Probiotics for Prosperity: Is There a Role for Probiotics in the Fight Against Obesity? Review of Meta-Analyses of Randomized Controlled Trials

Figures & data

Figure 1 PRISMA flow diagram for study selection.

Table 1 Meta-Analyses of Trials Including Probiotics and/or Synbiotics Use for Obesity

Study Author, Year	N BW BMI	n BW BMI	Dur wks	Base BW BMI	Mean Difference BW (95% CI) BMI (95% CI)	Additional Anthropometric Outcomes, Subgroup and Regression Analysis, and Comments.
Borgeraas et al, 2018^Citation26	777 866	13 13	3–12	81 28	–0.60 (–1.19, –0.01)–0.27 (–0.45, –0.08)	BFM: –0.42 (–1.08, 0.23) BF (%): –0.60 (–1.20, –0.01) Subgroup analysis: larger effect in generally healthy, duration >8 (vs <8) wks, food (vs capsules), if BW was the primary outcome.
Cao et al, 2020^Citation27	NR 2105	NR 32	3–12	NR NR	NR –0.25 (–0.33, –0.17)	WC: –0.99 (–1.33, –0.66) BF (%): –0.75 (–0.90, –0.61) Regression analysis: inverse association between duration and weight loss.
Companys et al, 2020^Citation28	666 840	10 12	4–24	NR NR	–0.26 (–0.43, –0.09)^a –0.35 (–0.48, –0.22)^a	WC: –0.37 (–0.52, –0.21)^a BFM: –0.30 (–0.48, –0.12)^a Subgroup analysis: L gasseri, L. casei, L. curvatus and L. plantarum appeared more efficacious than placebo.
Dong et al, 2019^Citation29	NR 599	NR 8	3–24	81	NR –0.34 (–0.68, 0.01)	WC: –0.35 (–0.81, 0.11) BFM: –0.31 (–0.64, 0.03) BF (%): –0.30 (–0.58, –0.02)
Dror et al, 2017^Citation30	771 NR	14 8	3–26	NR NR	–0.54 (–0.83, –0.25) –0.43 (–0.54, –0.33)
Hadi et al, 2020^Citation31	1185 1308	19 22	4–28	NR NR	–0.80 (–1.56, –0.03) –0.12 (–0.40, 0.16)	WC: –2.07 (–3.11, –1.03) BF (%): 0.02 (–1.27, 1.87) Subgroup analysis: larger effect if multi (vs single) species, duration <12 (vs >12) wks.
John et al, 2018^Citation32	790 968	13 14	2–24	76 30	–0.65 (–1.12, –0.18) –0.33 (–0.47, –0.18)	BFM: –0.94 (–1.17, –0.72) Subgroup analysis: larger effect if dose <10^Citation9(vs >10^Citation9) CFU/d, duration >12 (vs <12) wks, single (vs multi) strain. L gasseri, L. casei, L. curvatus and L. plantarum appeared more efficacious than placebo.
Koutnikova et al, 2019^Citation33	3422 4015	58 68	2–28	77 28	–0.39 (–0.57, –0.31) –0.33 (–0.53, –0.12)	WC: –1.01 (–1.55, –0.48) BFM: –0.62 (–0.91, –0.34) Subgroup analysis: larger effect if used mixtures containing B. breve, B. longum, Streptococcus salivarius subsp. thermophilus, L. acidophilus, L. casei, L. delbrueckii.
Park et al 2015^Citation34	196 154	4 4	3–12	86 32	–1.77 (–4.84, 1.29) 0.77 (–0.24, 1.78)	Population: included adolescents (NW, OW, OB) who gained BW.
Skonieczna-Zydecka et al, 2020^Citation35	1360 1252	25 22	4–24	72 27	–0.09 (–0.2, 0.02) –0.45 (–0.69, –0.21)	WC: –1.21 (–2.27, –0.16) Population: healthy, 66% of RCTs included non-obese adults. Regression analysis: direct association of BMI loss with duration and baseline BMI.
Sun et al, 2015^Citation36	NR 234	NR 4	8–12	NR 28	NR –0.52 (–0.81, –0.25)	WC: –2.II (–3.54, –0.68)
Suzumura et al, 2019^Citation37	1239 895	18 15	3–24	89 30	–0.54 (–1.09, 0.01) –0.19 (–0.43, 0.04)	WC: –0.82 (–1.43, –0.21) Subgroup analysis: larger effect if duration >8 (vs <8) wks.
Wang et al, 2019^Citation38	641 717	10 11	8–24	81 30	–0.55 (–0.91, –0.19) –0.30 (–0.43, –0.18)	WC: –1.20 (–2.21, –0.19) BFM: –0.91 (–1.19, –0.63) Subgroup analysis: larger effect if dose >10^10(vs <10^10) CFU/d, single (vs multi) strain, capsules or powder (vs food).
Zhang et al 2015^Citation39	1545 1548	21 19	3–24	76 28	–0.59 (–0.30, –0.87) –0.49 (–0.74, –0.24)	Subgroup analysis: larger effect if duration >8 (vs <8) wks, multi (vs single) strain, if only included RCTs for OW/OB.

Notes: All meta-analyses included RCTs of predominantly overweight or obese adults without or with comorbidities. The outcome values are mean difference (final minus baseline). Number of participants for data on WC and BF can differ from number of participants for analyses of BW and BMI. Baseline BW and BMI are mean values. The daily doses varied with the average between 10⁸ and 10¹⁰ CFU/day.

a The data are for capsules and powder, for food BW: NS; BMI: –0.33 (–0.51, –0.16).

Abbreviations: B, Bifidobacterium; Base, baseline; BW (kg), body weight; BF, body fat; BFM (kg), body fat mass; BMI (kg/m²), body mass index; CFU, colony-forming units; CI, confidence interval; d, day; Dur, duration; L, Lactobacillus; N/n, number of participants/number of trials; NR, not reported; NS, not significant; NW, normal weight; OB, obese; OW, overweight; WC (cm), waist circumference; wks, weeks.

Figure 2 The potential role of probiotics in the fight against obesity.

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