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.

2020-06-08
Journal of clinical medicine 9(6)
- Karolina Skonieczna-Żydecka
- Karolina Kaźmierczak-Siedlecka
- Mariusz Kaczmarczyk
- Joanna Śliwa-Dominiak
- Dominika Maciejewska
- Katarzyna Janda
- Ewa Stachowska
- Beata Łoniewska
- Damian Malinowski
- Krzysztof Borecki
- Wojciech Marlicz
- Igor Łoniewski

PubMed: 32521799
DOI: 10.3390/jcm9061788

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.

Research Insights

Supplement	Health Outcome	Effect Type	Effect Size
Lactobacillus rhamnosus lysate powder	Reduced Body Mass Index	Beneficial	Small
Lactobacillus rhamnosus lysate powder	Reduced Total Cholesterol	Beneficial	Small
Lactobacillus rhamnosus lysate powder	Reduced Waist Circumference	Beneficial	Small