Endocr Pract. 2016 Oct;22(10):1224-1234. doi: 10.4158/EP151157.RA. Epub 2016 Jul 13.
To review the data from randomized controlled trials (RCTs) for the roles of microbiota, pre-, pro- and synbiotics in metabolic conditions (obesity, prediabetes, and diabetes mellitus type 2 [DM2]).
Primary literature was reviewed on the topics including RCTs of pre-, pro- and synbiotics use for metabolic disease.
Gut bacteria (microbiota) benefit digestion and have multiple other functions. Microbiota could increase harvesting of energy from the food and cause subclinical inflammation seen in metabolic disorders. Diet-related interventions including prebiotics, probiotics, and synbiotics (combining pre-and probiotics) may benefit metabolic conditions. Prebiotics are complex carbohydrates (i.e., dietary fiber). Results of RCTs of prebiotics suggested a neutral effect on body weight, decreased fasting and postprandial glucose, and improved insulin sensitivity and lipid profile. Some inflammation markers were reduced, sometimes substantially (20-30%). RCTs for probiotics demonstrated significant but small effects on body weight (<3%) and metabolic parameters. The effect was seen mostly with fermented milk or yogurt compared to capsule form, consumption for at least 8 weeks, and use of multiple rather than a single bacterial strain. Changes in microbiota were seen at times with both pre- and probiotics. Pickled and fermented foods, particularly vegetables and beans, could serve as a dietary source of pre-, pro-, and synbiotics. These foods showed possible benefits for morbidity and mortality in prospective cohort studies.
Pre-, pro-, and synbiotics could prove useful, but further research is needed to clarify their clinical relevance for the prevention and management of metabolic disease.
A1c = glycohemoglobin A1c CI = confidence interval CVD = cardiovascular disease GMB = gut (large bowel) microbiota DM2 = diabetes mellitus type 2 HOMA-IR = homeostatic model assessment of insulin resistance LDL = low-density lipoprotein LPS = lipopolysaccharide NAFLD = nonalcoholic fatty liver disease RCT = randomized controlled trial SMD = standardized mean difference TG = triglycerides.
综述随机对照试验（RCT）中微生物组、前体、益生菌和合生菌在代谢性疾病（肥胖、糖尿病前期和 2 型糖尿病[DM2]）中的作用的数据。
对包括前体、益生菌和合生菌用于代谢性疾病的 RCT 在内的主题进行了文献综述。
肠道细菌（微生物组）有益于消化，并具有多种其他功能。微生物组可以增加从食物中获取能量，并导致代谢紊乱中出现亚临床炎症。与饮食相关的干预措施，包括前体、益生菌和合生菌（将前体和益生菌结合起来），可能有益于代谢状况。前体是复杂的碳水化合物（即膳食纤维）。前体 RCT 的结果表明，对体重无影响，降低空腹和餐后血糖，改善胰岛素敏感性和血脂谱。一些炎症标志物降低，有时幅度较大（20-30%）。益生菌 RCT 显示对体重（<3%）和代谢参数有显著但较小的影响。这种影响主要见于发酵乳或酸奶，与胶囊形式相比，至少 8 周的消费，以及使用多种而不是单一的细菌菌株。前体和益生菌有时都会引起微生物组的变化。腌制和发酵食品，特别是蔬菜和豆类，可以作为前体、益生菌和合生菌的饮食来源。这些食物在前瞻性队列研究中显示出对发病率和死亡率的可能益处。
前体、益生菌和合生菌可能有用，但需要进一步研究以阐明它们在预防和管理代谢性疾病方面的临床相关性。
A1c=糖化血红蛋白 A1c；CI=置信区间；CVD=心血管疾病；GMB=肠道（大肠）微生物组；DM2=2 型糖尿病；HOMA-IR=稳态模型评估的胰岛素抵抗；LDL=低密度脂蛋白；LPS=脂多糖；NAFLD=非酒精性脂肪性肝病；RCT=随机对照试验；SMD=标准化均数差；TG=甘油三酯。
