短链脂肪酸与胰岛素敏感性：系统评价和荟萃分析。
Short-chain fatty acids and insulin sensitivity: a systematic review and meta-analysis.
机构信息
are with the Diabetes and Islet Biology Group, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia.
are with the School of Life Sciences, University of Technology Sydney, Ultimo, New South Wales, Australia.
出版信息
Nutr Rev. 2024 Jan 10;82(2):193-209. doi: 10.1093/nutrit/nuad042.
CONTEXT
There is substantial evidence that reduced short-chain fatty acids (SCFAs) in the gut are associated with obesity and type 2 diabetes, although findings from clinical interventions that can increase SCFAs are inconsistent.
OBJECTIVE
This systematic review and meta-analysis aimed to assess the effect of SCFA interventions on fasting glucose, fasting insulin, and homeostatic model assessment of insulin resistance (HOMA-IR).
DATA SOURCES
Relevant articles published up to July 28, 2022, were extracted from PubMed and Embase using the MeSH (Medical Subject Headings) terms of the defined keywords [(short-chain fatty acids) AND (obesity OR diabetes OR insulin sensitivity)] and their synonyms. Data analyses were performed independently by two researchers who used the Cochrane meta-analysis checklist and the PRISMA guidelines.
DATA EXTRACTION
Clinical studies and trials that measured SCFAs and reported glucose homeostasis parameters were included in the analysis. Standardized mean differences (SMDs) with 95%CIs were calculated using a random-effects model in the data extraction tool Review Manager version 5.4 (RevMan 5.4). The risk-of-bias assessment was performed following the Cochrane checklist for randomized and crossover studies.
DATA ANALYSIS
In total, 6040 nonduplicate studies were identified, 23 of which met the defined criteria, reported fasting insulin, fasting glucose, or HOMA-IR values, and reported change in SCFA concentrations post intervention. Meta-analyses of these studies indicated that fasting insulin concentrations were significantly reduced (overall effect: SMD = -0.15; 95%CI = -0.29 to -0.01, P = 0.04) in treatment groups, relative to placebo groups, at the end of the intervention. Studies with a confirmed increase in SCFAs at the end of intervention also had a significant effect on lowering fasting insulin (P = 0.008). Elevated levels of SCFAs, compared with baseline levels, were associated with beneficial effects on HOMA-IR (P < 0.00001). There was no significant change in fasting glucose concentrations.
CONCLUSION
Increased postintervention levels of SCFAs are associated with lower fasting insulin concentrations, offering a beneficial effect on insulin sensitivity.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number CRD42021257248.
背景
有大量证据表明，肠道中短链脂肪酸（SCFAs）的减少与肥胖和 2 型糖尿病有关，尽管可以增加 SCFAs 的临床干预措施的结果并不一致。
目的
本系统评价和荟萃分析旨在评估 SCFA 干预对空腹血糖、空腹胰岛素和稳态模型评估的胰岛素抵抗（HOMA-IR）的影响。
数据来源
使用定义的关键词的 MeSH（医学主题词）术语[（短链脂肪酸）和（肥胖或糖尿病或胰岛素敏感性）]及其同义词，从 PubMed 和 Embase 中提取截至 2022 年 7 月 28 日发表的相关文章。两名研究人员独立进行数据分析，使用 Cochrane 荟萃分析检查表和 PRISMA 指南。
数据提取
纳入分析的是测量 SCFAs 并报告葡萄糖稳态参数的临床研究和试验。使用 Review Manager 版本 5.4（RevMan 5.4）的数据提取工具计算标准化均数差（SMD）及其 95%CI，采用随机效应模型。根据 Cochrane 随机和交叉研究检查表进行风险偏倚评估。
数据分析
总共确定了 6040 份非重复研究，其中 23 项符合定义标准，报告了空腹胰岛素、空腹血糖或 HOMA-IR 值，并报告了干预后 SCFA 浓度的变化。对这些研究的荟萃分析表明，与安慰剂组相比，干预结束时治疗组的空腹胰岛素浓度显著降低（总体效应：SMD=-0.15；95%CI=-0.29 至-0.01，P=0.04）。在干预结束时 SCFAs 确实增加的研究也对降低空腹胰岛素有显著影响（P=0.008）。与基线水平相比，SCFAs 水平升高与 HOMA-IR 有益影响相关（P<0.00001）。空腹血糖浓度没有显著变化。
结论
干预后 SCFAs 水平升高与空腹胰岛素浓度降低有关，对胰岛素敏感性有益。
系统评价注册
PROSPERO 注册号 CRD42021257248。
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