Gastrointestinal Endoscopy Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Nutr Res. 2020 Nov;83:1-14. doi: 10.1016/j.nutres.2020.06.018. Epub 2020 Jul 3.
Obesity and metabolic syndrome are important health problems that can lead to significant morbidity/mortality as well as subsequent health concerns. Alterations in the gut microbiota have been implicated in both obesity and metabolic syndrome. Fecal Microbiota Transplantation (FMT) has emerged as a new promising therapeutic approach aimed at manipulating the gut microbiota in various chronic diseases. Randomized clinical trials assessing the use of FMT in obese and metabolic syndrome patients have been reported. The purpose of this systematic review with meta-analysis using randomized clinical trials (RCT) is to evaluate the role of FMT for the treatment of obesity and metabolic syndrome and its impact on clinically relevant parameters. We searched the main databases, as well as the gray literature, to identify RCTs comparing FMT from lean donor(s) vs placebo for obese/metabolic syndrome patients. We included all studies that utilized any form of placebo (sham, saline, autologous FMT, or placebo capsules). Six studies met the inclusion criteria and were included for final analysis with a total of 154 patients. We looked for clinically significant parameters related to obesity and metabolic syndrome and organized the findings into early (2-6 weeks after intervention) and late (12 weeks after intervention) outcomes. Two to 6 weeks after intervention, mean HbA was lower in the FMT group (MD = -1.69 mmol/L, CI [-2.88, -0.56], P = .003) and mean HDL cholesterol was higher in the FMT group (MD = 0.09 mmol/L, CI [0.02, 0.15], P = .008). There was no difference in obesity parameters 6 to 12 weeks after intervention. No serious adverse events were reported. The findings for this meta-analysis show that FMT may have a role for the treatment of metabolic syndrome, but there is currently not enough evidence to support its use in clinical practice. High-quality well-powered RCTS with longer follow-up are necessary to clarify the role of FMT in this patient cohort.
肥胖和代谢综合征是重要的健康问题，可导致显著的发病率/死亡率以及随后的健康问题。肠道微生物群的改变与肥胖和代谢综合征都有关。粪便微生物群移植（FMT）已成为一种新的有前途的治疗方法，旨在操纵各种慢性疾病中的肠道微生物群。已经报道了评估 FMT 在肥胖和代谢综合征患者中的使用的随机临床试验。本系统评价使用随机临床试验（RCT）的目的是评估 FMT 在肥胖和代谢综合征治疗中的作用及其对临床相关参数的影响。我们搜索了主要数据库以及灰色文献，以确定比较从瘦供体（s）与安慰剂的 FMT 治疗肥胖/代谢综合征患者的 RCT。我们纳入了所有使用任何形式安慰剂（假、盐水、自体 FMT 或安慰剂胶囊）的研究。六项研究符合纳入标准，并纳入最终分析，共 154 名患者。我们寻找与肥胖和代谢综合征相关的临床显著参数，并将研究结果组织成早期（干预后 2-6 周）和晚期（干预后 12 周）结果。干预后 2-6 周，FMT 组的平均 HbA 较低（MD=-1.69mmol/L，CI[-2.88，-0.56]，P=0.003），FMT 组的平均 HDL 胆固醇较高（MD=0.09mmol/L，CI[0.02，0.15]，P=0.008）。干预后 6 至 12 周，肥胖参数无差异。未报告严重不良事件。本荟萃分析的结果表明，FMT 可能在治疗代谢综合征方面发挥作用，但目前没有足够的证据支持其在临床实践中的应用。需要进行高质量、大样本、随访时间更长的 RCT，以阐明 FMT 在该患者群体中的作用。
