Resistant starch improves cardiometabolic disease outcomes: A narrative review of randomized trials

Healthy dietary patterns with adequate fiber improve cardiometabolic (CM) outcomes and attenuate disease progression. Resistant starch (RS) is a fermentable fiber that affects CM outcomes; however, studies are heterogeneous and inconsistent. Thus, the purpose of this narrative review is to assess the impact of RS intake by type and amount on CM out-comes while considering subject characteristics and trial duration. Randomized crossover or parallel studies (n = 31) were selected and compared according to acute (1 day; n = 12), medium ( > 1-30 days; n = 8), or long ( > 30 days; n = 11) duration. Most acute trials in healthy adults showed improvements in postprandial glycemic outcomes irrespective of RS type or amount. However, a more pronounced reduction occurred when test meals did not match for available carbohydrate. Daily RS intake had a minimal effect on CM outcomes in medium duration trials, but insulin resistant adults had better glycemic control at 4 weeks. Several longer duration trials (8-12 weeks) showed favorable CM outcomes with daily RS intake in adults with type 2 diabetes (T2D), but not in those at risk for T2D. Furthermore, some studies reported improved lipids, inflammatory biomarkers, and heart rate. Future studies should consider matching for available carbohydrates between the RS and control groups to un-derstand the gut microbiome ' s role. Furthermore, energy and fiber should be considered. Overall, the acute intake of RS improves glycemic outcomes, and consuming RS at for least 4 and up to 8 to 12 weeks in adults with prediabetes and T2D, respectively, appears to im-prove CM outcomes.

Automated summary

Adequate fiber in healthy dietary patterns improves cardiometabolic outcomes. Resistant starch (RS), a fermentable fiber, has varying effects on cardiometabolic outcomes. Acute trials show glycemic improvements regardless of RS type or amount, while longer trials show favorable outcomes in adults with type 2 diabetes (T2D) but not in those at risk for T2D. Future studies should consider matching for available carbohydrates and consider energy and fiber intake.