J Acad Nutr Diet. 2023 Jun;123(6):933-952.e1. doi: 10.1016/j.jand.2023.01.006. Epub 2023 Jan 10.
Microbiome therapies (probiotic, prebiotic, and synbiotics) have been proposed as adjuvants in the control of central obesity; however, their results for patients with type 2 diabetes (T2D) remain inconclusive.
The aim of this systematic review and meta-analysis was to evaluate the effect of microbiome therapies on central obesity as measured by waist circumference (WC), and to evaluate the effect of microbiome therapies for glycemic parameters (fasting glucose [FPG], fasting insulin [FPI], hemoglobin A1c [HbA1c], and insulin resistance [HOMA1-IR]) in patients with T2D.
SCOPUS, Pubmed, EBSCO, and LILACS databases were searched for studies that investigated the effect of microbiome therapies on WC up to June 1, 2022. Heterogeneity was determined using Cochran's Q test and quantified using the inconsistency index. The random effects model was used to calculate the pooled difference in means (DM) and 95% confidence intervals (95%CI). Egger's test and Beggs-Muzamar's test were used to assess publication bias.
Fifteen reports were included (443 treated and 387 controls). Overall, a significant decrease in WC was found (DM = -0.97 cm; 95% confidence interval [95%CI] = -1.74 to -0.20; P = 0.014); however, when stratified by type of microbiome therapy, only probiotics significantly decreased WC (DM = -0.62 cm; 95%CI = -1.00 to -0.24; P = 0.002). No effect was observed for prebiotics and synbiotics. With respect to glycemic parameters, HbA1c, FPG, and HOMA1-IR significantly decrease with microbiome therapies (P ≤ 0.001). When stratified by the type of therapy, for probiotic treatments, HbA1c, FPG, and HOMA1-IR scores decrease (P < 0.001). For prebiotic treatments, HbA1c and FPG (P ≤ 0.001) levels decrease, whereas FPI increased (P = 0.012). Synbiotic treatments were only associated with an increase in FPI (P = 0.031).
Findings indicate that using probiotics alone improved WC in patients with T2D. Both probiotics and prebiotics decreased HbA1c and FPG; however, prebiotics and synbiotics resulted in an increase in FPI. The formulation of the therapy (single vs multi) had no difference on the effect.
微生物组疗法（益生菌、益生元和合生菌）已被提议作为控制中心性肥胖的辅助手段；然而，它们对 2 型糖尿病（T2D）患者的效果仍不确定。
本系统评价和荟萃分析旨在评估微生物组疗法对腰围（WC）的中心性肥胖的影响，并评估微生物组疗法对 T2D 患者的血糖参数（空腹血糖[FPG]、空腹胰岛素[FPI]、糖化血红蛋白[HbA1c]和胰岛素抵抗[HOMA1-IR]）的影响。
截至 2022 年 6 月 1 日，我们在 SCOPUS、Pubmed、EBSCO 和 LILACS 数据库中搜索了研究微生物组疗法对 WC 影响的研究。使用 Cochran's Q 检验和不一致性指数来确定异质性。使用随机效应模型计算平均差异（DM）和 95%置信区间（95%CI）。使用 Egger 检验和 Beggs-Muzamar 检验评估发表偏倚。
纳入了 15 份报告（443 例治疗组和 387 例对照组）。总体而言，WC 显著下降（DM=-0.97cm；95%CI=-1.74 至-0.20；P=0.014）；然而，按微生物组疗法的类型分层时，只有益生菌显著降低 WC（DM=-0.62cm；95%CI=-1.00 至-0.24；P=0.002）。益生菌和合生菌对 WC 无影响。关于血糖参数，HbA1c、FPG 和 HOMA1-IR 随着微生物组疗法的应用而显著降低（P≤0.001）。按治疗类型分层时，对于益生菌治疗，HbA1c、FPG 和 HOMA1-IR 评分降低（P<0.001）。对于益生元治疗，HbA1c 和 FPG（P≤0.001）水平降低，而 FPI 增加（P=0.012）。合生菌治疗仅与 FPI 增加相关（P=0.031）。
研究结果表明，单独使用益生菌可改善 T2D 患者的 WC。益生菌和益生元均降低 HbA1c 和 FPG；然而，益生元和合生菌导致 FPI 增加。治疗方案的制定（单一与多种）对效果没有影响。
