Effect of Dietary Acetic Acid Supplementation on Plasma Glucose, Lipid Profiles, and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis

Published:January 09, 2021DOI:



      Acetic acid is a short-chain fatty acid that has demonstrated biomedical potential as a dietary therapeutic agent for the management of chronic and metabolic illness comorbidities. In human beings, its consumption may improve glucose regulation and insulin sensitivity in individuals with cardiometabolic conditions and type 2 diabetes mellitus. Published clinical trial evidence evaluating its sustained supplementation effects on metabolic outcomes is inconsistent.


      This systematic review and meta-analysis summarized available evidence on potential therapeutic effects of dietary acetic acid supplementation via consumption of acetic acid–rich beverages and food sources on metabolic and anthropometric outcomes.


      A systematic search was conducted in Medline, Scopus, EMBASE, CINAHL Plus, and Web of Science from database inception until October 2020. Randomized controlled trials conducted in adults evaluating the effect of dietary acetic acid supplementation for a minimum of 1 week were included. Meta-analyses were performed using a random-effects model on fasting blood glucose (FBG), triacylglycerol (TAG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), glycated hemoglobin (HbA1c), body mass index (BMI), and body fat percentage. Statistical heterogeneity was assessed by calculation of Q and I2 statistics, and publication bias was assessed by calculation of Egger’s regression asymmetry and Begg’s test.


      Sixteen studies were included, involving 910 participants who consumed between 750 and 3600 mg acetic acid daily in interventions lasting an average of 8 weeks. Dietary acetic acid supplementation resulted in significant reductions in TAG concentrations in overweight and obese but otherwise healthy individuals (mean difference [MD] = −20.51 mg/dL [95% confidence intervals = −32.98, −8.04], P = .001) and people with type 2 diabetes (MD = −7.37 mg/dL [−10.15, −4.59], P < .001). Additionally, acetic acid supplementation significantly reduced FBG levels (MD = −35.73 mg/dL [−63.79, −7.67], P = .01) in subjects with type 2 diabetes compared with placebo and low-dose comparators. No other changes were seen for other metabolic or anthropometric outcomes assessed. Five of the 16 studies did not specify the dose of acetic acid delivered, and no studies measured blood acetate concentrations. Only one study controlled for background acetic acid-rich food consumption during intervention periods. Most studies had an unclear or high risk of bias.


      Supplementation with dietary acetic acid is well tolerated, has no adverse side effects, and has clinical potential to reduce plasma TAG and FBG concentrations in individuals with type 2 diabetes, and to reduce TAG levels in people who are overweight or obese. No significant effects of dietary acetic acid consumption were seen on HbA1c, HDL, or anthropometric markers. High-quality, longer-term studies in larger cohorts are required to confirm whether dietary acetic acid can act as an adjuvant therapeutic agent in metabolic comorbidities management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mendis S.A.T.
        • Bettcher D.
        • Branca F.
        • et al.
        World Health Organization Global Status Report on Noncommunicable Diseases. 2014.
        (Accessed February 12, 2019)
        • Yach D.
        • Hawkes C.
        • Gould C.
        • Hofman K.J.
        The global burden of chronic diseases: Overcoming impediments to prevention and control.
        JAMA. 2004; 291: 2616-2622
      1. World Health Organization. Diet, nutrition and the prevention of chronic diseases. 2003. World Health Organization Technical Report Series No. 916. 2003:1-60. Accessed February 5, 2019.

        • O’Keefe J.H.
        • Gheewala N.M.
        • O’Keefe J.O.
        Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health.
        J Am Coll Cardiol. 2008; 51: 249-255
        • Cani P.D.
        • Delzenne N.M.
        The role of the gut microbiota in energy metabolism and metabolic disease.
        Curr Pharm Des. 2009; 15: 1546-1558
        • Korner J.
        • Aronne L.J.
        Pharmacological approaches to weight reduction: therapeutic targets.
        J Clin Endocrinol Metab. 2004; 89: 2616-2621
        • Yanovski S.Z.
        • Yanovski J.A.
        Long-term drug treatment for obesity: a systematic and clinical review.
        JAMA. 2014; 311: 74-86
        • Greenway F.L.
        • Caruso M.K.
        Safety of obesity drugs.
        Expert Opin Drug Saf. 2005; 4: 1083-1095
        • Petsiou E.I.
        • Mitrou P.I.
        • Raptis S.A.
        • Dimitriadis G.D.
        Effect and mechanisms of action of vinegar on glucose metabolism, lipid profile, and body weight.
        Nutr Rev. 2014; 72: 651-661
        • Hernández M.A.G.
        • Canfora E.E.
        • Jocken J.W.E.
        • Blaak E.E.
        The short-chain fatty acid acetate in body weight control and insulin sensitivity.
        Nutrients. 2019; 11: 1943
        • den Besten G.
        • van Eunen K.
        • Groen A.K.
        • Venema K.
        • Reijngoud D.-J.
        • Bakker B.M.
        The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism.
        J Lipid Res. 2013; 54: 2325-2340
        • Keenan M.J.
        • Zhou J.
        • Hegsted M.
        • et al.
        Role of resistant starch in improving gut health, adiposity, and insulin resistance.
        Adv Nutr. 2015; 6: 198-205
        • Bloemen J.G.
        • Venema K.
        • van de Poll M.C.
        • Olde Damink S.W.
        • Buurman W.A.
        • Dejong C.H.
        Short chain fatty acids exchange across the gut and liver in humans measured at surgery.
        Clin Nutr. 2009; 28: 657-661
        • Stipanuk M.
        • Caudell M.
        Biochemical, Physiological, and Molecular Aspects of Human Nutrition.
        3rd ed. Elsevier, 2012
        • Lim J.
        • Henry C.J.
        • Haldar S.
        Vinegar as a functional ingredient to improve postprandial glycemic control-human intervention findings and molecular mechanisms.
        Mol Nutr Food Res. 2016; 60: 1837-1849
        • Nicholson J.K.
        • Holmes E.
        • Kinross J.
        • et al.
        Host-gut microbiota metabolic interactions.
        Science. 2012; 336: 1262-1267
        • Ali Z.
        • Wang Z.
        • Amir R.M.
        • et al.
        Potential uses of vinegar as a medicine and related in vivo mechanisms.
        Int J Vitam Nutr Res. 2016; 86: 127-151
        • Budak N.H.
        • Aykin E.
        • Seydim A.C.
        • Greene A.K.
        • Guzel-Seydim Z.B.
        Functional properties of vinegar.
        J Food Sci. 2014; 79: R757-R764
        • Breidt F.
        • McFeeters R.F.
        • Pérez-Díaz I.
        • Lee C.-H.
        Fermented vegetables.
        in: Doyle M.P. Buchanan R.L. Food Microbiology: Fundamentals & Frontiers. 4th ed. American Society of Microbiology, 2013
        • Sarkola T.
        • Iles M.R.
        • Kohlenberg-Mueller K.
        • Eriksson C.J.
        Ethanol, acetaldehyde, acetate, and lactate levels after alcohol intake in white men and women: effect of 4-methylpyrazole.
        Alcohol Clin Exp Res. 2002; 26: 239-245
        • Gill P.A.
        • van Zelm M.C.
        • Ffrench R.A.
        • Muir J.G.
        • Gibson P.R.
        Successful elevation of circulating acetate and propionate by dietary modulation does not alter T-regulatory cell or cytokine profiles in healthy humans: a pilot study.
        Eur J Nutr. 2020; 59: 2651-2661
        • Yamashita H.
        • Maruta H.
        • Jozuka M.
        • et al.
        Effects of acetate on lipid metabolism in muscles and adipose tissues of type 2 diabetic Otsuka Long-Evans Tokushima Fatty (OLETF) rats.
        Biosci Biotechnol Biochem. 2009; 73: 570-576
        • Gu X.
        • Zhao H.L.
        • Sui Y.
        • Guan J.
        • Chan J.C.
        • Tong P.C.
        White rice vinegar improves pancreatic beta-cell function and fatty liver in streptozotocin-induced diabetic rats.
        Acta Diabetol. 2012; 49: 185-191
        • Fushimi T.
        • Tayama K.
        • Fukaya M.
        • et al.
        Acetic acid feeding enhances glycogen repletion in liver and skeletal muscle of rats.
        J Nutr. 2001; 131: 1973-1977
        • Li X.
        • Chen H.
        • Guan Y.
        • et al.
        Acetic acid activates the AMP-activated protein kinase signaling pathway to regulate lipid metabolism in bovine hepatocytes.
        PLoS One. 2013; 8e67880
        • Beh B.K.
        • Mohamad N.E.
        • Yeap S.K.
        • et al.
        Anti-obesity and anti-inflammatory effects of synthetic acetic acid vinegar and Nipa vinegar on high-fat-diet-induced obese mice.
        Sci Rep. 2017; 7: 6664
        • Shishehbor F.
        • Mansoori A.
        • Shirani F.
        Vinegar consumption can attenuate postprandial glucose and insulin responses: a systematic review and meta-analysis of clinical trials.
        Diabetes Res Clin Pract. 2017; 127: 1-9
        • Higgins J.P.T.
        Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. [Updated March 2011].
        (Accessed February 20, 2019)
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        J Clin Epidemiol. 2009; 62: 1006-1012
      2. Covidence Systematic Review Software. Veritas Health Innovation, 2017
        • Cheng L.J.
        • Jiang Y.
        • Wu V.X.
        • Wang W.
        A systematic review and meta-analysis: vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus.
        J Adv Nurs. 2020; 76: 459-474
        • Higgins J.P.T.
        • Altman D.G.
        • Gøtzsche P.C.
        • et al.
        The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343
      3. Higgins JPT, Altman DG, Sterne JAC. Assessing risk of bias in included studies. Chapter 8. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS, eds. Cochrane Handbook for Systematic Reviews of Interventions, version 5.2.0. Cochrane; 2017. Updated June 2017. Accessed March 25, 2019.

      4. RevMan. The Cochrane Collaboration, 2014
        • Brockwell S.E.
        • Gordon I.R.
        A comparison of statistical methods for meta-analysis.
        Stat Med. 2001; 20: 825-840
        • Higgins J.P.
        • Thompson S.G.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Begg C.B.
        • Mazumdar M.
        Operating characteristics of a rank correlation test for publication bias.
        Biometrics. 1994; 50: 1088-1101
        • Macaskill P.
        • Walter S.D.
        • Irwig L.
        A comparison of methods to detect publication bias in meta-analysis.
        Stat Med. 2001; 20: 641-654
        • Ali Z.
        • Ma H.
        • Wali A.
        • Ayim I.
        • Rashid M.T.
        • Younas S.
        A double-blinded, randomized, placebo-controlled study evaluating the impact of dates vinegar consumption on blood biochemical and hematological parameters in patients with type 2 diabetes.
        Trop J Pharm Res. 2018; 17: 2463-2469
        • Ali Z.
        • Ma H.
        • Wali A.
        • Ayim I.
        • Sharif M.N.
        Daily date vinegar consumption improves hyperlipidemia, β-carotenoid and inflammatory biomarkers in mildly hypercholesterolemic adults.
        J Herb Med. 2019; 17-18: 100265
        • An S.Y.
        • Lee M.S.
        • Jeon J.Y.
        • et al.
        Beneficial effects of fresh and fermented kimchi in prediabetic individuals.
        Ann Nutr Metab. 2013; 63: 111-119
        • Choi I.H.
        • Noh J.S.
        • Han J.-S.
        • Kim H.J.
        • Han E.-S.
        • Song Y.O.
        Kimchi, a fermented vegetable, improves serum lipid profiles in healthy young adults: randomized clinical trial.
        J Med Food. 2013; 16: 223-229
        • Derakhshandeh-Rishehri S.-M.
        • Heidari-Beni M.
        • Feizi A.
        • Askari G.-R.
        • Entezari M.-H.
        Effect of honey vinegar syrup on blood sugar and lipid profile in healthy subjects.
        Int J Prev Med. 2014; 5: 1608-1615
        • Gheflati A.
        • Bashiri R.
        • Ghadiri-Anari A.
        • Reza J.Z.
        • Kord M.T.
        • Nadjarzadeh A.
        The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: a randomized controlled clinical trial.
        Clin Nutr ESPEN. 2019; 33: 132-138
        • Johnston C.S.
        • Quagliano S.
        • White S.
        Vinegar ingestion at mealtime reduced fasting blood glucose concentrations in healthy adults at risk for type 2 diabetes.
        J Funct Foods. 2013; 5: 2007-2011
        • Johnston C.S.
        • White A.M.
        • Kent S.M.
        Preliminary evidence that regular vinegar ingestion favorably influences hemoglobin A1c values in individuals with type 2 diabetes mellitus.
        Diabetes Res Clin Pract. 2009; 84: e15-e17
        • Kim E.K.
        • An S.-Y.
        • Lee M.-S.
        • et al.
        Fermented kimchi reduces body weight and improves metabolic parameters in overweight and obese patients.
        Nutr Res. 2011; 31: 436-443
        • Kondo T.
        • Kishi M.
        • Fushimi T.
        • Ugajin S.
        • Kaga T.
        Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects.
        Biosci Biotechnol Biochem. 2009; 73: 1837-1843
        • Mahmoodi M.
        • Hosseini-Zijoud S.M.
        • Hassanshahi G.
        • et al.
        The effect of white vinegar on some blood biochemical factors in type 2 diabetic patients.
        Glob J Hematol Endocrinol. 2013; 1: 50-54
        • Park J.E.
        • Kim J.Y.
        • Kim J.
        • et al.
        Pomegranate vinegar beverage reduces visceral fat accumulation in association with AMPK activation in overweight women: a double-blind, randomized, and placebo-controlled trial.
        J Funct Foods. 2014; 8: 274-281
        • Wang C.-K.
        • Fu H.Y.
        • Chiang M.
        Cardiovascular disease prevention of cranberry vinegar.
        Nutr Sci J. 2007; 32: 129-132
        • Jasbi P.
        • Baker O.
        • Shi X.
        • et al.
        Daily red wine vinegar ingestion for eight weeks improves glucose homeostasis and affects the metabolome but does not reduce adiposity in adults.
        Food Funct. 2019; 10: 7343-7355
        • Kausar S.
        • Abbas M.A.
        • Ahmad H.
        • et al.
        Effect of apple cider vinegar in type 2 diabetic patients with poor glycemic control: a randomized placebo controlled design.
        Int J Med Res Health Sci. 2019; 8: 149-159
        • Nazni P.
        • Singh R.
        • Devi R.S.
        • et al.
        Assessment of hypoglycemic effects of apple cider vinegar in type 2 diabetes.
        Int J Food Nutr Sci. 2015; 4: 4
        • Begg C.
        • Cho M.
        • Eastwood S.
        • et al.
        Improving the quality of reporting of randomized controlled trials: the consort statement.
        JAMA. 1996; 276: 637-639
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; 340: c332
        • Shishehbor F.
        • Mansoori A.
        • Sarkaki A.R.
        • Jalali M.T.
        • Latifi S.M.
        Apple cider vinegar attenuates lipid profile in normal and diabetic rats.
        Pak J Biol Sci. 2008; 11: 2634-2638
        • Sakakibara S.
        • Yamauchi T.
        • Oshima Y.
        • Tsukamoto Y.
        • Kadowaki T.
        Acetic acid activates hepatic AMPK and reduces hyperglycemia in diabetic KK-A(y) mice.
        Biochem Biophys Res Commun. 2006; 344: 597-604
        • Marques F.Z.
        • Nelson E.
        • Chu P.Y.
        • et al.
        High-fiber diet and acetate supplementation change the gut microbiota and prevent the development of hypertension and heart failure in hypertensive mice.
        Circulation. 2017; 135: 964-977
        • Santos H.O.
        • de Moraes W.M.A.M.
        • da Silva G.A.R.
        • Prestes J.
        • Schoenfeld B.J.
        Vinegar (acetic acid) intake on glucose metabolism: a narrative review.
        Clin Nutr ESPEN. 2019; 32: 1-7
        • Lu Z.X.
        • Walker K.Z.
        • Muir J.G.
        • O'Dea K.
        Arabinoxylan fibre improves metabolic control in people with type II diabetes.
        Eur J Clin Nutr. 2004; 58: 621
        • Boll E.V.
        • Ekstrom L.M.
        • Courtin C.M.
        • et al.
        Effects of wheat bran extract rich in arabinoxylan oligosaccharides and resistant starch on overnight glucose tolerance and markers of gut fermentation in healthy young adults.
        Eur J Nutr. 2016; 55: 1661-1670
        • Kimura I.
        • Ozawa K.
        • Inoue D.
        • et al.
        The gut microbiota suppresses insulin-mediated fat accumulation via the short-chain fatty acid receptor GPR43.
        Nat Commun. 2013; 4: 1829
        • Johnston C.S.
        • Kim C.M.
        • Buller A.J.
        Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes.
        Diabetes Care. 2004; 27: 281-282
        • Ostman E.
        • Granfeldt Y.
        • Persson L.
        • Bjorck I.
        Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects.
        Eur J Clin Nutr. 2005; 59: 983-988
        • Freeland K.R.
        • Wolever T.M.
        Acute effects of intravenous and rectal acetate on glucagon-like peptide-1, peptide YY, ghrelin, adiponectin and tumour necrosis factor-alpha.
        Br J Nutr. 2010; 103: 460-466
        • Brown A.J.
        • Goldsworthy S.M.
        • Barnes A.A.
        • et al.
        The Orphan G protein-coupled receptors GPR41 and GPR43 are activated by propionate and other short chain carboxylic acids.
        J Biol Chem. 2003; 278: 11312-11319
        • Ang Z.
        • Ding J.L.
        GPR41 and GPR43 in obesity and inflammation: protective or causative?.
        Front Immunol. 2016; 7 (28-28)
        • Karra E.
        • Chandarana K.
        • Batterham R.L.
        The role of peptide YY in appetite regulation and obesity.
        J Physiol. 2009; 587: 19-25
        • Barrera J.G.
        • Sandoval D.A.
        • D’Alessio D.A.
        • Seeley R.J.
        GLP-1 and energy balance: an integrated model of short-term and long-term control.
        Nat Rev Endocrinol. 2011; 7: 507-516
        • Zhao L.
        • Zhang F.
        • Ding X.
        • et al.
        Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes.
        Science. 2018; 359: 1151-1156
        • Sugiyama S.
        • Fushimi T.
        • Kishi M.
        • et al.
        Bioavailability of acetate from two vinegar supplements: capsule and drink.
        J Nutr Sci Vitaminol (Tokyo). 2010; 56: 266-269
        • Siler S.Q.
        • Neese R.A.
        • Hellerstein M.K.
        De novo lipogenesis, lipid kinetics, and whole-body lipid balances in humans after acute alcohol consumption.
        Am J Clin Nutr. 1999; 70: 928-936
        • Hu J.
        • Kyrou I.
        • Tan B.K.
        • et al.
        Short-chain fatty acid acetate stimulates adipogenesis and mitochondrial biogenesis via GPR43 in brown adipocytes.
        Endocrinology. 2016; 157: 1881-1894
        • Gill P.A.
        • van Zelm M.C.
        • Muir J.G.
        • Gibson P.R.
        Review article: short chain fatty acids as potential therapeutic agents in human gastrointestinal and inflammatory disorders.
        Aliment Pharmacol Ther. 2018; 48: 15-34
        • Petersen K.F.
        • Impellizeri A.
        • Cline G.W.
        • Shulman G.I.
        The effects of increased acetate turnover on glucose-induced insulin secretion in lean and obese humans.
        J Clin Transl Sci. 2019; 3: 18-20
        • Liu J.
        • Zeng F.-F.
        • Liu Z.-M.
        • Zhang C.-X.
        • Ling W-h
        • Chen Y.-M.
        Effects of blood triglycerides on cardiovascular and all-cause mortality: a systematic review and meta-analysis of 61 prospective studies.
        Lipid Health Dis. 2013; 12: 159
        • Austin M.A.
        • Hokanson J.E.
        • Edwards K.L.
        Hypertriglyceridemia as a cardiovascular risk factor.
        Am J Cardiol. 1998; 81: 7B-12B
        • Tayek C.J.
        • Cherukuri L.
        • Hamal S.
        • Tayek J.A.
        Importance of fasting blood glucose goals in the management of type 2 diabetes mellitus: a review of the literature and a critical appraisal.
        J Diab Metab Disord Cont. 2018; 5: 113-117
        • Aykın E.
        • Budak N.
        • Güzel-Seydim Z.B.
        Bioactive components of mother vinegar.
        J Am Coll Nutr. 2015; 34: 80-89
        • Sáiz-Abajo M.J.
        • González-Sáiz J.M.
        • Pizarro C.
        Multi-objective optimisation strategy based on desirability functions used for chromatographic separation and quantification of l-proline and organic acids in vinegar.
        Anal Chim Acta. 2005; 528: 63-76
        • Jung J.Y.
        • Lee S.H.
        • Kim J.M.
        • et al.
        Metagenomic analysis of kimchi, a traditional Korean fermented food.
        Appl Environ Microbiol. 2011; 77: 2264
        • Natera R.
        • Castro R.
        • de Valme Garcia-Moreno M.
        • Hernandez M.J.
        • Garcia-Barroso C.
        Chemometric studies of vinegars from different raw materials and processes of production.
        J Agric Food Chem. 2003; 51: 3345-3351


      D. S. Valdes is a PhD student, Be Active Sleep and Eat (BASE) Facility, Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia.


      D. So is a PhD student, Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria, Australia.


      P. A. Gill is a Postdoctoral researcher, Department of Gastroenterology, and is a postdoctoral researcher, Department of Immunology and Pathology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria, Australia.


      N. J. Kellow is a senior lecturer, Be Active Sleep and Eat (BASE) Facility, Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia.

      Linked Article

      • Corrigendum
        Journal of the Academy of Nutrition and DieteticsVol. 121Issue 7
        • Preview
          Corrigendum to: Effect of Dietary Acetic Acid Supplementation on Plasma Glucose, Lipid Profiles, and Body Mass Index in Human Adults: A Systematic Review and Meta-analysis
        • Full-Text
        • PDF