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Open Access | Online First

The effect of chitosan on blood lipids in patients with hypercholesterolemia and hyperlipidemia: a systematic review and meta-analysis

Shun Zhang1,2, Dong-Wei Ma3, Xin Yang3, Liang Chen4, Hui Xia1,2, Shao-Kang Wang1,2, Gui-Ju Sun1,2, Wang Liao1,2()
Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China
Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China
ZhiShi Plastic Clinic, Sanya 572000, China
School of Ocean and Tropical Medicine, Guangdong Medical University, Zhanjiang 524000, China
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Highlights

(1) Lipid-Lowering Effect: Chitosan reduces TC, LDL-C, and TG, with potential for hyperlipidemia treatment.

(2) Weight and BMI Reduction: Chitosan lowers body weight and BMI, aiding obesity management.

(3) Broad Applications: Chitosan shows promise in lipid-lowering and weight control for functional foods.

Graphical Abstract

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Chitosan markedly reduces serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), BMI, body weight, and triglycerides (TG), showing potential therapeutic value for hyperlipidemia, hypercholesterolemia and other cardiovascular diseases.

Abstract

Chitosan, a deacetylated polymer of the polysaccharide chitin, has received increasing attentions due to its potential health benefits, especially in the management of lipid metabolism. This meta-analysis aims to analyze the lipid-lowering effects of chitosan in patients with hypercholesterolemia and hyperlipidemia. Twenty-two trials were included in this meta-analysis. It was found that the levels of triglyceride (TG) (mean difference = −4.39; 95% confidence interval (CI): −7.51, −1.27, P = 0.006 < 0.05), total cholesterol (TC) (mean difference = −7.87; 95% CI: −9.54, −6.20, P < 0.001), body weight (mean difference = −1.15; 95% CI: −1.43, −0.87, P < 0.001), body mass index (BMI) (mean difference = −0.52; 95% CI: −0.63, −0.41, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) (mean difference = −6.89; 95% CI: −9.05, −4.73, P < 0.001) were significantly reduced in the intervention group as compared with the control group. However, the difference of high-density lipoprotein cholesterol (HDL-C) (mean difference = 0.66, 95% CI: −0.26, 1.58, P > 0.05) was statistically insignificant. We found that the duration of the chitosan treatment significantly affected the level of HDL-C (P non-linearity = 0.018,9). According to the study's findings, chitosan might play an important role in the regulation of blood lipid profile in human. However, larger-scale randomized controlled trials are necessary to make the evidence to be more persuasive.

Keywords

chitosanhypercholesterolemiahyperlipidemialipid profile

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Food & Medicine Homology
DOI: 10.26599/FMH.2025.9420061
Cite this article:
Zhang S, Ma D-W, Yang X, et al. The effect of chitosan on blood lipids in patients with hypercholesterolemia and hyperlipidemia: a systematic review and meta-analysis. Food & Medicine Homology, 2025, https://doi.org/10.26599/FMH.2025.9420061
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Baseline characteristics of participants and design characteristics of included articles

YearDiseaseRegionSample(I/C)Circle (weeks)Dose (mg/day)Age range (I/C)Study designChitosan typeReference
Note: I: Intervention group, C: Control group.
2004OverweightNew Zealand125/125243,00047.0 ± 11.7/48.0 ± 11.5ParallelChitosan capsules[26]
2003ObeseCanada11/1164,18535.4 ± 8.6/38.5 ± 7.8ParallelChitosan capsules (glucomannan, chitosan, fenugreek, Gymnema sylvestre, and vitamin C)[27]
2018ObeseGermany61/551212,80041.50 ± 11.75/41.50 ± 11.75ParallelChitosan tablets (Biopolymer 3200 tablets consist of β-1, 4-polymer of D-glucosamine and N-acetyl-D-glucosamine containing >80% chitosan, 5%–10% vitamin C, 1%–5% tartaric acid and 5%–10% water)[28]
2007HyperlipidemiaTaiwan, China20/20893661.1 ± 2.5, 61.6 ± 2.7/63.9 ± 2.6ParallelWater-soluable chitosan capsules Water-insoluable chitosan capsules[25]
2022OverweightIran31/30123,00013.51 ± 2.15/13.12 ± 2.02ParallelChitosan powder (standard fruit flavorings)[8]
2006OverweightUSA46/42123,00043.90 ± 1.71/48.70 ± 1.79ParallelChitosan tablets (chitosan, and one mg per tablet of beta-glucan, snowhite oat fiber, betaine HCL and aloe saponins)[29]
2003HypercholesterolemiaJapan41/4381,20056.7 ± 8.0/56.4 ± 9.0ParallelChitosan capsules[23]
2012OverweightGermany52/541280045.4 ± 7.0/48.3 ± 7.1ParallelPolyglucosamine L112 tablets (cellulose from plants, vitamin C, tartaric acid, silicon dioxide, and magnesium stearate (vegetable origin))[41]
2017OverweightSpain25/31123,00041.50 ± 11.75/41.50 ± 11.75Parallelβ-Glucan-chitin-chitosan fraction (BGCC) (protein, fat, carbohydrates, dietary fibre, ash)[30]
2015OverweightGermany45/42241,20048.60 ± 8.67/50.00 ± 8.91ParallelPG (a 125–145 kDa chitosan (low molecular weight chitosan (LMWC) with ascorbic acid and tartaric acid)[31]
1999OverweightUK15/1541,00046.7 ± 8.8/41.3 ± 11.3ParallelChitosan capsules (deacetylated chitin biopolymer)[14]
2008HypercholesterolemiaUSA15, 12/1484,500, 6,75046 ± 5, 45 ± 6/45 ± 8ParallelChitosan tablets (each chitosan tablet contained 750 mg ChitoClear® fg 95[32]
2001OverweightUSA29/3083,00041.0 ± 8.2/40.0 ± 8.3ParallelChitosan capsules (the chitosan used in this study (LipoSan Ultra™) consisted of >90% chitosan and <10% succinic acid)[42]
2023OverweightItaly58/61123,00052.47 ± 1.30/50.60 ± 10.76ParallelPG (Verum tablets contained 73% polyglucosamine L112, ascorbic and tartaric acid, as well as further tableting aids)[33]
2010ObeseMexico6/6122,25041.6 ± 6.3/42.6 ± 5.6ParallelChitosan tablets[34]
2001Obese/hypercholesterolemiaSingapore36/32123,08442.6 ± 6.7/43.3 ± 7.7ParallelChitosan capsules (“Absorbitol” a salt of chitosan)[35]
2007HypercholesterolemiaCanada13, 23, 21, 20/18121,200, 1,600, 2,400, 2,40055 ± 12, 53 ± 9, 52 ± 8, 51 ± 10/53 ± 13ParallelHEP-40™ (a highly deacetylated (93%), low-molecular weight chitosan)[36]
1997Chronic renal failureJapan40/40121,35038/38ParallelChitosan tablets (moisture, protein, fat, ash, chitosan, dextran)[37]
2017DyslipidemiaItaly30/9121052 ± 12/52 ± 6ParallelNew nutraceutical formulation (berberine, red yeast rice and chitosan)[38]
2016ObeseIndia56/30122,50035.33 ± 11.23/36.28 ± 10.49ParallelChitosan capsules (chitosan, magnesium stearate and colloidal silicone dioxide)[39]
2017ObeseItaly49/48481,60047.00 ± 7.75/46.40 ± 4.42ParallelPG (a low-MW chitosan used in fixed combinations with ascorbic and tartaric acids)[40]
2020ObeseSpain37/365227352.3 ± 7.4/49.5 ± 10.4ParallelLipigo (a polysaccharide-rich fraction containing beta-glucan, chitin, and chitosan, obtained by a specific hydrolysis procedure of residual Saccharomyces S. cerevisiae from brewery)[20]

Risk of bias assessment

Random sequence generationAllocation concealmentBlinding of participants and personnelBlinding of outcome assessmentIncomplete outcome dataSelective reportingOther sources of biasReference
Note: L = Low: H = high; U = Unclear.
LLLLLLL[26]
LLLLLLL[27]
UULLLLL[28]
UUHHLLL[25]
LLLLLLL[8]
LLLLLLL[29]
LLLLLLL[23]
ULLLLLL[41]
LLLLLLL[30]
LLLLLLL[31]
LLLLLLL[14]
LLLLLLL[32]
LLLLLLL[42]
HHLLLLL[33]
UULLLLL[34]
ULLLLLL[35]
LLLLLLL[36]
HHLLLLL[37]
LLLLLLL[38]
LLHHLLL[39]
LLLLLLL[40]
UULLLLL[20]

Results of subgroup analysis in included studies.

SubgroupsTCTGLDL-CHDL-C
NWMD (95% CI)HeterogeneityNWMD (95% CI)HeterogeneityNWMD (95% CI)HeterogeneityNWMD (95% CI)Heterogeneity
PI2 (%)PI2 (%)PI2 (%)PI2 (%)
Note: N: number of trials. −: No data reported.
Study regionTotal1,363−7.87 (−9.54, −6.20)−62.31,034−4.39 (−7.51, −1.27)0.83801,128−6.89 (−9.05, −4.73)0.26115.21,2080.66 (−0.26, 1.58)0.4890
Asia353−9.55 (−13.49, −5.61)−83.7439−2.25 (−5.94, 1.43)0.9430359−3.53 (−7.07, 0.00)0.81504391.36 (−0.05, 2.77)0.0648.3
Europe524−11.88 (−15.43, −8.32)0.21928.8447−8.02 (−14.64, −1.39)0.6970533−9.03 (−12.54, −5.52)0.02162.2533−0.38 (−1.78, 1.02)0.9810
America236−6.28 (−9.17, −3.38)0.8930148−16.12 (−28.65, −3.59)0.8410236−8.69 (−13.04, −4.33)0.96702361.70 (−0.70, 4.11)0.9310
Oceania250−5.42 (−8.64, −2.20)−−−−−−−−−−−−−−
DiseaseTotal1,363−7.87 (−9.54, −6.20)−62.31,034−4.39 (−7.51, −1.27)0.83801,128−6.89 (−9.05, −4.73)0.26115.21,2080.66 (−0.26, 1.58)0.4890
Overweight/obese935−8.29 (−10.39, −6.18)0.04947567−3.47 (−6.74, −0.20)0.43.9741−6.05 (−8.73, −3.37)0.2818.37410.51 (−0.50, 1.51)0.8730
Hyperlipidemia/hypercholesterolemia348−7.16 (−9.89, −4.43)−73.7387−13.86 (−24.34, −3.39)0.9890387−8.43 (−12.08, −4.79)0.31113.63871.40 (−0.83, 3.63)0.14131.3
Other80−118.81 (−480.33, 242.71)−−80−35.40 (−441.29, 370.49)−−−−−−8012.77 (−44.84, 70.38)−−
DosageTotal1,363−7.87 (−9.54, −6.20)−62.31,034−4.39 (−7.51, −1.27)0.83801,128−6.89 (−9.05, −4.73)0.26115.21,2080.66 (−0.26, 1.58)0.4890
Low dosage564−10.33 (−12.73, −7.93)−69.4603−12.44 (−18.86, −6.02)0.9910493−11.72 (−15.08, −8.36)0.7460573−0.60 (−2.26, 1.07)0.4460
Hight dosage799−5.57 (−7.89, −3.24)0.21724.6431−1.91 (−5.47, 1.66)0.9290635−3.48 (−6.30, −0.66)0.95206351.21 (0.11, 2.30)0.6980