The effects of resistant starches on inflammatory bowel disease in preclinical and clinical settings: a systematic review and meta-analysis

Abstract

Background Inflammatory bowel disease (IBD) is a debilitating chronic disease with limited treatment options. Resistant starches may represent a novel treatment for IBD. However, its efficacy and safety remain unclear. Our objective was to perform a systematic review to summarize the preclinical and clinical effects of resistant starch, which may help guide future studies. Methods Medline, EMBASE, and the Cochrane Central Register were searched. Included studies investigated the use of resistant starch therapy in in vivo animal models of IBD or human patients with IBD. Articles were screened, and data extracted, independently and in duplicate. The primary outcomes were clinical remission (clinical) and bowel mucosal damage (preclinical). Results 21 preclinical (n = 989 animals) and seven clinical (n = 164 patients) studies met eligibility. Preclinically, resistant starch was associated with a significant reduction in bowel mucosal damage compared to placebo (standardized mean difference − 1.83, 95% CI − 2.45 to − 1.20). Clinically, five studies reported data on clinical remission but clinical and methodological heterogeneity precluded pooling. In all five, a positive effect was seen in patients who consumed resistant starch supplemented diets. The majority of studies in both the preclinical and clinical settings were at a high or unclear risk of bias due to poor methodological reporting. Conclusions Our review demonstrates that resistant starch is associated with reduced histology damage in animal studies, and improvements in clinical remission in IBD patients. These results need to be tempered by the risk of bias of included studies. Rigorously designed preclinical and clinical studies are warranted. Trial registration The review protocols were registered on PROSPERO (preclinical: CRD42019130896; clinical: CRD42019129513).

Lactulose Modulates the Structure of Gut Microbiota and Alleviates Colitis-Associated Tumorigenesis

“…Standard deviations are listed in Table S1 . Starch degradation and amino acid metabolism are associated with gastrointestinal disorders such as IBD [ 28 ], while heme biosynthesis has been shown to contribute to bacterial virulence, promote inflammation, and worsen the prognosis of patients with IBD [ 29 ]. With respect to the effect of lactulose ( Figure 7 ), heme biosynthesis ( Figure 7 , Nos.…”

“…In IBD patients, starch degradation and amino acid metabolism pathway were significantly affected. Therefore, dietary fibers, such as resistant starches, are proposed as a promising treatment for IBD [ 28 ]. The present study revealed similar changes in the starch degradation and amino acid metabolism pathway in AOM/DSS.…”

Increasing the Versatility of Durum Wheat through Modifications of Protein and Starch Composition and Grain Hardness

“…Short-chain fatty acids (SCFAs), especially butyrate, contribute to the well-being of colonocytes with a possible role in the prevention of colon cancer [ 69 , 70 , 71 ]. In addition, increases in SCFAs result in lowering of the bowel pH, and this contributes to hindering the proliferation of pathogenic bacteria and reducing inflammation in irritable bowel disease [ 72 ]. In addition, the foods with high resistant starch have low glycaemic index and can help in preventing the onset of type II diabetes and obesity [ 69 , 73 ].…”

Components of the Fiber Diet in the Prevention and Treatment of IBD—An Update

“…One of the few human studies indicates that RS contributes to the maintenance of clinical remission in patients with IBD and reduces the intensity of symptoms associated with active disease. It is also associated with an increase in SCFA production [ 102 ]. In another study, Rose et al presented that starch-entrapped microspheres, due to their maintenance of low pH and their involvement in butyrate production, can reduce harmful bacteria, for example Bacteroides and Fusobacterium [ 103 ].…”