Department of Endocrinology, 'Evangelismos' General Hospital of Athens, 45-47 Ypsilantou street, 10676, Athens, Greece.
Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece.
Curr Obes Rep. 2020 Sep;9(3):179-192. doi: 10.1007/s13679-020-00379-w.
In this review, we summarize current evidence on gut microbiome and obesity; we discuss the role of probiotics, prebiotics, synbiotics, and postbiotics in obesity prevention and management; and we highlight and analyze main limitations, challenges, and controversies of their use.
Overall, the majority of animal studies and meta-analyses of human studies examining the use of probiotics and synbiotics in obesity has shown their beneficial effects on weight reduction and other metabolic parameters via their involvement in gut microbiota modulation. Bifidobacterium and Lactobacillus strains are still the most widely used probiotics in functional foods and dietary supplements, but next generation probiotics, such as Faecalibacterium prausnitzii, Akkermansia muciniphila, or Clostridia strains, have demonstrated promising results. On the contrary, meta-analyses of human studies on the use of prebiotics in obesity have yielded contradictory results. In animal studies, postbiotics, mainly short-chain fatty acids, may increase energy expenditure through induction of thermogenesis in brown adipose tissue as well as browning of the white adipose tissue. The main limitations of studies on biotics in obesity include the paucity of human studies; heterogeneity among the studied subgroups regarding age, gender, and lifestyle; and use of different agents with potential therapeutic effects in different formulations, doses, ratio and different pharmacodynamics/pharmacokinetics. In terms of safety, the supplementation with prebiotics, probiotics, and synbiotics has not been associated with serious adverse effects among immune-competent individuals, with the exception of the use of probiotics and synbiotics in immunocompromised patients. Further large-scale Randomized Controlled Trials (RCTs) in humans are required to evaluate the beneficial properties of probiotics, prebiotics, synbiotics, and postbiotics; their ideal dose; the duration of supplementation; and the durability of their beneficial effects as well as their safety profile in the prevention and management of obesity.
本文总结了目前关于肠道微生物组与肥胖的相关证据，讨论了益生菌、益生元、合生元和后生元在肥胖预防和管理中的作用，并强调和分析了它们使用的主要局限性、挑战和争议。
总的来说，大多数动物研究和人体研究的荟萃分析表明，益生菌和合生元通过调节肠道微生物群来减轻体重和其他代谢参数方面具有有益作用。双歧杆菌和乳杆菌仍然是功能性食品和膳食补充剂中使用最广泛的益生菌，但下一代益生菌，如普拉梭菌、阿克曼氏菌或梭菌，已经显示出了有希望的结果。相反，关于益生元在肥胖中的应用的人体研究的荟萃分析得出了相互矛盾的结果。在动物研究中，后生元主要是短链脂肪酸，可能通过诱导棕色脂肪组织产热以及白色脂肪组织的褐变来增加能量消耗。肥胖症中关于生物制剂的研究的主要局限性包括：人类研究较少；研究亚组在年龄、性别和生活方式方面存在异质性；以及使用不同的制剂、剂量、比例和不同的药效学/药代动力学具有潜在治疗效果的不同制剂。就安全性而言，除了在免疫功能低下的患者中使用益生菌和合生元外，益生元、益生菌和合生元的补充与严重不良事件无关。需要进行更多大规模的随机对照试验（RCT）来评估益生菌、益生元、合生元和后生元的有益特性、理想剂量、补充持续时间、以及它们在肥胖预防和管理中的有益效果的持久性及其安全性概况。
