Teo Yu Qing Jolene, Chong Bryan, Soong Rou Yi, Yong Cai Ling, Chew Nicholas Ws, Chew Han Shi Jocelyn
University of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Ireland.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Clin Nutr. 2024 Jun;43(6):1563-1583. doi: 10.1016/j.clnu.2024.05.019. Epub 2024 May 10.
BACKGROUND & AIMS: Though probiotics, prebiotics and synbiotics have been shown to confer health benefits, their effects on cardiometabolic risk factors remain unclear. Therefore, we conducted an umbrella review to examine their effectiveness on anthropometric, cardiometabolic and inflammatory markers.
We conducted an umbrella review on eligible systematic reviews with meta-analysis (SRMA) published from journals' inception till 13 January 2023 retrieved from seven electronic databases (CINAHL, EMBASE, ProQuest, PubMed, Scopus, The Cochrane Library, and Web of Science). Methodological quality was appraised using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool and certainty of evidence was graded into five classes. Random-effects meta-analyses were performed on outcome effect sizes at the SRMA and primary study levels. Extent of overlapping articles were evaluated using corrected cover area.
24 systematic reviews representing 265 unique studies, 1076 unique effect sizes and 25,973 subjects were included. Synbiotics were evidently more effective in improving weight (-1.91 kg, 95%CI -3.45 kg to -0.37 kg, p = 0.02), total cholesterol (-12.17 mg/dl, 95%CI -17.89 mg/dl to -6.46 mg/dl, p < 0.001), low-density lipoprotein (-12.26 mg/dl, 95%CI -18.27 mg/dl to -6.25 mg/dl, p < 0.01), waist circumference (-1.85 cm, 95%CI -2.77 cm to -0.94 cm, p < 0.01), and fasting plasma glucose (-9.68 mg/dl, 95%CI -16.18 mg/dl to -3.18 mg/dl, p < 0.01). Prebiotics were more effective in improving body mass index (-0.34 kg/m, 95%CI -0.48 kg/m to -0.20 kg/m, p < 0.01), and HOMA-IR (-0.92, 95%CI -1.91 to 0.07, p = 0.06). Probiotics were shown to be more effective in reducing diastolic blood pressure (-1.34 mmHg, 95%CI -2.14 mmHg to -0.55 mmHg, P < 0.01) improving insulin level change (-0.84 mIU/mL, 95%CI -1.27 mIU/mL to -0.41 mIU/mL, p < 0.01), and the percentage of body fat (-0.66%, 95%CI -0.70% to -0.61%, p < 0.01). For all outcomes, the credibility of evidence was classified as class IV.
Pre-, pro-, and synbiotics can significantly enhance anthropometric indices, glucose and lipid profiles, blood pressure, and inflammatory markers in individuals confronting obesity. While suggesting their supplementation holds promise for this population, the true clinical impact hinges on tailoring these interventions to specific indications and customizing treatment strategies to align with individual patient needs.
尽管益生菌、益生元及合生元已被证明有益健康，但其对心脏代谢危险因素的影响仍不明确。因此，我们进行了一项综合性综述，以研究它们对人体测量指标、心脏代谢指标及炎症标志物的影响。
我们对从7个电子数据库（CINAHL、EMBASE、ProQuest、PubMed、Scopus、Cochrane图书馆和Web of Science）检索到的、从创刊至2023年1月13日发表的符合条件的系统评价及荟萃分析（SRMA）进行了综合性综述。使用多重系统评价评估工具2（AMSTAR2）对方法学质量进行评估，并将证据的确定性分为五类。对SRMA和初级研究水平的结局效应量进行随机效应荟萃分析。使用校正覆盖面积评估文章重叠程度。
纳入了24项系统评价，代表265项独特研究、1076个独特效应量及25973名受试者。合生元在改善体重（-1.91kg，95%置信区间-3.45kg至-0.37kg，p=0.02）、总胆固醇（-12.17mg/dl，95%置信区间-17.89mg/dl至-6.46mg/dl，p<0.001）、低密度脂蛋白（-12.26mg/dl，95%置信区间-18.27mg/dl至-6.25mg/dl，p<0.01）、腰围（-1.85cm，95%置信区间-2.77cm至-0.94cm，p<0.01）及空腹血糖（-9.68mg/dl，95%置信区间-16.18mg/dl至-3.18mg/dl，p<0.01）方面明显更有效。益生元在改善体重指数（-0.34kg/m²，95%置信区间-0.48kg/m²至-0.20kg/m²，p<0.01）及胰岛素抵抗指数（-0.92，95%置信区间-1.91至0.07，p=0.06）方面更有效。益生菌在降低舒张压（-1.34mmHg，95%置信区间-2.14mmHg至-0.55mmHg，P<0.01）、改善胰岛素水平变化（-0.84mIU/mL，95%置信区间-1.27mIU/mL至-0.41mIU/mL，p<0.01）及体脂百分比（-0.66%，95%置信区间-0.70%至-0.61%，p<0.01）方面更有效。对于所有结局，证据的可信度被归类为IV级。
益生元、益生菌及合生元可显著改善肥胖个体的人体测量指标、血糖和血脂水平、血压及炎症标志物。虽然表明补充这些物质对该人群有前景，但真正的临床影响取决于针对特定适应症调整这些干预措施，并根据个体患者需求定制治疗策略。
