The effects of SCFAs on glycemic control in humans: a systematic review and meta-analysis

BACKGROUND: Noncommunicable disease development is related to impairments in glycemic and insulinemic responses, which can be modulated by fiber intake. Fiber's beneficial effects upon metabolic health can be partially attributed to the production of SCFAs via microbial fermentation of fiber in the gastrointestinal tract. OBJECTIVES: We aimed to determine the effects of SCFAs, acetate, propionate, and butyrate on glycemic control in humans. METHODS: The CENTRAL, Embase, PubMed, Scopus, and Web of Science databases were searched from inception to 7 December 2021. Papers were included if they reported a randomized controlled trial measuring glucose and/or insulin compared to a placebo in adults. Studies were categorized by the type of SCFA and intervention duration. Random-effects meta-analyses were performed for glucose and insulin for those subject categories with ≥3 studies, or a narrative review was performed. RESULTS: We identified 43 eligible papers, with 46 studies within those records (n = 913), and 44 studies were included in the meta-analysis. Vinegar intake decreased the acute glucose response [standard mean difference (SMD), −0.53; 95% CI, −0.92 to −0.14; n = 67] in individuals with impaired glucose tolerance or type 2 diabetes and in healthy volunteers (SMD, −0.27; 95% CI, −0.54 to 0.00; n = 186). The meta-analyses for acute acetate, as well as acute and chronic propionate studies, showed no significant effect. CONCLUSIONS: Vinegar decreased the glucose response acutely in healthy and metabolically unhealthy individuals. Acetate, propionate, butyrate, and mixed SCFAs had no effect on blood glucose and insulin in humans. Significant heterogeneity, risks of bias, and publication biases were identified in several study categories, including the acute vinegar glucose response. As evidence was very uncertain, caution is urged when interpreting these results. Further high-quality research is required to determine the effects of SCFAs on glycemic control.