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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

Study Design

Type
Review
Population
healthy people not receiving adjunctive medication
Methods
systematic search (PubMed/MEDLINE/Embase) until 1 August 2019 for randomized controlled trials in >20 adult patients; random-effect meta-analysis subgroup and meta-regression analysis
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

  • Lactobacillus rhamnosus→Reduced Body Mass Index

    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

    Effect
    Beneficial
    Effect size
    Small
  • Lactobacillus rhamnosus→Reduced Total Cholesterol

    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).

    Effect
    Beneficial
    Effect size
    Small
  • Lactobacillus rhamnosus→Reduced Waist Circumference

    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.

    Effect
    Beneficial
    Effect size
    Small
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