Dietary astaxanthin supplementation has been demonstrated to have many beneficial and health-promoting effects. The purpose of this systematic review and meta-analysis was to assess the effect of astaxanthin supplementation on fatigue, cognition, and exercise efficiency. A total of 11 randomized controlled trials (RCTs) with 346 healthy participants were included. The random effects model and pooled standardized mean difference (SMDs) were used according to Hedge’s g for the meta-analysis, and a meta-regression was also conducted. The results of the two existing studies showed a positive trend for astaxanthin in subjective fatigue relief. The effects of astaxanthin supplementation for 8–12 weeks on cognitive accuracy were marginally significant (SMD: .12; 95% CI: −.02–.26) and on reaction time was not significant (SMD: −.08; 95% CI: −.26 to .10). Remarkably, astaxanthin supplementation combined with regular training could enhance the fat oxidation (SMD: 2.56; 95% CI: 1.24–3.89), and significantly improve the physical performance (SMD: .62; 95% CI: .17–1.06). The subgroup analysis further showed significantly greater benefits when performing the aerobic exercises performance (SMD: .45; 95% CI: .13–.76), when the dose was ≥ 20 mg (SMD: .37; 95% CI: .11–.63), and when the supplementation duration was > 12 weeks (SMD: .66; 95% CI: .13–.63). We conclude that astaxanthin supplementation could significantly enhance aerobic exercise efficiency, especially at higher doses and for longer durations. Further studies based on large sample sizes are imperatively warranted.
AoiW.MaokaT.AbeR.FujishitaM.TominagaK. (2018). Comparison of the effect of non-esterified and esterified astaxanthins on endurance performance in mice. Journal of Clinical Biochemistry & Nutrition, 62(2), 161–166. https://doi.org/10.3164/jcbn.17-89
2.
AzzolinoD.ArosioB.MarzettiE.CalvaniR.CesariM. (2020). Nutritional Status as a mediator of fatigue and its underlying mechanisms in older people. Nutrients, 12(2), 444. https://doi.org/10.3390/nu12020444
3.
BehrensM.GubeGubeM.ChaabeneH.PrieskeO.ZenonA.BroscheidK. C.SchegaL.HusmannF.WeippertM. (2023). Fatigue and human performance: An updated framework. Sports Medicine, 53(1), 7–31. https://doi.org/10.1007/s40279-022-01748-2
4.
BorensteinM.HedgesL. V.HigginsJ. P. (2011). Introduction to meta-analysis. John Wiley & Sons.
5.
BrownD. R.WarnerA. R.DebS. K.GoughL. A.SparksS. A.McNaughtonL. R. (2021). The effect of astaxanthin supplementation on performance and fat oxidation during a 40 km cycling time trial. Journal of Science and Medicine in Sport, 24(1), 92–97. https://doi.org/10.1016/j.jsams.2020.06.017
6.
CaoY.YangL.QiaoX.XueC.XuJ. (2023). Dietary astaxanthin: An excellent carotenoid with multiple health benefits. Critical Reviews in Food Science and Nutrition, 63(18), 3019–3045. https://doi.org/10.1080/10408398.2021.1983766
7.
CatalaP.GutierrezP.ÉcijaA. C.Serrano del MoralÁ.PeñacobaC. (2021). Do cognitive abilities influence physical and mental fatigue in patients with chronic pain after walking according to a clinical guideline for physical exercise?International Journal of Environmental Research and Public Health, 18(24), 13148. https://doi.org/10.3390/ijerph182413148
8.
ChangM. X.XiongF. (2020). Astaxanthin and its effects in inflammatory responses and inflammation-associated diseases: Recent advances and future directions. Molecules, 25(22), 5342. https://doi.org/10.3390/molecules25225342
DuvalS.TweedieR. (2000). A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95(449), 89–98. https://doi.org/10.1080/01621459.2000.10473905
11.
EarnestC. P.LupoM.WhiteK. M.ChurchT. S. (2011). Effect of astaxanthin on cycling time trial performance. International Journal of Sports Medicine, 32(11), 882–888. https://doi.org/10.1055/s-0031-1280779
12.
EnokaR. M.DuchateauJ. (2016). Translating fatigue to human performance. Medicine & Science in Sports & Exercise, 48(11), 2228–2238. https://doi.org/10.1249/MSS.0000000000000929
13.
FakhriS.YarmohammadiA.YarmohammadiM.FarzaeiM. H.EcheverriaJ. (2021). Marine natural products: Promising candidates in the modulation of gut-brain axis towards neuroprotection. Marine Drugs, 19(3), 165. https://doi.org/10.3390/md19030165
14.
Greenhouse-TucknottA.WrightsonJ. G.RaynsfordM.HarrisonN. A.DekerleJ. (2020). Interactions between perceptions of fatigue, effort, and affect decrease knee extensor endurance performance following upper body motor activity, independent of changes in neuromuscular function. Psychophysiology, 57(9), e13602. https://doi.org/10.1111/psyp.13602
15.
HankenK.ElingP.HildebrandtH. (2015). Is there a cognitive signature for MS-related fatigue?Multiple Sclerosis Journal, 21(4), 376–381. https://doi.org/10.1177/1352458514549567
16.
HardyS. E.StudenskiS. A. (2010). Qualities of fatigue and associated chronic conditions among older adults. Journal of Pain and Symptom Management, 39(6), 1033–1042. https://doi.org/10.1016/j.jpainsymman.2009.09.026
17.
HayashiM.IshibashiT.MaokaT. (2018). Effect of astaxanthin-rich extract derived from Paracoccus carotinifaciens on cognitive function in middle-aged and older individuals. Journal of Clinical Biochemistry & Nutrition, 62(2), 195–205. https://doi.org/10.3164/jcbn.17-100
HigginsJ. P.AltmanD. G.GotzscheP. C.JuniP.MoherD.OxmanA. D.SavovicJ.SchulzK. F.WeeksL.SterneJ. A.Cochrane Bias Methods Group Cochrane Statistical Methods Group. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ, 343(oct18 2), d5928. https://doi.org/10.1136/bmj.d5928
20.
HigginsJ. P. T.ThomasJ.ChandlerJ.CumpstonM.LiT.PageM. J.WelchV. A. (2019). Cochrane handbook for systematic reviews of interventions (2nd ed.): The Cochrane Collaboration and John Wiley & Sons.
21.
HongoN.FujishitaM.TakahashiY.AdachiY. (2017). Daily fatigue-reducing effect of astaxanthin—a randomized, placebo-controlled, double-blind, parallel-group study. Japanese Pharmacology & Therapeutics, 45(1), 61–72.
22.
ImaiA.OdaY.ItoN.SekiS.NakagawaK.MiyazawaT.UedaF. (2018). Effects of dietary supplementation of astaxanthin and sesamin on daily fatigue: A randomized, double-blind, placebo-controlled, two-way crossover study. Nutrients, 10(3), 281. https://doi.org/10.3390/nu10030281
23.
KatagiriM.SatohA.TsujiS.ShirasawaT. (2012). Effects of astaxanthin-rich Haematococcus pluvialis extract on cognitive function: A randomised, double blind, placebo-controlled study. Journal of Clinical Biochemistry & Nutrition, 51(2), 102–107. https://doi.org/10.3164/jcbn.D-11-00017
24.
KlugerB. M.KruppL. B.EnokaR. M. (2013). Fatigue and fatigability in neurologic illnesses: Proposal for a unified taxonomy. Neurology, 80(4), 409–416. https://doi.org/10.1212/WNL.0b013e31827f07be
25.
LeavittV. M.DeLucaJ. (2010). Central fatigue: Issues related to cognition, mood and behavior, and psychiatric diagnoses. PMR, 2(5), 332–337. https://doi.org/10.1016/j.pmrj.2010.03.027
26.
LiuS. Z.AliA. S.CampbellM. D.KilroyK.ShanklandE. G.RoshanravanB.MarcinekD. J.ConleyK. E. (2018). Building strength, endurance, and mobility using an astaxanthin formulation with functional training in elderly. Journal of Cachexia, Sarcopenia and Muscle, 9(5), 826–833. https://doi.org/10.1002/jcsm.12318
27.
LiuS. Z.ValenciaA. P.VanDorenM. P.ShanklandE. G.RoshanravanB.ConleyK. E.MarcinekD. J. (2021). Astaxanthin supplementation enhances metabolic adaptation with aerobic training in the elderly. Physiol Rep, 9(11), Article e14887. https://doi.org/10.14814/phy2.14887
28.
MagginiS.ÓváriV.Ferreres GiménezI.Pueyo AlamánM. G. (2021). Benefits of micronutrient supplementation on nutritional status, energy metabolism, and subjective wellbeing. Nutricion Hospitalaria, 38(Spec No2), 3–8. https://doi.org/10.20960/nh.03788
29.
MalmstenC. L.LignellA. (2008). Dietary supplementation with astaxanthin-rich algal meal improves strength endurance– a double blind placebo controlled study on male students. Carotenoid Science, 13, 20–22.
30.
MarkunS.GravestockI.JägerL.RosemannT.PichierriG.BurgstallerJ. M. (2021). Effects of vitamin B12 supplementation on cognitive function, depressive symptoms, and fatigue: A systematic review, meta-analysis, and meta-regression. Nutrients, 13(3), Article 923. https://doi.org/10.3390/nu13030923
31.
MentingJ.TackC. J.BleijenbergG.DondersR.Droogleever FortuynH. A.FransenJ.GoedendorpM. M.KalkmanJ. S.Strik-AlbersR.van AlfenN.van der WerfS. P.VoermansN. C.van EngelenB. G.KnoopH. (2018). Is fatigue a disease-specific or generic symptom in chronic medical conditions?Health Psychology, 37(6), 530–543. https://doi.org/10.1037/hea0000598
32.
MoherD.LiberatiA.TetzlaffJ.AltmanD. G.PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097.
33.
Musa-VelosoK.VendittiC.LeeH. Y.DarchM.FloydS.WestS.SimonR. (2018). Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutrition Reviews, 76(8), 581–602. https://doi.org/10.1093/nutrit/nuy022
34.
NakagawaK.KikoT.MiyazawaT.Carpentero BurdeosG.KimuraF.SatohA.MiyazawaT. (2011). Antioxidant effect of astaxanthin on phospholipid peroxidation in human erythrocytes. British Journal of Nutrition, 105(11), 1563–1571. https://doi.org/10.1017/S0007114510005398
35.
NantachaiG.VasupanrajitA.TunvirachaisakulC.SolmiM.MaesM. (2022). Oxidative stress and antioxidant defenses in mild cognitive impairment: A systematic review and meta-analysis. Ageing Research Reviews, 79, 101639. https://doi.org/10.1016/j.arr.2022.101639
36.
PageM. J.McKenzieJ. E.BossuytP. M.BoutronI.HoffmannT. C.MulrowC. D.ShamseerL.TetzlaffJ. M.AklE. A.BrennanS. E.ChouR.GlanvilleJ.GrimshawJ.M.HróbjartssonA.LaluM. M.LiT.LoderE. W.Mayo-WilsonE.McDonaldS.MoherD. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71.
37.
QiuCWinbladB.FratiglioniL (2005). The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol, 4(8), 487–499.
38.
ResP. T.CermakN. M.StinkensR.TollaksonT. J.HaenenG. R.BastA.Van LoonL. (2013). Astaxanthin supplementation does not augment fat use or improve endurance performance. Medicine & Science in Sports & Exercise, 20(1), 1158–1165. https://doi.org/10.1249/MSS.0b013e31827fddc4
39.
SandercockP. (2011). The authors say: ‘The data are not so robust because of heterogeneity’—so, how should I deal with this systematic review?Cerebrovascular Diseases, 31(6), 615–620. https://doi.org/10.1159/000326068
40.
ShamseerL.MoherD.ClarkeM.GhersiD.LiberatiA.PetticrewM.ShekelleP.StewartL. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 350, g7647. https://doi.org/10.1136/bmj.g7647
41.
TakamiM.AoiW.TerajimaH.TanimuraY.WadaS.HigashiA. (2019). Effect of Dietary antioxidant-rich foods combined with aerobic training on energy metabolism in healthy young men. Journal of Clinical Biochemistry & Nutrition, 64(1), 79–85. https://doi.org/10.3164/jcbn.18-40
42.
TardyA. L.PouteauE.MarquezD.YilmazC.ScholeyA. (2020). Vitamins and minerals for energy, fatigue and cognition: a narrative review of the biochemical and clinical evidence. Nutrients, 12(1), 228–247. https://doi.org/10.3390/nu12010228
TufanaruC.MunnZ.StephensonM.AromatarisE. (2015). Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. International Journal of Evidence-Based Healthcare, 13(3), 196–207. https://doi.org/10.1097/XEB.0000000000000065
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