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Effects of Inulin on Lipid Parameters in Humans -- Williams 129 (7): 1471 -- Journal ...

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(Journal of Nutrition. 1999;129:1471S-1473S.)


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1999 The American Society for Nutritional Sciences
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Christine M. Williams Download to citation manager

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Hugh Sinclair Unit of Human Nutrition, Department of Food
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Science and Technology, University of Reading, Reading,
Articles by Williams, C. M.
RG6 6AP

ABSTRACT
TOP
Convincing lipid-lowering effects of the fructooligosaccharide ABSTRACT
inulin have been demonstrated in animals, yet attempts to INTRODUCTION
Lipid responses to inulin...
reproduce similar effects in humans have generated conflicting Lipid responses to inulin...
results. This may be because of the much lower doses used in Mechanism of lipid-lowering in...
CONCLUSION
humans as a result of the adverse gastrointestinal symptoms REFERENCES
exhibited by most subjects consuming daily doses in excess of 30
g. Two studies that fed either oligofructose (20 g/d) or inulin (14 g/d) observed no effect on fasting
total, LDL or HDL cholesterol, or serum triglycerides. Two other studies that fed inulin either in a
breakfast cereal (9 g/d) or as a powdered addition to beverages and meals (10 g/d) reported similar
reductions in fasting triglycerides (-27 and -19%, respectively). In one of these studies, total and
LDL cholesterol concentrations were also modestly reduced (5 and 7%, respectively). Because
animal studies have identified inhibition of hepatic fatty acid synthesis as the major site of action for
the triglyceride-lowering effects of inulin, and because this pathway is relatively inactive in humans
unless a high carbohydrate diet is fed, future attempts to demonstrate lipid-lowering effects of inulin
should consider the nature of the background diet as a determinant of response.

KEY WORDS: inulin triglycerides human trials

INTRODUCTION
Inulin is a natural storage oligomer of fructose found in many TOP
ABSTRACT
plants, including onion, garlic, leek, chicory and artichoke. Daily INTRODUCTION
intake from these sources is estimated to be in the region of 212 Lipid responses to inulin...

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g/d in the Western diet (Roberfroid 1993 ). Oligofructoses Lipid responses to inulin...
(OFS) 2 of varying chain lengths can be obtained from inulin by Mechanism of lipid-lowering in...
CONCLUSION
enzymatic hydrolysis. Because of their gelling and thickening REFERENCES
properties, both inulin and OFS are useful as food ingredients
and have found widespread application in recent years in items such as bread, processed cheese and
dairy products (Dyssler and Hoffem 1995 ); in addition, they may hold the promise of health
benefits. Dramatic reductions in serum triglycerides have been reported in rats consuming relatively
high doses of OFS, although reductions in cholesterol have been seen only with long-term feeding
(Delzenne et al. 1993 , Fiordaliso et al. 1995 ). Recent studies have shown the effects on serum
triglycerides to be due to reduced secretion of VLDL particles from the liver and to be associated
with reduced activity and gene expression of the key regulatory enzyme, fatty acid synthetase (Kok
et al. 1996a and 1996b ). Although the data obtained from animal studies suggest convincing
lipid-lowering properties of OFS, much less information is available from human studies, in which
the doses that can be applied are much lower than those that have been used to elicit effects in
animals.

Lipid responses to inulin and OFS in subjects with raised


blood lipids
TOP
Subjects with non insulin-dependent diabetes (NIDDM) who ABSTRACT
were administered 8 g OFS (Neosugar) in a packed coffee drink INTRODUCTION
Lipid responses to inulin...
or coffee jelly for 14 d exhibited an 8% reduction in total, and a Lipid responses to inulin...
10% reduction in LDL cholesterol, compared with a control Mechanism of lipid-lowering in...
CONCLUSION
group given sucrose in the same food vehicles (Yamashati et al. REFERENCES
1984 ). No effects on other serum lipids or on blood glucose
concentrations were observed. Similar reductions in blood lipids were reported to have been
observed in a group of Japanese subjects with hyperlipidemia (Hidaka et al. 1986 ), but no data
were shown to support this conclusion. More recently, Davidson et al. (1998) in a randomized
crossover trial in subjects with modest hyperlipidemia, showed significantly lower total and LDL
concentrations during the inulin (Raftiline) phase compared with the placebo phase, but the authors
reported no effects on HDL cholesterol or serum triglyceride concentrations.

Lipid responses to inulin and OFS in normal subjects


TOP
Although studies conducted in normal subjects are few in ABSTRACT
number, they are generally well designed and include respectable INTRODUCTION
Lipid responses to inulin...
numbers of subjects. Luo and co-workers (Luo et al.1996 ) Lipid responses to inulin...
investigated effects of Neosugar OFS (20 g/d) fed as 100-g Mechanism of lipid-lowering in...
CONCLUSION
cookies in a randomized crossover design with treatment periods REFERENCES
of 4 wk. Sucrose was used as placebo. No changes in serum
triglycerides, cholesterol or apolipoproteins were observed in either the treatment or placebo periods,
although there was a strong trend in the reduction of free fatty acid (FFA) concentrations with OFS.
In contrast, Canzi et al. (1995) observed significantly lower triglyceride and cholesterol
concentrations in young male volunteers who consumed 9 g inulin (Raftiline) added to a rice

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breakfast cereal for a period of 4 wk. The study was a randomized sequential design with a placebo
period (rice cereal) followed by a test period (rice cereal plus inulin). Total cholesterol and LDL
cholesterol levels were reduced by 5 and 7%, respectively, with the inulin treatment compared with
the placebo. Fasting triglyceride concentrations were reduced by 27% during inulin treatment and
remained significantly lower 4 wk after the end of the inulin phase. In the group as a whole (test and
control periods), strong and significant associations were observed between fecal secondary bile
acids and serum cholesterol (P < 0.05) and, most notably, triglycerides (P < 0.001).

Pedersen et al. (1997) reported no effect on blood lipids of a daily intake of 14 g inulin added to a
low fat spread for a period of 4 wk. The study was a double-blind randomized cross over design in 66
young healthy women. Although HDL cholesterol and the LDL:HDL cholesterol ratio were lower at
the end of both the control and test (inulin) periods, there were no significant differences in blood
lipids between placebo and inulin. Although this was a rigorously designed study, the fact that
subjects were required to consume 40 g of spread per day (30 g/d fat) (approximately twice the
normal level of spread intake and 50% of total fat intake for young women) may have contributed to
the negative findings observed in this group. As discussed below, triglyceride-lowering with inulin
may be more likely if the background diet is high in carbohydrate rather than fat.

In a recently conducted study, 58 middle-aged subjects with moderately raised blood lipid
concentrations consumed 10 g/d of inulin (Raftiline) or placebo in a powdered form that could be
added to beverages, soups or cereal (Jackson et al. 1998 ). The study was a double-blind parallel
control design with equal numbers of subjects allocated to placebo and inulin groups using stratified
randomization. Subjects consumed the inulin or placebo products for 8 wk with fasting blood
samples collected at baseline, 4 and 8 wk of intervention and 4 wk after the end of feeding. There
were no significant changes in total, LDL or HDL cholesterol or apolipoproteins B and A in either of
the groups over the 8-wk intervention, although 4 wk after the intervention, total and LDL
cholesterol levels were lower than at baseline in the placebo group. Serum triglycerides were 19%
lower at 8 wk than at baseline in the inulin-treated group (Fig. 1 ) and values were significantly
lower than in controls (P < 0.05). Baseline triglyceride values were identical in the two groups and
did not contribute to the lower values found in the inulin group at 8 wk. Serum triglycerides returned
to baseline values 4 wk after treatment ended. A number of factors may have contributed to the
positive findings for effects of inulin on serum triglycerides in this study. Subjects were chosen for
their modestly raised triglyceride values at baseline, and the study was conducted over a longer
period than any of the previous human studies. This appears to be of particular importance because,
like the other studies, no significant differences in fasting serum lipids were seen at 4 wk, but
significantly lower triglyceride values were observed at 8 wk. The method of dietary intervention
used was simple, designed to ensure optimal compliance and to prevent confounding changes in
intakes of other nutrients or foods that might complicate the interpretation of the findings. Although
there were important changes in serum triglycerides in the group as a whole, it should be noted that
not all subjects showed a positive response to inulin feeding; in ~25% of subjects, there were no
alterations in serum triglycerides, either at 4 or 8 wk. This lack of response may reflect individual
differences in responsiveness to inulin, variations in background diet or lack of compliance to the
product. Individual variation may also explain why, in a subgroup of subjects who undertook
evaluation of postprandial lipid and glucose responses to standard meals, there were no significant
differences in postprandial plasma triglycerides at 8 wk compared with baseline in inulin-treated

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subjects. Fasting and postprandial FFA levels were significantly lower 8 wk after inulin treatment
compared with baseline. However, lower fasting (but not postprandial) FFA were also observed at 8
wk in the placebo group.

Figure 1. Fasting plasma triglycerides in subjects (n =


27/group) receiving either inulin (10 g/d, Raftiline) or
placebo (10 g/d, maltodextrin) for 8 wk with follow-up
measurement at 12 wk. Reproduced with permission from
Jackson et al. (1998) .

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Mechanism of lipid-lowering in response to OFS and


inulin in humans
TOP
Further studies are required to determine whether there are ABSTRACT
consistent lipid-lowering effects of inulin and OFS in humans. INTRODUCTION
Lipid responses to inulin...
Present data suggest that in subjects with hyperlipidemia, any Lipid responses to inulin...
effects that do occur result primarily in reductions in cholesterol, Mechanism of lipid-lowering in...
CONCLUSION
whereas in normal subjects, effects on serum triglycerides are the REFERENCES
dominant feature. This latter response is similar to that observed
in animals, in which effects of cholesterol are small, and has been suggested to reflect reduced
secretion of VLDL particles secondary to inhibition of de novo fatty acid synthesis. If this
mechanism is also the effect that operates in humans and is responsible for the reduced triglyceride
concentration observed in the two human studies reported above, it may also explain why such
effects are difficult to demonstrate in humans. The high levels of fat present in the diet of most
humans mean that rates of de novo fatty acid synthesis are low or nonexistent because exogenous
dietary fatty acids are used as the substrate for triglyceride VLDL synthesis (Aarsland et al. 1996 ).
In humans, drugs and dietary fatty acids that reduce serum triglycerides appear to increase
triglyceride clearance and fatty acid oxidation; they also divert fatty acids into hepatic phospholipid
synthesis, rather than inhibit de novo fatty acid synthesis. These observations suggest that attempts to
address the putative triglyceride-lowering properties of inulin and OFS should use subjects
consuming a high background dietary carbohydrate intake. Investigations conducted in subjects with
NIDDM would be of particular value because in these individuals, triglyceride rather than cholesterol
is the primary lipid abnormality seen, and a high carbohydrate diet is used as a standard dietary
approach in the treatment of NIDDM.

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CONCLUSION
TOP
Although convincing lipid-lowering effects of inulin and OFS ABSTRACT
have been observed in animals, the studies have used relatively INTRODUCTION
Lipid responses to inulin...
high levels; equivalent doses could not be used in humans Lipid responses to inulin...
because of known adverse gastrointestinal side effects at intake Mechanism of lipid-lowering in...
CONCLUSION
levels >30 g/d. Studies that have investigated effects of inulin REFERENCES
and OFS in humans are few in number, although those that have
been conducted are well designed and include relatively large numbers of subjects. The studies used
varying levels of supplementation; (920 g/d) with a variety of inulin-enriched foods used to increase
daily intakes. In studies conducted in normal subjects, two reported no effects of inulin or OFS on
serum lipids, whereas two others reported significant reductions in serum triglycerides (-19 and -
27%) with more modest changes in serum total and LDL cholesterol. Future studies that aim to
investigate effects of inulin or OFS on serum lipids should consider the choice of subjects, the
duration of the study and the levels of fat and carbohydrate in the background diet as important
variables that may influence outcome.

FOOTNOTES
1
Presented at the conference Nutritional and Health Benefits of Inulin and Oligofructose held May
1819, 1998 in Bethesda, MD. This symposium was supported in part by educational grants from the
National Institutes of Health Office of Dietary Supplements, the U.S. Department of Agriculture and
Orafti Technical Service. Published as a supplement to The Journal of Nutrition. Guest editors for the
symposium publication were John A. Milner, The Pennsylvania State University, and Marcel
Roberfroid, Louvain University, Brussels, Belgium.

2
Abbreviations used: FFA, free fatty acids; NIDDM, noninsulin-dependent diabetes mellitus; OFS,
oligofructose.

REFERENCES
TOP
ABSTRACT
1. Aarsland A., Chinkes D., Wolfe R. R. Contributions of de INTRODUCTION
novo synthesis of fatty acids to total VLDL-triglyceride secretion Lipid responses to inulin...
Lipid responses to inulin...
during prolonged hyperglycemia/hyperinsulinemia in normal Mechanism of lipid-lowering in...
man. J. Clin. Investig. 1996;98:2008-2017 CONCLUSION
[Abstract/Free Full Text] REFERENCES

2. Canzi. E., Brighenti, F., Casiraghi, M. C., Del Puppo, E. & Ferrari, A. (1995) Prolonged
consumption of inulin in ready to eat breakfast cereals: effects on intestinal ecosystem, bowel habits
and lipid metabolism. Cost 92. Workshop on Dietary Fiber and Fermentation in the Colon, 15:17/04.
Helsinki, Finland.

3. Davidson M. H., Synecki C., Maki K. C., Drennan K. B. Effects of dietary inulin in serum lipids
in men and women with hypercholesterolemia. Nutr. Res. 1998;3:503-517

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4. Delzenne N., Kok N., Fiordaliso M., Deboyser D., Goethals F., Roberfroid M. Dietary
fructooligosaccharides modifies lipid metabolism in rats. Am. J. Clin. Nutr. 1993;57:820S(abs.)

5. Dyssler P., Hoffem D. Inulin, an alternative dietary fibre. Properties and quantitative analysis. Eur.
J. Clin. Nutr. 1995;49:S142-S152

6. Fiordaliso M. F., Kok N., Desager J. P., Goethals F., Deboyser D., Roberfroid M., Delzenne N.
Dietary oligofructose lowers triglycerides, phospholipids and cholesterol in serum and very low
density lipoproteins of rats. Lipids 1995;30:163-167[Medline]

7. Hidaka H., Eida T., Takizawa T., Tokunaga T., Tashiro Y. Effects of fructooligosaccharides on
intestinal flora and human health. Bifid. Microflora 1986;5:37-50

8. Jackson, K. G., Taylor, G.R.J., Clohessy, A. M., Luff, J. E., Thomas, C. M. & Williams, C. M.
(1999) The effect of a daily ingestion of inulin on fasting and postprandial lipid metabolism in
middle aged men and women. Proc. Nutr. Soc. (in press).

9. Kok N., Roberfroid M., Delzenne N. Involvement of lipogenesis in the lower VLDL secretion
induced by oligofructose in rats. Br. J. Nutr. 1996;76:881-890[Medline]

10. Kok N., Roberfroid M., Delzenne N. Dietary oligofructose modifies the impact of fructose on
hepatic traiacylglycerol metabolism. Metabolism 1996;45:1547-1550[Medline]

11. Luo J., Rizkalla S. W., Alamowitch C., Boussairi A., Blayo A., Barry J.-L., Laffitte A., Guyon
F., Bornet F.R.J., Slama G. Chronic consumption of short-chain fructooligosaccharides by healthy
subjects decreased basal hepatic glucose production but had no effect on insulin-stimulated glucose
metabolism. Am. J. Clin. Nutr. 1996;63:939-945[Abstract]

12. Pedersen A., Sandstrom B., Van Amelsvoort J.M.M. The effect of ingestion of inulin on blood
lipids and gastrointestinal symptoms in healthy females. Br. J. Nutr. 1997;78:215-222[Medline]

13. Roberfroid M. Dietary fiber, inulin and oligofructose: a review comparing their physiological
effects. Crit. Rev. Food Sci. Nutr. 1993;33:102-148

14. Yamashita K., Kawai K., Itakura M. Effects of fructo-oligosaccharides on blood glucose and
serum lipids in diabetic subjects. Nutr. Res. 1984;4:961-966

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