Prebiotics for people with cystic fibrosis

Key messages

Growth and nutritional status can impact lung function and overall survival in people with cystic fibrosis (CF), and prebiotics, a source of food for healthy bacteria in the gut, might be of benefit.

We did not find any trials that looked at how prebiotics affect people with CF, and such trials are needed.

How can prebiotics be used to treat people with CF?

We know that growth and nutritional status are important in CF as they affect lung function and overall survival. People with CF have an imbalance of bacteria and also inflammation in their guts. Oral prebiotics, which are commercially available, may improve both gut health and overall health. The most studied examples of these prebiotics are inulin, fructo-oligosaccharides, galacto-oligosaccharides, and human milk oligosaccharides. Prebiotics may be found naturally in whole plant foods (e.g. chicory root, onions, and bananas), but artificial prebiotic supplements are also available.

What did we want to find out?

Prebiotics have been able to reduce gut symptoms in other conditions, so we wanted to know if they can also help people with CF by improving growth and nutritional status and reducing gut symptoms without any side effects. We also wanted to know if they could improve lung function, reduce the number of flare-ups of the disease and admissions to hospital for CF, and improve the quality of life of people with CF.

What did we do?

We searched for trials comparing individual or multiple combinations of oral (swallowed) prebiotics compared to no treatment or a placebo (treatment with no active ingredient); a single different prebiotic or a combination of other prebiotics; or a probiotic or a symbiotic (a combination of prebiotics and probiotics). We did not restrict trials based on age or how ill or healthy people were with regard to their CF.

What did we find?

We found no trials for inclusion at this time. We did find one trial that is under way, but no results are available yet.

How up-to-date is the evidence?

The evidence is current to October 2022.

Authors' conclusions: 

This review did not find any evidence for the use of prebiotics in people with CF. Until such evidence is available, it is reasonable for clinicians to follow any local guidelines and to discuss the use of dietary prebiotics with their patients.

Large and robust RCTs assessing the dietary prebiotics of inulin or galacto-oligosaccharides or fructo-oligosaccharides, or any combination of these, are needed. Such studies should be of at least 12 months in duration and assess outcomes such as growth and nutrition, gastrointestinal symptoms, pulmonary exacerbations, lung function, inflammatory biomarkers, hospitalisations, intestinal microbial profiling, and faecal short-chain fatty acids. Trials should include both children and adults and aim to be adequately powered to allow for subgroup analysis by age.

Read the full abstract...

Cystic fibrosis (CF) is a multisystem disease; the importance of growth and nutritional status is well established given their implications for lung function and overall survivability. Furthermore, it has been established that intestinal microbial imbalance and inflammation are present in people with CF. Oral prebiotics are commercially available substrates that are selectively utilised by host intestinal micro-organisms and may improve both intestinal and overall health.


To evaluate the benefits and harms of prebiotics for improving health outcomes in children and adults with CF.

Search strategy: 

We searched the Cochrane Cystic Fibrosis Trials Register compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews. Date of last search: 19 October 2022.

We also searched PubMed and online trials registries. Date of last search: 13 January 2023.

Selection criteria: 

Randomised controlled trials (RCTs) and quasi-RCTs assessing the efficacy of prebiotics in children and adults with CF. We planned to only include the first treatment period from cross-over RCTs, regardless of washout period.

Data collection and analysis: 

We did not identify any relevant trials.

Main results: 

We did not identify any relevant trials for inclusion in this review.