A Systematic Review of Randomized Controlled Trials, Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies, Intake of Various Food Groups and Risk of Breast Cancer: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies, http://www.nutrition.org/publications/guidelines-and-policies/license/, Receive exclusive offers and updates from Oxford Academic. 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 … “Laboratory studies have shown the anti-adhesion activity of cranberry … At present, there is no evidence that cranberry can be used to treat UTIs. Art. Previous studies also provide evidence that cranberry derivatives are effective against UTIs. The outcome was incidence of UTIs at 12 mo (21). The addition of 14 further studies suggests that cranberry juice … Two authors independently assessed and extracted data. Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC. Beerepoot et al. The overall recurrence rate of UTIs … Terms: (1) beverage, cranberry, fruit beverage, fruit drink, fruit juice, To assess the effectiveness of cranberry in preventing UTIs in susceptible populations. Here’s where things get murky, though — like, blood-in-your-urine murky. Among the generally healthy population, the risk of having an uncomplicated UTI is ∼50 times higher in adult women than in adult men (3). The main reporting used in the analysis was without Barbosa-Cesnik et al. Schlager TA, Anderson S, Trudell J, Hendley JO. Other preparations (such as powders) need to be quantified using standardised methods to ensure the potency, and contain enough of the 'active' ingredient, before being evaluated in clinical studies or recommended for use. UTI, urinary tract infection. Risk ratios (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Cranberries and UTIs have been evaluated in evidence-based systematic reviews and meta-analyses, but instead of providing clarity on the efficacy of the cranberry for prevention of rUTIs, these systematic reviews have resulted in conflicting conclusions. A Cochrane review found only a small number of poor-quality trials, providing insufficient support to recommend cranberry juice to prevent UTI. Withdrawal of cranberry juice from people who benefited resulted in recurrence in 61%. A lot of people swear cranberry works for them. Cranberry products (such as tablets or capsules) were also ineffective (although had the same effect as taking antibiotics), possibly due to … Repetitive use of antibiotics, however, is recognized as a factor in the development of multidrug resistance bacteria and recently is reported to affect the human commensal microbiota (7, 8). (20), Wang et al. To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. cranberry juice is beneficial in 73% of male and female UTI subjects. Cranberries (usually as cranberry juice) have been used to try and treat UTIs, particularly in high risk groups such as older people. During the development of primary care recommendations both in Europe and in the United States, the relevance of evidence to patient subgroups is deemed to be a challenge (52). Wang et al. All randomised controlled trials (RCTs) or quasi-RCTs of cranberry products for the prevention of UTIs. study (47). The Jepson et al. (20) and Wang et al. Half said their doctor had recommended drinking cranberry juice to treat or prevent the infection.About 72 percent said they have used cranberry juice to help with a UTI. (19) ranged from patients with complicated disease conditions to otherwise healthy women to special groups (elderly, children, and pregnant women). “Cranberry juice, especially the juice concentrates you find at the grocery store, will not treat a UTI or bladder infection,” said Dr. Timothy Boone in a statement.“It can offer more hydration and possibly wash bacteria from your body more effectively, but the active ingredient in cranberry is long-gone by the time it reaches your bladder.” Cranberry juice is the liquid juice of the cranberry, typically manufactured to contain sugar, water, and other fruit juices.Cranberry – a fruit native to North America – is recognized for its bright red color, unique, tart taste; and versatility for product manufacturing. The comparison/control arms were placebo, no treatment, water, methenamine hippurate, antibiotics, or lactobacillus. 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). 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). Both concluded that there was insufficient evidence to recommend the use of cranberry in treating UTIs, although some weak research did offer support for cranberry juice in preventing UTIs. Therefore, conclusions on cranberry and UTIs should consider differences in results across various populations studied when interpreting results from meta-analyses. We searched the Cochrane Renal Group's Specialised Register (4 June 2013) through contact with the Trials' Search Co-ordinator using search terms relevant to this review.We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies. In this comparison, it was noted that different values were extracted from 1 of the studies that was included in Jepson et al. It is interesting that the Cochrane analysis was an update of a 2008 report that resulted in a conclusion similar to that derived by Wang et al., indicating a shift in the conclusions from this group (20, 21). Inconsistency in meta-analysis methodologies, including clinical (i.e., participants, outcome, and intervention) and methodological heterogeneity (i.e., trial design and execution including inclusion/exclusion criteria), can lead to varying results and interpretations, as appears to have been the case here. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. Cranberries have historically been associated with urinary tract health, particularly among women with rUTIs (10–12). Both Jepson et al. Ten studies were included in the 2008 update, and 14 studies have been added to this update. Early reviews on the cranberry and UTIs have noted that efficacy was observed in clinical trials assessing prevention of rUTIs in generally healthy women, but not against cUTIs or as a treatment for UTIs (11, 13). 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. As shown in Table 6, RR values extracted from the Kontiokari et al. 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. Guidance for Industry, US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, A review of clinical practice guidelines found that they were often based on uncertain relevance to primary care patients, This is a free access article, distributed under terms (, Nut Consumption for Cognitive Performance: A Systematic Review, Does Personalized Nutrition Advice Improve Dietary Intake in Healthy Adults? DOI: 10.1002/14651858.CD001321.pub5, Copyright © 2020 The Cochrane Collaboration. Cranberry juice does not appear to have a significant benefit in preventing UTIs and may be unacceptable to consume in the long term. (20) and Wang et al. Augmentation with Atypical Antipsychotics for Treatment-Resistant Depression. It is uncertain whether it is effective in other susceptible groups. Cranberries for preventing urinary tract infections. (47) and 1 without. In our comparison, more similarity in results was present among uncomplicated UTI subgroups, which helps explain the null effects reported in the Jepson et al. And lab studies have found chemicals called proanthocyanidins in cranberries can stop E. coli (the bug that causes most urinary infections) from sticking to the lining of the urinary tract. 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 … Although the analysis by Wang et al. Because women with recurrent UTIs are the group to whom most recommendations regarding cranberry consumption is directed, inclusion of other groups in the efficacy assessment could influence clinical practice quality. Care should be taken when recommending cranberry for long-term use in patients who are known urinary oxalate stone formers. Jepson RG, Williams G, Craig JC. Because the significance of RR estimates in the Kontiokari et al. These data suggest inclusion of groups with different pathophysiologic status (e.g., cUTIs) could modify the strength of overall risk estimates accorded to generally healthy at-risk populations. (19) and 0.61 (95% CI: 0.40, 0.91) by Jepson and Craig (21). There is some evidence from four good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12‐month period, particularly in women with recurrent UTIs. Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Jernberg C, Löfmark S, Edlund C, Jansson JK. As shown in Table 4, people with neuropathic bladder or spinal injuries and radiotherapy patients contributed 30.3% of the total weight to the overall RR estimate, whereas women with rUTIs contributed only 24.5% of the total weight. Urinary tract infections (UTIs)6 are the second most common infection of any organ system and the most common urological disease in the United States, with a total annual cost of >$3.5 billion (1). No. study (47) introduced substantial heterogeneity (I2 = 65% and 59%, respectively). An evidence assessment was performed on the selected reports that evaluated the efficacy of the cranberry for rUTI prevention in women with rUTIs. NA, not applicable (studies were published after the search date); UTI, urinary tract infection. Steel N, Abdelhamid A, Stokes T, Edwards H, Fleetcroft R, Howe A, Qureshi N. Supported by Ocean Spray Cranberries, Inc. In its purest form, cranberry juice can definitely help fight UTI as well as many other health problems. 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). : CD001321. study (34) in Jepson et al., 2012 (20), Wang et al., 2012 (19), and Beerepoot et al., 2013 (27). Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). We use cookies to improve your experience on our site. 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. In fact, as Susan Scutti reports for CNN, a 2012 review of 24 studies totalling 4,473 participants found little evidence of positive effects, and concluded that cranberry juice "cannot be recommended for the prevention of UTIs". US Department of Health and Human Services, FDA, Center for Drug Evaluation and Research. (19) and Beerepoot et al. Cranberries (usually as cranberry juice) have been used to prevent urinary tract infections (UTIs). 1 However, 2 recent randomized studies, not included in the Cochrane review, found that women taking cranberry juice have fewer symptomatic UTIs. 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. RCTs or quasi-RCTs; cranberry products for the prevention of UTIs in all populations; studies men, women, or children susceptible to UTI; excluded studies on treatment of UTIs; excluded studies on UTIs not caused by bacterial infection; outcomes: incidence of UTIs. Results from several clinical studies have suggested that cranberries may decrease rUTIs in healthy women (11, 13–16). More evidence is necessary to recommend its use for clinical indications other than UTI prophylaxis. The reviews were not systematic and came to … (19) reported substantial heterogeneity with inclusion of 1 specific study by Barbosa-Cesnik et al. On the other hand, some counter this argument. Cranberry and recurrent cystitis: more than marketing? Cranberry has been effective in vitro and in vivo in animals for the … (20), only 1 included women with rUTIs [because this was only a letter without additional data, it was excluded from Jepson et al. This is particularly important for women with uncomplicated rUTIs who have developed antimicrobial resistance. Evidence summary. 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. The methodological challenges discussed in the present review are consistent with literature in a broader context of clinical practice guidelines. 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). 4 In general, studies in people who are at increased risk for UTIs or those who have had recurrent UTIs show that cranberry products decrease the risk of UTIs by about one-third. (47) were different from other studies, including a lower threshold for UTI diagnosis (103 cfu/mL compared to a common threshold: 105 cfu/mL). Litwin MS, Saigal CS, Yano EM, Avila C, Geschwind SA, Hanley JM, Joyce GF, Madison R, Pace J, Polich SM, et al. (20) also found a similar trend for a reduction in RR in the same group, it was not statistically significant (RR = 0.74; 95% CI: 0.42, 1.31). Despite significant heterogeneity with inclusion of the Barbosa-Cesnik et al. study (34) differed at the 6- and 12-mo follow-up, such inconsistency in the timing of outcome measurements could influence the strength of the summary RR estimates in the meta-analyses. Inadequately addressing issues such as clinical heterogeneity in studies used in a meta-analysis may contribute to increased variability in the summary effect estimates and lead to different conclusions. FDA has concluded that there is limited scientific evidence … Some studies have found that drinking cranberry juice or taking cranberry pills can prevent UTIs, especially in women who are at risk for these infections. Terms summarized for comparison of scope or search. (19), and Beerepoot et al. Overall, however, the RR estimates for rUTI prevention in this subgroup of women are similar across the systematic reviews. Thus far, there … Wang et al. This updated review comes from the well-respected Cochrane Collaboration and its results are likely to be reliable. With this new qualified health claim in hand, cranberry beverages that meet FDA’s content threshold requirement can feature a product claim like: “Limited and inconsistent scientific evidence shows that by consuming one serving (8 oz) each day of a cranberry juice beverage, healthy women who have had a urinary tract infection (UTI… Why Does Cranberry Juice Help UTI? 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