Abstract
Fecal microbiota transplantation (FMT) is a gut microbial-modulation strategy that has been investigated for the treatment of a variety of human diseases, including obesity-associated metabolic disorders. This study appraises current literature and provides an overview of the effectiveness and limitations of FMT as a potential therapeutic strategy for obesity and metabolic syndrome (MS). Five electronic databases and two gray literature sources were searched up to 10 December 2018. All interventional and observational studies that contained information on the relevant population (adult patients with obesity and MS), intervention (receiving allogeneic FMT) and outcomes (metabolic parameters) were eligible. From 1096 unique citations, three randomized placebo-controlled studies (76 patients with obesity and MS, body mass index = 34.8 ± 4.1 kg/m2, fasting plasma glucose = 5.8 ± 0.7 mmol/L) were included for review. Studies reported mixed results with regards to improvement in metabolic parameters. Two studies reported improved peripheral insulin sensitivity (rate of glucose disappearance, RD) at 6 weeks in patients receiving donor FMT versus patients receiving the placebo control. In addition, one study observed lower HbA1c levels in FMT patients at 6 weeks. No differences in fasting plasma glucose, hepatic insulin sensitivity, body mass index (BMI), or cholesterol markers were observed between two groups across all included studies. While promising, the influence of FMT on long-term clinical endpoints needs to be further explored. Future studies are also required to better understand the mechanisms through which changes in gut microbial ecology and engraftment of microbiota affect metabolic outcomes for patients with obesity and MS. In addition, further research is needed to better define the optimal fecal microbial preparation, dosing, and method of delivery.
Highlights
Obesity and metabolic syndrome (MS) are among the greatest health epidemics of the 21st century.In 2016 alone, nearly 2 billion adults were overweight and over 650 million adults were obese [1].As a group of obesity-related metabolic abnormalities, the prevalence of MS has reached about 25% of the world’s adult population [2,3]
Bariatric surgery is currently the most effective sustained treatment for obesity yet is associated with significant operative risks and complications [12,13]
After screening titles and abstracts, and removing duplicates, studies were selected for full-text screening titles and abstracts, and removing duplicates, 23 studies23 were selected for full-text review review
Summary
Obesity and metabolic syndrome (MS) are among the greatest health epidemics of the 21st century.In 2016 alone, nearly 2 billion adults were overweight and over 650 million adults were obese [1].As a group of obesity-related metabolic abnormalities, the prevalence of MS has reached about 25% of the world’s adult population [2,3]. Obesity and metabolic syndrome (MS) are among the greatest health epidemics of the 21st century. Therapeutic strategies aimed at managing obesity and MS include lifestyle interventions, pharmacologic therapies, and bariatric surgery [5,6,7,8,9,10,11]. Pharmacologic therapies, on the other hand, are costly and associated with significant side effects with long-term use [8,9,10]. Bariatric surgery is currently the most effective sustained treatment for obesity yet is associated with significant operative risks and complications [12,13]. Safe, and effective therapeutic approaches are, required to address the growing obesity epidemic
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