Most studies of other cranberry products (tablets and capsules) did not report how much of the 'active' ingredient the product contained, and therefore the products may not have had enough potency to be effective. Lee BB, Haran MJ, Hunt LM, Simpson JM, Marial O, Rutkowski SB, Middleton JW, Kotsiou G, Tudehope M, Cameron ID. In this comparison, it was noted that different values were extracted from 1 of the studies that was included in Jepson et al. In particular, our analysis suggests consideration should be given to completion of additional research on cranberries for UTI prevention among women with rUTIs. Probiotics for preventing urinary tract infections in adults and children, Still waiting for evidence about whether cranberries are a useful treatment for urinary tract infections, Probiotics for preventing urinary tract infections in people with bladder dysfunction after a nervous system injury, D-mannose for preventing and treating urinary tract infections, Long-term antibiotics for preventing recurrent urinary tract infection in children, Now cranberries are just for Christmas – new evidence suggests cranberry juice unlikely to prevent urinary tract infections. Silverman JA, Schreiber HL, Hooton TM, Hultgren SJ. The Jepson et al. Wing DA, Rumney PJ, Preslicka CW, Chung JH. The influences of specific studies on the overall conclusions were also explored. The evidence suggests that cranberry juice has been over-rated as a therapeutic agent for UTIs and that quality is crucial. Overall, however, the RR estimates for rUTI prevention in this subgroup of women are similar across the systematic reviews. Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. If you’re considering cranberry juice for UTI prevention look for a pure, unsweetened … The discussion section in both systematic reviews explored potential reasons that findings by Barbosa-Cesnik et al. Some studies have shown evidence in support of the fact that cranberry juice helps in curbing the adverse effects of UTIs. Many studies reported low compliance and high withdrawal/dropout problems which they attributed to palatability/acceptability of the products, primarily the cranberry juice. Similarly, outcome measures differed in the diagnosis of a UTI (e.g., lower threshold of bacteria for UTI diagnosis) and varied in the timing of UTI assessments (e.g., 6- vs. 12-mo follow-up). Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen RAJr. A lower cutoff used to define UTI may increase the sensitivity but decrease the specificity of a test, which may bias the overall RR of treatment compared with the control/placebo toward a null effect. This article explores the methodological differences that contributed to these disparate findings. When divergent conclusions are drawn from meta-analyses of a similar pool of original trials, it becomes a challenge for clinicians and policymakers to make the most appropriate or relevant recommendations to the public and clinicians. “Consuming 500 mg [X capsules/tablets/soft gels] each day of [this identified cranberry dietary supplement] may help reduce the risk of recurrent urinary tract infection (UTI) in healthy women. This further points out that the biology and clinical relevance should be considered when identifying populations for assessment. However, the calculation of the cost implications was based on participants experiencing more than two UTIs … Generalization of research evidence from high-risk populations to low-risk groups should be avoided to ensure the integrity of guidelines and reduce unwanted harm on patients, which is yet to be enhanced (52). There is moderately-high level evidence that cranberry juice is ineffective in the prevention of UTIs in young sexually-active women, as compared to placebo juice. Some early evidence shows that drinking cranberry juice might lower the risk of kidney stones forming. Misconception: Drinking buckets of cranberry juice can cure, and even prevent bladder, infections. Vasileiou I, Katsargyris A, Theocharis S, Giaginis C. Caljouw MA, van den Hout WB, Putter H, Achterberg WP, Cools HJ, Gussekloo J. Stapleton AE, Dziura J, Hooton TM, Cox ME, Yarova-Yarovaya Y, Chen S, Gupta K. Takahashi S, Hamasuna R, Yasuda M, Arakawa S, Tanaka K, Ishikawa K, Kiyota H, Hayami H, Yamamoto S, Kubo T, et al. Moher D, Liberati A, Tetzlaff J, Altman DG. A Cochrane review found only a small number of poor-quality trials, providing insufficient support to recommend cranberry juice to prevent UTI. There was a small trend towards fewer UTIs in people taking cranberry product compared to placebo or no treatment but this was not a significant finding. Authors provided details on search strategy but not inclusion/exclusion criteria and results of the search strategy. Cranberry juice does not appear to have a significant benefit in preventing UTIs and may be unacceptable to consume in the long term. The literature search identified 83 records (Figure 1), and 9 systematic reviews met the inclusion criteria for the evidence assessment (Table 1). As shown in Table 6, RR values extracted from the Kontiokari et al. On examination of these trials in the reference section of the text … (19) analyses had the same research questions, similar overall inclusion criteria for study selection, and comparable statistical models (Table 3). Inconsistency in meta-analysis methodologies, including clinical (i.e., participants, outcome, and intervention) and methodological heterogeneity (i.e., trial design and execution including i… The overall recurrence rate of UTIs in above study was lower than expected and speculatively, it might be that the active ingredient is simply water. In contrast, a meta-analysis by the Cochrane Collaboration, also published in 2012, concluded that “…cranberry juice is less effective than previously indicated….cranberry juice cannot currently be recommended for the prevention of UTIs” (20). A lot of people swear cranberry works for them. Two authors independently assessed and extracted data. One of the most widely held beliefs about UTIs is that drinking cranberry juice (or taking cranberry supplements) can prevent and get rid of them. Evidence summary. It’s a long-standing adage that drinking cranberry juice can help, but what does the evidence … Beerepoot et al. Wang et al. There also is a large body of clinical trial research in humans using a variety of cranberry products in different patient populations. Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. The 4 studies contributed the majority (53.7%) of total weight to the total RR estimate in Jepson et al., 2012 (20). Our health evidence - how can it help you. Flow diagram of literature search. study (34) were 0.62 (95% CI: 0.34, 1.12) by Jepson et al. This review identified 24 studies (4473 participants) comparing cranberry products with control or alternative treatments. The outcome was cumulative incidence rate of 1 or more UTIs at the end of follow-up period (19, 20). It is believed to have PACs that curb the growth and adherence of the harmful bacteria that are responsible for causing UTIs. Reasons for this nonsignificant RR in Jepson et al. How to manage rUTIs without inducing multidrug resistance in women is an important consideration in clinical practice (6, 7, 9). Key Nutrient Facts Dubbed as a superfruit, a cup of cranberries is loaded with over 8,000 antioxidant capacity as well as important nutrients such as carbohydrates, proteins, calcium, iron, potassium, zinc, B vitamins, vitamin C , vitamin E and vitamin K. Bathing Suits Cause UTIs. Urinary tract infections are the second most common type of infection in U.S. adults, accounting for about 8.1 million visits to health care providers each year. If you have cloudy urine, pelvic pain, or if you … Specifically, a meta-analysis by Wang and colleagues published in 2012 concluded that “cranberry products were associated with protective effects against UTIs (RR: 0.62; 95% CI: 0.49, 0.80), particularly for women with rUTIs (RR: 0.53; 95% CI: 0.33, 0.83)” (19). Traditionally, the cranberry has been used to prevent rUTIs among generally healthy women. Consumers should look for products containing 36 mg of PACs. At present, there is no evidence that cranberry can be used to treat UTIs. The relationship between cranberry juice and UTIs has long been the subject of research. All randomised controlled trials (RCTs) or quasi-RCTs of cranberry products for the prevention of UTIs. In one analysis, populations with pathological/physiological conditions contributed 75.6% of the total weight to the summary risk estimate (RR: 0.86; 95% CI: 0.71, 1.04); another weighted the evidence relatively equally across UTI populations (RR: 0.62; 95% CI: 0.49, 0.80); and a third included only women with recurrent UTIs (RR: 0.53; 95% CI: 0.33, 0.83). The Cochrane reviewers concluded that randomized studies assessing effectiveness of cranberry juice for treatment of UTI have not yet been conducted. No significant herb-drug reactions with cranberry have been re… Cranberry and recurrent cystitis: more than marketing? The current proposed mechanism is plausible and supported by the results of in vitro and preclinical studies. (19) and Beerepoot et al. Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC. A survey of Healthline readers revealed that a majority of people seem to believe cranberry juice can help with a urinary tract infection.About 60 percent who answered the unscientific online poll the past few days said they have had a UTI in the past. Although some of small studies demonstrated a small benefit for women with recurrent UTIs, there were no statistically significant differences when the results of a much larger study were included. Despite similar research questions, the meta-analyses varied in the studies that were included, as well as the data that were extracted. Results from several clinical studies have suggested that cranberries may decrease rUTIs in healthy women (11, 13–16). Cranberry products significantly reduced the incidence of UTIs at 12 mo vs. placebo/control; cranberry products were more effective at reducing the incidence of UTIs in women with rUTIs than in elderly men and women or people requiring catheterization, To assess the effectiveness of cranberry juice and other cranberry products in preventing UTIs in susceptible populations, There is some evidence from 2 good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12-mo period in women; effectiveness of cranberry in other groups, such as children and elderly men and women, is not clear, The elderly in a hospital (mean age: 81 y), Participants with intermittent catheterization, People with neuropathic bladder/spinal injuries, RCTs and quasi-RCTs; comparison of cranberry products vs. placebo, no treatment, or any other treatment; outcomes: incidence of UTIs, Software: Review Manager; random-effects models, RCTs; comparison of cranberry products vs. placebo/nonplacebo control; outcome: incidence of UTIs, Software: R; random-effects models (DerSimonian-Laird method) when, Cranberry-containing products are associated with protective effect against UTIs, Women with recurrent urinary tract infections, People with neuropathic bladder [and spinal injuries in Jepson et al., 2012 (, Participants with catheterization (intermittent or indwelling), 9 studies [excluding Barbosa-Cesnik et al., 2011 (, Number of women with recurrent UTI in 12 mo; total number completing the study, Copyright © 2020 American Society for Nutrition. Schlager TA, Anderson S, Trudell J, Hendley JO. The subpopulation analyses for cranberries and UTIs among healthy women with rUTIs were compared to understand the reason for lack of statistical significance in the Jepson et al. Quality was assessed using the Cochrane risk of bias assessment tool. : CD001321. (27). Information was collected on methods, participants, interventions and outcomes (incidence of symptomatic UTIs, positive culture results, side effects, adherence to therapy). (47) and 1 without. Data included in the meta-analyses showed that, compared with placebo, water or not treatment, cranberry products did not significantly reduce the occurrence of symptomatic UTI overall (RR 0.86, 95% CI 0.71 to 1.04) or for any the subgroups: women with recurrent UTIs (RR 0.74, 95% CI 0.42 to 1.31); older people (RR 0.75, 95% CI 0.39 to 1.44); pregnant women (RR 1.04, 95% CI 0.97 to 1.17); children with recurrent UTI (RR 0.48, 95% CI 0.19 to 1.22); cancer patients (RR 1.15 95% CI 0.75 to 1.77); or people with neuropathic bladder or spinal injury (RR 0.95, 95% CI: 0.75 to 1.20). For example, the FDA has recently published a guidance document “identifying cUTIs, which occur in the presence of a functional or anatomical abnormality of the urinary tract or in the presence of catheterization,” as distinct from uncomplicated UTIs for purposes of research on therapies (51). US Department of Health and Human Services, FDA, Center for Drug Evaluation and Research. More evidence is necessary to recommend its use for clinical indications other than UTI prophylaxis. But consider the … (27). Cranberry juice does not appear to have a significant benefit in preventing UTIs and may be unacceptable to consume in the long term. There also is a large body of clinical trial research in humans using a variety of cranberry products in different patient populations. Foda MM, Middlebrook PF, Gatfield CT, Potvin G, Wells G, Schillinger JF. NA, not applicable (studies were published after the search date); UTI, urinary tract infection. study (47) introduced substantial heterogeneity (I2 = 65% and 59%, respectively). Therefore, conclusions on cranberry and UTIs should consider differences in results across various populations studied when interpreting results from meta-analyses. (20)]. Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). A 2012 Cochrane review concludedthat there was no good evidence to suggest cranberries offer any meaningful benefits: Cranberries (usually as cranberry juice) have been used to prevent urinary tract infections (UTIs). Despite significant heterogeneity with inclusion of the Barbosa-Cesnik et al. Jepson RG, Williams G, Craig JC. Wang et al. (19) report also addressed separate populations in their conclusions, noting that cranberry products appear to be more effective for prevention of rUTIs in women. Overall, 21 studies were identified across all analyses; however, each analysis included only a subset of 2–13 studies. meta-analysis (20) was published as an update of the previous Cochrane analysis from 2008 (21), and yet only 4 of the studies were in common between the 2 analyses. Evidence-based information on cranberry juice and urine infections from hundreds of trustworthy sources for health and social care. This is the third update of our review first published in 1998 and updated in 2004 and 2008. The FDA would accept the following wording for the qualified claim for juices: “Limited and inconsistent scientific evidence shows that by consuming one serving (8 oz) each day of a … (19) ranged from patients with complicated disease conditions to otherwise healthy women to special groups (elderly, children, and pregnant women). This may help prevent bladder and other UTIs. Based on the discussion of scientific evidence, it can be seen that while there is little proof that cranberry juice can treat UTIs, the presence of A-type proanthocyanidins in the fruit helps provide some form of … Ten studies were included in the 2008 update, and 14 studies have been added to this update. Because these recommendations are usually based on the best available evidence including systematic reviews and meta-analysis, how to define the relevant population and to generalize the findings in such systematic reviews may indirectly influence the quality and efficacy of clinical practice. Eleven studies were not included in the meta-analyses because either the design was a cross-over study and data were not reported separately for the first phase, or there was a lack of relevant data. The effectiveness of cranberry was not significantly different to antibiotics for women (RR 1.31, 95% CI 0.85, 2.02) and children (RR 0.69 95% CI 0.32 to 1.51). To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. These differences were due to the selection of outcome measures at different time points (i.e., at 6- vs. 12-mo follow-up). (19) analyses (Table 2). The … The present review was conducted to characterize the status of evidence-based assessments on the use of cranberry and prevention of rUTIs in healthy women. The methodological challenges discussed in the present review are consistent with literature in a broader context of clinical practice guidelines. To our knowledge, this is the first assessment of evidence-based systematic reviews on cranberries and the prevention of rUTIs, with evaluation of methodological discrepancies between the high profile meta-analyses. Most notably, the populations influencing the conclusions varied. At present, there is no evidence that cranberry can be used to treat UTIs. In its purest form, cranberry juice can definitely help fight UTI as well as many other health problems. Differences in selection of studies in 5 different analyses1. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. 4 Cranberry products (juice, tablets, or capsules) are not routinely recommended to reduce the incidence of recurrent UTI. The review found no evidence from studies about the effects of cranberry juice or other cranberry products on UTIs. Among the generally healthy population, the risk of having an uncomplicated UTI is ∼50 times higher in adult women than in adult men (3). Structural heterogeneity of a human norovirus vaccine candidate. “Laboratory studies have shown the anti-adhesion activity of cranberry … Art. (47), in the analysis of the use of cranberry to treat women with rUTIs (Supplemental Table 1). Traditionally, the cranberry has been used to prevent rUTIs among generally healthy women. DOI: 10.1002/14651858.CD001321.pub5, Copyright © 2020 The Cochrane Collaboration. 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