervention . Consumption of the synbiotic bread , compared to the probiotic and control breads , led to a significant decrease in serum TAG ( P = 0.005 ) , VLDL-C ( P = 0.005 ) , TC/HDL-C ( P = 0.002 ) and a significant increase in serum HDL-C levels ( P = 0.01 ) . No significant effect of synbiotic bread consumption on FPG , TC , LDL-C and non-HDL-C levels was seen compared to the probiotic and control breads ( P > 0.05 ) . Trial registry code : http://www.i rct .ir I RCT 201311215623N13 Short-chain fructooligosaccharides ( FOS ) are prebiotics , which escape digestion in the small intestine and are fermented by the colonic microflora into short-chain fatty acids . Recently , we found that the daily consumption of 20 g FOS decreased basal hepatic glucose production in healthy subjects without any effect on insulin-stimulated glucose metabolism . In this study , we evaluated the effects of the chronic ingestion of FOS on plasma lipid and glucose concentrations , hepatic glucose production and insulin resistance in type 2 diabetics . Type 2 diabetic volunteers ( n = 10 ; 6 men , 4 women ) received either 20 g/d FOS or sucrose for 4 wk in a double-blind crossover design . FOS did not modify fasting plasma glucose and insulin concentrations or basal hepatic glucose production . The plasma glucose response to a fixed exogenous insulin bolus did not differ at the end of the two periods . Erythrocyte insulin binding also did not differ . Serum triacylglycerol , total and HDL cholesterol , free fatty acid , apolipoproteins A1 and B and lipoprotein ( a ) concentrations were not modified by the chronic ingestion of FOS . We conclude that 4 wk of 20 g/d of FOS had no effect on glucose and lipid metabolism in type 2 diabetics BACKGROUND & AIMS The gut microbiota affects host lipid and glucose metabolism , satiety , and chronic low- grade inflammation to contribute to obesity and type 2 diabetes . Fermentation end products , in particular the short-chain fatty acid ( SCFA ) acetate , are believed to be involved in these processes . We investigated the long-term effects of supplementation with galacto-oligosaccharides ( GOS ) , an acetogenic fiber , on the composition of the human gut microbiota and human metabolism . METHODS We performed a double-blinded , placebo-controlled , parallel intervention study of 44 overweight or obese ( body mass index , 28 - 40 kg/m2 ) prediabetic men and women ( ages , 45 - 70 y ) from October 2014 through October 2015 in Maastricht , The Netherl and s. The participants were assigned r and omly to groups who ingested 15 g GOS or isocaloric placebo ( maltodextrin ) daily with their regular meals for 12 weeks . Before and after this period , we collected data on peripheral and adipose tissue insulin sensitivity , fecal microbiota composition , plasma and fecal SCFA , energy expenditure and substrate oxidation , body composition , and hormonal and inflammatory responses . The primary outcome was the effect of GOS on peripheral insulin sensitivity , measured by the hyperinsulinemic-euglycemic clamp method . RESULTS Supplementation of diets with GOS , but not placebo , increased the abundance of Bifidobacterium species in feces by 5-fold ( P = .009 ; q = 0.144 ) . Microbial richness or diversity in fecal sample s were not affected . We did not observe any differences in fecal or fasting plasma SCFA concentrations or in systemic concentrations of gut-derived hormones , incretins , lipopolysaccharide-binding protein , or other markers of inflammation . In addition , no significant alterations in peripheral and adipose tissue insulin sensitivity , body composition , and energy and substrate metabolism were found . CONCLUSIONS Twelve-week supplementation of GOS selectively increased fecal Bifidobacterium species abundance , but this did not produce significant changes in insulin sensitivity or related substrate and energy metabolism in overweight or obese prediabetic men and women . ClincialTrials.gov number , NCT02271776 Purpose : The worldwide prevalence of metabolic disorders such as diabetes is increasing rapidly . Currently , the complications of diabetes are the major health concern . The aim of this study was to investigate the effect of high performance ( HP ) inulin supplementation on glucose homeostasis via KLF5 mRNA expression in adults with type 2 diabetes . Methods : In the present clinical trial conducted for a duration of 6 weeks , 46 volunteers diabetic patients referring to diabetes clinic in Tabriz , Iran , were r and omly assigned into intervention ( n= 23 , consuming 10 gr/d HP inulin ) and control groups ( n= 23 , consuming 10 gr/ d starch ) . We assessed glycemic and anthropometric indices , blood lipids and plasmatic level of miR-375 as well as KLF5 mRNA expression before and after the intervention . Results : Findings indicated that inulin supplementation significantly decreased fasting plasma glucose ( FPG ) in comparison to the placebo group ( P<0.001 ) . Also Intra-group and between group results showed that inulin supplementation result ed in significant decrease in KLF5 mRNA expression in peripheral blood mononuclear cells ( P BMC s ) ( Fold change : 0.61± 0.11 ; P-value= 0.001 ) and significant increase in plasmatic level of miR-375 ( Fold change : 3.75± 0.70 ; P-value=0.004 ) . Conclusion : Considering the improvements of FPG level in diabetic patients , it seems that HP inulin supplementation may be beneficial in controlling diabetes via the expression of some genes . However , further studies are needed to achieve concise conclusions Background The purpose of this study was to evaluate the effects of high performance inulin supplementation on blood glycemic control and antioxidant status in women with type 2 diabetes . Methods In a r and omized , triple-blind controlled trial , 49 females ( fiber intake < 30 g/day , 25<body mass index < 35 kg/m2 ) with type 2 diabetes were recruited from the Iran Diabetes Society and from endocrinology and metabolism clinics associated with the Tabriz University of Medical Science . The participants were divided into one of two groups in which the participants either received 10 g/day of inulin ( intervention , n=24 ) or maltodextrin ( control , n=25 ) for 2 months . Fasting blood sample s were obtained and both glycemic control and antioxidant status were determined at baseline and at the end of the study . Results At the end of the study period , there were significant decreases in fasting plasma glucose ( 8.47 % ) , glycosylated hemoglobin ( 10.43 % ) , and malondialdehyde ( 37.21 % ) levels and significant increases in total antioxidant capacity ( 18.82 % ) and superoxide dismutase activity ( 4.36 % ) in the inulin group when compared to the maltodextrin group ( P<0.05 ) . Changes in fasting insulin , homeostasis model assessment of insulin resistance , and catalase activity were not significant in the inulin group when compared with the maltodextrin group . Glutathione peroxidase activity remained unchanged in both groups . Conclusion Inulin supplementation may improve some glycemic and antioxidant indices and decrease malondialdehyde levels in women with type 2 diabetes . Further investigations are needed in order to confirm the positive effects that inulin may have on the glycemic and antioxidant indices of patients with type 2 diabetes Objective . This trial aims to examine the effects of a Probiotic Mixture ( VSL#3 ) on glycemic status and inflammatory markers , in women with GDM . Material s and Methods . Over a period of 8 weeks , 82 women with gestational diabetes were r and omly assigned to either an intervention group ( n = 41 ) which were given VSL#3 capsule or to a control group which were given placebo capsule ( n = 41 ) . Fasting plasma glucose , homeostatic model assessment of insulin resistance , glycosylated hemoglobin , high-sensitivity C-reactive protein , tumor necrosis factor-α , interleukin-6 , Interferon gamma , and interleukin-10 were measured before and after the intervention . Results . After 8 wk of supplementation FPG , HbA1c , HOMA-IR , and insulin levels remained unchanged in the probiotic and placebo groups . The comparison between the two groups showed no significant differences with FPG and HbA1c , but there were significant differences in insulin levels and HOMA-IR ( 16.6 ± 5.9 ; 3.7 ± 1.5 , resp . ) . Unlike the levels of IFN-g ( 19.21 ± 16.6 ) , there was a significant decrease in levels of IL-6 ( 3.81 ± 0.7 ) , TNF-α ( 3.10 ± 1.1 ) , and hs-CRP ( 4927.4 ± 924.6 ) . No significant increase was observed in IL-10 ( 3.11 ± 5.7 ) in the intervention group as compared with the control group . Conclusions . In women with GDM , supplementation with probiotics ( VSL#3 ) may help to modulate some inflammatory markers and may have benefits on glycemic control The present study was carried out to examine the effect of the daily intake of 10 g inulin on fasting blood lipid , glucose and insulin levels in healthy middle-aged men and women with moderately raised total plasma cholesterol ( TC ) and triacylglycerol ( TAG ) levels .  This study was a double-blind r and omized placebo-controlled parallel study in which fifty-four middle-aged subjects received either inulin or placebo for a period of 8 weeks . Fasting blood sample s were collected before the supplementation period ( baseline sample s 1 and 2 , separated by 1 week ) and at weeks 4 and 8 , with a follow-up at week 12 . Compared with baseline values , insulin concentrations were significantly lower at 4 weeks ( P < 0.01 ) in the inulin group . There was a trend for TAG values , compared with baseline , to be lower in the inulin group at 8 weeks ( P < 0.08 ) returning to baseline concentrations at week 12 . On comparison of the inulin and placebo groups , the fasting TAG responses over the 8-week test period were shown to be significantly different ( P < 0.05 , repeated measures ANOVA ) , which was largely due to lower plasma TAG levels in the inulin group at week 8 . The percentage change in TAG levels in the inulin group during the 8-week study was shown to correlate with the initial TAG level of the subjects ( rs -0.499 , P = 0.004 ) . We therefore conclude that the daily addition of 10 g inulin to the diet significantly reduced fasting insulin concentrations during the 8-week test period and result ed in lower plasma TAG levels , particularly in subjects in whom fasting TAG levels were greater than 1.5 mmol/l . These data support findings from animal studies that fructans influence the formation and /or degradation of TAG-rich lipoprotein particles , and the insulin data are also consistent with recent studies showing attenuation of insulin levels in fructan-treated rats Background Obesity is a major public health problem in many poor countries where micronutrient deficiencies are prevalent . A partial meal replacement may be an effective strategy to decrease obesity and increase micronutrient intake in such population s. The objective was to evaluate the efficacy of a partial meal replacement with and without inulin on weight reduction , blood lipids and micronutrients intake in obese Mexican women . Methods In a r and omized controlled clinical trial 144 women ( 18–50 y ) with BMI ≥ 25 kg/m2 , were allocated into one of the following treatments during 3 months : 1 ) Two doses/d of a partial meal replacement ( PMR ) , 2 ) Two doses/d of PMR with inulin ( PMR + I ) , 3 ) Two doses/d of 5 g of inulin ( INU ) and 4 ) Control group ( CON ) . All groups received a low calorie diet ( LCD ) . Weight , height , hip and waist circumference were measured every 2 weeks and body composition , lipids and glucose concentration and nutrient intake were assessed at baseline and after 3 months . Results All groups significantly reduced weight , BMI , waist and hip circumference . Differences between groups were only observed in BMI and weight adjusted changes : At 45 days PMR group lost more weight than INU and CON groups by 0.9 and 1.2Kg , respectively . At 60 days , PMR + I and PMR groups lost more weight than in INU by 0.7 and 1Kg , respectively . Subjects in PMR , PMR + I and INU significantly decreased triglycerides . Energy intake was reduced in all groups . Fiber intake increased in PMR + I and INU groups . Some minerals and vitamins intakes were higher in PMR and PMR + I compared with INU and CON groups . Conclusion Inclusion of PMR with and without inulin to a LCD had no additional effect on weight reduction than a LCD alone but reduced triglycerides and improved intake of micronutrients during caloric restriction . PMR could be a good alternative for obese population s with micronutrient deficiencies . Clinical Trials . Gov INTRODUCTION It is essential to determine which snack foods are most affective for appetite control . The objective of the current study was to assess the responses of two different cookies on satiety and cardiovascular risk factors . MATERIAL AND METHODS 38 patients were r and omized : group I ( FOS enriched cookie , n=19 ) and group II ( control cookie , n=19 ) . Previous and after 1 month , the subjects rated their feelings of satiety/hunger with a test meal of 5 cookies . RESULTS After the test meal , the basal area under curve of the first hunger/satiety score was higher with satiety cookie than with control cookie , the data after 1 month of treatment was higher with satiety cookie than with control cookie , too . The score was higher than the fasting level for 20 minutes with satiety cookie and for 40 minutes with the same cookie , too . In satiety group , these scores ( 20 min and 40 min ) were higher than control group before and after 1 month of treatment . The results were in the same way with the 100 mm 5-point visual satiety scale . Cardiovascular risk factors and dietary intake remained unchanged after dietary intervention . CONCLUSION A FOS enriched cookie produced greater ratings of satiety than a control cookie , without effects on cardiovascular risk factors or dietary intakes BACKGROUND Previous studies suggest that the beneficial health effects of a diet rich in whole grains could be a result of the individual fibres found in the grain . The present study aim ed to investigate the influence of a diet high in either wheat fibre ( as an example of an insoluble fibre ) or inulin ( a nondigestible carbohydrate ) on markers of cardiovascular disease . METHODS Ten male participants classified as at higher risk of cardiovascular disease [ mean ( SD ) body mass index 30.2 ( 3 ) kg m(-2 ) , mean ( SD ) waist circumference 106.4 ( 7 ) cm , mean ( SD ) age 39.8 ( 9 ) years ] were recruited to a r and omised , controlled , cross-over study comparing the consumption of bespoke bread rolls containing either inulin , wheat germ or refined grain ( control ) ( 15 g day(-1 ) ) for 4 weeks with a 4-week washout period between each regime . At the end of each regime , participants underwent an oral glucose tolerance test ( OGTT ) , measures of pulse wave velocity ( PWV ) , 24-h ambulatory blood pressure ( AMBP ) , plasma lipid status and markers of glucose control . RESULTS There was no difference in measures of glucose control , lipid status , 24-h AMBP or PWV after the intervention periods and no changes compared to baseline . There was no significant difference between OGTT glucose and insulin time profiles ; however , there was a significant difference in area under the curves between the wheat fibre and control interventions when comparing change from baseline ( control + 10.2 % , inulin + 4.3 % , wheat fibre -2.5 % ; P = 0.03 ) . CONCLUSIONS Only limited differences between the interventions were identified , perhaps as a consequence of the amount of fibre used and intervention length . The wheat germ intervention result ed in a significant reduction in glucose area under the curve , suggesting that this fibre may aid glucose control This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND & AIMS The aim of this experiment was to evaluate the potential beneficial effect of supplementation with different inulin-type fructan fractions against common features of the metabolic syndrome in a rat model of this syndrome ( fructose-fed rat ) . METHODS Forty Wistar rats were r and omly divided into five groups and the animals received for 4 weeks either a semi-purified starch or fructose-based diet , or diets in which fructose was partially substituted with various fructans : 10 g/100 g of long-chain inulin or oligofructose , or an oligofructose-enriched inulin . After this period , blood pressure was measured and sample s of blood and tissues were collected for selected biochemical analyses . RESULTS As compared to the starch-fed group , the fructose-fed rats presented : hypertriglyceridemia , hypertension , increased susceptibility to heart peroxidation and renal damages . Long-chain inulin and oligofructose-enriched inulin supplementation prevented fructose induced elevated blood pressure , susceptibility to heart peroxidation and renal damages . All inulin-type fructans containing diets prevented fructose induced hypertriglyceridemia . CONCLUSIONS These results suggest that supplementation with inulin-type fructans is efficient against fructose induced hypertension and that effects are most pronounced for long-chain inulin and oligofructose-enriched inulin . We hypothesize that the anti-hypertensive effect of inulin could be explained by the reduction of the high fructose induced oxidative stress Studies on humans with diabetes mellitus showed that the crosstalk between the intestinal microbiota and the host has a key role in controlling the disease . The aim of this study was to evaluate the effects of sodium butyrate and high performance inulin supplementation simultaneously or singly on glycemic status , lipid profile , and glucagon-like peptide 1 level in adults with type 2 diabetes mellitus . Sixty patients were recruited for the study . The participants were r and omly allocated , using r and omized block procedure , to one of the four treatment groups ( A , B , C , or D ) . Group A received sodium butyrate capsules , group B received inulin supplement powder , group C was exposed to the concomitant use of inulin and sodium butyrate , and group D consumed placebo for 45 consecutive days . Markers of glycemia , lipid profile , and glucagon-like peptide 1 were measured pre- and post-intervention . Dietary supplementation in groups A , B , and C significantly reduced diastolic blood pressure in comparison with the placebo group ( p<0.05 ) . Also , intra-group statistical analysis showed that only treatment with sodium butyrate + inulin ( group C ) significantly reduced fasting blood sugar ( p=0.049 ) and waist to hip ratio ( p=0.020 ) . Waist circumference in groups B and C reduced significantly after the intervention ( p=0.007 and p=0.011 ; respectively ) . The post hoc Tukey tests showed significant increase in glucagon-like peptide 1 concentration in groups A and C in comparison with group D ( p<0.05 ) . The results suggest that inulin supplementation may be useful to diabetic patients and these effects could be increased with butyrate supplement Aberrant microbiota composition and function have been linked to several pathologies , including type 2 diabetes . In animal models , prebiotics induce favourable changes in the intestinal microbiota , intestinal permeability ( IP ) and endotoxaemia , which are linked to concurrent improvement in glucose tolerance . This is the first study to investigate the link between IP , glucose tolerance and intestinal bacteria in human type 2 diabetes . In all , twenty-nine men with well-controlled type 2 diabetes were r and omised to a prebiotic ( galacto-oligosaccharide mixture ) or placebo ( maltodextrin ) supplement ( 5·5 g/d for 12 weeks ) . Intestinal microbial community structure , IP , endotoxaemia , inflammatory markers and glucose tolerance were assessed at baseline and post intervention . IP was estimated by the urinary recovery of oral 51Cr-EDTA and glucose tolerance by insulin-modified intravenous glucose tolerance test . Intestinal microbial community analysis was performed by high-throughput next-generation sequencing of 16S rRNA amplicons and quantitative PCR . Prebiotic fibre supplementation had no significant effects on clinical outcomes or bacterial abundances  compared with placebo ; however , changes in the bacterial family Veillonellaceae correlated inversely with changes in glucose response and IL-6 levels ( r -0·90 , P=0·042 for both ) following prebiotic intake . The absence of significant changes to the microbial community structure at a prebiotic dosage/length of supplementation shown to be effective in healthy individuals is an important finding . We propose that concurrent metformin treatment and the high heterogeneity of human type 2 diabetes may have played a significant role . The current study does not provide evidence for the role of prebiotics in the treatment of type 2 diabetes Purpose In obesity and diabetes the liver is highly susceptible to abnormal uptake and storage of fat . In certain individuals hepatic steatosis predisposes to the development of non-alcoholic steatohepatitis ( NASH ) , a disease marked by hepatic inflammation and fibrosis . Although the precise pathophysiology of NASH is unknown , it is believed that the gut microbiota-liver axis influences the development of this disease . With few treatment strategies available for NASH , exploration of gut microbiota-targeted interventions is warranted . We investigated the therapeutic potential of a prebiotic supplement to improve histological parameters of NASH . Methods In a placebo-controlled , r and omized pilot trial , 14 individuals with liver-biopsy-confirmed NASH [ non-alcoholic fatty liver activity score ( NAS ) ≥ 5 ] were r and omized to receive oligofructose ( 8 g/day for 12 weeks followed by 16 g/day for 24 weeks ) or isocaloric placebo for 9 months . The primary outcome measure was the change in liver biopsy NAS score and the secondary outcomes included changes in body weight , body composition , glucose tolerance , inflammatory markers , and gut microbiota . Results Independent of weight loss  , oligofructose improved liver steatosis relative to placebo and improved overall NAS score ( P = 0.016 ) . Bifidobacterium was enhanced by oligofructose , whereas bacteria within Clostridium cluster XI and I were reduced with oligofructose ( P < 0.05 ) . There were no adverse side effects that deterred individuals from consuming oligofructose for treatment of this disease . Conclusions Independent of other lifestyle changes , prebiotic supplementation  reduced histologically-confirmed steatosis in patients with NASH . Larger follow-up studies are warranted . Clinical TrialThis trial was registered at Clinical trials.com as NCT03184376 ♦ Background : Fructo-oligosaccharides ( FOS ) exhibit soluble-fiber properties that beneficially affect bowel function and relieve constipation . The effects of FOS supplementation on constipation and biochemical parameters were examined in elderly continuous ambulatory peritoneal dialysis ( CAPD ) patients . ♦ Methods : This r and omized , double-blind , placebo-controlled , cross-over study was performed in elderly CAPD patients ( 5 males and 4 females ) with chronic constipation . All subjects were r and omly assigned to receive either 20 g FOS or placebo daily for 30 days . After a 14-day washout period , the patients were switched to the other substance for 1 more month . Before and after each treatment period , frequency of defecation , characteristics of feces , and colonic transit were evaluated . Biochemical parameters were also assessed . ♦ Results : Fructo-oligosaccharides significantly increased the frequency of defecation ( 10.5 ± 2.0 vs 6.2 ± 1.4 times per week , p < 0.005 ) and changed the feces ' appearance from type 1 ( nut-like ) to type 4 ( sausage – like ) . The colonic transit determined by geometric center ( GC ) was augmented after FOS supplementation ( 3.9 ± 0.3 vs 3.2 ± 0.4 , p < 0.05 ) . Fructo-oligosaccharides had no effects on biochemical parameters . Fructo-oligosaccharides caused mild discomforts which were well tolerated after dose adjustment . ♦ Conclusions : Fructo-oligosaccharide supplementation is effective , well tolerated , and can be an alternative to other laxatives in CAPD patients with constipation . Further studies are needed to better assess the biochemical effects of FOS in the chronic kidney disease population Short-term studies have shown that the addition to diet of inulin-type fructans , a nondigestible carbohydrate , may have a plasma lipid-lowering effect in humans . Whether this beneficial effect persists during long-term administration has not been determined . The study was aim ed at determining whether a prolonged ( 6 months ) administration of inulin-type fructans to healthy subjects has a lipid-lowering action . In a double-blind , r and omized , placebo-controlled study , 17 healthy subjects were studied before and after 6 months of daily administration of placebo ( 8 subjects ) or 10 g of a mix of inulin and oligofructose ( 9 subjects ) . During this 6-month period , they consumed their usual diet and did not modify their everyday way of life . We measured plasma lipid concentrations ; cholesterol synthesis and hepatic lipogenesis ; and adipose tissue and circulating mononuclear cell messenger RNA concentrations of key regulatory genes of cholesterol metabolism . Compared with the administration of placebo , the administration of inulin-type fructans had no effect on plasma triacylglycerol concentrations and hepatic lipogenesis and induced only a nonsignificant trend for decreased plasma total and low-density lipoprotein cholesterol levels and increased high-density lipoprotein cholesterol concentration . Cholesterol synthesis was not significantly modified . Of all the messenger RNA concentrations measured , none was significantly modified by the administration of inulin-type fructans . In conclusion , contrary to what was observed in short-term studies , we observed no significant beneficial effect of a long-term ( 6-month ) administration of inulin-type fructans on plasma lipids in healthy human subjects BACKGROUND S AND AIMS Type 2 diabetic mellitus ( T2DM ) asone of the main causes of morbidity and mortality is associated with immune system disturbances and metabolic abnormalities . In the current study we aim ed to evaluate the effects of oligofructose-enriched inulin on T-cell subsets and their related cytokines , anthropometric and metabolic parameters in patients with T2DM . METHODS Forty-six diabetic females patients were r and omly allocated into intervention ( n=27 ) and control ( n=22 ) groups . Subjects in the intervention group received a daily dose of 10 g of oligofructose-enriched inulin and subjects in control group received a placebo for two months . Anthropometric variables , metabolic parameters including fasting serum glucose ( FSG ) , hemoglobin A1c ( HbA1c ) , lipid profile and blood pressure were measured at the beginning and after two months . Immune markers also included serum interleukin (IL)-4 , IL-12 and interferon (IFN)-γ concentrations were assessed and CD3(+ ) , CD4(+ ) , CD8(+ ) and CD11b(+)T-cell counts were determined by flow cytometry at baseline and end of the trial . RESULTS After two months intervention , significant improvements in anthropometric variables , blood pressure and serum lipids occurred in prebiotic-treated group ( P<0.001 ) . Serum IL-4 , IL-12 and IFN-γ concentrationsalso significantly decreased in intervention group ( P<0.001 ) . No significant changes in CD3(+ ) , CD4(+ ) , CD8(+ ) and CD11b(+ ) T-cell counts were observed in treatment groups after intervention . CONCLUSION The present study showed several beneficial effects of oligofructose-enriched inulin on the improvement of the glycemic status , lipid profile , and immune markers in patients with T2DM . Further studies are needed to confirming our findings and to better clarify the underlying mechanisms BACKGROUND Rodent studies show that oligofructose promotes weight loss , stimulates satiety hormone secretion , reduces energy intake , and improves lipid profiles . OBJECTIVE Our objective was to examine the effects of oligofructose supplementation on body weight and satiety hormone concentrations in overweight and obese adults . DESIGN This study was a r and omized , double-blind , placebo-controlled trial . Forty-eight otherwise healthy adults with a body mass index ( in kg/m2 ) > 25 were r and omly assigned to receive 21 g oligofructose/d or a placebo ( maltodextrin ) for 12 wk . Body composition ( by dual-energy X-ray absorptiometry ) ; meal tolerance tests , including satiety hormone response ; food intake ; and subjective appetite ratings were determined . RESULTS There was a reduction in body weight of 1.03 + /- 0.43 kg with oligofructose supplementation , whereas the control group experienced an increase in body weight of 0.45 + /- 0.31 kg over 12 wk ( P = 0.01 ) . A lower area under the curve ( AUC ) for ghrelin ( P = 0.004 ) and a higher AUC for peptide YY ( PYY ) with oligofructose ( P = 0.03 ) coincided with a reduction in self-reported caloric intake ( P < or = 0.05 ) . Glucose decreased in the oligofructose group and increased in the control group between initial and final tests ( P < or = 0.05 ) . Insulin concentrations mirrored this pattern ( P < or = 0.05 ) . Oligofructose supplementation did not affect plasma active glucagon-like peptide 1 secretion . According to a visual analog scale design ed to assess side effects , oligofructose was well tolerated . CONCLUSIONS Independent of other lifestyle changes , oligofructose supplementation has the potential to promote weight loss and improve glucose regulation in overweight adults . Suppressed ghrelin and enhanced PYY may contribute in part to the reduction in energy intake . The trial was registered at clinical trials.gov as NCT00522353 Background : Fermentable carbohydrates ( FCHO ) have been shown to improve insulin sensitivity in normoglycaemic and insulin-resistant subjects . However , there are no data on subjects with prediabetes . We aim ed to investigate the effect of the FCHO inulin , on glucose homeostasis in subjects with prediabetes . Methods : In a double-blind and placebo-controlled crossover study , 40 volunteers with prediabetes were r and omly allocated to take 30 g/day of inulin or cellulose for 2 weeks in a crossover trial , following a 4-week dose-escalation run-in . Fasting insulin and glucose were measured for all subjects . Fifteen of the 40 subjects also underwent a meal tolerance test to assess insulin sensitivity , free fatty acids and glucagon-like peptide-1 concentrations . A sub analysis was carried out to examine any differences between the prediabetes subtypes . Results : Inulin was associated with a significant increase in ( 0 - 30 min)incremental AUC ( iAUC ) for insulin ( treatment : p < 0.04 ) and ( 0 - 60 min)iAUC for insulin ( treatment : p < 0.04 ) compared to control . There was a significant reduction in insulin resistance measured by the homeostatic model assessment in the isolated-impaired fasting glucose ( p < 0.05 ) but not in the isolated-impaired glucose tolerance groups ( p = 0.59 ) . Conclusion : The FCHO , inulin , may have unique metabolic effects that are of particular benefit to people at risk of diabetes , which warrant further investigation
target: Moreover , subgroup analyses suggested that the effects of glycemic control were significantly influenced by the sex of the subjects and the type and the method of intake of ITF .
  Conclusions Our analyses confirmed that these four main glycemic indicators were significantly reduced by ITF supplementation , particularly in the prediabetes and T2DM population .
  Evidence supports that reasonable administration of ITF supplementation may have potential clinical value as an adjuvant therapy for prediabetes and T2DM management .
background: Background Currently , many clinical trials have shown that inulin-type fructans ( ITF ) supplementation is associated with glycemic control ; nevertheless , the results are inconclusive .
  The aim of this meta- analysis of r and omized controlled trials was to assess the effects of ITF supplementation on glycemic control .