Elsevier

Clinical Nutrition

Volume 34, Issue 5, October 2015, Pages 845-858
Clinical Nutrition

Meta-analyses
A systematic review and meta-analysis of the prebiotics and synbiotics effects on glycaemia, insulin concentrations and lipid parameters in adult patients with overweight or obesity

https://doi.org/10.1016/j.clnu.2014.10.004Get rights and content

Summary

Background & aims

Several studies have reported the effects of prebiotics and synbiotics supplementation in lipid profile and glucose homeostasis, however a pooled analysis of clinical trials that assessed these parameters has not been performed in overweight or obese individuals. The aim of this study was to evaluate the effects of prebiotics and synbiotics on plasma lipid profile, fasting insulin and fasting glucose in adults with overweight or obesity.

Methods

Randomized controlled trials were systematically searched before May 2014 in electronic databases and screening reference lists. Combined and stratified (diabetics and non-diabetics trials) meta-analyzes were performed.

Results

Thirteen trials, representing 513 adult participants with Body Mass Index ≥25 kg/m² were included. Prebiotic supplementation reduced plasma total cholesterol (SMD −0.25; 95% CI −0.48, −0.02) and LDL-c (SMD −0.22; 95% CI −0.44, −0.00) concentrations in overall analysis, and reduced triglycerides (SMD −0.72; 95% CI −1.20, −0.23) and increased HDL-c (SMD 0.49; 95% CI 0.01, 0.97) concentrations in diabetic trials. Synbiotic supplementation reduced plasma fasting insulin (SMD −0.39; 95% CI −0.75, −0.02) and triglycerides (SMD −0.43; 95% CI −0.70, −0.15) concentrations.

Conclusions

The improvement of the evaluated parameters supports prebiotics and synbiotics supplementation as an adjuvant therapy in obesity-related comorbidities, such as dyslipidemia and insulin resistance.

Introduction

Overweight and obesity have been a global epidemic for several years, prevalent among children and adults, decreasing quality and expectancy of life [1], [2]. The excessive fat accumulation results in an alteration of carbohydrate [3] and lipid metabolism [4], a condition that can lead to the development of non-communicable diseases such as type 2 diabetes, dyslipidemia and cardiovascular diseases [5], [6]. Concerning the traditional treatments of obesity, which include diet, physical activity, as well as pharmacological and surgical treatment, the intestinal microbiota modulation has been a new therapeutic target in clinical trials to reduce the risks related to obesity [7].

It is firmly established that the gut microbiota differs between obese and lean individuals, both in composition and function, a difference that has also been found between diabetics and non-diabetics [8], [9]. Prebiotics and synbiotics may stimulate the growth and activity of beneficial bacteria like Lactobacillus and Bifidobacterium [10]. A dietary prebiotic is a selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon host health [10]. A dietary synbiotic is a product that contains both probiotics, which are live microorganisms that confer a health benefit on the host when administered in adequate amounts, and prebiotics [11]. Hence, they are being used to modulate gut microbiota with potential benefits for glucose homeostasis and lipid profile through mechanisms such as energy harvest, storage and expenditure from diet, satiety hormone balance, regulation of lipid synthesis and improvement in insulin resistance and the immune function [10].

Many studies have reported the effects of prebiotics, probiotics and synbiotics on metabolic outcomes, particularly the lipid profile and glucose homeostasis. Nevertheless, according to our search in databases, no systematic review or meta-analysis has evaluated the effect of prebiotics and synbiotics on these outcomes in overweight or obese individuals only. Therefore, we conducted a meta-analysis of randomized controlled trials in adults with overweight or obesity to provide a comprehensive summary of the literature concerning the effect of prebiotics and synbiotics on metabolic outcomes (total cholesterol, low density lipoprotein cholesterol – LDL-c, high density lipoprotein cholesterol – HDL-c, triglycerides, fasting glucose and fasting insulin).

Section snippets

Methods

The methods were consistent with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement [12].

Search results

A total of 1128 studies were identified through the database search. Of these, 463 duplicate articles and 37 articles published in languages other than English or Spanish were excluded. After reading titles and abstracts, 605 articles were excluded and 23 full-text articles were assessed for eligibility. Checking references resulted in two more papers. Finally, 14 articles (ten prebiotic and four synbiotic articles) were included. Among the fourteen selected articles, two were different

Discussion

To our knowledge, the present meta-analysis is the first that included trials performed only with overweight or obese individuals. Regarding prebiotics, a meta-analysis [32] suggested that the inulin had a lowering effect on total cholesterol, LDL-c and triglycerides concentrations in hyperlipidemic individuals. The characteristics of the meta-analysis were similar to ours in dose, treatment duration, sample size and mean age. When stratified for hyperlipidemia, these findings correspond with

Conclusion

The meta-analysis shows that, in general, prebiotics reduced plasma total cholesterol and LDL-c concentrations in adult subjects with overweight or obesity, and they also decreased plasma triglycerides and increase HDL-c concentrations in adult diabetic subjects with overweight or obesity, while synbiotics decreased plasma fasting insulin and triglycerides concentrations. Thus, the supplementation of prebiotics or synbiotics could take part in the management of obesity-related comorbidities,

Statement of authorship

Bruna Teles Soares Beserra, Ricardo Fernandes, Vinicius André do Rosario, Michel Carlos Mocellin, Marilyn Gonçalves Ferreira Kuntz and Erasmo Benicio Santos de Moraes Trindade contributed to conception and design of the study; Bruna Teles Soares Beserra, Ricardo Fernandes, Vinicius André do Rosario, Michel Carlos Mocellin and Marilyn Gonçalves Ferreira Kuntz contributed to drafting the manuscript; Michel Carlos Mocellin contributed to statistical analysis; Bruna Teles Soares Beserra, Ricardo

Conflicts of interest

No conflict of interests needs to be reported.

Acknowledgments

The authors are grateful to the Post-Graduate Program in Nutrition – Federal University of Santa Catarina, Brazil and Coordination of Improvement of Higher Education Personnel (CAPES)/Fellowship Program Social Demand for scholarship grant to the first five authors (BTSB, RF, VAR, MCM, MGFK).

References (40)

  • Organization WH

    Obesity: preventing and managing the global epidemic

    (2000)
  • R. Fernandes et al.

    Relationship between acute phase proteins and serum fatty acid composition in morbidly obese patients

    Dis Markers

    (2013)
  • Association AD

    Standards of medical care in diabetes—2013

    Diabetes Care

    (2013)
  • M.D. Jensen et al.

    2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task force on practice guidelines and the obesity society

    Circulation

    (2014)
  • N.M. Delzenne et al.

    Targeting gut microbiota in obesity: effects of prebiotics and probiotics

    Nat Rev Endocrinol

    (2011)
  • N. Larsen et al.

    Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults

    PLoS One

    (2010)
  • P.J. Turnbaugh et al.

    A core gut microbiome in obese and lean twins

    Nature

    (2009)
  • M. Roberfroid et al.

    Prebiotic effects: metabolic and health benefits

    Br J Nutr

    (2010)
  • F. Guarner et al.

    World Gastroenterology Organisation global guidelines: probiotics and prebiotics October 2011

    J Clin Gastroenterol

    (2012)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration

    Ann Intern Med

    (2009)
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