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

Published:October 20, 2014DOI:https://doi.org/10.1016/j.clnu.2014.10.004

      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.

      Keywords

      Abbreviations:

      BMI (body mass index), CFU (Colony Forming Units), CI (confidence interval), EPHPP (Effective Public Health Practice Project), FOS (fructo-oligosaccharide), GOS (galacto-oligosaccharide), HDL-c (high density lipoprotein cholesterol), HOMA (homeostatic model assessment), LDL-c (low density lipoprotein cholesterol), LPS (lipopolysaccharide), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis), RCT (randomized clinical trial), SMD (standardized mean difference), TLR (toll like receptor), USA (United States of America), VLDL (very low density lipoprotein cholesterol)
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      References

        • Olshansky S.J.
        • Passaro D.J.
        • Hershow R.C.
        • Layden J.
        • Carnes B.A.
        • Brody J.
        • et al.
        A potential decline in life expectancy in the United States in the 21st century.
        N Engl J Med. 2005; 352: 1138-1145
        • Organization WH
        Obesity: preventing and managing the global epidemic.
        (Technical report no 894) WHO, Geneva,2000
        • Karastergiou K.
        • Mohamed-Ali V.
        The autocrine and paracrine roles of adipokines.
        Mol Cell Endocrinol. 2010; 318: 69-78
        • Fernandes R.
        • Beserra B.T.S.
        • Cunha R.S.G.
        • Hillesheim E.
        • Camargo C.deQ.
        • Pequito D.C.T.
        • et al.
        Relationship between acute phase proteins and serum fatty acid composition in morbidly obese patients.
        Dis Markers. 2013; : 105-112
        • Association AD
        Standards of medical care in diabetes—2013.
        Diabetes Care. 2013; 36: S11-S66
        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • Ard J.D.
        • Comuzzie A.G.
        • Donato K.A.
        • 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; 129: S102-S138
        • Delzenne N.M.
        • Neyrinck A.M.
        • Backhed F.
        • Cani P.D.
        Targeting gut microbiota in obesity: effects of prebiotics and probiotics.
        Nat Rev Endocrinol. 2011; 7: 639-646
        • Larsen N.
        • Vogensen F.K.
        • van den Berg F.W.
        • Nielsen D.S.
        • Andreasen A.S.
        • Pedersen B.K.
        • et al.
        Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults.
        PLoS One. 2010; 5: e9085
        • Turnbaugh P.J.
        • Hamady M.
        • Yatsunenko T.
        • Cantarel B.L.
        • Duncan A.
        • Ley R.E.
        • et al.
        A core gut microbiome in obese and lean twins.
        Nature. 2009; 457: 480-484
        • Roberfroid M.
        • Gibson G.R.
        • Hoyles L.
        • McCartney A.L.
        • Rastall R.
        • Rowland I.
        • et al.
        Prebiotic effects: metabolic and health benefits.
        Br J Nutr. 2010; 104: S1-S63
        • Guarner F.
        • Khan A.G.
        • Garisch J.
        • Eliakim R.
        • Gangl A.
        • Thomson A.
        • et al.
        World Gastroenterology Organisation global guidelines: probiotics and prebiotics October 2011.
        J Clin Gastroenterol. 2012; 46: 468-481
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gotzsche P.C.
        • Ioannidis J.P.
        • 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; 151: W65-W94
        • Thomas B.H.
        • Ciliska D.
        • Dobbins M.
        • Micucci S.
        A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions.
        Worldviews Evid Based Nurs. 2004; 1: 176-184
        • Moher D.
        • Hopewell S.
        • Schulz K.F.
        • Montori V.
        • Gotzsche P.C.
        • Devereaux P.J.
        • et al.
        CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; 340: c869
        • Wu X.
        • Ma C.
        • Han L.
        • Nawaz M.
        • Gao F.
        • Zhang X.
        • et al.
        Molecular characterisation of the faecal microbiota in patients with type II diabetes.
        Curr Microbiol. 2010; 61: 69-78
        • Higgins J.P.T.
        • Green S.
        Cochrane handbook for systematic reviews of interventions.
        John Wiley & Sons, Chichester2008
        • White I.R.
        • Thomas J.
        Standardized mean differences in individually-randomized and cluster-randomized trials, with applications to meta-analysis.
        Clin Trials. 2005; 2: 141-151
        • Parvin Dehghan B.P.G.
        • Asgharijafarabadi Mohammad
        Effects of high performance inulin supplementation on glycemic status and lipid profile in women with type 2 diabetes: a randomized, placebo-controlled clinical trial.
        Health Promot Perspect. 2013; 3: 9
        • Pourghassem Gargari B.
        • Dehghan P.
        • Aliasgharzadeh A.
        • Asghari Jafar-Abadi M.
        Effects of high performance inulin supplementation on glycemic control and antioxidant status in women with type 2 diabetes.
        Diabetes Metab J. 2013; 37: 140-148
        • Balcazar-Munoz B.R.
        • Martinez-Abundis E.
        • Gonzalez-Ortiz M.
        Effect of oral inulin administration on lipid profile and insulin sensitivity in subjects with obesity and dyslipidemia.
        Rev Med Chil. 2003; 131: 597-604
        • Asemi Z.
        • Khorrami-Rad A.
        • Alizadeh S.A.
        • Shakeri H.
        • Esmaillzadeh A.
        Effects of synbiotic food consumption on metabolic status of diabetic patients: a double-blind randomized cross-over controlled clinical trial.
        Clin Nutr. 2014; 33: 198-203
        • de Luis D.A.
        • de la Fuente B.
        • Izaola O.
        • Aller R.
        • Gutiérrez S.
        • Morillo M.
        • et al.
        Double blind randomized clinical trial controlled by placebo with a FOS enriched cookie on society and cardiovascular risk factors in obese patients.
        Nutr Hosp. 2013; 28: 78-85
        • Dewulf E.M.
        • Cani P.D.
        • Claus S.P.
        • Fuentes S.
        • Puylaert P.G.
        • Neyrinck A.M.
        • et al.
        Insight into the prebiotic concept: lessons from an exploratory, double blind intervention study with inulin-type fructans in obese women.
        Gut. 2013; 62: 1112-1121
        • Eslamparast T.
        • Poustchi H.
        • Zamani F.
        • Sharafkhah M.
        • Sharafkhah R.
        • Hekmatdoost A.
        • et al.
        Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study.
        Am J Clin Nutr. 2014; 99: 535-542
        • Genta S.
        • Cabrera W.
        • Habib N.
        • Pons J.
        • Carillo I.M.
        • Grau A.
        • et al.
        Yacon syrup: beneficial effects on obesity and insulin resistance in humans.
        Clin Nutr. 2009; 28: 182-187
        • Luo J.
        • Van Yperselle M.
        • Rizkalla S.W.
        • Rossi F.
        • Bornet F.R.
        • Slama G.
        • et al.
        Chronic consumption of short-chain fructooligosaccharides does not affect basal hepatic glucose production or insulin resistance in type 2 diabetics.
        J Nutr. 2000; 130: 1572-1577
        • Malaguarnera M.
        • Vacante M.
        • Antic T.
        • Giordano M.
        • Chisari G.
        • Acquaviva R.
        • et al.
        Bifidobacterium longum with fructo-oligosaccharides in patients with non alcoholic steatohepatitis.
        Dig Dis Sci. 2012; 57: 545-553
        • Moroti C.
        • Souza Magri L.F.
        • de Rezende Costa M.
        • Cavallini D.C.
        • Sivieri K.
        Effect of the consumption of a new symbiotic shake on glycemia and cholesterol levels in elderly people with type 2 diabetes mellitus.
        Lipids Health Dis. 2012; 11: 29
        • Parnell J.A.
        • Reimer R.A.
        Weight loss during oligofructose supplementation is associated with decreased ghrelin and increased peptide YY in overweight and obese adults.
        Am J Clin Nutr. 2009; 89: 1751-1759
        • Tovar A.R.
        • Caamano Mdel C.
        • Garcia-Padilla S.
        • García O.P.
        • Duarte M.A.
        • Rosado J.L.
        • et al.
        The inclusion of a partial meal replacement with or without inulin to a calorie restricted diet contributes to reach recommended intakes of micronutrients and decrease plasma triglycerides: a randomized clinical trial in obese Mexican women.
        Nutr J. 2012; 11: 44
        • Vulevic J.
        • Juric A.
        • Tzortzis G.
        • Gibson G.R.
        A mixture of trans-galactooligosaccharides reduces markers of metabolic syndrome and modulates the fecal microbiota and immune function of overweight adults.
        J Nutr. 2013; 143: 324-331
        • Huang Guo X.-M.L.
        • Zhang Qiu-Xiang
        • Tian Feng-Wei
        • Zhang Hao
        • Zhang He-Ping
        • Chen Wei
        Effects of inulin on the plasma lipid profile of normolipidemic and hyperlipidemic subjects.
        Clin Lipidol. 2012; 7: 8
        • Brighenti F.
        Dietary fructans and serum triacylglycerols: a meta-analysis of randomized controlled trials.
        J Nutr. 2007; 137: 2552S-2556S
        • Kellow N.J.
        • Coughlan M.T.
        • Reid C.M.
        Metabolic benefits of dietary prebiotics in human subjects: a systematic review of randomised controlled trials.
        Br J Nutr. 2013; : 1-15
        • Ng D.S.
        Diabetic dyslipidemia: from evolving pathophysiological insight to emerging therapeutic targets.
        Can J Diabetes. 2013; 37: 319-326
        • Creely S.J.
        • McTernan P.G.
        • Kusminski C.M.
        • Fisher F.M.
        • da Silva N.F.
        • Khanolkar M.
        • et al.
        Lipopolysaccharide activates an innate immune system response in human adipose tissue in obesity and type 2 diabetes.
        Am J Physiol Endocrinol Metab. 2007; 292: E740-E747
        • Bonsu N.K.
        • Johnson C.S.
        • McLeod K.M.
        Can dietary fructans lower serum glucose?.
        J Diabetes. 2011; 3: 58-66
        • Vespasiani-Gentilucci U.
        • Carotti S.
        • Perrone G.
        • Mazzarelli C.
        • Galati G.
        • Onetti-Muda A.
        • et al.
        Hepatic toll-like receptor 4 expression is associated with portal inflammation and fibrosis in patients with NAFLD.
        Liver Int. 2014;
        • Hardy H.
        • Harris J.
        • Lyon E.
        • Beal J.
        • Foey A.D.
        Probiotics, prebiotics and immunomodulation of gut mucosal defences: homeostasis and immunopathology.
        Nutrients. 2013; 5: 1869-1912
        • Fedewa A.
        • Rao S.S.
        Dietary fructose intolerance, fructan intolerance and FODMAPs.
        Curr Gastroenterol Rep. 2014; 16: 370