Effects of isolated soluble fiber supplementation on body weight,
glycemia, and insulinemia in adults with overweight and obesity: a
systematic review and meta-analysis of randomized controlled trials
Sharon V Thompson,1 Bridget A Hannon,1 Ruopeng An,1,2 and Hannah D Holscher1–3
1
Division of Nutritional Sciences, and Departments of 2Kinesiology and Community Health and 3Food Science and Human Nutrition, University of Illinois,
Urbana, IL
ABSTRACT
Background: There is strong epidemiologic evidence that dietary
fiber intake is protective against overweight and obesity; however,
results of intervention studies have been mixed. Soluble fiber ben-
eficially affects metabolism, and fiber supplementation may be a
feasible approach to improve body composition and glycemia in
adults with overweight and obesity.
Objective: We evaluated randomized controlled trials (RCTs) of
isolated soluble fiber supplementation in overweight and obese
adults on outcomes related to weight management [body mass index
(BMI; in kg/m2), body weight, percentage of body fat, and waist
circumference] and glucose and insulin metabolism (homeostasis
model assessment of insulin resistance and fasting insulin)
through a systematic review and meta-analysis.
Design: We searched PubMed, Web of Science, Cumulative Index to
Nursing and Allied Health Literature and Cochrane Library databases.
Eligible studies were RCTs that compared isolated soluble fiber with
placebo treatments without energy-restriction protocols. Random-
effects models were used to estimate pooled effect sizes and 95%
CIs. Meta-regressions were performed to assess outcomes in relation
to the intervention duration, fiber dose, and fiber type. Publication bias
was assessed via Begg’s and Egger’s tests and funnel plot inspection.
Results: Findings from 12 RCTs (n = 609 participants) from 2 to
17 wk of duration are summarized in this review. Soluble fiber
supplementation reduced BMI by 0.84 (95% CI: 21.35, 20.32;
P = 0.001), body weight by 2.52 kg (95% CI: 24.25, 20.79 kg;
P = 0.004), body fat by 0.41% (95% CI: 20.58%, 20.24%; P , 0.001),
fasting glucose by 0.17 mmol/L (95% CI: 20.28, 20.06 mmol/L;
P = 0.002), and fasting insulin by 15.88 pmol/L (95% CI: 229.05,
22.71 pmol/L; P = 0.02) compared with the effects of placebo
treatments. No publication bias was identified. Considerable
between-study heterogeneity was observed for most outcomes.
Conclusions: Isolated soluble fiber supplementation improves anthro-
pometric and metabolic outcomes in overweight and obese adults,
thereby indicating that supplementation may improve fiber intake and
health in these individuals. However, the interpretation of these findings
warrants caution because of the considerable between-study heterogene-
ity. This trial was registered at clinicaltrials.gov as NCT03003897. Am J
Clin Nutr 2017;106:1514–28.
Keywords: body composition, glucose, insulin, meta-analysis, soluble
fiber supplementation
1514 Am J Clin Nutr 2017;106:1514–28. Printed in USA. Ó 2017 American Society for Nutrition
INTRODUCTION
Overweight and obesity are substantial public health challenges. A
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majority of adults in the United States are now overweight or obese
(1), and in 2010, excess weight was connected with $316 billion in
health care costs (2). The fiscal impact of overweight and obesity is
exacerbated by heightened risks of detrimental physical and mental
health conditions as well as all-cause mortality (3, 4). Epidemiologic
data have strongly linked dietary fiber consumption with reduced risk
of obesity (5–7). The result of intervention studies, which have
used a range of different types and amounts of fibers, have been
mixed but have generally shown body-composition and meta-
bolic improvements (8–14).
In May 2016, the Food and Drug Administration issued a defi-
nition of dietary fiber that governs which fibers may be included on a
Nutrition or Supplement Facts Label, and fiber was defined as
nondigestible carbohydrates $3 monomeric units that are inherent
in food and isolated or synthetic fibers with shown physiologic
benefits (15, 16). Dietary fiber is a 2015–2020 Dietary Guidelines
for Americans nutrient of public health concern because con-
sumption barely surpasses 50% of adequate intake recommenda-
tions (17–22). The contrast between adequate intake, which is based
on the protective impact of fiber against coronary artery disease, and
Supported by the University of Illinois College of Agricultural, Consumer
and Environmental Sciences (Jonathan Baldwin Turner Fellowship; to SVT),
the Agriculture and Food Research Initiative (competitive grant 2015-68001-
23248 from the USDA National Institute of Food and Agriculture; to BAH),
and the USDA National Institute of Food and Agriculture (hatch project
ILLU-698-902; to HDH). 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.
Supplemental Tables 1 and 2 and Supplemental Figures 1–3 are available
from the “Online Supporting Material” link in the online posting of the ar-
ticle and from the same link in the online table of contents at http://ajcn.
nutrition.org.
Address correspondence to HDH (e-mail: hholsche@illinois.edu).
Abbreviations used: MQS, Heyland Methodologic Quality Score; RCT,
randomized controlled trial; SMD, standardized mean difference.
Received June 22, 2017. Accepted for publication October 2, 2017.
First published online November 1, 2017; doi: https://doi.org/10.3945/
ajcn.117.163246.
Supplemental Material can be found at:
http://ajcn.nutrition.org/content/suppl/2017/11/01/ajcn.117.1
63246.DCSupplemental.html
 SUPPLEMENTAL FIBER IMPROVES WEIGHT AND GLYCEMIA
actual intake is even greater in adults with obesity (17, 19). Cereals
are the predominant source of dietary fiber in US diets and are fol-
lowed by more meager proportions that are obtained from vegetable
and fruit sources (19, 22, 23). Because dietary fiber that is obtained
from whole foods (e.g., inherent in food) remains grossly inadequate,
enhancing the fiber content of the food supply via supplementation of
isolated or synthetic fibers with known physiologic benefits may be a
feasible strategy to improve fiber intake and health (24, 25).
Dietary fibers are heterogeneous, and their physicochemical
properties (e.g., solubility, viscosity, and fermentability) in-
fluence therapeutic consumption effects (26). Soluble fiber intake
has been linked to increased satiety and improved blood lipid
concentrations and glycemic response. Putative mechanisms for
these metabolic benefits include elevated bile-acid excretion and
appetite-suppressing hormones and incretin hormone changes
that delay nutrient absorption and gastric emptying (27–30).
Furthermore, emerging research suggests that fiber fermentation
by the gastrointestinal microbiota and increased luminal con-
centrations of microbial fermentation end products (e.g. short-
chain fatty acids) may also impact energy intake and absorption,
body weight, and glycemic control (31–36).
The impetus for this study was to systematically identify and
quantitatively evaluate the efficacy of isolated soluble fiber
supplementation on body composition and glucose and insulin
homeostasis in overweight and obese adults. We hypothesized
that soluble fiber supplementation would improve glucose and
insulin concentrations and reduce BMI (in kg/m2), body weight,
body fat, and waist circumference independent of energy
restriction.
METHODS
Study selection criteria
Systematic review and meta-analysis procedures were
conducted in accordance with the Cochrane Handbook for
Systematic Reviews of Interventions and reported according
to Preferred Reporting Items for Systematic Reviews and Meta-
Analyses guidelines (37, 38). The study protocol was registered
at clinicaltrials.gov as NCT03003897. We included peer-
reviewed randomized controlled trials (RCTs) involving partic-
ipants who were 1) adults aged $18 y; 2) overweight or obese
[BMI $25.0 for US populations or $23.0 for Asian populations
(39) or with a waist circumference $40 inches (94 cm) in men
or $35 inches (80 cm) in women or a waist-to-hip ratio $0.90
in men or $0.85 in women] (40); 3) weight stable and not actively
trying to lose weight at screening; and 4) without physician-
diagnosed chronic conditions at screening (e.g., hypertension,
type 2 diabetes, and cardiovascular disease). We included
studies that involved comparison groups who received either a
placebo without soluble fiber or an isolated soluble fiber treat-
ment as part of controlled consumption studies or ad libitum–
supplementation interventions that were conducted in free-living
subjects. We excluded studies that met any of the following
criteria: studies conducted in animals, mechanistic research, or
human trials involving children; conference proceedings; arti-
cles not published in English; studies #1 wk in duration; and
studies that pooled outcome-measure data for healthy weight
individuals and those with overweight and obesity. Because the
objective of this meta-analysis was to explore the efficacy of
1515
supplementation alone on outcomes of interest, we evaluated the
provision of supplemental soluble fiber in the absence of other
interventions. Thus, studies that involved whole-food treatments
or high-fiber–profile diets and weight-loss protocols that used
counseling or energy restriction were excluded.
Search strategy
We located peer-reviewed articles in 4 electronic bibliographic
databases including PubMed, (www.ncbi.nlm.nih.gov/pubmed),
Web of Science (www.wokinfo.com), the Cumulative Index to
Nursing and Allied Health Literature (www.ebscohost.com/
nursing/products/cinahl-databases/the-cinahl-database), and
Cochrane Library (www.thecochranelibrary.com) databases
from database initiation through 26 January 2017 using the
search strategy described in Supplemental Table 1. After ac-
quiring the initial search results, titles and abstracts of articles
were evaluated for suitability against study-selection criteria.
Full-text articles were retrieved and assessed for inclusion. A
cited reference search (forward reference search) and a reference
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list search (backward reference search) were conducted on the
basis of the eligible articles that were identified from the key-
word search. Articles that were identified through the forward
and backward reference searches were screened and evaluated
with the use of the same study selection criteria. Our reference
search was repeated on all newly identified articles until no
additional relevant articles were found. Two raters (SVT and
BAH) separately determined the inclusion or exclusion of all
articles that were retrieved for a full-text evaluation, and dis-
agreements in categorical assignment (yes or no) were resolved
through a consensus. The interrater agreement for the full-text
search was evaluated with the use of Cohen’s k.
Data extraction
We extracted the following information from included studies:
author, publication year, study design, soluble fiber–intervention
duration, soluble fiber dosage, study population and eligibility,
numbers of participants who were analyzed at baseline and at
the end of the treatment period (study completers), treatment
group size, outcomes measured, and intervention effectiveness.
Outcomes of interest included those that are related to body
composition including BMI, body weight, percentage of body
fat, and waist circumference as well as biomarkers of glucose
and insulin homeostasis including fasting glucose and insulin,
glycated hemoglobin, the Matsuda index, and the HOMA-IR
(41). All relevant outcome data were extracted regardless of
whether these data were analyzed within the primary studies.
Meta-analysis
We conducted a meta-analysis when $2 studies reported means
and variance data for similar outcomes of interest. Measures of
central tendency were included in the meta-analysis as published
or approximated if raw data were unable to be obtained by study
authors. Treatment-group data were pooled for the 2 studies that
included high and low treatment dosages (42, 43).
All units of measure were converted to standard International
System units before inclusion in the meta-analysis. Data that
were collected at baseline and at the end of the respective
treatment periods were incorporated in the meta-analysis. We
1516 THOMPSON ET AL.
assessed the between-study heterogeneity of soluble fiber–in-
tervention effects using the I2 statistic (44). The following I2
interpretive categories were used: ,30% was considered low
heterogeneity, 30–75% was considered moderate heterogeneity,
and .75% was deemed considerable heterogeneity (38, 44). A
random-effects model was used as the default method to esti-
mate pooled effects and 95% CIs. This model was used instead
of a fixed-effects model because of the observed variation in
study treatments and protocols (38). We conducted meta-
regressions to assess outcomes in relation to the following 3
prespecified factors: intervention duration, daily dose of soluble
fiber, and soluble fiber category. Factors were selected on the
basis of the likelihood of influence on outcomes of interest. The
intervention duration was defined as the time period (weeks)
when participants received the treatment or placebo; the soluble
fiber dose was defined as daily grams of fiber treatment as
provided during the intervention; and the categorization of sol-
uble fibers was based on their physicochemical properties
[e.g., 1) soluble, viscous, and fermentable or 2) soluble, non-
viscous, and fermentable]. Studies that provided .1 dose of
soluble fiber and interventions that mixed multiple soluble fiber
types were excluded from the meta-regressions. The meta-
analysis was conducted with RevMan version 5.3.5 software
(The Nordic Cochrane Center, The Cochrane Collaboration).
Meta-regression and publication-bias analyses were performed
with Stata version 14.1 software (StatCorp LP). P # 0.05 was
accepted as statistically significant.
Sensitivity analysis
Study outliers were identified through a sensitivity analysis in
which pooled effects of the meta-analysis were calculated after
the systematic sequential removal of individual studies. A study
was considered to be an outlier if, on omission, the pooled-effect
size changed .10% (45).
Study quality and risk of bias assessment
We evaluated study quality using the Heyland Methodologic
Quality Score (MQS). This instrument quantifies study methodo-
logic quality on the basis of 9 criteria, including random assignment,
analysis, blinding, patient selection, baseline group compara-
bility, extent of follow-up, treatment protocol, co-interventions,
and outcomes (46). Included studies were given a score between
0 (lowest quality) and 14 (highest quality), and those with a score
$8 were considered high-quality trials. The Cochrane Risk of
Bias tool was used to evaluate study bias according to the fol-
lowing 7 domains: sequence generation, allocation concealment,
blinding of participants, blinding of personnel, outcome assess-
ment, incomplete outcome data, selective reporting, and other
potential sources of bias (38). The MQS and Cochrane Risk of
Bias Tool were used to measure the strength of study evidence
and potential bias but did not determine study inclusion.
RESULTS
Study selection
We identified a total of 9204 potentially eligible articles from
keyword search (4381 articles from PubMed, 3221 articles from
the Web of Science, 748 articles from CINAHL, and 854 articles
from the Cochrane Library) (Figure 1). After duplicate abstracts
were removed, a total of 7013 abstracts remained, in which 6824
were excluded on the basis of the article title and abstract
screening. We included 189 articles in the full-text review dur-
ing which 174 articles were excluded for not meeting study-
selection eligibility criteria. In the excluded articles, 30 studies
were ,1 wk in duration (47–76); 3 studies included a duplicate
study population as had been evaluated in other articles (77–79);
14 studies provided ineligible study treatments (78, 80–90); 23
studies provided dietary fiber to both treatment and placebo
groups (91–113); 2 studies only included normal-weight adults
(114, 115); 11 studies reported central-tendency measures for
participants who were not solely in the overweight or obese
categories (115–125); 11 studies were published in languages
other than English (126–136); 8 studies were conference pro-
ceedings (137–144); 9 studies reported nonrelevant outcomes
(145–152); 5 studies involved participants with previously di-
agnosed and currently treated metabolic disease (153–157); 48
studies were review papers (18, 26, 29, 159–203); and 10 studies
included energy restriction or weight-loss programs in addition
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to fiber supplementation (204–213). Three studies met our in-
clusion criteria but were unable to be included in the meta-
analysis because of the presentation of geometric means and
SEs or an absence of pretreatment and posttreatment data for
study completers (214–216). One RCT was identified and in-
cluded in the review after the forward and backward searches
(217). We included this study despite the use of current weight
as a percentage of ideal body weight for participant screening as
opposed to BMI or other anthropometric measures listed in the
pre-established study inclusion criteria. Interrater agreement was
94%, and Cohen’s k was 0.70, indicating substantial agreement
between raters (218).
Study and participant characteristics
Characteristics of the included studies are summarized in
Table 1. We included a total of 12 studies with 609 participants
that were published between 1984 and 2016 and assessed sol-
uble fiber supplementation in overweight and obese, but other-
wise healthy, adults in the meta-analysis. All included studies
were placebo-controlled RCTs with intervention durations
ranging from 2 to 17 wk. Data were analyzed for subjects who
were measured at baseline and posttreatment time points. Eleven
(92%) of the 12 trials had parallel-arm designs (42, 43, 217,
219–226), and 2 studies (17%) administered multiple doses of
soluble fiber (42, 43). A 4-wk washout period was used for the
crossover study (227). All included studies incorporated a
nonfiber placebo treatment. Placebo-treatment vehicles were
identical to those for the soluble fiber treatment (n = 4; 33%)
(42, 220, 223, 226) or included added maltodextrin (n = 5; 42%)
(43, 219, 222, 224, 227), starch (n = 2; 17%) (217, 221), or rice
flour (n = 1; 8%) (225). One study provided dried glucose syrup
in addition to the placebo treatment (223). Three trials (25%)
involved solely female participants (217, 219, 220), and 2 trials
(17%) (221, 222) involved only male participants. Four studies
(33%) were conducted in Asian populations (221–223, 225).
Primary outcomes for the included studies included measures
that were related to body composition in 8 studies (217, 220–
222, 224–227) and to glucose or insulin in 8 studies (42, 219–
222, 224, 225, 227). One study specifically evaluated fiber
 SUPPLEMENTAL FIBER IMPROVES WEIGHT AND GLYCEMIA 1517

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FIGURE 1 Study search and selection summary. Articles were identified from (www.ncbi.nlm.nih.gov/pubmed), the Web of Science (www.wokinfo.
com), the Cumulative Index to Nursing and Allied Health Literature (www.ebscohost.com/nursing/products/cinahl-databases/the-cinahl-database), and the
Cochrane Library (www.thecochranelibrary.com) and through forward and backward searches of articles that were assessed during the full-text evaluation.

tolerance (220), and 3 studies included measures of energy in-
take or appetite as primary outcomes (43, 223, 224). Fiber-
intake compliance was high (85–100%) when reported and
was evaluated in 8 studies through in-person observations (222),
packet returns (43, 224, 225), or self-reported consumption re-
cords (42, 43, 219, 220, 225, 226).
The types of soluble fiber treatments and daily dosages varied
in studies. One study (220) administered individualized dosages
of soluble fiber on the basis of body weight, and the remaining
studies provided daily soluble fiber treatments between 3 and 34 g.
Six of the included studies included soluble fiber treatments #10 g/d
(42, 217, 219, 221, 226, 227), and 5 studies included treatments
between 15 and 34 g soluble fiber/d (43, 222–225). Two studies
provided 2 doses of soluble fiber (42, 43). Five (42%) of the 12
included studies provided nonviscous but fermentable fiber
supplements in the form of manno-oligosaccharides, galacto-
oligosaccharides, and fructo-oligosaccharides (220, 223, 224,
226, 227). Five studies (42%) used fiber treatments that were re-
ported to be soluble, viscous, and fermentable (42, 217, 219, 222,
225). Four of these studies used individual fiber types including
b-glucan (42), flaxseed mucilage (219), mannans (225), and a
proprietary formulation consisting of wheat and maize-derived
dextrin (222). One study (43) administered a 50:50 mixture of
pectin (a soluble, viscous, fermentable fiber) and oligofructose (a
soluble, nonviscous, fermentable fiber), and another study (221)
provided a varied mix of viscous and nonviscous fermentable fi-
bers. Baseline total dietary fiber intakes were reported and were
shown to be similar between treatment and placebo groups in 3 of
the 12 included studies (43, 223, 225). One study presented
baseline intake values that were greater than the mean US intake
(31.6 g/d for both treatment and control groups) with the use of
data from one 24-h dietary recall (223); a second study reported
intakes that were similar to mean US consumption values
(i.e., w16–17 g/d) at baseline but did not include the methodology
for how these data were collected (43); and a third study reported
mean baseline dietary fiber intakes of 9.6 g/d for both treatment
and placebo groups with the use of data from 7-d diet records
(225). Measures of energy intake were reported in 8 studies (67%)
(43, 220–225, 227), 3 of which observed significant reductions in
intake in the treatment group compared with in the placebo group
(222–224). Four studies (33%) used additional screening pro-
cedures to include individuals without a previous diagnosis of
metabolic disease but with elevated glucose (42, 221), lipids
(220), or metabolic syndrome risk factors (227) at screening.
Study quality and biases
All but one of the included studies [i.e., Walsh et al. (217)]
could be considered high quality according to the MQS (Table 1,
Supplemental Table 2). Two studies reported the use of
TABLE 1
Details of RCTs (n = 12) included in the meta-analysis1
1518

Baseline fiber Duration, Outcome measures

Study, year (ref) Study design Fiber treatment Placebo treatment Dose intake, g/d wk MQS Study population Sample size, n evaluated

Bays et al., 2011 (42) DB, parallel arm Barley b-glucan in flavored Flavored water beverage HD: 6 g/d Not reported 12 9 30–70 y old 44 4 Glucose
water beverage without fiber LD: 3 g/d BMI (in kg/m2): 25–40 HD treatment: 15 Y Insulin, HD
LD treatment: 15 Y HOMA-IR, HD
Placebo: 14
Brahe et al., 2015 (219) SB, parallel arm Flaxseed mucilage in Breakfast buns with 10 g/d Not reported 6 8 Women aged 40–70 y 39 4 Glucose
breakfast buns maltodextrin BMI: 30–45 Treatment: 19 4 Insulin
Placebo: 20 4 HOMA-IR
Genta et al., 2009 (220) DB, parallel arm Fructo-oligosaccharide in syrup Sugar-free syrup without 0.14 g/kg Not reported 17 8 Women aged 31–49 y 35 Y Weight
fiber BMI $30 Treatment: 20 Y BMI
Placebo: 15 Y Body fat percentage
Y WC
4 Glucose
Y Insulin
Y HOMA-IR
Kobayakawa et al., DB, parallel arm Galactomannan, glucomannan, Powdered starch without 7.5 g/d Not reported 12 9 Asian men aged 20–65 y 30 Y Weight
2013 (221) b-glucan, and alginic acid fiber in water BMI ,35 with visceral obesity Treatment: 15 Y BMI
powder in water Placebo: 15 Y Glucose
Li et al., 2010 (222) DB, parallel arm Soluble dextrin from maize and Fruit juice with 34 g/d Not reported 12 10 Asian men aged 20–35 y 120 Y Weight
wheat starch in fruit juice maltodextrin BMI .24 Treatment: 60 Y BMI
Placebo: 60 Y Body fat percentage
4 Glucose
4 Insulin
Y HOMA-IR
Morel et al., 2015 (223) DB, parallel arm Galacto-oligosaccharide in tea Tea and glucose syrup 18 g/d Treatment: 31.6 2 11 Asian adults aged 18–45 y 44 Y Weight
without fiber Placebo: 31.6 BMI: 25–28 Treatment: 22 Y BMI
Placebo: 22 4 Body fat percentage
4 WC
Parnell and Reimer DB, parallel arm Oligofructose powder in Maltodextrin powder in 21 g/d Not reported 12 9 20–70 y old 39 Y Weight
2009 (224) participant-selected participant-selected BMI .25 Treatment: 21
THOMPSON ET AL.

beverages beverages Placebo: 18

Reimer et al., 2013 DB, parallel arm Glucomannan, alginate, and Rice flour powder in 15 g/d Treatment: 9.6 14 8 Asian adults aged 20–65 y 56 4 Weight
(225) xanthan gum powder in yogurt Placebo: 9.6 BMI: 24–30 Treatment: 28 4 BMI
yogurt Placebo: 28 Y WC
Y Glucose
4 Insulin
Salinardi et al., DB, parallel arm Manno-oligosaccharide Coffee beverage without 4 g/d Not reported 12 9 19–65 y old 54 4 Weight
2010 (226) powder in coffee beverage fiber BMI: 27–33 Treatment: 29
Placebo: 25
Savastano et al., DB, parallel arm Pectin and oligofructose Maltodextrin powder in HD: 30 g/d HD treatment: 17.1 3 10 18–60 y old 88 4 Weight
2014 (43) powder in water water LD: 15 g/d LD treatment: 16.9 BMI: 25–34.9 Treatment: 30 HD, 4 Glucose
Placebo: 16.3 29 LD
Placebo: 29 4 Insulin
4 HOMA-IR
Vulevic et al., DB, crossover Galacto-oligosaccharide Maltodextrin powder in 5.5 g/d Not reported 12 9 18–65 y old 45 4 Glucose
2013 (227) powder in water water BMI .25 Treatment: 45 Y Insulin
Placebo: 45
Walsh et al., 1984 DB, parallel arm Glucomannan powder in Starch powder in capsules 3 g/d Not reported 8 7 Obese women at .20% 20 Y Weight
(217) capsules of ideal body weight Treatment: 10
Placebo: 10
1
Arrows indicate the direction of outcomes that were evaluated by the authors within the primary studies after soluble fiber consumption (4, null; Y, significant decrease). Glucose and insulin values refer
to fasting concentrations. DB, double blinded; HD, high dose; LD, low dose; MQS, Heyland Methodologic Quality Score; RCT, randomized controlled trial; ref, reference; SB, single blinded; WC, waist
circumference.

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 SUPPLEMENTAL FIBER IMPROVES WEIGHT AND GLYCEMIA 1519
TABLE 2
Risk of bias for studies included in the meta-analysis according to the Cochrane Risk of Bias Tool1
Random- Participant- Outcome- Incomplete
sequence Allocation personnel assessment outcome Selective
Study, year (ref) generation concealment blinding blinding data reporting Other bias

Bays et al., 2011 (42) Unclear Unclear Low Low Low Low Low
Brahe et al., 2015 (219) Low Low High Unclear Low Low Low
Genta et al., 2009 (220) Unclear Unclear Low Low High Low Low
Kobayakawa et al., 2013 (221) Low Low Low Low Low Low Low
Li et al., 2010 (222) Low Low Low Low Low Low Low
Morel et al., 2015 (223) Low Unclear Low Low Low Low Low
Parnell and Reimer, 2009 (224) Low Unclear Low Unclear Low Low Low
Reimer et al., 2013 (225) Unclear Unclear Low Low Low Low Low
Salinardi et al., 2010 (226) Low Low Low Low Low Low Low
Savastano et al., 2014 (43) Low Low Low Low Low Low Low
Vulevic et al., 2013 (227) Unclear Unclear Low Low Low Low Low
Walsh et al., 1984 (217) High Unclear Low Low Unclear Unclear Low
1
Bias designations by study criteria are indicated by 7 domains with categories including low risk if negative aspects of the study design were not likely
to influence the study findings, high risk if the study design was likely to influence the study findings, or unclear risk if high or low risk could not be assigned
because of a lack of evidence. Ref, reference.

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concealed randomization procedures (219, 221), and 3 studies
used intention-to-treat statistical procedures (43, 222, 223). Two-
thirds of studies described treatment and control groups as being
similar at the baseline time point (42, 217, 220, 221, 223, 224, 226,
227). A total of 87% of studies used double-blinded RCT designs
(42, 43, 217, 220–227), and nearly all (93%) of the studies
provided a detailed description of study procedures (42, 43, 219,
221–227). A majority of trials (n = 10) were considered to have low
risk of bias according to the Cochrane Risk of Bias Tool (Sup-
plemental Figure 1, Table 2).
Meta-analysis on body composition
Body-composition meta-analyses are presented in Table 3 and
Figure 2 for BMI (n = 7 studies) (219–225), body weight (n =
10) (43, 217, 219–226), percentage of body fat (n = 4) (219,
222–224), and waist circumference (n = 6) (219–223, 225).
Soluble fiber supplementation reduced BMI by 0.84 (95% CI:
21.35, 20.32; I2 = 95%, P = 0.001), body weight by 2.52 kg
(95% CI: 24.25, 20.79 kg; I2 = 96%, P = 0.004), and per-
centage of body fat by 0.41% (95% CI: 20.58%, 20.24%;
I2 = 89%) (P = 0.000) compared with the effects of the placebo
treatment. There was no significant effect (P = 0.24) of soluble
fiber consumption on waist circumference (22.01 cm; 95% CI:
25.36, 1.35 cm; I2 = 97%). In a sensitivity analysis, the removal
of Genta et al. (220) from the meta-analysis substantially re-
duced I2 measures of between-study heterogeneity to 77% for
BMI, to 76% for body weight and the percentage of body fat
(Supplemental Figure 2), and to 15% for waist circumference,
but significant differences between soluble fiber treatment and
placebo treatment remained for these outcomes. A sensitivity
analysis also revealed that the significant differences that were
observed between placebo and soluble fiber treatment on BMI,
body weight, and the percentage of body fat persisted after the
removal of other potential outlier studies that shifted the pooled
mean difference $10%. The percentage of mean difference
change was .10% in 5 of 7 studies for BMI (219, 220, 222, 223,
225), in 4 of 10 studies for body weight (219, 220, 225, 226), in
3 of 4 studies for the percentage of body fat (219, 223, 224), and
in 4 of 6 studies for waist circumference (219, 220, 222, 223).
Meta-analysis on fasting glucose, insulin, and HOMA-IR
Meta-analysis results for fasting glucose (n = 8 studies) (42, 43,
219–221, 224, 225, 227), fasting insulin (n = 7) (42, 219–221, 224,
225, 227), and HOMA-IR (n = 5) (42, 219–221, 225) are shown in

TABLE 3
Meta-analysis and publication bias results for included studies1
P

Outcome Included studies, n (references) Pooled difference2 P Egger’s test Begg’s test

BMI, kg/m 2
7 (219–225) 20.84 (21.35, 20.32) 0.001 0.62 0.65
Body weight, kg 10 (43, 217, 219–226) 22.52 (24.25, 20.79) 0.004 0.28 0.42
Body fat, % 4 (219, 222–224) 20.41 (20.58, 20.24) ,0.00001 0.95 1.00
Waist circumference, cm 6 (219–223, 225) 22.01 (25.36, 1.35) 0.24 0.69 0.85
Glucose, mmol/L 8 (42, 43, 219–221, 224, 225, 227) 20.17 (20.28, 20.06) 0.002 0.87 1.00
Insulin, pmol/L 7 (42, 219–221 224, 225, 227) 215.88 (229.05, 22.71) 0.02 0.11 0.88
HOMA-IR 5 (42, 219–221, 225) 21.33 (22.98, 0.32) 0.12 0.54 1.00
1
Meta-analysis was conducted with the use of random-effects models. Publication bias was assessed with the use of Egger’s and Begg’s tests.
2
All values are between-group means (95% CIs) between soluble fiber–treatment and placebo groups.
1520 THOMPSON ET AL.

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FIGURE 2 Forest plots for randomized controlled trials of soluble fiber–intervention studies included in a BMI (in kg/m2) subgroup meta-analysis (n = 358) (A),
a body weight subgroup meta-analysis (expressed as kg) (n = 520), body fat subgroup meta-analysis (expressed as %) (n = 237) (C), and waist-circumference subgroup
meta-analysis (expressed as cm) (n = 320) (D). Random-effects models were used to calculate mean differences (gray squares), 95% CIs (horizontal lines through gray
squares), and pooled-effect sizes (black diamonds). The study weight (expressed as %) indicates the relative contribution of individual studies to the overall pooled-
effect size. Between-study heterogeneity was calculated via the I2 statistic.
 SUPPLEMENTAL FIBER IMPROVES WEIGHT AND GLYCEMIA 1521

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FIGURE 3 Forest plots for soluble fiber–intervention studies included in meta-analyses for a fasting glucose subgroup meta-analysis (expressed as mmol/L)
(n = 415) (A), fasting insulin subgroup meta-analysis (expressed as pmol/L) (n = 327) (B), and HOMA-IR subgroup meta-analysis ( n = 200) (C). Random-effects
models were used to calculate mean differences (gray squares), 95% CIs (horizontal lines through gray squares), and pooled-effect sizes (black diamonds). The study
weight (expressed as %) indicates the relative contribution of individual studies to the overall pooled-effect size. Between-study heterogeneity was calculated via the I2
statistic.

Table 3 and Figure 3. Soluble fiber supplementation reduced
fasting glucose concentrations by 0.17 mmol/L (95% CI: 20.28,
20.06 mmol/L; I2 = 56%, P = 0.002) and fasting insulin con-
centrations by 15.88 pmol/L (95% CI: 229.05, 22.71 pmol/L;
I2 = 88%, P = 0.02) compared with the effects of the placebo.
The numeric reduction in HOMA-IR of 1.33 U with soluble fiber
supplementation was NS (95% CI: 22.98, 0.32 U; I2 = 97%, P =
0.12). The omission of Genta et al. (220) from the meta-analysis
reduced I2 measures of between-study heterogeneity to ,50%
for fasting glucose, fasting insulin, and HOMA-IR (Supplemental
Figure 3) while maintaining the significant differences between
soluble fiber treatment and the placebo. The percentage of mean
difference change was.10% in 3 of 8 studies for fasting glucose
(219, 221, 224), in 2 of 7 studies for fasting insulin (220, 224), and
in 4 of 5 studies for HOMA-IR (219–221, 225).
Publication bias assessment
No publication bias was indicated for any outcomes as de-
termined via a funnel plot inspection and Begg’s test and Egger’s
test P values .0.05 (Table 2).
Meta-regressions for intervention duration, fiber dose, and
fiber type
The intervention duration (range: 2–17 wk) and fiber dose
(range: 3–34 g/d) were not significantly related to study out-
comes. Meta-regressions that were conducted by fiber type
indicated a more pronounced reduction in HOMA-IR (re-
gression coefficient: 24.11; P = 0.009; 95% CI: 25.77, 22.46)
by nonviscous, fermentable, soluble fiber supplements than by
viscous, fermentable fiber types.
1522 THOMPSON ET AL.
DISCUSSION
This systematic review and meta-analysis of RCTs revealed
significant reductions in BMI, body weight, body fat, and
fasting glucose and insulin concentrations after soluble fiber
supplementation in overweight and obese adults without
physician-diagnosed disease. A meta-analysis of body-
composition measures revealed significant, clinically mean-
ingful reductions of 0.84 U BMI and 2.5 kg body weight when
isolated soluble fiber was compared with placebo. Even slight
reductions in weight can produce metabolic improvements. Each
kilogram of lost body weight was connected with a 16% re-
duction in type 2 diabetes risk (228), and a 2–5% weight loss was
linked to improvements in fasting blood glucose and glycated
hemoglobin, which are 2 recognized cardiovascular disease risk
factors (229).
Meta-regressions revealed differences in HOMA-IR by fiber
type with a more pronounced reduction in insulin resistance
observed with nonviscous, fermentable fiber. Previous research
has indicated variable physiologic effects for soluble fibers
with different viscosity and fermentability profiles (26, 35,
170). Soluble, viscous, fermentable fiber is known to lower
blood glucose and lipid concentrations (26, 230), and emerging
research has indicated that similar metabolic improvements
may result from nonviscous, fermentable fiber consumption
(231). Meta-regressions of fiber doses (3–34 g) and inter-
vention durations (2–17 wk) revealed that these factors were
not associated with investigated outcomes. Weight loss oc-
curred after a 3-mo supplementation period with the use of 3 g
glucomannan/d and 34 g soluble dextrin/d (217, 222). These
findings may be related to differences in polymer chain length
and fermentability between fiber types with the potentially
more fermentable glucomannan having a stronger impact per
gram on anthropometric or metabolic outcomes than would
soluble dextrin (232). It is also reasonable to postulate that the
lack of dose response could indicate benefits for even slight
increases in soluble fiber consumption.
To our knowledge, this meta-analysis is the first to assess the
efficacy of isolated soluble fiber supplementation within RCTs on
body composition and metabolic health in overweight and obese
adults. Existing systematic reviews and meta-analyses have
mostly focused on individual soluble fiber types or pooled studies
with varied study designs and participant populations (e.g.,
healthy adults assessed alongside individuals with diagnosed
chronic disease). In accordance with our findings, one review of
insoluble and soluble fiber interventions (177) reported a mean
weight loss of 1.9 kg over 3.8 mo with 14 g additional dietary
fiber/d, and a glucomannan-focused meta-analysis observed re-
ductions in fasting glucose by 0.44 mmol/L (95% CI: 214.16,
20.72 mmol/L) and in body weight by 0.79 kg (95% CI: 21.53,
20.05 kg) (197). Another systematic review showed that iso-
lated soluble fiber decreased energy intake (69% compared with
30%) and appetite (59% compared with 14%) more frequently
than did insoluble fiber treatments (29). However, unlike our
study, significant reductions in body-composition outcomes
were not observed between isolated soluble fiber and insoluble
fiber (29). Another meta-analysis that was specific to soluble,
fermentable, and nonviscous fiber treatments reported a signif-
icant lowering of postprandial glucose [standardized mean dif-
ference (SMD): 20.76; 95% CI: 21.41, 20.12) and insulin
(SMD: 20.77; 95% CI: 21.50, 20.04) but a nonsignificant
change in body weight (SMD: 20.48; 95% CI: 21.19, 0.23)
(231).
Limitations of the present study should be noted. The number
of eligible studies was small, and no soluble fiber or placebo
treatment was provided twice. A sensitivity analysis also revealed
the presence of influential outlier studies. One study (220) in-
creased the heterogeneity across outcomes; however, its removal
did not negate detected differences between soluble fiber and
placebo groups. The outcome’s significance was unaffected by
this study’s omission, but the heterogeneity remained high for
BMI and body weight. We evaluated the efficacy of isolated
soluble fiber on body composition and metabolic outcomes
independent of researcher-imposed energy restriction or
weight-loss counseling. Despite weight-maintenance protocols,
3 studies reported reduced energy intake in treatment groups
(222–224), thus providing evidence that may support the sati-
ating impact of soluble fiber. Fiber-related satiation and other
mechanisms of action could not be assessed in the present study
nor could the long-term impact of soluble fiber supplementation
Downloaded from ajcn.nutrition.org by guest on December 11, 2017
beyond the published study-treatment period. Our findings may
not be generalizable to healthy-weight individuals or patients
with diagnosed chronic conditions although a review of studies
that were conducted in type 2 diabetes patients reported a 50%
reduction in the postprandial glucose peak after soluble fiber
intake that was equivalent to 8–10% of the total cereal gram
weight (233). There are several methodologic strengths of the
present study. Our analysis involved high-quality studies (mean
MQS: 8.9) and rigorous exclusion criteria that reduced the
presence of confounding variables such as a diagnosed disease
and weight-loss counseling. A thorough assessment of study
quality and biases was performed with the use of validated
methods, and we investigated sources of study heterogeneity
using a sensitivity analysis.
In conclusion, because of the observed improvements in
body composition, glucose, and insulin in the present study and
the extensive dietary fiber intake gap between recommended
intake and actual dietary fiber intake in the United States,
isolated soluble fiber supplementation may be a feasible ap-
proach to improve weight and metabolic health in overweight
and obese individuals. Indeed, the findings reported herein
provide evidence that enhancing the fiber content of the food
supply via isolated soluble fiber supplementation may benefit
this at-risk population, which has important implications to
food regulators, manufacturers, clinicians, and consumers
alike. Although caution is warranted when evaluating our
findings because of the high between-study heterogeneity,
these results suggest that isolated soluble fiber supplementation
has promising implications for weight management and im-
proved glucose and insulin homeostasis in overweight and
obese individuals.
We thank Caitlyn Edwards for her contributions, George Fahey for review-
ing the manuscript, and Nicola McKeown for the helpful dietary fiber research
study database.
The authors’ responsibilities were as follows—SVT and BAH: conducted
the research; SVT: performed the statistical analysis; HDH: had primary
responsibility for the final content of the manuscript; and all authors: con-
tributed to the research design, wrote the manuscript, and read and approved
the final manuscript. None of the authors reported a conflict of interest re-
lated to the study.
 SUPPLEMENTAL FIBER IMPROVES WEIGHT AND GLYCEMIA
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