Moralejo Review Cranberry Products May Prevent Full Text2008

• Loading metrics

Open Access

Peer-reviewed

Research Article

Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis

• Jia-yue Xia,
• Chao Yang,
• Deng-feng Xu,
• Hui Xia,
• Li-gang Yang,
• Gui-ju Lord's day

ten

• Published: September ii, 2021
• https://doi.org/x.1371/journal.pone.0256992

Figures

Abstract

The efficacy of cranberry (Vaccinium spp.) as adjuvant therapy in preventing urinary tract infections (UTIs) remains controversial. This study aims to update and determine cranberry furnishings as adjuvant therapy on the recurrence rate of UTIs in susceptible groups. According to PRISMA guidelines, nosotros conducted a literature search in Web of Science, PubMed, Embase, Scopus, and the Cochrane Library from their inception dates to June 2021. We included articles with data on the incidence of UTIs in susceptible populations using cranberry-containing products. We then conducted a trial sequential analysis to control the risk of type I and type Two errors. This meta-analysis included 23 trials with 3979 participants. Nosotros plant that cranberry-based products intake can significantly reduce the incidence of UTIs in susceptible populations (chance ratio (RR) = 0.70; 95% confidence interval(CI): 0.59 ~ 0.83; P<0.01). Nosotros identified a relative adventure reduction of 32%, 45% and 51% in women with recurrent UTIs (RR = 0.68; 95% CI: 0.56 ~ 0.81), children (RR = 0.55; 95% CI: 0.31 ~ 0.97) and patients using indwelling catheters (RR = 0.49; 95% CI: 0.33 ~ 0.73). Meanwhile, a relative take chances reduction of 35% in people who use cranberry juice compared with those who utilise cranberry capsule or tablet was observed in the subgroup assay (RR = 0.65; 95% CI: 0.54 ~ 0.77). The TSA result for the effects of cranberry intake and the decreased hazard of UTIs in susceptible groups indicated that the effects were conclusive. In conclusion, our meta-assay demonstrates that cranberry supplementation significantly reduced the risk of developing UTIs in susceptible populations. Cranberry can be considered as adjuvant therapy for preventing UTIs in susceptible populations. Yet, given the limitations of the included studies in this meta-assay, the conclusion should be interpreted with caution.

Citation: Xia J-y, Yang C, Xu D-f, Xia H, Yang 50-g, Dominicus G-j (2021) Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis. PLoS One 16(9): e0256992. https://doi.org/ten.1371/periodical.pone.0256992

Editor: Frank T. Spradley, University of Mississippi Medical Center, UNITED STATES

Received: June 20, 2021; Accepted: Baronial xix, 2021; Published: September 2, 2021

Copyright: © 2021 Xia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Information Availability: All relevant data are within the manuscript and its Supporting information files.

Funding: The author(s) received no specific funding for this piece of work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Urinary tract infections (UTIs) are among the near prevalent bacterial infections in the customs, outpatient and inpatient facilities, affecting about 150 million people annually [i]. By and large, UTIs can be categorized into complicated and simple, or as upper (pyelonephritis) and lower (confined to the bladder). According to U.Due south. Centers for Disease Control and Prevention, UTIs cause about xiii,000 deaths each twelvemonth [two]. Bacteriuria is a typical feature of UTI, with a high prevalence amidst young people and an age-related increment in both men and women [1]. Until the historic period of 60 years and older, the prevalence of bacteriuria is significantly higher in women than in men [3]. Adult women, in particular, are susceptible to UTIs, with nearly xx% to 30% of women with an infection experiencing recurrence [4]. Other populations with a loftier risk of UTIs include pregnant women, children, elderly patients, participants with indwelling catheters, and patients with neuropathic bladder [5, half-dozen].

Cranberries (Vaccinium macrocarpon), originated in New Zealand, are rich in complex phytochemical compositions, such equally A-type proanthocyanidins (PACS), anthocyanins, benzoic acid and ursolic acid [7]. Escherichia coli, a primary pathogen involved in UTIs, is reported to be prevented from adhering to uroepithelial cells past PACs contained in cranberries in the urinary tract [8, ix]. Co-ordinate to several recent consensus and guidelines on UTI management, the efficacy of cranberry supplementation every bit an adjuvant therapy has not yet reached a definitive conclusion on preventing and treating UTIs, and the quality of evidence was low. Therefore, information technology is necessary to assess the effects of cranberry intake on the incidence of UTIs in susceptible groups.

In 2012, Jepson et al. [6] conducted a systematic review of cranberry intake equally adjuvant therapy for preventing and treating UTIs, and it was concluded that cranberry products failed to significantly reduce the occurrence of UTIs when compared with placebo or control groups. Additionally, a meta-analysis included 28 clinical studies in 2017 demonstrated that cranberry intake is associated with preventing UTIs, and that supplementing cranberry-based products provides a beneficial effect on reducing the incidence of UTIs [10]. However, few previous studies evaluated the effects of cranberry and UTIs in susceptible populations. Additionally, the efficacy of cranberry intake in preventing UTIs in susceptible individuals is yet not conclusive.

Some new relevant trials with inconsistent conclusions on using cranberry to prevent and care for UTIs accept recently been published. The trial sequential assay (TSA) method was applied to command the inflation of blazon I error rates. We, therefore, conducted an updated systematic review and meta-analysis with TSA to evaluate the effects of cranberry intake every bit adjuvant therapy for preventing and treating UTIs in susceptible populations.

Materials and methods

Ethics statement

There was no need for upstanding approval since all included studies in this systematic review of meta-assay were officially published in a peer-reviewed journal.

Literature search strategy

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted [11]. Relevant literature was identified through searching systematically in June 2021 in the following v electronic databases: Spider web of Science, PubMed, Embase, Scopus and Cochrane Library. Search terms included cranberry, Vaccinium macrocarpon, Vaccinium microcarpum, Vaccinium oxycoccus, Vaccinium erythrocarpum AND Urinary Tract Infection(s), UTI, bacteriuria, pyelonephritis, cystitis, pyuria, dysuria, Escherichia coli, and coli, without language restrictions. Additionally, the reference lists of the eligible manufactures were further manually retrieved by the reviewers to recognize potentially relevant studies. Data extraction was performed by two reviewers independently (J. Y. X. and C. Y.). Any disagreements were resolved by discussion or, if needed, by consultation with a third review writer (X. H.). The details of the search strategy are shown in S1 Table.

Inclusion and exclusion criteria

Two review authors (J. Y. 10. and C. Y.) independently extracted the study data of the eligible manufactures from the literature search. Original studies were included if they met the following inclusion criteria:(1) study design was limited only to randomized controlled trial; (2) For the intervention used, we only include trials which compared cranberry-containing products to a placebo or non-placebo control group; (3) outcomes which tin can exist calculated or reported as the number of participants experiencing a UTI; (iv) The study susceptible populations included participants with recurrent UTIs, elderly men and women, pregnant women, children, participants with indwelling catheter, and participants with neuropathic bladder. The following exclusion criteria were used: (one) the trials whose intervention independent cranberry in combination with some other bioactive compound; (2) studies that clearly did not adhere to the aforementioned inclusion criteria; (iii) creature studies, instance reports, reviews, conference papers, editorials, and studies with insufficient data. Any discrepancy upon inclusion or exclusion of the report was resolved by word among the authors (J. Y. X., C. Y. and X. H.).

Data extraction and methodological assessment

The cumulative incidence of participants with recurrent urinary tract infection(southward) was used for pooled gamble ratio estimates. Two authors (J. Y. Ten. and C. Y.) extracted detailed information of written report methodology, characteristics of participants, intervention details, and outcomes reported. We assumed the incidence of UTI as the prespecified chief outcome, which was expressed as either incidence or cumulative incidence rate. Trials which compared cranberry-based products to a placebo or non-treatment control were included. Quality assessment of included studies was performed based on the Cochrane Risk of Bias tool [12], and the tool covers seven domains (random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome cess, incomplete outcome data, selective outcome reporting and other bias) and each item was scored equally "high run a risk," "depression risk," or "unclear" for all selected studies.

Data synthesis and analysis

Meta-analyses were performed by using Stata SE (fifteen.0) and R (5 four.0.iii). Statistical significance was divers as P < 0.05 (2-sided). Data were calculated as hazard ratios with 95% confidence interval (95% CI). Heterogeneity within studies was assessed past means of the I^two metrics and chi-square statistics, either I² >l% or p value of χ² test <0.x was considered as statistically significant heterogeneity. We applied a stock-still-effect model past Mantel-Haenszel to estimate the summary risk if the heterogeneity was low to moderate (I² < 50%). Otherwise, the random-effects model by DerSimonian and Laird method was used [13]. We conducted subgroup analyses by prespecified covariates, including study design, report analysis, risk of random sequence generation, handling in control grouping, population blazon, historic period, form of cranberry-containing products, and dose frequency used. A Galbraith plot was constructed to identify potential outlier studies. Funnel plot and egger's regression were drawn to graphically evaluate publication bias, and a 'trim and fill' analysis was used to further observe the stability of results if in that location is whatever asymmetry in funnel plot [14].

Trial Sequential Analysis (TSA)

In society to control the take a chance of type I and type 2 errors, a trial sequential analysis method was conducted on the incidence of UTIs. We performed TSA software (version 0.nine.five.10 beta) to arrange CIs due to sparse data and echo testing on the cumulative meta-assay. If the cumulative Z-bend crosses the TSA monitoring purlieus, or enters the Required Information Size line, the result tin be concluded that a business firm decision tin exist reached and no further studies are needed [15]. TSA was performed at the level of an overall 5% risk of a type I error and with 80% ability.

Results

Search results and trial characteristics

A period diagram for included trials is shown in Fig i. A full of 3431 articles were identified initially with the search strategy from five electronic databases, of which 3217 were removed later reviewing championship and abstracts, including 1916 duplications. And and then, 214 full-text trials were retrieved for farther information; of those, 186 studied were excluded for the following reasons: 140 for review articles, 31 for not bachelor full manufactures, 15 for non-randomized controlled trials. Finally, eight trials were excluded for not existence expressed as incidence rate and 3 of the 20 included studies were each divided into two trials. The study by Caljouw et al. was divided since information technology included participants at high and low UTI risk [17]. Stothers used two ways of orally administering cranberry-based products, that is cranberry tablets and cranberry juice [16]. Fly et al. administered two doses of PACs, including a high dose (240 mg PACs per day) and a low dose (fourscore mg PACs per day) [18]. Therefore, xx-three trials with sufficient data were eligible for inclusion into the final meta-analysis.

In this systematic review, we identified twenty-eight trials that were eligible for qualitative synthesis. There were 24 parallel-group and 4 crossover group (S2 Table). All of these crossover trials had no washout periods. Nineteen trials were conducted according to the intention-to-treat principle, and 9 trials used per-protocol analysis. Twelve trials did non provide their randomization information, and suffered from a loftier charge per unit of participants lost to follow-upwardly (0%-48%). In addition, ix trials had loftier reporting bias (S3 Table).

There were 4699 subjects included in the qualitative analysis (S4 Table). Of the 28 trials, 16 were performed in North America (U.s. and Canada), 5 were conducted in Europe (United kingdom of great britain and northern ireland, Finland, and Italy), 2 were performed in the Kingdom of the netherlands, and 5 split studies from Japan, Taiwan (China), India, Czech republic and Turkey. The vast majority of studies followed subjects from Hospital clinic. According to the characteristics of included study subjects, the written report population were further categorized into half-dozen different subgroups: women with recurrent UTIs, neuropathic bladder, children, pregnant patients, elderly patients and patients with indwelling catheters.

Characteristics of interventions of the included trials are summarized in S5 Table. Cranberry-containing products differed remarkably in cranberry form, manufacturer, daily dosage, PAC content, and dosing frequency. Fifteen trials administered cranberry juice, whereas one trial used both cranberry juice and cranberry tablets, and twelve trials used cranberry capsules. Eleven trials used cranberry-based products from the manufacturer Body of water Spray. Daily cranberry amount ranged from 0.4 to 194.4g and the actual cranberry amount was not reported in the eleven trials. Xx-three trials used a formula placebo, whereas 5 trials did not used a placebo.

Differences were virtually notable in the definitions of UTI (S6 Table). Clinical symptoms to ascertain UTI were required in most trials, and the baseline bacteriuria were non excluded in xviii trials; In addition, the thresholds of bacteriuria ranged from ≥x^three to ≥ten⁵ CFU/mL. The presence of UTI symptoms was not required in eleven trials. Because there were no reliable biological detection methods to examine the compliance of subjects, well-nigh studies utilize indirect methods for purpose. These included periodic interviews, self-reported questionnaires and recording the number of remaining pills. In most trials, the occurrence of UTI was expressed equally incidence or cumulative incidence. In that location were four trials for which nosotros were unable to summate and obtain cumulative incidence, and iv trials did not provide specific number of events. Finally, 8 trials were excluded, and a total of twenty-three trials were further analyzed in quantitative synthesis.

Quantitative data synthesis

Data on UTI cumulative incidence included 3979 participants across the 23 trials [xvi–35], with 1978 in the cranberry intervention groups and 2001 in the placebo or control groups. At that place was moderate heterogeneity across trials (RR = 0.70; 95% CI: 0.59 ~ 0.83; Iⁱⁱ = 48%) (Fig 2). The Galbraith plot showed that the trials by Ferrara et al. [25], Caljouw et al. [17] and Barbosa-Cesnik et al. [26] were potential sources of heterogeneity (Fig iii). Influential plot further demonstrated that these three trials [17, 25, 26] had significant impact on the pooled summary guess (Fig 4), justifying its exclusion from the main analysis. Afterwards exclusion of these iii trials, heterogeneity decreased from 48% to six% (RR = 0.62; 95% CI: 0.54 ~ 0.79; I² = 6%; P = 0.39) (Fig 5). The results suggested that the trials past Ferrara et al. [25], Caljouw et al. [17] and Barbosa-Cesnik et al. [26] may contribute to the source of heterogeneity.

Fig 3. Galbraith plot.

There are 3 statistical outliers, A, B and C, which represent the trials past Ferrara et al., Barbosa-Cesnik et al., and Caljouw et al. (b) Low UTI run a risk, respectively. And there is a statistical extreme signal, D, which stand for the trial by Caljouw et al. (a) High UTI take chances.

https://doi.org/ten.1371/journal.pone.0256992.g003

Fig 5. Woods plot: Summary effect of cranberry in prevention of urinary tract infection afterward excluding three possible sources of heterogeneity, expressed every bit gamble ratio (RR).

West(fixed) indicates weights in fixed-effect Mantel-Haenszel model.

https://doi.org/10.1371/journal.pone.0256992.g005

Cranberry ingestion effects

According to all included twenty-three studies, the estimated weighted risk ratio significantly reduced in the take a chance of recurrent UTIs with cranberry intervention compared to placebo or command (RR = 0.70, 95% CI:0.59 ~ 0.83; P<0.01). At that place was a moderate degree of heterogeneity (I² = 48%). TSA resulted in a required information size of iii,823, which was reached, and the cumulative Z-bend crossed the boundaries (Fig 6). Therefore, it was possible to reach a conclusion with no demand for further boosted trials. The application of the TSA of cranberry-containing products ingestion on the incidence of UTIs in susceptible populations was strengthening the conclusions accomplished.

Subgroup and sensitivity analyses

A subgroup analysis was conducted to assess the influence of population type, mean patient age, course of cranberry-containing products, and dose frequency on the effectiveness of cranberries in the prevention of UTIs. The effects of cranberry intake on UTIs in subgroup based on characteristics of subjects and interventions are summarized in Fig 7. Although the previous evidence indicated that cranberries may reduce UTIs overall [twenty, 32], the subgroup assay showed that compared with placebo or command, cranberries did non significantly decrease recurrent UTIs in some of the subgroups, including patients with neuropathic bladder (RR = 0.80; 95% CI:0.57 ~ i.14), significant patients (RR = 0.79; 95% CI:0.37 ~ 1.67) and elderly patients (RR = 0.89; 95% CI:0.75 ~ ane.05).

Additionally, a sensitivity assay was performed to judge the influence of each individual study on pooled RRs. we did not find a relatively change, which indicated that the summary pooled approximate was stable to study characteristics, treatment in control group and definitions of UTIs (S7 Table). On the whole, the sensitivity analysis revealed that the findings of our meta-analysis were robust.

Publication bias

In this meta-assay, A funnel plot was used to evaluate the publication bias qualitatively, and Egger'south regression were used to judge the publication bias quantitatively. Visual scanning of funnel plot suggested no asymmetry with Egger'southward regression test (t = -ane.34, p-value = 0.1956) (Fig 8). Results did not signal evidence of publication bias.

Give-and-take

Our meta-analysis results revealed a 30% reduction in the take a chance of developing UTI in susceptible populations who consumed cranberry-containing products than those who did not (RR = 0.seventy; 95% CI: 0.59 ~ 0.83; I² = 48%). We conducted a subgroup analysis to determine the source of heterogeneity. Moreover, we performed meta-regression to explore the potential sources of heterogeneity; however, no statistically pregnant sources of heterogeneity were identified. The influential and Galbraith plots indicated that three studies were the primary sources of heterogeneity [17, 25, 26], and they may explain some unknown heterogeneity.

Barbosa-Cesnik et al. [26] concluded that cranberry juice has no protective consequence against UTIs in women compared to those using a placebo(RR = i.43; 95% CI: 0.87 ~ 2.33). Two potential reasons may account for this study's divergence. First, unlike previous studies, Barbosa-Cesnik et al. [26] defined UTI using the lowest bacteriuria threshold, which is not less than chiliad colony-forming units [CFU]/mL. According to Kontiokari et al. [20], who used a higher bacteriuria threshold (100,000 CFU/mL), cranberry juice provided positive effects on lowering the recurrence of UTIs. Second, we found that the morbidity of UTIs in the control group in the trial by Barbosa-Cesnik et al. [26] was significantly lower than that in the trial by Kontiokari et al. [xx]. Barbosa-Cesnik et al. [26] argued that placebo containing ascorbic acid, might be benign to prevent UTI. For the trial by Ferrara et al. [25], they concluded that iii treatment arms are among children aged 3–14 years, and children recruited in this study did not meet the original inclusion criteria. In add-on, compared to the trial past Salo et al. [28], the intervention amount of cranberry is relatively at a high dose, resulting in a meaning difference between the incidence rate of cranberry intervention and control or placebo groups. In the report by Caljouw et al. [17], they evaluated the effectiveness of cranberry capsules amid vulnerable elderly. The results indicated that for residents with a loftier hazard of UTI at baseline, taking cranberry capsules twice daily tin can significantly lower the incidence rate of clinically defined UTI. A possible reason in our assay for the heterogeneity is that this written report used 2 different criteria for defining UTI, which was distinctly different from that in others studies. When nosotros extracted aggregate data from this report, some errors volition be unavoidable. Still, it remains unknown whether the population studied in the trial past Ferrara et al. [25], Barbosa-Cesnik et al. [26] and Caljouw et al. [17] were markedly different in other aspects from other trials in our meta-analysis.

Our meta-analysis results exhibit some similarities with previous studies. Co-ordinate to Wang et al. [36] and Jepson et al. [6], consuming cranberry-containing products provided beneficial effects on preventing UTIs. Still, Jepson et al. [6] suggested that the do good of cranberry-containing products might be limited in some subgroups, mostly for women with recurrent UTI, and might be absent in most population groups. We ended that supplementing cranberry may be beneficial in preventing and treating UTIs in susceptible populations, particularly for women with recurrent UTIs (RR = 0.68; 95% CI: 0.56 ~ 0.81), children (RR = 0.55; 95% CI: 0.31 ~ 0.97) and patients using indwelling catheters (RR = 0.49; 95% CI: 0.33 ~ 0.73).

Our sensitivity analysis revealed that our findings remained stable across report designs, placebo controls, and definitions, and that the outcome estimate did not change significantly when the 3 studies were excluded (RR = 0.62; 95% CI: 0.54 ~ 0.79; I² = 6%). We conducted a subgroup assay to explore potential sources of heterogeneity, and discovered no significant sources of heterogeneity between subgroups of age, different individuals, cranberry forms, and dose frequency.

Cranberry in juice form was observed to be more than effective than cranberry capsule or tablets in the subgroup analysis. The antibacterial activity of cranberry juice may be due to the intake of large amount of liquid. This issue in our analysis might be because people who consuming cranberry juice were ameliorate hydrated than those using cranberry capsules or tablets. Additionally, since the precise mechanism of the protective issue of cranberries against UTIs is still not fully elucidated, the better preventive issue of cranberry juice, to some extent, might exist due to the condiment or synergistic effect of other withal unknown substances in the juice. However, a large volume of cranberry juice with high sugar content may cause severe gastrointestinal symptoms or other agin effects, as observed by Wing et al. [18], who had to modify their treatment regimens to allow less frequent dosing to maintain compliance and avert early withdrawal. All the same, although these adverse effects are a concern, until the exact mechanism backside the protective effects of cranberries confronting UTIs is conspicuously comprehended, use of cranberry in juice grade might be more favorable than cranberry in capsules or tablets.

The present systematic review and meta-analysis with TSA indicate that cranberry intake can prevent UTIs in susceptible populations. However, although European Association of Urology recommends regular consumption of cranberries as a nutritive method to effectively prevent UTIs, the data from relevant studies are inconclusive because few available studies lasted longer than a year. As a effect, at that place is bereft evidence to support the efficacy of cranberry products in clinical use. Future studies should continue to be performed for a longer period.

The treatment effect of cranberry products may depend on their PAC concentration. Currently, the well-nigh recognized mechanism past which cranberry can prevent UTIs usually involves its interference with bacterial adhesion in the urinary tract [37]. Cranberry consumption can cause an antiadhesion response in urine. If leaner are unable to adhere to cells, they cannot grow and crusade infection [37].

This meta-analysis possessed several strengths. Our study examined the efficacy of cranberry-containing products in susceptible populations and used trial sequential analysis to determine whether the evidence for cranberry consumption preventing UTIs in susceptible populations is sufficient. Additionally, it was performed and reported based on current guidelines [38, 39], and comprised an evaluation of results employing numerous sensitivity analyses, as well as investigation of the risk of bias using an updated assessment tool. In addition, there were potential limitations to our review.: starting time, bereft data in several included studies caused certain limitations. Nosotros attempted to contact the authors three times but were unable to obtain any pertinent information. Second, ane study used a mixture of juice concentrate including cranberry juice and lingonberry juice [20]. Lingonberry (Vaccinium visit-idaea) and Cranberry would almost likely incorporate like phytochemical composition, so the observed beneficial effects may not be entirely attributed to cranberry alone. Tertiary, there was lack of in-consistency among the doses of PACs used in the included studies. The daily recommended intake of PACs, to decrease the number of recurrent UTIs, is non lower than 36 mg, and inconsistent dosages betwixt dissimilar studies may crusade different outcomes.

Decision

In summary, evidence from our updated meta-analysis indicated that cranberry supplementation significantly reduced the incidence of occurring UTIs in susceptible populations. Furthermore, cranberry may be considered as a promising adjuvant therapy for preventing UTIs in susceptible individuals. Even so, due to some limits of the included trials in this review, the conclusion therefore should be interpreted with caution. Farther loftier-quality studies with appropriate large sample size are required to verify our results.

Supporting data

Acknowledgments

Nosotros sincerely thank all support from all authors.

References

1. i. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(v):269–84. Epub 2015/04/09. pmid:25853778.
   • View Article
   • PubMed/NCBI
   • Google Scholar
2. 2. Kumar MS, Das AP. Emerging nanotechnology based strategies for diagnosis and therapeutics of urinary tract infections: A review. Adv Colloid Interface Sci. 2017;249:53–65. Epub 2017/07/03. pmid:28668171.
   • View Article
   • PubMed/NCBI
   • Google Scholar
3. 3. Johnson CC. Definitions, nomenclature, and clinical presentation of urinary tract infections. Med Clin Due north Am. 1991;75(ii):241–52. Epub 1991/03/01. pmid:1996031.
   • View Article
   • PubMed/NCBI
   • Google Scholar
4. four. Foxman B, Chocolate-brown P. Epidemiology of urinary tract infections: transmission and chance factors, incidence, and costs. Infect Dis Clin Northward Am. 2003;17(ii):227–41. Epub 2003/07/x. pmid:12848468.
   • View Article
   • PubMed/NCBI
   • Google Scholar
5. 5. Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775–807. Epub 2009/05/xvi. pmid:19441868.
   • View Article
   • PubMed/NCBI
   • Google Scholar
6. 6. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;ten(x):Cd001321. Epub 2012/10/nineteen. pmid:23076891.
   • View Article
   • PubMed/NCBI
   • Google Scholar
7. seven. Pappas E, Schaich KM. Phytochemicals of cranberries and cranberry products: label, potential health effects, and processing stability. Crit Rev Nutrient Sci Nutr. 2009;49(nine):741–81. Epub 2010/05/06. pmid:20443158.
   • View Article
   • PubMed/NCBI
   • Google Scholar
8. 8. Ermel G, Georgeault South, Inisan C, Besnard M. Inhibition of adhesion of uropathogenic Escherichia coli bacteria to uroepithelial cells by extracts from cranberry. J Med Nutrient. 2012;xv(ii):126–34. pmid:22082066.
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
9. 9. Sunday J, Marais JPJ, Khoo C, LaPlante Yard, Vejborg RM, Givskov M, et al. Cranberry () oligosaccharides decrease biofilm germination by uropathogenic. J Funct Foods. 2015;17:235–42. pmid:26613004.
   • View Commodity
   • PubMed/NCBI
   • Google Scholar
10. ten. Luís Â, Domingues F, Pereira Fifty. Tin Cranberries Contribute to Reduce the Incidence of Urinary Tract Infections? A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Clinical Trials. J Urol. 2017;198(3):614–21. pmid:28288837.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
11. 11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4). pmid:19622511.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
12. 12. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. pmid:22008217.
    • View Article
    • PubMed/NCBI
    • Google Scholar
13. 13. George BJ, Aban IB. An application of meta-assay based on DerSimonian and Laird method. Journal of Nuclear Cardiology. 2016;23(4):690–2. pmid:26245193
    • View Article
    • PubMed/NCBI
    • Google Scholar
14. 14. Duval South, Tweedie R. Trim and fill up: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63. Epub 2000/07/06. pmid:10877304.
    • View Article
    • PubMed/NCBI
    • Google Scholar
15. xv. Wetterslev J, Jakobsen JC, Gluud C. Trial Sequential Assay in systematic reviews with meta-analysis. BMC Med Res Methodol. 2017;17(1):39. Epub 2017/03/08. pmid:28264661.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
16. 16. Stothers Fifty. A randomized trial to evaluate effectiveness and price effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol. 2002;9(3):1558–62. pmid:12121581.
    • View Article
    • PubMed/NCBI
    • Google Scholar
17. 17. Caljouw MAA, van den Hout WB, Putter H, Achterberg WP, Cools HJM, Gussekloo J. Effectiveness of cranberry capsules to prevent urinary tract infections in vulnerable older persons: a double-blind randomized placebo-controlled trial in long-term intendance facilities. J Am Geriatr Soc. 2014;62(1):103–10. pmid:25180378.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
18. 18. Wing DA, Rumney PJ, Preslicka CW, Chung JH. Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study. J Urol. 2008;180(4):1367–72. pmid:18707726.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
19. 19. Schlager TA, Anderson Due south, Trudell J, Hendley JO. Effect of cranberry juice on bacteriuria in children with neurogenic bladder receiving intermittent catheterization. J Pediatr. 1999;135(six):698–702. pmid:10586171.
    • View Article
    • PubMed/NCBI
    • Google Scholar
20. 20. Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ. 2001;322(7302):1571. pmid:11431298.
    • View Article
    • PubMed/NCBI
    • Google Scholar
21. 21. McGuinness SD, Krone R, Metz LM. A Double-Blind, Randomized, Placebo-Controlled Trial of Cranberry Supplements in Multiple Sclerosis. Journal of Neuroscience Nursing. 2002;34(ane):4–vii. 01376517-200202000-00002.
    • View Article
    • Google Scholar
22. 22. Waites KB, Canupp KC, Armstrong South, DeVivo MJ. Effect of cranberry extract on bacteriuria and pyuria in persons with neurogenic bladder secondary to spinal string injury. J Spinal String Med. 2004;27(1):35–40. pmid:15156935.
    • View Article
    • PubMed/NCBI
    • Google Scholar
23. 23. McMurdo MET, Bissett LY, Price RJG, Phillips G, Crombie IK. Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in infirmary? A double-blind, placebo-controlled trial. Age Ageing. 2005;34(three):256–61. pmid:15863410.
    • View Article
    • PubMed/NCBI
    • Google Scholar
24. 24. Hess MJ, Hess PE, Sullivan MR, Nee M, Yalla SV. Evaluation of cranberry tablets for the prevention of urinary tract infections in spinal string injured patients with neurogenic bladder. Spinal Cord. 2008;46(9):622–6. pmid:18392039.
    • View Article
    • PubMed/NCBI
    • Google Scholar
25. 25. Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children. Scand J Urol Nephrol. 2009;43(5):369–72. pmid:19921981.
    • View Article
    • PubMed/NCBI
    • Google Scholar
26. 26. Barbosa-Cesnik C, Brownish MB, Buxton K, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23–30. pmid:21148516.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
27. 27. Sengupta M, Alluri KV, Golakoti T, Gottumukkala GV, Raavi J, Kotchrlakota Fifty, et al. 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. Current Bioactive Compounds. 2011;7:39–46.
    • View Commodity
    • Google Scholar
28. 28. Salo J, Uhari Thousand, Helminen M, Korppi M, Nieminen T, Pokka T, et al. Cranberry juice for the prevention of recurrences of urinary tract infections in children: a randomized placebo-controlled trial. Clin Infect Dis. 2012;54(3):340–6. pmid:22100577.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
29. 29. Takahashi South, Hamasuna R, Yasuda M, Arakawa S, Tanaka Thousand, Ishikawa K, et al. A randomized clinical trial to evaluate the preventive outcome of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother. 2013;19(1):112–7. pmid:22961092.
    • View Article
    • PubMed/NCBI
    • Google Scholar
30. xxx. Foxman B, Cronenwett AEW, Spino C, Berger MB, Morgan DM. Cranberry juice capsules and urinary tract infection subsequently surgery: results of a randomized trial. Am J Obstet Gynecol. 2015;213(2):194.e1-.e8. pmid:25882919.
    • View Article
    • PubMed/NCBI
    • Google Scholar
31. 31. Vostalova J, Vidlar A, Simanek V, Galandakova A, Kosina P, Vacek J, et al. Are High Proanthocyanidins Key to Cranberry Efficacy in the Prevention of Recurrent Urinary Tract Infection? Phytother Res. 2015;29(x):1559–67. pmid:26268913.
    • View Article
    • PubMed/NCBI
    • Google Scholar
32. 32. Maki KC, Kaspar KL, Khoo C, Derrig LH, Schild AL, Gupta K. Consumption of a cranberry juice potable lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. Am J Clin Nutr. 2016;103(6):1434–42. pmid:27251185.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
33. 33. Wan Yard-Southward, Liu C-One thousand, Lee W-Chiliad, Ko Thousand-C, Huang C-Southward. Cranberries for Preventing Recurrent Urinary Tract Infections in Uncircumcised Boys. Altern Ther Health Med. 2016;22(6):20–iii. pmid:27866177.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
34. 34. Temiz Z, Cavdar I. The effects of training and the employ of cranberry capsule in preventing urinary tract infections after urostomy. Complement Ther Clin Pract. 2018;31:111–7. pmid:29705442.
    • View Article
    • PubMed/NCBI
    • Google Scholar
35. 35. Mooren ES, Liefers WJ, de Leeuw JW. Cranberries after pelvic floor surgery for urinary tract infection prophylaxis: A randomized controlled trial. Neurourol Urodyn. 2020;39(5):1543–9. pmid:32449530.
    • View Article
    • PubMed/NCBI
    • Google Scholar
36. 36. Wang C-H, Fang C-C, Chen Northward-C, Liu SS-H, Yu P-H, Wu T-Y, et al. Cranberry-containing products for prevention of urinary tract infections in susceptible populations: a systematic review and meta-analysis of randomized controlled trials. Curvation Intern Med. 2012;172(13):988–96. pmid:22777630.
    • View Article
    • PubMed/NCBI
    • Google Scholar
37. 37. Blumberg JB, Camesano TA, Cassidy A, Kris-Etherton P, Howell A, Manach C, et al. Cranberries and their bioactive constituents in human health. Advances in nutrition (Bethesda, Md). 2013;4(6):618–32. pmid:24228191.
    • View Commodity
    • PubMed/NCBI
    • Google Scholar
38. 38. Higgins, JPT. Cochrane handbook for systematic reviews of interventions version five.0. 2: Cochrane handbook for systematic reviews of interventions.
39. 39. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. pmid:19621072.
    • View Article
    • PubMed/NCBI
    • Google Scholar

spenceconage.blogspot.com

Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256992

Share this post