Dietary Alteration of the Gut Microbiome and Its Impact on Weight and Fat Mass: A Systematic Review and Meta-Analysis

George Kunnackal John, Lin Wang, Julie Nanavati, Claire Twose, Rajdeep Singh, Gerard Mullin, George Kunnackal John, Lin Wang, Julie Nanavati, Claire Twose, Rajdeep Singh, Gerard Mullin

Abstract

Dietary alteration of the gut microbiome is an important target in the treatment of obesity. Animal and human studies have shown bidirectional weight modulation based on the probiotic formulation used. In this study, we systematically reviewed the literature and performed a meta-analysis to assess the impact of prebiotics, probiotics and synbiotics on body weight, body mass index (BMI) and fat mass in adult human subjects. We searched Medline (PubMed), Embase, the Cochrane Library and the Web of Science to identify 4721 articles, of which 41 were subjected to full-text screening, yielding 21 included studies with 33 study arms. Probiotic use was associated with significant decreases in BMI, weight and fat mass. Studies of subjects consuming prebiotics demonstrated a significant reduction in body weight, whereas synbiotics did not show an effect. Overall, when the utilization of gut microbiome-modulating dietary agents (prebiotic/probiotic/synbiotic) was compared to placebo, there were significant decreases in BMI, weight and fat mass. In summary, dietary agents for the modulation of the gut microbiome are essential tools in the treatment of obesity and can lead to significant decreases in BMI, weight and fat mass. Further studies are needed to identify the ideal dose and duration of supplementation and to assess the durability of this effect.

Keywords: gut microbiome; obesity treatment; probiotics; weight loss.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Influence of the gut microbiome on obesity. The figure depicts the bidirectional influence of gut health on obesity via alterations in the microbiome. SCFA: short-chain fatty acid; IgA: immunoglobulin A; GLP-1: glucagon-like peptide-1; HPA: hypothalamic–pituitary–adrenal (axis).
Figure 2
Figure 2
Study flow diagram.
Figure 3
Figure 3
Forest plot of effect of any dietary modulation agent (prebiotic/probiotic/synbiotic) on: (A) body mass index (BMI); (B) body weight; (C) fat mass. Data synthesis using the random effects model for the mean differences amongst the included randomized controlled trials comparing all gut microbiome-modulating interventions (prebiotics/probiotics/synbiotics) vs. placebo showed significant differences for BMI in 19 studies (A) (overall mean difference (MD) = −0.28 (95% CI −0.43, −0.14), p < 0.001), body weight reduction in 18 studies (B) (MD = −0.64 kg (95% CI −1.03, −0.26), p < 0.001) and fat mass in 11 studies (C) (MD = −0.60 kg (95% CI −1.05, −0.16), p < 0.001). CI: Confidence intervals. SD: Standard deviation.
Figure 4
Figure 4
Forest plot of effect of probiotics on: (A) BMI; (B) body weight; (C) fat mass. Data synthesis using the random effects model for the mean differences amongst the included randomized controlled trials comparing probiotics vs. placebo showed significant differences for BMI in 14 study arms (A) (overall MD = −0.33 (95% CI −0.47, −0.18), p < 0.001), body weight reduction in 13 study arms (B) (MD = −0.65 kg (95% CI −1.12, −0.18), p < 0.01) and fat mass in 8 study arms (C) (MD = −0.94 kg (95% CI −1.17, −0.72), p < 0.001).
Figure 5
Figure 5
Forest plot of effect of prebiotics on: (A) BMI; (B) body weight; (C) fat mass. Data synthesis using the random effects model for the mean differences in body mass index (BMI), body weight and fat mass for the included randomized controlled trials of prebiotics versus placebo. Prebiotics intervention was found to trend towards a reduction in BMI in five studies with a MD = −0.27 ((95% CI −0.56, 0.02), p = 0.07) (Figure 5A), while the reduction in body weight in five studies was significant (MD = −0.90 kg (95% CI −1.77, −0.02), p = 0.04), Figure 5B. The prebiotics did not change the fat mass when compared to the placebo in three clinical trials, Figure 5C.
Figure 6
Figure 6
Forest plot of effect of synbiotics on: (A) BMI; (B) body weight. Data synthesis using the random effects model for the mean differences in BMI and body weight for the included randomized controlled trials of synbiotics versus placebo. There was no significant reduction in BMI or body weight in the three studies (Figure 6A,B).
Figure 7
Figure 7
Risk of bias assessment. (A) Details of included studies; (B) overall summary.

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