Effects of probiotics, prebiotics, and synbiotics on polycystic ovary syndrome: a systematic review and meta-analysis

References

• Abenavoli, L., E. Scarpellini, C. Colica, L. Boccuto, B. Salehi, J. Sharifi-Rad, V. Aiello, B. Romano, A. De Lorenzo, A. A. Izzo, et al. 2019. Gut microbiota and obesity: A role for probiotics. Nutrients 11 (11):2690. doi: 10.3390/nu11112690.
   PubMed Web of Science ®Google Scholar
• Aguiar, C., E. Alegria, R. C. Bonadonna, A. L. Catapano, F. Cosentino, M. Elisaf, M. Farnier, J. Ferrières, P. P. Filardi, N. Hancu, et al. 2015. A review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: A report from an expert consensus meeting on the role of fenofibrate-statin combination therapy. Atherosclerosis Supplements 19:1–12. doi: 10.1016/S1567-5688(15)30001-5.
   PubMed Web of Science ®Google Scholar
• Ahmadi, S., M. Jamilian, M. Karamali, M. Tajabadi-Ebrahimi, P. Jafari, M. Taghizadeh, M. R. Memarzadeh, and Z. Asemi. 2017. Probiotic supplementation and the effects on weight loss, glycaemia and lipid profiles in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Human Fertility (Cambridge, England) 20 (4):254–61. doi: 10.1080/14647273.2017.1283446.
   PubMed Web of Science ®Google Scholar
• Ahmadi, S., R. Nagpal, S. Wang, J. Gagliano, D. W. Kitzman, S. Soleimanian-Zad, M. Sheikh-Zeinoddin, R. Read, and H. Yadav. 2019. Prebiotics from acorn and sago prevent high-fat-diet-induced insulin resistance via microbiome-gut-brain axis modulation. The Journal of Nutritional Biochemistry 67:1–13. doi: 10.1016/j.jnutbio.2019.01.011.
   PubMed Web of Science ®Google Scholar
• Andersson, U., C. Bränning, S. Ahrné, G. Molin, J. Alenfall, G. Onning, M. Nyman, and C. Holm. 2010. Probiotics lower plasma glucose in the high-fat fed C57BL/6J mouse. Beneficial Microbes 1 (2):189–96. doi: 10.3920/BM2009.0036.
   PubMed Web of Science ®Google Scholar
• Araya, M., L. Morelli, G. Reid, Sanders ME, Stanton C, Pineiro M, Ben Embarek P. 2002. Guidelines for the evaluation of probiotics in food. Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food, London, Ontario, Canada. http://www.who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf
   Google Scholar
• Azziz, R., E. Carmina, Z. Chen, A. Dunaif, J. S. Laven, R. S. Legro, D. Lizneva, B. Natterson-Horowtiz, H. J. Teede, and B. O. Yildiz. 2016. Polycystic ovary syndrome. Nature Reviews. Disease Primers 2:16057. doi: 10.1038/nrdp.2016.57.
   PubMed Web of Science ®Google Scholar
• Bock, P. M., G. H. Telo, R. Ramalho, M. Sbaraini, G. Leivas, A. F. Martins, and B. D. Schaan. 2021. The effect of probiotics, prebiotics or synbiotics on metabolic outcomes in individuals with diabetes: A systematic review and meta-analysis. Diabetologia 64 (1):26–41. doi: 10.1007/s00125-020-05295-1.
   PubMed Web of Science ®Google Scholar
• Breton, J., N. Tennoune, N. Lucas, M. Francois, R. Legrand, J. Jacquemot, A. Goichon, C. Guerin, J. Peltier, M. Pestel-Caron, et al. 2016. Gut commensal E. coli proteins activate host satiety pathways following nutrient-induced bacterial growth. Cell Metabolism 23 (2):324–34. doi: 10.1016/j.cmet.2015.10.017.
   PubMed Web of Science ®Google Scholar
• Cani, P. D., and N. M. Delzenne. 2009. The role of the gut microbiota in energy metabolism and metabolic disease. Current Pharmaceutical Design 15 (13):1546–58. doi: 10.2174/138161209788168164.
   PubMed Web of Science ®Google Scholar
• Champagne, C. P., R. P. Ross, M. Saarela, K. F. Hansen, and D. Charalampopoulos. 2011. Recommendations for the viability assessment of probiotics as concentrated cultures and in food matrices. International Journal of Food Microbiology 149 (3):185–93. doi: 10.1016/j.ijfoodmicro.2011.07.005.
   PubMed Web of Science ®Google Scholar
• Chapman, M. J., H. N. Ginsberg, P. Amarenco, F. Andreotti, J. Borén, A. L. Catapano, O. S. Descamps, E. Fisher, P. T. Kovanen, J. A. Kuivenhoven, et al. 2011. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovas-cular disease: Evidence and guidance for management. European Heart Journal 32 (11):1345–61. doi: 10.1093/eurheartj/ehr112.
   PubMed Web of Science ®Google Scholar
• Chen, Y., Z. Minghui, and W. Channi. 2018. Effect of probiotic supplementation on blood sugar and lipids in patients with polycystic ovary syndrome. International Journal of Gynecology & Obstetrics 45 (2):199–202.
   Google Scholar
• Coutinho, E. A., and A. S. Kauffman. 2019. The role of the brain in the pathogenesis and Physiology of Polycystic Ovary Syndrome (PCOS). Medical Sciences 7 (8):84. doi: 10.3390/medsci7080084.
   Google Scholar
• Cozzolino, M., A. Vitagliano, L. Pellegrini, M. Chiurazzi, A. Andriasani, G. Ambrosini, and N. Drabińska, E. Jarocka-Cyrta, L. H. Markiewicz, and U. Krupa-Kozak. 2018. The effect of oligofructose-enriched inulin on faecal bacterial counts and microbiota-associated characteristics in celiac disease children following a gluten-free diet: Results of a randomized, placebo-controlled trial. Nutrients 10 (2):201. doi: 10.3390/nu10020201.
   PubMed Web of Science ®Google Scholar
• Cozzolino, M., A. Vitagliano, L. Pellegrini, M. Chiurazzi, A. Andriasani, G. Ambrosini, and N. Garrido. 2020. Therapy with probiotics and synbiotics for polycystic ovarian syndrome: A systematic review and meta-analysis. European Journal of Nutrition 59 (7):2841–56. doi: 10.1007/s00394-020-02233-0.
   PubMed Web of Science ®Google Scholar
• Eshre TR GASP. 2004. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility 81 (1):19–25. doi: 10.1016/j.fertnstert.2003.10.004.
   Web of Science ®Google Scholar
• Esmaeilinezhad, Z., S. Babajafari, Z. Sohrabi, M. H. Eskandari, S. Amooee, and R. Barati-Boldaji. 2019. Effect of synbiotic pomegranate juice on glycemic, sex hormone profile and anthropometric indices in PCOS: A randomized, triple blind, controlled trial. Nutrition, Metabolism, and Cardiovascular Diseases 29 (2):201–8. doi: 10.1016/j.numecd.2018.07.002.
   PubMed Web of Science ®Google Scholar
• Fauser, B. C., B. C. Tarlatzis, R. W. Rebar, R. S. Legro, A. H. Balen, R. Lobo, E. Carmina, J. Chang, B. O. Yildiz, J. S. Laven, et al. 2012. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility and Sterility 97 (1):28–38. doi: 10.1016/j.fertnstert.2011.09.024.
   PubMed Web of Science ®Google Scholar
• Ferrarese, R., E. R. Ceresola, A. Preti, and F. Canducci. 2018. Probiotics, prebiotics and synbiotics for weight loss and metabolic syndrome in the microbiome era. European Review for Medical and Pharmacological Sciences 22 (21):7588–605. doi: 10.26355/eurrev_201811_16301.
   PubMed Web of Science ®Google Scholar
• Firouzi, S., H. A. Majid, A. Ismail, N. A. Kamaruddin, and M. Y. Barakatun-Nisak. 2017. Effect of multi-strain probiotics (multi-strain microbial cell preparation) on glycemic control and other diabetes-related outcomes in people with type 2 diabetes: A randomized controlled trial. European Journal of Nutrition 56 (4):1535–50. doi: 10.1007/s00394-016-1199-8.
   PubMed Web of Science ®Google Scholar
• Ghanei, N., N. Rezaei, G. A. Amiri, F. Zayeri, G. Makki, and E. Nasseri. 2018. The probiotic supplementation reduced inflammation in polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Journal of Functional Foods 42:306–11. doi: 10.1016/j.jff.2017.12.047.
   Web of Science ®Google Scholar
• Gibson, G. R., R. Hutkins, M. E. Sanders, S. L. Prescott, R. A. Reimer, S. J. Salminen, K. Scott, C. Stanton, K. S. Swanson, P. D. Cani, et al. 2017. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews Gastroenterology & Hepatology 14 (8):491–502. doi: 10.1038/nrgastro.2017.75.
   PubMed Web of Science ®Google Scholar
• Goodarzi, M. O., D. A. Dumesic, G. Chazenbalk, and R. Azziz. 2011. Polycystic ovary syndrome: Etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology 7 (4):219–31. doi: 10.1038/nrendo.2010.217.
   PubMed Web of Science ®Google Scholar
• Gunning, M. N., T. Sir Petermann, N. Crisosto, B. B. van Rijn, M. A. de Wilde, J. P. Christ, C. Uiterwaal, W. de Jager, M. Eijkemans, A. R. Kunselman, et al. 2020. Cardiometabolic health in offspring of women with PCOS compared to healthy controls: A systematic review and individual participant data meta-analysis. Human Reproduction Update 26 (1):103–17. doi: 10.1093/humupd/dmz036.
   PubMed Web of Science ®Google Scholar
• Gurung, M., Z. Li, H. You, R. Rodrigues, D. B. Jump, A. Morgun, and N. Shulzhenko. 2020. Role of gut microbiota in type 2 diabetes pathophysiology. EbioMedicine 51:102590. doi: 10.1016/j.ebiom.2019.11.051.
   PubMed Web of Science ®Google Scholar
• Hadi, A., S. Moradi, A. Ghavami, S. Khalesi, and M. Kafeshani. 2020. Effect of probiotics and synbiotics on selected anthropometric and biochemical measures in women with polycystic ovary syndrome: A systematic review and meta-analysis. European Journal of Clinical Nutrition 74 (4):543–7. doi: 10.1038/s41430-019-0434-9.
   PubMed Web of Science ®Google Scholar
• Hendijani, F., and V. Akbari. 2018. Probiotic supplementation for management of cardiovascular risk factors in adults with type II diabetes: A systematic review and meta-analysis. Clinical Nutrition (Edinburgh, Scotland) 37 (2):532–41. doi: 10.1016/j.clnu.2017.02.015.
   PubMed Web of Science ®Google Scholar
• Heshmati, J., F. Farsi, S. Yosaee, M. Razavi, M. Rezaeinejad, E. Karimie, and M. Sepidarkish. 2019. The effects of probiotics or synbiotics supplementation in women with polycystic ovarian syndrome: A systematic review and meta-analysis of randomized clinical trials. Probiotics and Antimicrobial Proteins 11 (4):1236–47. doi: 10.1007/s12602-018-9493-9.
   PubMed Web of Science ®Google Scholar
• Higgins, J. P. T., J. Thomas, J. Chandler, M. Cumpston, T. Li, MJ. Page, and V. A. Welch, eds. 2019. Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). Chichester (UK): John Wiley & Sons. www.training.cochrane.org/handbook.
   Google Scholar
• Holscher, H. D. 2017. Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes 8 (2):172–84. doi: 10.1080/19490976.2017.1290756.
   PubMed Web of Science ®Google Scholar
• Homayoni Rad, A., E. V. Mehrabany, B. Alipoor, L. V. Mehrabany, and M. Javadi. 2012. Do probiotics act more efficiently in foods than in supplements? Nutrition 28 (7–8):733–6. doi: 10.1016/j.nut.2012.01.012.
   PubMed Web of Science ®Google Scholar
• Insenser, M., M. Murri, R. Del Campo, M. Á. Martínez-García, E. Fernández-Durán, and H. F. Escobar-Morreale. 2018. Gut microbiota and the polycystic ovary syndrome: Influence of sex, sex hormones, and obesity. The Journal of Clinical Endocrinology & Metabolism 103 (7):2552–62. doi: 10.1210/jc.2017-02799.
   PubMed Web of Science ®Google Scholar
• Jamilian, M., S. Mansury, F. Bahmani, Z. Heidar, E. Amirani, and Z. Asemi. 2018. The effects of probiotic and selenium co-supplementation on parameters of mental health, hormonal profiles, and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome. Journal of Ovarian Research 11 (1):80. doi: 10.1186/s13048-018-0457-1.
   PubMed Web of Science ®Google Scholar
• Jiao, N., S. S. Baker, C. A. Nugent, M. Tsompana, L. Cai, Y. Wang, M. J. Buck, R. J. Genco, R. D. Baker, R. Zhu, et al. 2018. Gut microbiome may contribute to insulin resistance and systemic inflammation in obese rodents: A meta-analysis. Physiological Genomics 50 (4):244–54. doi: 10.1152/physiolgenomics.00114.2017.
   PubMed Web of Science ®Google Scholar
• Jumpertz, R., D. S. Le, P. J. Turnbaugh, C. Trinidad, C. Bogardus, J. I. Gordon, and J. Krakoff. 2011. Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans. The American Journal of Clinical Nutrition 94 (1):58–65. doi: 10.3945/ajcn.110.010132.
   PubMed Web of Science ®Google Scholar
• Karamali, M., S. Eghbalpour, S. Rajabi, M. Jamilian, F. Bahmani, M. Tajabadi-Ebrahimi, F. Keneshlou, S. M. Mirhashemi, M. Chamani, G. S. Hashem, et al. 2018. Effects of probiotic supplementation on hormonal profiles, biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. Archives of Iranian Medicine 21 (1):1–7.
   PubMed Web of Science ®Google Scholar
• Karimi, E., J. Heshmati, N. Shirzad, S. Vesali, M. J. Hosseinzadeh-Attar, A. Moini, and M. Sepidarkish. 2020. The effect of synbiotics supplementation on anthropometric indicators and lipid profiles in women with polycystic ovary syndrome: A randomized controlled trial. Lipids in Health and Disease 19 (1):60. doi: 10.1186/s12944-020-01244-4.
   PubMed Web of Science ®Google Scholar
• Karimi, E., A. Moini, M. Yaseri, N. Shirzad, M. Sepidarkish, M. Hossein-Boroujerdi, and M. J. Hosseinzadeh-Attar. 2018. Effects of synbiotic supplementation on metabolic parameters and apelin in women with polycystic ovary syndrome: A randomised double-blind placebo-controlled trial. The British Journal of Nutrition 119 (4):398–406. doi: 10.1017/S0007114517003920.
   PubMed Web of Science ®Google Scholar
• Kasińska, M. A., and J. Drzewoski. 2015. Effectiveness of probiotics in type 2 diabetes: A meta-analysis. Polish Archives of Internal Medicine 125 (11):803–13. doi: 10.20452/pamw.3156.
   Google Scholar
• Ko, C. W., J. Qu, D. D. Black, and P. Tso. 2020. Regulation of intestinal lipid metabolism: Current concepts and relevance to disease. Nature Reviews. Gastroenterology & Hepatology 17 (3):169–83. doi: 10.1038/s41575-019-0250-7.
   PubMed Web of Science ®Google Scholar
• Kogure, G. S., I. P. Lopes, V. B. Ribeiro, M. C. Mendes, S. Kodato, C. Furtado, M. F. Silva de Sá, R. A. Ferriani, L. Lara, and R. Reis. 2020. The effects of aerobic physical exercises on body image among women with polycystic ovary syndrome. Journal of Affective Disorders 262:350–8. doi: 10.1016/j.jad.2019.11.025.
   PubMed Web of Science ®Google Scholar
• Liao, D., C. Zhong, C. Li, L. Mo, and Y. Liu. 2018. Meta-analysis of the effects of probiotic supplementation on glycemia, lipidic profiles, weight loss and C-reactive protein in women with polycystic ovarian syndrome. Minerva Medica 109 (6):479–87. doi: 10.23736/S0026-4806.18.05728-2.
   PubMed Web of Science ®Google Scholar
• Lindheim, L., M. Bashir, J. Münzker, C. Trummer, V. Zachhuber, B. Leber, A. Horvath, T. R. Pieber, G. Gorkiewicz, V. Stadlbauer, et al. 2017. Alterations in gut microbiome composition and barrier function are associated with reproductive and metabolic defects in women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PloS One 12 (1):e0168390. doi: 10.1371/journal.pone.0168390.
   PubMed Web of Science ®Google Scholar
• Liu, R., C. Zhang, Y. Shi, F. Zhang, L. Li, X. Wang, Y. Ling, H. Fu, W. Dong, J. Shen, et al. 2017. Dysbiosis of gut microbiota associated with clinical parameters in polycystic ovary syndrome. Frontiers in Microbiology 8:324. doi: 10.3389/fmicb.2017.00324.
   PubMed Web of Science ®Google Scholar
• Macut, D., J. Bjekic-Macut, D. Rahelic, and M. Doknic. 2017. Insulin and the polycystic ovary syndrome. Diabetes Research and Clinical Practice 130:163–70. doi: 10.1016/j.diabres.2017.06.011.
   PubMed Web of Science ®Google Scholar
• Meng, X., H. Y. Zhou, H. H. Shen, E. Lufumpa, X. M. Li, B. Guo, and B. Z. Li. 2019. Microbe-metabolite-host axis, two-way action in the pathogenesis and treatment of human autoimmunity. Autoimmunity Reviews 18 (5):455–75. doi: 10.1016/j.autrev.2019.03.006.
   PubMed Web of Science ®Google Scholar
• Moghetti, P. 2016. Insulin resistance and polycystic ovary syndrome. Current Pharmaceutical Design 22 (36):5526–34. doi: 10.2174/1381612822666160720155855.
   PubMed Web of Science ®Google Scholar
• Moher, D., L. Shamseer, M. Clarke, D. Ghersi, A. Liberati, M. Petticrew, P. Shekelle, and L. A. Stewart. 2015. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews 4:1. doi: 10.1186/2046-4053-4-1.
   PubMed Web of Science ®Google Scholar
• Nasri, K., M. Jamilian, E. Rahmani, F. Bahmani, M. Tajabadi-Ebrahimi, and Z. Asemi. 2018. The effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: A randomized, double-blind, placebo-controlled trial. BMC Endocrine Disorders 18 (1):21 doi: 10.1186/s12902-018-0248-0.
   PubMed Web of Science ®Google Scholar
• Oberfroid, M., G. R. Gibson, L. Hoyles, A. L. McCartney, R. Rastall, I. Rowland, D. Wolvers, B. Watzl, H. Szajewska, B. Stahl, et al. 2010. Prebiotic effects: Metabolic and health benefits. British Journal of Nutrition 104 (Suppl 2):S1–S63. doi: 10.1017/S0007114510003363.
   PubMedGoogle Scholar
• Ostadmohammadi, V., M. Jamilian, F. Bahmani, and Z. Asemi. 2019. Vitamin D and probiotic co-supplementation affects mental health, hormonal, inflammatory and oxidative stress parameters in women with polycystic ovary syndrome. Journal of Ovarian Research 12 (1):5. doi: 10.1186/s13048-019-0480-x.
   PubMedGoogle Scholar
• Oulangé, C. L., A. L. Neves, J. Chilloux, J. K. Nicholson, and M. E. Dumas. 2016. Impact of the gut microbiota on inflammation, obesity, and metabolic disease. Genome Medicine 8 (1):42. doi: 10.1186/s13073-016-0303-2.
   PubMedGoogle Scholar
• Pandey, K. R., S. R. Naik, and B. V. Vakil. 2015. Probiotics, prebiotics and synbiotics- a review. Journal of Food Science and Technology 52 (12):7577–87. doi: 10.1007/s13197-015-1921-1.
   PubMed Web of Science ®Google Scholar
• Patel, S. 2018. Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology 182:27–36. doi: 10.1016/j.jsbmb.2018.04.008.
   PubMed Web of Science ®Google Scholar
• PCOS GREA. 2004. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Human Reproduction 19 (1):41–7. doi: 10.1093/humrep/deh098.
   PubMed Web of Science ®Google Scholar
• Qi, X., C. Yun, L. Sun, J. Xia, Q. Wu, Y. Wang, L. Wang, Y. Zhang, X. Liang, L. Wang, et al. 2019. Gut microbiota-bile acid-interleukin-22 axis orchestrates polycystic ovary syndrome. Nature Medicine 25 (8):1225–33. doi: 10.1038/s41591-019-0509-0.
   PubMed Web of Science ®Google Scholar
• Sacerdote, A., P. Dave, V. Lokshin, and G. Bahtiyar. 2019. Type 2 diabetes mellitus, insulin resistance, and vitamin D. Current Diabetes Reports 19 (10):101. doi: 10.1007/s11892-019-1201-y.
   PubMed Web of Science ®Google Scholar
• Samimi, M., A. Dadkhah, H. Haddad Kashani, M. Tajabadi-Ebrahimi, E. Seyed Hosseini, and Z. Asemi. 2018. The effects of synbiotic supplementation on metabolic status in women with polycystic ovary syndrome: A randomized double-blind clinical trial. Probiotics and Antimicrobial Proteins 11 (4):1355–61. doi: 10.1007/s12602-018-9405-z.
   Web of Science ®Google Scholar
• Scheithauer, T. P., G. M. Dallinga-Thie, W. M. de Vos, M. Nieuwdorp, and D. H. van Raalte. 2016. Causality of small and large intestinal microbiota in weight regulation and insulin resistance. Molecular Metabolism 5 (9):759–70. doi: 10.1016/j.molmet.2016.06.002.
   PubMed Web of Science ®Google Scholar
• Schoeler, M., and R. Caesar. 2019. Dietary lipids, gut microbiota and lipid metabolism. Reviews in Endocrine & Metabolic Disorders 20 (4):461–72. doi: 10.1007/s11154-019-09512-0.
   PubMed Web of Science ®Google Scholar
• Schünemann, H. J., A. H. J. Schünemann, A. D. Oxman, J. Brozek, P. Glasziou, R. Jaeschke, G. E. Vist, J. W. Williams, R. Kunz, J. Craig, et al. 2008. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ 336 (7653):1106–10. doi: 10.1136/bmj.39500.677199.AE.
   PubMed Web of Science ®Google Scholar
• Seganfredo, F. B., C. A. Blume, M. Moehlecke, A. Giongo, D. S. Casagrande, J. Spolidoro, A. V. Padoin, B. D. Schaan, and C. C. Mottin. 2017. Weight-loss interventions and gut microbiota changes in overweight and obese patients: A systematic review. Obesity Reviews 18 (8):832–51. doi: 10.1111/obr.12541.
   PubMed Web of Science ®Google Scholar
• Sevda, G., P. Dehghan, S. Mohammad-Alizadeh Charandabi, A. Aliasgarzadeh, and M. Mirghafourvand. 2018. Effect of prebiotic on anthropometric indices in women with polycystic ovarian syndrome: A triple-blind, randomized, controlled clinical trial. Iranian Red Crescent Medical Journal. 20:e67270. doi: 10.5812/ircmj.67270.
   Web of Science ®Google Scholar
• Shabani, A., M. Noshadian, M. Jamilian, M. Chamani, S. Mohammadi, and Z. Asemi. 2018. The effects of a novel combination of selenium and probiotic on weight loss, glycemic control and markers of cardio-metabolic risk in women with polycystic ovary syndrome. Journal of Functional Foods 46:329–34. doi: 10.1016/j.jff.2018.04.071.
   Web of Science ®Google Scholar
• Shamasbi, S., P. Dehgan, S. Mohammad-Alizadeh Charandabi, A. Aliasgarzadeh, and M. Mirghafourvand. 2018. The effect of resistant dextrin as a prebiotic on metabolic parameters and androgen level in women with polycystic ovarian syndrome: A randomized, triple-blind, controlled, clinical trial. European Journal of Nutrition 58 (2):629–40. doi: 10.1007/s00394-018-1648-7.
   PubMed Web of Science ®Google Scholar
• Shamasbi, S. G., S. Ghanbari-Homayi, and M. Mirghafourvand. 2020. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: A systematic review and meta-analysis. European Journal of Nutrition 59 (2):433–50. doi: 10.1007/s00394-019-02033-1.
   PubMed Web of Science ®Google Scholar
• Shoaei, T., M. Heidari-Beni, H. G. Tehrani, A. Feizi, A. Esmaillzadeh, and G. Askari. 2015. Effects of probiotic supplementation on pancreatic β-cell function and C-reactive protein in women with polycystic ovary syndrome: A randomized double-blind placebo-controlled clinical trial. International Journal of Preventive Medicine 6:27. doi: 10.4103/2008-7802.153866.
   PubMed Web of Science ®Google Scholar
• Shorakae, S., S. Ranasinha, S. Abell, G. Lambert, E. Lambert, B. de Courten, and H. Teede. 2018. Inter-related effects of insulin resistance, hyperandrogenism, sympathetic dysfunction and chronic inflammation in PCOS. Clinical Endocrinology 89 (5):628–33. doi: 10.1111/cen.13808.
   PubMed Web of Science ®Google Scholar
• Shorakae, S., H. Teede, B. de Courten, G. Lambert, J. Boyle, and L. J. Moran. 2015. The emerging role of chronic low-grade inflammation in the pathophysiology of polycystic ovary syndrome. Seminars in Reproductive Medicine 33 (4):257–69. doi: 10.1055/s-0035-1556568.
   PubMed Web of Science ®Google Scholar
• Stanley, S. A., L. Kelly, K. N. Latcha, S. F. Schmidt, X. Yu, A. R. Nectow, J. Sauer, J. P. Dyke, J. S. Dordick, and J. M. Friedman. 2016. Bidirectional electromagnetic control of the hypothalamus regulates feeding and metabolism. Nature 531 (7596):647–50. doi: 10.1038/nature17183.
   PubMed Web of Science ®Google Scholar
• Tabrizi, R., M. Moosazadeh, K. B. Lankarani, M. Akbari, S. T. Heydari, F. Kolahdooz, and Z. Asemi. 2018. The effects of synbiotic supplementation on glucose metabolism and lipid profiles in patients with diabetes: A systematic review and meta-analysis of randomized controlled trials. Probiotics and Antimicrobial Proteins 10 (2):329–42. doi: 10.1007/s12602-017-9299-1.
   PubMed Web of Science ®Google Scholar
• Tabrizi, R., V. Ostadmohammadi, M. Akbari, K. B. Lankarani, S. Vakili, P. Peymani, M. Karamali, F. Kolahdooz, and Z. Asemi. 2019. The effects of probiotic supplementation on clinical symptom, weight loss, glycemic control, lipid and hormonal profiles, biomarkers of inflammation, and oxidative stress in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Probiotics and Antimicrobial Proteins 11(2): 729–742. doi: 10.1007/s12602-019-09559-0.
   Google Scholar
• Teede, H., A. Deeks, and L. Moran. 2010. Polycystic ovary syndrome: A complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Medicine 8 (41):41. doi: 10.1186/1741-7015-8-41.
   PubMedGoogle Scholar
• Trost, S. G., N. Owen, A. E. Bauman, J. F. Sallis, and W. Brown. 2002. Correlates of adults' participation in physical activity: Review and update. Medicine & Science in Sports & Exercise 34 (12):1996–2001. 10.1097/00005768-200212000-00020.
   PubMed Web of Science ®Google Scholar
• Vallianou, N. G., T. Stratigou, and S. Tsagarakis. 2018. Microbiome and diabetes: Where are we now? Diabetes Research and Clinical Practice 146:111–8. doi: 10.1016/j.diabres.2018.10.008.
   PubMed Web of Science ®Google Scholar
• van de Wouw, M., H. Schellekens, T. G. Dinan, and J. F. Cryan. 2017. Microbiota-Gut-Brain Axis: Modulator of Host Metabolism and Appetite. The Journal of Nutrition 147 (5):727–45. doi: 10.3945/jn.116.240481.
   PubMed Web of Science ®Google Scholar
• Viollet, B., B. Guigas, N. Sanz Garcia, J. Leclerc, M. Foretz, and F. Andreelli. 2012. Cellular and molecular mechanisms of metformin: An overview. Clinical Science (London, England : 1979) 122 (6):253–70. doi: 10.1042/CS20110386.
   PubMed Web of Science ®Google Scholar
• Xue, J., X. Li, P. Liu, K. Li, L. Sha, X. Yang, L. Zhu, Z. Wang, Y. Dong, L. Zhang, et al. 2019. Inulin and metformin ameliorate polycystic ovary syndrome via anti-inflammation and modulating gut microbiota in mice. Endocrine Journal 66 (10):859–70. doi: 10.1507/endocrj.EJ18-0567.
   PubMed Web of Science ®Google Scholar
• Yamashiro, Y. 2017. Gut Microbiota in Health and Disease. Annals of Nutrition & Metabolism 71 (3–4):242–6. doi: 10.1159/000481627.
   PubMed Web of Science ®Google Scholar
• Yoo, J. Y., and S. S. Kim. 2016. Probiotics and Prebiotics: Present Status and Future Perspectives on Metabolic Disorders. Nutrients 8 (3):173. doi: 10.3390/nu8030173.
   PubMed Web of Science ®Google Scholar
• Zahra, E., R. Barati-Boldaji, N. R. Brett, J. O. T. de Zepetnek, N. Bellissimo, S. Babajafari, and Z. Sohrabi. 2019. The effect of synbiotics pomegranate juice on cardiovascular risk factors in PCOS patients: A randomized, triple-blinded, controlled trial. Journal of Endocrinological Investigation 43 (4):539–48. doi: 10.1007/s40618-019-01139-x.
   PubMed Web of Science ®Google Scholar
• Zeng, B., Z. Lai, L. Sun, Z. Zhang, J. Yang, Z. Li, J. Lin, and Z. Zhang. 2019. Structural and functional profiles of the gut microbial community in polycystic ovary syndrome with insulin resistance (IR-PCOS): A pilot study. Research in Microbiology 170 (1):43–52. doi: 10.1016/j.resmic.2018.09.002.
   PubMed Web of Science ®Google Scholar
• Zhu, Z., X. Pengbin, and H. Yaqiong. 2020. Effects of vitamin D and probiotics supplementation on bacterial diversity, metabolism and hormone level in patients with polycystic ovary syndrome. Chinese Journal of Microecology 32 (3):317–21.
   Google Scholar