Abstract
Obesity is a growing health threat worldwide. Administration of probiotics in obesity has also parallelly increased but without any protocolization. We conducted a systematic review exploring the administration pattern of probiotic strains and effective doses for obesity-related disorders according to their capacity of positively modulating key biomarkers and microbiota dysbiosis. Manuscripts targeting probiotic strains and doses administered for obesity-related disorders in clinical studies were sought. MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched using keywords during the last fifteen years up to April 2020. Two independent reviewers screened titles, abstracts, and then full-text papers against inclusion criteria according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. From 549 interventional reports identified, we filtered 171 eligible studies, from which 24 full-text assays were used for calculating intervention total doses (ITD) of specific species and strains administered. Nine of these reports were excluded in the second-step because no specific data on gut microbiota modulation was found. Six clinical trials (CT) and 9 animal clinical studies were retained for analysis of complete outcome prioritized (body mass index (BMI), adiposity parameters, glucose, and plasma lipid biomarkers, and gut hormones). Lactobacillus spp. administered were double compared to Bifidobacterium spp.; Lactobacillus as single or multispecies formulations whereas most Bifidobacteria only through multispecies supplementations. Differential factors were estimated from obese populations’ vs. obesity-induced animals: ITD ratio of 2 × 106 CFU and patterns of administrations of 11.3 weeks to 5.5 weeks, respectively. Estimation of overall probiotics impact from selected CT was performed through a random-effects model to pool effect sizes. Comparisons showed a positive association between the probiotics group vs. placebo on the reduction of BMI, total cholesterol, leptin, and adiponectin. Moreover, negative estimation appeared for glucose (FPG) and CRP. While clinical trials including data for positive modulatory microbiota capacities suggested that high doses of common single and multispecies of Lactobacillus and Bifidobacterium ameliorated key obesity-related parameters, the major limitation was the high variability between studies and lack of standardized protocols. Efforts in solving this problem and searching for next-generation probiotics for obesity-related diseases would highly improve the rational use of probiotics.
Highlights
The literature search focused on the selection of relevant data from probiotic studies, such as specific detailed microbial strains, doses, and patterns of administration during clinical interventions to effectively modulate dysbiotic microbiota in obesity and related endocrine and metabolic diseases
We found suitable results for 4 clinical trials with monostrain probiotic formula reuteri to targeting different patient populations, and they found diverse results for the same clinical administered through different intervention total doses (ITD) from 8.4 × 109 to 4 × 1012 CFU and parameters
The present systematic review has achieved and served to compile key data on the probiotic strains preferentially used for obesity-related metabolic disorders, effective doses, administration patterns, and the expected clinical benefits connected to microbiota dysbiosis modulation
Summary
Probiotics remain a major complementary intervention resource for modulating microbiota dysbiosis, which is associated with several disorders and metabolic diseases [1,2]. Doses of certain probiotic strains might effectively modify misbalanced microbiota to make them healthier or, in other words, generate eubiosis [3,4]. Despite their numerous benefits, inadequate consumption of probiotics can even have undesirable effects, such as harmful metabolic activities, alterations of the integrity of the intestinal barrier, an inappropriate immune response, and the generation of antibiotic resistance genes and systemic infections [5,6]. It is important to harmonize the knowledge on what specific probiotics should be recommended for dysbiosis, in what doses, and for how long
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