The study, titled "Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank," was published in The BMJ last week. It was conducted by researchers associated with Tulane University in New Orleans, LA; Harvard University in Boston, MA; and Harbin Medical University in Harbin, China.
The study used data from the UK Biobank, which is a population-wide, questionnaire based nutritional and health survey effort. It generates data somewhat akin to the NHANES (National Health and Nutrition Examination Survey) in the United States, but has a follow-on component to examine future health outcomes.
Huge data set
UK Biobank started recruiting participants in 2006, and by 2010 had met its goal of close to 500,000 participants between the ages of 40-69. The plan is to follow the participants for 30 years.
Glucosamine is a natural component of joint cartilage. It has been used as a joint health supplement for decades, and is usually derived from the shells of shellfish like shrimp. But vegetarian, fermentation derived sources are available as well.
In the UK Biobank survey, participants were enrolled in one of 22 centers scattered around the country. They completed a touch screen survey that asked among other things whether they used a variety of supplements.
Glucosamine was one of the choices. Among the other dietary ingredients included in the questionnaire were minerals such as calcium, iron and zinc, the common vitamins, and fish oil.
The researchers adjusted their statistical model for the healthfulness of diets, age, sex, household income and others factors, such as smoking.
Honing in on the specific effect of glucosamine
Then the researchers sought to further winnow the group of glucosamine users to eliminate confounding factors within this group.
“First, because participants who took glucosamine also tended to take other supplements more often than participants who did not take glucosamine, we did a sensitivity analysis by excluding participants who used any other supplements. Second, to minimize the influence of reverse causation, we performed a sensitivity analysis by excluding participants who developed CVD events within two years of follow-up. Third, to control the influence of genetic predisposition to CHD or stroke, we adjusted for CHD or stroke genetic risk score,” they wrote.
The researchers found that about 19% of the respondents said they used glucosamine.
That group also tended to exercise somewhat more than the non glucosamine users and included fewer smokers. Whether they exercised more as a result of better mobility attributable to glucosamine use or whether it signified a greater commitment to a healthy lifestyle overall was not assessed.
Cardioprotective effects
In any case, the cardioprotective effects of glucosamine were not related to different levels of physical activity, the researchers said. They did say the positive effects seemed to be greater for smokers than for non smokers or those who had quit years before.
The researchers looked at the effect of glucosamine use on CHD events, cardiovascular disease events, coronary heart disease death, and different types of stroke: non-fatal, fatal, ischemic and hemorrhagic.
They concluded that glucosamine use seems to have a role to play in protecting against these events, with the exception of stroke, where glucosamine use was associated with marginally reduced risk of non fatal stroke. The results in the other categories of stroke were not statistically significant.
“Habitual use of glucosamine supplement to relieve osteoarthritis pain might also be related to lower risks of CVD events. Further clinical trials are needed to test this hypothesis,” the researchers concluded.
A new role for glucosamine?
Cal Bewick, CEO of Ethical Naturals, said the study result was welcome, but cautioned against over optimism. Ethical Naturals supplies a patented, vegetarian, fermentation-derived form of the ingredient called GreenGrown Glucosamine.
“Clearly one study is not going to be enough to support a whole new range of structure/function claims for glucosamine,” Bewicke told NutraIngredients-USA. “But I think it will lead to a whole new area of research.”
Glucosamine is one of the ingredients that has had a potentially problematical supply history. Much of the ingredient still comes from rendering plants in China that take in leftovers from the shrimp farming industry. It has not been known as a very clean process.
Harping on the ‘plant-based’ and ‘clean’ messages
Bewicke said his company’s ingredient gets around these issues, even though they have not seemed to have concerned consumers much over the years. There has been no ‘pink slime’ moment for glucosamine.
“It is well known that the production of glucosamine from shellfish results in quite a lot of toxic waste material. Fermentation by contrast is a very clean process,” he said.
Bewick said vegetarian glucosamine has been on the market for many years (Cargill launched its Regenasure fermentation ingredient back in the early 2000, and the Ethical Naturals ingredient has been on the market since 2008). While it still represents a fairly small part of the overall market, he said it is poised to benefit from the enduring plant-sourced nutrition trend.
“Such a high percentage of consumers now prefer plant-sourced material,” he said.
Source: The BMJ
Association of habitual glucosamine use with risk of cardiovascular disease: prospective study in UK Biobank
Authors: Ma H, et al.