The Effect of Probiotics and Synbiotics on Risk Factors Associated with Cardiometabolic Diseases in Healthy People—A Systematic Review and Meta-Analysis with Meta-Regression of Randomized Controlled Trials

Abstract

We aimed to systematically review the effectiveness of probiotic/synbiotic formulations to counteract cardiometabolic risk (CMR) in healthy people not receiving adjunctive medication. The systematic search (PubMed/MEDLINE/Embase) until 1 August 2019 was performed for randomized controlled trials in >20 adult patients. Random-effect meta-analysis subgroup and meta-regression analysis of co-primary (haemoglobin A1c (HbA1C), glucose, insulin, body weight, waist circumference (WC), body mass index (BMI), cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), triglycerides, and blood pressure) and secondary outcomes (uric acid, plasminogen activator inhibitor-1–PAI-1, fibrinogen, and any variable related to inflammation/endothelial dysfunction). We included 61 trials (5422 persons). The mean time of probiotic administration was 67.01 ± 38.72 days. Most of probiotic strains were of Lactobacillus and Bifidobacterium genera. The other strains were Streptococci, Enterococci, and Pediococci. The daily probiotic dose varied between 106 and 1010 colony-forming units (CFU)/gram. Probiotics/synbiotics counteracted CMR factors (endpoint data on BMI: standardized mean difference (SMD) = −0.156, p = 0.006 and difference in means (DM) = −0.45, p = 0.00 and on WC: SMD = −0.147, p = 0.05 and DM = −1.21, p = 0.02; change scores on WC: SMD = −0.166, p = 0.04 and DM = −1.35, p = 0.03) in healthy persons. Overweight/obese healthy people might additionally benefit from reducing total cholesterol concentration (change scores on WC in overweight/obese: SMD: −0.178, p = 0.049). Poor quality of probiotic-related trials make systematic reviews and meta-analyses difficult to conduct and draw definite conclusions. “Gold standard” methodology in probiotic studies awaits further development.

<p>Probiotics for Prosperity: Is There a Role for Probiotics in the Fight Against Obesity? Review of Meta-Analyses of Randomized Controlled Trials</p>

“…[26][27][28][30][31][32][33]35,36,38,39 Similarly, most of the analyses showed a reduction of other anthropometric measures, including waist circumference, body fat mass, and/or body fat percentage. [26][27][28][29][31][32][33][35][36][37][38] Meta-analyses that included metabolic and inflammation-related parameters predominantly showed beneficial effects for those measures. The improvements were demonstrated for glucose, 28,33,38 HbA1c, 28,33 insulin, 28,33,38 HOMA-IR, 28,33,38 lipids, 28,29,36,38 liver function test, 33 and inflammatory markers.…”

“…The literature review identified 14 meta-analyses dedicated to evaluating probiotic and/or synbiotic effects on body weight and/or BMI (Table 1). [26][27][28][29][30][31][32][33][34][35][36][37][38][39] Overall, the majority (11 of 14) of meta-analyses showed that probiotic use in RCTs resulted in reduced body weight and/or BMI compared to placebo. [26][27][28][30][31][32][33]35,36,38,39 Similarly, most of the analyses showed a reduction of other anthropometric measures, including waist circumference, body fat mass, and/or body fat percentage.…”

“…[26][27][28][29][30][31][32][33][34][35][36][37][38][39] Overall, the majority (11 of 14) of meta-analyses showed that probiotic use in RCTs resulted in reduced body weight and/or BMI compared to placebo. [26][27][28][30][31][32][33]35,36,38,39 Similarly, most of the analyses showed a reduction of other anthropometric measures, including waist circumference, body fat mass, and/or body fat percentage. [26][27][28][29][31][32][33][35][36][37][38] Meta-analyses that included metabolic and inflammation-related parameters predominantly showed beneficial effects for those measures.…”

Probiotics as a Treatment for “Metabolic Depression”? A Rationale for Future Studies

“…The metaanalysis assessing the effect of probiotics on risk factors of cardiometabolic diseases in healthy people revealed reduced BMI and WC and, additionally, total cholesterol (TC) in overweight subjects. Most of the genera were Lactobacillus and Bifidobacterium, the mean time of probiotic administration was 67 days and the daily probiotic dose varied between 10 6 and 10 10 colony-forming units (CFU)/gram [101]. Another meta-analysis confirmed that the improvements in metabolic variables were mostly observed with Bifidobacterium and Lactobacillus genera, adding data on favourable effects of Streptococcus salivarius subsp.…”

Probiotics as a Treatment for “Metabolic Depression”? A Rationale for Future Studies

“…The meta-analysis assessing the effect of probiotics on risk factors of cardiometabolic diseases in healthy people revealed reduced BMI and WC and, additionally, total cholesterol (TC) in overweight subjects. Most of the genera were Lactobacillus and Bifidobacterium, the mean time of probiotic administration was 67 days and the daily probiotic dose varied between 10 6 and 10 10 colony-forming units (CFU)/gram [ 101 ]. Another meta-analysis confirmed that the improvements in metabolic variables were mostly observed with Bifidobacterium and Lactobacillus genera, adding data on favourable effects of Streptococcus salivarius subsp.…”