Cranberry has been effective in vitro and in vivo in animals for the prevention of UTI. “There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period… the large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time… not clear what is the optimum dosage or method of administration… further properly designed studies with relevant outcomes are needed.” Step 2: … This is a free access article, distributed under terms (http://www.nutrition.org/publications/guidelines-and-policies/license/) that permit unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. RR (cranberry vs. placebo/control) by subgroup in 3 meta-analysis reviews1. (19) noted that the inclusion of the Barbosa-Cesnik et al. Approximately 1 dozen clinical trials have been performed testing the effects of cranberries on the urinary tract. 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. This is particularly important for women with uncomplicated rUTIs who have developed antimicrobial resistance. Infections are localized to the bladder (cystitis), renal parenchyma (pyelonephritis) or prostate (acute or chronic bacterial prostatitis). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Most notably, the populations influencing the conclusions varied. The methodological challenges discussed in the present review are consistent with literature in a broader context of clinical practice guidelines.  |  Although results from a number of clinical studies have been published supporting its benefits, the efficacy of the cranberry on prevention of rUTIs remains controversial, in part because of conflicting conclusions from meta-analyses. Supplemental Data and Supplemental Table 1 are available from the “Online Supporting Material” link in the online posting of the article and from the same link in the online table of contents at http://advances.nutrition.org. Beerepoot et al. 2020 Jun;35(6):1821-1829. doi: 10.1007/s11606-020-05745-x. At present, there is no evidence that cranberry can be used to treat UTIs. Carey MR, Vaughn VM, Mann J, Townsend W, Chopra V, Patel PK. Moher D, Liberati A, Tetzlaff J, Altman DG. The literature search identified 83 records (Figure 1), and 9 systematic reviews met the inclusion criteria for the evidence assessment (Table 1). The Jepson et al. In this comparison, it was noted that different values were extracted from 1 of the studies that was included in Jepson et al. Jepson 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). Aydin A, Ahmed K, Zaman I, Khan MS, Dasgupta P. Jernberg C, Löfmark S, Edlund C, Jansson JK. 2018 May 2;18(1):29. doi: 10.1186/s12894-018-0342-7. Similar research designs with conflicting conclusions1. Cranberry juice and cystitis have been traditionally linked, but is it all a big myth or is there some convincing evidence behind it all? Clinical trial registries include Cochrane Controlled Trials Registry (CCTR), CENTRAL, clinitrials.gov, and the International Clinical Trials Register (ICTR). Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Salo J, Uhari M, Helminen M, Korppi M, Nieminen T, Pokka T, Kontiokari T. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Sengupta K, Alluri KV, Golakoti T, Gottumukkala GV, Raavi J, Kotchrlakota L, Sigalan SC, Dey D, Ghosh S, Chatterjee A. Cowan CC, Hutchison C, Cole T, Barry SJ, Paul J, Reed NS, Russell JM. Citing Literature. Micali S, Isgro G, Bianchi G, Miceli N, Calapai G, Navarra M. Eells SJ, Bharadwa K, McKinnell JA, Miller LG. Unfortunately, most clinical trials have had design deficiencies and none have evaluated specific key cranberry-derived compounds considered likely to be active moieties (e.g. 2006 Jan;79(1):125-33 Table 5 compares the RR estimates by subgroup in the meta-analyses by Jepson et al. 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). Evidence was not conclusive in other groups. The proposed thought is that it can block the adherence of UTI-causing bacteria to the epithelial cells in the urinary tract. 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. Commentary on: Wang CH, Fang CC, Chen NC, et al. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. In 2020, the U.S. Food and Drug Administration announced that it would permit manufacturers to claim on product labels that there is “limited” evidence that daily consumption of specified amounts of cranberry dietary supplements may reduce the risk of recurrent UTI in healthy women who have had a UTI. A cornerstone of prevention of UTI recurrence has been the use of low-dose once-daily or post-coital antimicrobials; however, much interest has surrounded non-antimicrobial-based approaches undergoing investigation such as use of probiotics, vaccines, oligosaccharide inhibitors of bacterial adherence and colonization, and bacterial interference with immunoreactive extracts of Escherichia coli. This study does bring some credibility to the anecdotal evidence that cranberry juice can be used in the treatment of urinary tract infections. The 4 studies contributed the majority (53.7%) of total weight to the total RR estimate in Jepson et al., 2012 (20). Both Jepson et al. These studies also do not show any apparent harm from such products, though the risks seen in humans may only be evident with long-term use. Both Jepson et al. Proanthrocyanidins have anti-adhesive properties that make it harder for bacteria to stick to the walls and tissue within the urinary tract. (19) reported a reduction in heterogeneity to I2 = 43% when the study was excluded. In addition, recurrent UTIs are also common, occurring in up to one-third of women after first-episode UTIs. Does include noncranberry and non–UTI-related terms. 1  (20) and 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. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The … 2020 Apr 30;11:504. doi: 10.3389/fphar.2020.00504. study (47) introduced substantial heterogeneity (I2 = 65% and 59%, respectively). There is still room for additional research to be carried out in this area before we can definitively state that there are benefits to be derived. Epub 2020 Sep 18. Evidence-based information on cranberry urinary health from hundreds of trustworthy sources for health and social care. The effectiveness of cranberry products to reduce urinary tract infections in females: a literature review, A systematic review of the evidence for cranberries and blueberries in UTI prevention, Recurrent urinary tract infections among women: comparative effectiveness of 5 prevention and management strategies using a Markov chain Monte Carlo model, Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials, Cranberries for preventing urinary tract infections, Reduction of bacteriuria and pyuria after ingestion of cranberry juice, Reduction of bacteriuria and pyuria using cranberry juice [letter], Efficacy of cranberry in prevention of urinary tract infection in a susceptible pediatric population, Cranberry concentrate: UTI prophylaxis [letter], Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization, Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women, A doubleblind, randomized, placebo-controlled trial of cranberry supplements in multiple sclerosis, A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women, Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury. Study results on the benefits of cranberry for UTI prophylaxis have been mixed. USA.gov. 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. (47), in the analysis of the use of cranberry to treat women with rUTIs (Supplemental Table 1). (20) and Wang et al. Xiong S, Liu X, Deng W, Zhou Z, Li Y, Tu Y, Chen L, Wang G, Fu B.  |  The evidence for the beneficial effects of cranberry juice on UTIs is mixed, however. 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). Wang et al. Standard checklists, including Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), have been developed to evaluate the evidence quality that is linked to clinical recommendations, clarify meta-analysis methodology, and minimize possible bias (28, 50). Standardised high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women [PACCANN]: a double blind randomised controlled trial protocol. 2012 Oct 17;10(10):CD001321. McMurdo ME, Bissett LY, Price RJ, Phillips G, Crombie IK. 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. (19) further conducted a sensitivity analysis that identified the study by Barbosa-Cesnik et al. The addition of 14 further studies suggests that cranberry juice is less effective than previously indicated. 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. Walker EB, Barney DP, Mickelsen JN, Walton RJ, Mickelsen RAJr. -, Clin Pharmacol Ther. This mini-review examined the evidence available using a simple search on an internet-based resource designed to make evidence readily available to practitioners in the South Eastern NHS regions of the UK. 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. Urology 2001;57:407-13. -, Eur J Clin Nutr. RR was for participants with a history of recurrent lower UTIs or women with a UTI. Terms summarized for comparison of scope or search. (19) and Beerepoot et al. However, these trials suffer from a number of limitations. The discussion section in both systematic reviews explored potential reasons that findings by Barbosa-Cesnik et al. Authors provided details on search strategy but not inclusion/exclusion criteria and results of the search strategy. [Rational antimicrobial therapy - recommendations for common infections]. Single UTI episodes are very common, especially in adult women where there is a 50-fold predominance compared with adult men. This significant reduction was not seen when UTIs were confirmed by urine culture (19.8% versus 24.0%; very low quality evidence). Women with rUTIs represent a clinically relevant population, particularly because the alternative choices other than antibiotics are very limited and cranberry prophylaxis seems to be promising. A double-blind, placebo-controlled trial, Spinal-injured neuropathic bladder antisepsis (SINBA) trial, Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal cord injured patients with neurogenic bladder, Cranberry for UTI prevention in residents of long term care facilities (PACS) [Internet], Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study, Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children, Efficacy of cranberry juice for the prevention of urinary tract infections in pregnancy [abstract], Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial, Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial, A randomized, double blind, controlled, dose dependent clinical trial to evaluate the efficacy of a proanthocyanidin standardized whole cranberry (Vaccinium macrocarpon) powder on infections of the urinary tract, A randomised double-blind placebo controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Complicated urinary tract infections: developing drugs for treatment. (20) (RR: 0.86; 95% CI: 0.71, 1.04) was heavily influenced by results from studies in populations with complicated UTIs (cUTIs), particularly patients with neuropathic bladder, spinal cord injury, and radiotherapy. 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. Withdrawal rates have been quite high (up to 55%), suggesting that these products may not be acceptable over long periods. Cranberry capsules lowered the risk of UTIs by 50%. There is no universally accepted definition, but most clinicians would classify recurrent UTI as being two episodes of infection in six months, or three episodes in one year.1 The annual incidence of a single UTI is 30 per 1000 women,2 with 44% experiencing recurrence within 12 months.3 #### When … Eyes on Evidence December 2012 1 Cranberry products for the prevention of urinary tract infections Two large reviews evaluated the use of cranberry containing products for the prevention of urinary tract infections. Epub 2020 Jul 7. Please enable it to take advantage of the complete set of features! The overall conclusion on totality of evidence made by Jepson et al. (20) and 0.44 (95% CI: 0.21, 0.93) by both Wang et al. Free Online Library: Evidence based practice review: cranberry for urinary tract infection prophylaxis in children at risk of recurrent UTI. Cochrane Database Syst Rev. (27) (not shown) only assessed cranberry compared with placebo in women with rUTIs and reported the RR to be 0.53 (95% CI: 0.33, 0.83) Although Jepson et al. CENTRAL, Cochrane Central Registry of Controlled Trials; PAC, proanthocyanidin; RCT, randomized controlled trial; rUTI, recurrent urinary tract infection; UTI, urinary tract infection. 2016 Jun;103(6):1434-1442. (20)]. Cranberry products in a variety of formulations have also undergone extensive evaluation over several decades in the management of UTIs. Drinking cranberry juice is just one of the myths about preventing and treating urinary tract infections (UTIs). Clipboard, Search History, and several other advanced features are temporarily unavailable. Consumption of cranberry juice to prevent UTIs is actually very well-studied. Molecules. A lot of people swear cranberry works for them. (47) as an outlier and excluded this study from the analysis on which their final conclusion was based. eCollection 2020. The outcome was incidence of UTIs at 12 mo (21). Terms: (1) beverage, cranberry, fruit beverage, fruit drink, fruit juice, To assess the effectiveness of cranberry in preventing UTIs in susceptible populations. RCT, randomized clinical trial; UTI, urinary tract infection. Over the years, there has been conflicting evidence to support the use of cranberry juice in UTI prevention. 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. (20) and Wang et al. 2020 Feb 17;25(4):881. doi: 10.3390/molecules25040881. 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. (20) are discussed below. Some people find pure cranberry juice a bit sour, so if you only drank it for your health and not for the taste, it may be time to switch to a tastier alternative. (20) did not exclude this study, mainly because of its large sample size, whereas Wang et al. This further points out that the biology and clinical relevance should be considered when identifying populations for assessment. In the 2 most comprehensive systematic reviews, heterogeneity was handled differently, leading to an I2 of 65% in one and 43% in the other. Lee BB, Haran MJ, Hunt LM, Simpson JM, Marial O, Rutkowski SB, Middleton JW, Kotsiou G, Tudehope M, Cameron ID. The results of the study showed that there is some evidence to support the use of cranberry in reducing the number of symptomatic UTIs over a 12-month period, particularly in women who experience recurrent infections. The guidelines state that there is very little evidence to suggest that drinking cranberry juice will reduce the risk of developing UTIs, and 'no evidence' that it will cure cystitis. In terms of efficacy assessment of the cranberry on UTI prevention, population definition is a key methodological element for consideration in performing a meta-analysis. Traditionally, the cranberry has been used to prevent rUTIs among generally healthy women. 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. The active ingredients in cranberries prevent bacteria from adhering to the bladder wall. NA, not applicable; UTI, urinary tract infection. The comparisons on methodologies included inclusion/exclusion criteria, extracted data, and statistical methods. Cranberry juices and supplements have been used for UTI prophylaxis, but with variable efficacy. In the cranberry treatment group, 19% of patients developed a UTI, compared with 38% of the placebo group. 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. Recent scientific studies show it’s likely that cranberry tablets reduce the instances of UTIs. Only 2 studies were included in all analyses (Table 2), with another 5 studies included in both the Jepson et al. Hence, the focus has been on its use as a preventative strategy. 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). -, J Altern Complement Med. Wang CH, Fang CC, Chen NC, Liu SS, Yu PH, Wu TY, Chen WT, Lee CC, Chen SC. Recurrences requiring intervention are usually defined as two or more episodes over 6 months or three or more episodes over 1 year (this definition applies only to young women with acute uncomplicated UTIs). There has long been an interest in the use of cranberry, usually as a juice, to prevent and treat urinary tract infections (UTI). Further evidence suggests that the mechanism involves proanthrocyanidins, a type of polyphenol compound found in cranberries. A British January 2008 Cochrane Database Systematic Review of 10 studies reported that cranberry had value in preventing UTIs in women with a history of recurrent UTI 6. The identified meta-analyses from the literature search were selected for further detailed review. Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. (27). They also noted that th… -. “Limited scientific evidence shows that by consuming 500 mg each day of cranberry dietary supplement, healthy women who have had a urinary tract infection (UTI) may reduce their risk of recurrent UTI.” To date, the cranberry juice and supplement qualified health claim is the only one granted in 2020. (19) report also addressed separate populations in their conclusions, noting that cranberry products appear to be more effective for prevention of rUTIs in women. This site needs JavaScript to work properly. There is, however, some evidence that a daily 'dose' of cranberry juice may reduce the risk of recurrent urinary tract infection. Not all cranberry products contain enough active proanthocyanidins (PACs) for clinical efficacy. But consider the … Cochrane Database Syst Rev. The most recent update, in 2013, analyzed 24 studies and found that there was no statistically significant improvement in symptomatic UTIs from consuming cranberry juice. 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. 2020 Oct;20(4):3399-3406. doi: 10.3892/etm.2020.8970. Despite significant heterogeneity with inclusion of the Barbosa-Cesnik et al. (19) reported substantial heterogeneity with inclusion of 1 specific study by Barbosa-Cesnik et al. Maki KC, Kaspar KL, Khoo C, et al. The studies done so far do not show any evidence of efficacy for cranberry products in the prevention of UTI in dogs. Cranberries contain 2 compounds with antiadherence properties that prevent fimbriated Escherichia coli from adhering to uroepithelial cells in the urinary tract. NIH 2020;6(1):64. doi: 10.1186/s43094-020-00086-2. Searching for the term “cranberry” reveals a hit, however, the conclusion suggests weakness in the evidence base (in 2008): [3] “There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period… the large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time…  |  Arch Intern Med 2012;172:988–96. What does the research tell us? Exp Ther Med. (19) and Beerepoot et al. study (34) were 0.62 (95% CI: 0.34, 1.12) by Jepson et al. Just remember that even natural juices can contain a lot of sugar, so be mindful of moderating your consumption. Evidence summary. However, there is not much evidence to support that a glass of cranberry juice a day will keep the UTI away. Proanthrocyanidins have anti-adhesive properties that make it harder for bacteria to stick to … A literature search was conducted to identify eligible systematic reviews and meta-analyses to be included in this assessment (see Supplemental Data). However, problems still exist with standardization of cranberry products, which makes it extremely difficult to compare products or extrapolate results. Is Non-Steroidal Anti-Inflammatory Therapy Non-Inferior to Antibiotic Therapy in Uncomplicated Urinary Tract Infections: a Systematic Review. Despite these guidelines toward the best evidence syntheses, the presence of substantial heterogeneity in systematic reviews has made it a challenge for health care professionals and policymakers to apply such nonspecific findings (50). Aug. 23, 2010 -- Scientists report that within eight hours of drinking cranberry juice, the juice could help prevent bacteria from developing into an infection in the urinary tract. Search results Jump to search results. The outcome was cumulative incidence rate of 1 or more UTIs at the end of follow-up period (19, 20). Cranberry and recurrent cystitis: more than marketing? (27), to compare cranberry products to placebo/control on UTI incidence. In general, the preventive efficacy of cranberry has been variable and modest at best. It is pretty clear from this research that cranberry is not an effective treatment for UTI in humans.8There is, however, less clarity regarding the efficacy of cranberry products in preventing UTI. A prospective, double-blinded, placebo-controlled, crossover study, Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal cord injury, Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? Antioxidant-Rich polyphenols 18 this comparison, it was noted that the inclusion of the has... Findings by Barbosa-Cesnik et al selection of studies in 5 different analyses1 ; (. 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