Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84108, USA.
Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Nutrients. 2024 Oct 21;16(20):3564. doi: 10.3390/nu16203564.
: Several randomized controlled trials (RCTs) have shown conflicting results on cortisol levels following probiotic administration in healthy and diseased populations. Previous analyses were inconclusive due to limited studies, and evidence is lacking on how these effects vary by health status; region; therapy duration; medications, and use of single or multiple strains. : In this systematic review and meta-analysis (PROSPERO [CRD42024538539]), we searched PubMed, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, ProQuest, and Web of Science Preprints until 13 August 2024, for RCTs on probiotic administration, either alone or combined, across all age groups and without specific medical condition requirements. We applied random-effects meta-analysis, assessed bias using the Cochrane RoB 2 tool, and evaluated evidence certainty with GRADE. : We screened 1739 records and retrieved 46 RCTs (3516 participants). Probiotics supplementation decreased cortisol levels compared to the control arm [46 RCTs; SMD: -0.45; 95% CI: -0.83; -0.07; : 92.5%, low certainty]. Among various subgroups; probiotics supplementation decreased the cortisol levels in the subgroups without concomitant medications [37 RCTs; SMD: -0.30; 95% CI [-0.58; -0.03], : 88.7%] with a single probiotic strain [30 RCTs; SMD: -0.33; 95% CI: -0.63; -0.028; : 88.8%], in a healthy population [35 RCTs; SMD:-0.3; 95% CI: -0.58; -0.03; : 88.7] and in the Asia region [21 RCTs; SMD: -0.83; 95% CI: -1.58; -0.07; : 95%]. : A low level of evidence suggests probiotics might reduce cortisol levels, but more targeted studies are needed to identify variables affecting the response in specific subgroups.
: 几项随机对照试验（RCT）对健康人群和患病人群使用益生菌后皮质醇水平的结果存在矛盾。由于研究数量有限，先前的分析结果没有定论，并且缺乏关于这些影响如何因健康状况、地区、治疗持续时间、药物以及使用单一或多种菌株而变化的证据。 : 在这项系统评价和荟萃分析（PROSPERO [CRD42024538539]）中，我们检索了 PubMed、Cochrane 图书馆、Embase、Scopus、Web of Science、CINAHL、ProQuest 和 Web of Science 预印本，截至 2024 年 8 月 13 日，纳入了针对益生菌单独或联合使用的 RCT 研究，涵盖所有年龄段，没有特定的医疗条件要求。我们采用随机效应荟萃分析，使用 Cochrane RoB 2 工具评估偏倚，并使用 GRADE 评估证据确定性。 : 我们筛选了 1739 条记录，检索到 46 项 RCT（3516 名参与者）。与对照组相比，益生菌补充剂降低了皮质醇水平[46 项 RCT；SMD：-0.45；95%CI：-0.83；-0.07；92.5%，低确定性]。在各种亚组中；在没有同时使用药物的亚组中，益生菌补充剂降低了皮质醇水平[37 项 RCT；SMD：-0.30；95%CI：-0.58；-0.03]，使用单一益生菌菌株[30 项 RCT；SMD：-0.33；95%CI：-0.63；-0.028；88.8%]，在健康人群中[35 项 RCT；SMD：-0.3；95%CI：-0.58；-0.03；88.7%]和亚洲地区[21 项 RCT；SMD：-0.83；95%CI：-1.58；-0.07；95%]。 : 低水平的证据表明益生菌可能降低皮质醇水平，但需要更有针对性的研究来确定影响特定亚组反应的变量。
