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Urinary Tract Health and Antibacterial Benefits

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Cranberry juice and bacterial colonization in children--a placebo-controlled randomized trial

Posted: 
October 31, 2010
Authors: 
Kontiokari T, Salo J, Eerola E and Uhari M
Journal: 
Clin Nutr 24(6):1065-72
Abstract: 

BACKGROUND: The cranberry produces antimicrobial compounds such as proanthocyanidines in response to microbial invasion. In vitro it is able to prevent growth, adhesion or biofilm formation of a large number of bacteria, while clinically, cranberry juice has been shown to prevent urinary tract infections (UTI) in women. However, the effect of cranberry on bacterial colonization more widely has not been evaluated. We were interested in studying cranberry juice in children since many children with recurrent UTI need long-term antimicrobial prophylaxis and would benefit from an alternative.

OBJECTIVE: To evaluate the effect of cranberry juice on nasopharyngeal and colonic bacterial flora, to evaluate how well cranberry juice is accepted by children and to evaluate its effect on infectious diseases and related symptoms.

DESIGN: Children (mean age 4.3 years) in day care centers were randomized to receive either cranberry juice (n=171) or a placebo (n=170) for 3 months. Bacterial samples were collected before and after the intervention and analyzed for both respiratory bacterial pathogens and enteric fatty acid composition, reflecting changes in the colonic bacterial flora. Infectious diseases and their symptoms were monitored using symptom diaries. Compliance was evaluated as the number of drop-outs during the trial and by counting the numbers of doses taken.

RESULTS: The carriage of respiratory bacteria did not change significantly during the intervention, while fecal fatty acid composition changed significantly with time (P0.05). Cranberry juice had no effect on common infectious diseases or their symptoms. The cranberry juice was well accepted: the number of drop-outs in 3 months was 18 (11%) in the cranberry group and 11 (7%) in the placebo group, and most of the doses were taken as instructed, 145 (88%) and 129 (77%) children, respectively, taking at least 90% of the doses.

CONCLUSIONS: Cranberry juice was well accepted by the children, but led to no change in either the bacterial flora in the nasopharynx or the bacterial fatty acid composition of stools. Thus cranberries seem to have beneficial effect on urinary health only and this is not compromised by other unexpected antimicrobial effects.

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Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital? A double-blind, placebo-controlled trial.

Posted: 
October 31, 2010
Authors: 
McMurdo ME, Bissett LY, Price RJ, Phillips G and Crombie IK
Journal: 
Age Aging 34(3):256-61
Abstract: 

Background: cranberry juice is often given to older people in hospital to prevent urinary tract infection (UTI), although
there is little evidence to support its use.
Objective: to assess whether cranberry juice ingestion is effective in reducing UTIs in older people in hospital.
Design: randomised, placebo-controlled, double-blind trial.
Setting: Medicine for the Elderly assessment and rehabilitation hospital wards.
Subjects: 376 older patients in hospital.
Methods: participants were randomised to daily ingestion of 300 ml of cranberry juice or matching placebo beverage. The primary outcome was time to onset of first UTI. Secondary outcomes were adherence to beverage drinking, courses of antibiotics prescribed, and organisms responsible for UTIs.
Results: a total of 21/376 (5.6%) participants developed a symptomatic UTI: 14/189 in the placebo group and 7/187 in the cranberry juice group. These between-group differences were not significant, relative risk (RR) 0.51 [95% CI 0.21–1.22, P = 0.122). Although there were significantly fewer infections with Escherichia coli in the cranberry group (13 versus 4) RR 0.31 [95% CI 0.10–0.94, P =0.027], this should be interpreted with caution as it was a secondary outcome.
Conclusion: despite having the largest sample size of any clinical trial yet to have examined the effect of cranberry juice ingestion, the actual infection rate observed was lower than anticipated, making the study underpowered. This study has confirmed the acceptability of cranberry juice to older people. Larger trials are now required to determine whether it is effective in reducing UTIs in older hospital patients.

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Inhibitory effect of cranberry polyphenol on cariogenic bacteria

Posted: 
October 31, 2010
Authors: 
Yamanaka-Okada A, Sato E, Kouchi T, Kimizuka R, Kato T, Okuda K
Journal: 
Bull Tokyo Dent Coll 49(3):107-12
Abstract: 

The purpose of this study was to investigate the effect of cranberry polyphenol fraction on mutans streptococci. Hydrophobicity is an important factor in the adherence of bacteria to the tooth surface. We found that cranberry polyphenol fraction significantly decreased the hydrophobicity of Streptococcus sobrinus 6715, Streptococcus mutans MT8148R and JC2 in a dose-dependent manner (p

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Modulation of Helicobacter pylori colonization with cranberry juice and Lactobacillus johnsonii La1 in children

Posted: 
October 31, 2010
Authors: 
Gotteland M, Andrews M, Toledo M, Munoz L, Caceres P, Anziani A, Wittig E, Speisky H, Salazar G.
Journal: 
Nutrition 24(5):421-426
Abstract: 

OBJECTIVE: Probiotics and cranberry have been shown to inhibit Helicobacter pylori in vitro owing to bacteriocin production and high levels of proanthocyanidins, respectively. These effects have been confirmed in clinical trials with H. pylori-positive subjects. The aim of this study was to evaluate whether regular intake of cranberry juice and the probiotic Lactobacillus johnsonii La1 (La1) may result in an additive or synergistic inhibition of H. pylori in colonized children.METHODS: A multicentric, randomized, controlled, double-blind trial was carried out in 295 asymptomatic children (6-16 y of age) who tested positive for H. pylori by (13)C-urea breath test (UBT). Subjects were allocated in four groups: cranberry juice/La1 (CB/La1), placebo juice/La1 (La1), cranberry juice/heat-killed La1 (CB), and placebo juice/heat-killed La1 (control). Cranberry juice (200 mL) and La1 product (80 mL) were given daily for 3 wk, after which a second UBT was carried out. A third UBT was done after a 1-mo washout in those children who tested negative in the second UBT.RESULTS: Two hundred seventy-one children completed the treatment period (dropout 8.1%). Helicobacter pylori eradication rates significantly differed in the four groups: 1.5% in the control group compared with 14.9%, 16.9%, and 22.9% in the La1, CB, and CB/La1 groups, respectively (P

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Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women

Posted: 
October 31, 2010
Authors: 
Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M and Uhari M
Journal: 
BMJ 322(7302):1571
Abstract: 

OBJECTIVE: To determine whether recurrences of urinary tract infection can be prevented with cranberry-lingonberry juice or with Lactobacillus GG drink. Design: Open, randomised controlled 12 month follow up trial.

SETTING: Health centres for university students and staff of university hospital.

PARTICIPANTS: 150 women with urinary tract infection caused by Escherichia coli randomly allocated into three groups. Interventions: 50 ml of cranberry-lingonberry juice concentrate daily for six months or 100 ml of lactobacillus drink five days a week for one year, or no intervention. Main outcome measure: First recurrence of symptomatic urinary tract infection, defined as bacterial growth >/=10(5 )colony forming units/ml in a clean voided midstream urine specimen.

RESULTS: The cumulative rate of first recurrence of urinary tract infection during the 12 month follow up differed significantly between the groups (P=0.048). At six months, eight (16%) women in the cranberry group, 19 (39%) in the lactobacillus group, and 18 (36%) in the control group had had at least one recurrence. This is a 20% reduction in absolute risk in the cranberry group compared with the control group (95% confidence interval 3% to 36%, P=0.023, number needed to treat=5, 95% confidence interval 3 to 34).

CONCLUSION: Regular drinking of cranberry juice but not lactobacillus seems to reduce the recurrence of urinary tract infection.

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Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial

Posted: 
October 31, 2010
Authors: 
Di Martino P, Agniel R, David K, Templer C, Gaillard JL, Denys P, Botto H
Journal: 
World J Urol 24(1):21-7
Abstract: 

To determine the efficacy of the consumption of cranberry juice versus placebo with regard to the presence of in vitro bacterial anti-adherence activity in the urine of healthy volunteers. Twenty healthy volunteers, 10 men and 10 women, were included. The study was a double-blind, randomized, placebo-controlled, and cross-over study. In addition to normal diet, each volunteer received at dinner a single dose of 750 ml of a total drink composed of: (1) 250 ml of the placebo and 500 ml of mineral water, or (2) 750 ml of the placebo, or (3) 250 ml of the cranberry juice and 500 ml of mineral water, or (4) 750 ml of the cranberry juice. Each volunteer took the four regimens successively in a randomly order, with a washout period of at least 6 days between every change in regimen. The first urine of the morning following cranberry or placebo consumption was collected and used to support bacterial growth. Six uropathogenic Escherichia coli strains (all expressing type 1 pili; three positive for the gene marker for P-fimbriae papC and three negative for papC), previously isolated from patients with symptomatic urinary tract infections, were grown in urine samples and tested for their ability to adhere to the T24 bladder cell line in vitro. There were no significant differences in the pH or specific gravity between the urine samples collected after cranberry or placebo consumption. We observed a dose dependent significant decrease in bacterial adherence associated with cranberry consumption. Adherence inhibition was observed independently from the presence of genes encoding type P pili and antibiotic resistance phenotypes. Cranberry juice consumption provides significant anti-adherence activity against different E. coli uropathogenic strains in the urine compared with placebo.

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Cranberry is not effective for the prevention or treatment of urinary tract infections in individuals with spinal cord injury.

Posted: 
October 28, 2010
Authors: 
Opperman EA
Journal: 
Spinal Cord 48(6):451-6
Abstract: 

STUDY DESIGN: Literature review. OBJECTIVES: Urinary tract infections (UTIs) are the most common medical complication experienced by individuals with spinal cord injury (SCI). Recent research presents conflicting evidence regarding use of cranberry in reducing growth and colonization of uroepithelial cells by uropathogenic bacteria. The objective was to determine whether the literature supports the use of cranberry in preventing or treating UTIs in the SCI population. METHODS: MEDLINE was searched for intervention studies, which investigated the use of cranberry in the prevention or treatment of UTIs in the SCI population. If the studies met the inclusion criteria, full articles were located and reviewed. RESULTS: Five studies (four randomized clinical control-three trials using cranberry tablets vs placebos and one using cranberry juice-and one pilot study using cranberry juice) were identified which evaluated the effectiveness of cranberry products for the prevention or treatment of UTIs in the SCI population. Three studies reported no statistically significant effect of cranberry tablets in urinary pH, urinary bacterial count, urinary white blood cell (WBC) count, urinary bacterial, and WBC counts in combination or episodes of symptomatic UTIs. A fourth study showed that cranberry juice intake significantly reduced biofilm load compared with baseline. A final study reported fewer UTIs during the period with cranberry extract tablets vs placebo. CONCLUSIONS: Limited evidence from clinical trials that vary in design suggests that cranberry, in juice or supplement form, does not seem to be effective in preventing or treating UTIs in the SCI population. More rigorous clinical research is needed to confirm this.

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Cranberry juice and urinary tract infections: is there a beneficial relationship

Posted: 
October 28, 2010
Authors: 
Kuzminski LN
Journal: 
Nutr Rev 54(11 Pt 2):S87-90
Abstract: 

No abstract - Conclusion:
Science often causes us to disregard the validity of folklore
treatments for common medical conditions. However,
those folklore practices that retain a persistent consumer
and practitioner following over time merit rigorous scientific scrutiny. Approaches such as those described here
regarding UTI risk reduction by cranberry juice could serve
as a model to clarify the potential functional food role of
Cranberry juice in treating and preventing UTIs.

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Cranberry juice for prophylaxis of urinary tract infections – conclusions from clinical experience and research

Posted: 
October 19, 2010
Authors: 
Nowack R, Schmidt W
Journal: 
Phytomedicine 15(9):653-667
Abstract: 

Cranberry juice (Vaccinium macrocarpon) is a widely used and recommended North-American folk remedy for prophylaxis of urinary tract infections (UTI). Clinical trials have documented its efficacy in women with recurrent UTI, but so far not in other groups of patients. The composition of effective cranberry products and its dosage in UTI prophylaxis have not been defined. Intriguing experimental research has identified an anti-adhesive mechanism of cranberry juice that prevents docking of bacteria on host tissues. This efficacy mechanism can be traced in patients' urine following oral intake of cranberry products and appears to be due to proanthocyanidins with an A-type linkage of flavanols. The application of this anti-adhesion mechanism of cranberry-proanthocyandins is currently also investigated in other common diseases of bacterial pathogenesis, for example Helicobacter pylori-associated gastritis and dental caries/periodontal disease. The use of cranberry products appears to be safe and provide additional benefits by anti-oxidant and cholesterol-lowering activity.

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Anti-microbial activity of urine after ingestion of cranberry: a pilot study

Posted: 
October 13, 2010
Authors: 
Lee YL,Najm WI, Owens J, Thrupp L, Baron S, Shanbrom E, Cesario T
Journal: 
eCAM 7(2):227–232
Abstract: 

We explore the anti-microbial activity of urine specimens after the ingestion of a commercial cranberry preparation. Twenty subjects without urinary infection, off antibiotics and all supplements or vitamins were recruited. The study was conducted in two phases: in phase 1, subjects collected the first morning urine prior to ingesting 900mg of cranberry and then at 2, 4 and 6 h. In phase 2, subjects collected urine on 2 consecutive days: on Day 1 no cranberry was ingested (control specimens), on Day 2, cranberry was ingested. The pH of all urine specimens
were adjusted to the same pH as that of the first morning urine specimen. Aliquots of each specimen were independently inoculated with Escherichia coli, Klebsiella pneumoniae or Candida albicans. After incubation, colony forming units/ml (CFU ml 1) in the control specimen
was compared with CFU ml 1 in specimens collected 2, 4 and 6 h later. Specimens showing 50% reduction in CFU ml 1 were considered as having ‘activity’ against the strains tested. In phase 1, 7/20 (35%) subjects had anti-microbial activity against E. coli, 13/20 (65%) against K. pneumoniae and 9/20 (45%) against C. albicans in specimens collected 2–6 h after ingestion of cranberry. In phase 2, 6/9 (67%) of the subjects had activity against K. pneumoniae. This pilot
study demonstrates weak anti-microbial activity in urine specimens after ingestion of a single dose of commercial cranberry. Anti-microbial activity was noted only against K. pneumoniae 2–6 h after ingestion of the cranberry preparation.

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